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Peripheral diseases

Chapter 38 Exam 2

Arteriosclerosis a thickening, or hardening, of the arterial wall that is often associated with aging.
Atherosclerosis a type of arteriosclerosis, involves the formation of plaque within the arterial wall and is the leading risk factor for cardiovascular disease --Affects larger arteries
Atherosclerosis risk factors Low HDL-C • High LDL-C • Increased triglycerides • Genetic predisposition • Diabetes mellitus • Obesity • Sedentary lifestyle • Smoking • Stress • African-American or Hispanic ethnicity • Older adult
Patho of Atherosclerosis unknown thought to occur from blood vessel damage that causes an inflammatory response fatty streak formed, then becomes fibrous plaque unstable plaque can rupture rate of formation increased with lifestyle habits, diabetes, and or genes.
Stable vs unstable plaque rupture stable causes inadequate perfusion unstable causes a rapid thrombus formation due to platelet adhesion at exposed underlying tissue
Endothelial damage high hdl is good -- damage caused by high ldl low ldl is good -- damage caused by low hdl toxins from renal system failure CO from smoking weakened vessels from aging
Young adults have some small plaque
CVD affected population affects 16 millions, half of which are older 60
ASSESSMENT IN PATIENTS WITH ARTHEROSCLEROSIS palpate pulses ASSESS BOTH ARMS feel for temperature in periphery check for capillary refill (unreliable) >5 for old >3 for young extremity may be cool or cold with absent or diminished pulse.
Bruit -- found in larger arteries and heard with stethoscope -- a turbulent, swishing sound, which can be soft or loud in pitch. -- caused by blood moving through small artery --often occur in the carotid, aortic, femoral, and popliteal arteries.
Total serum cholesterol levels bellow 200 MG/DL is good
Total serum LDL LEVELS bellow 100 MG/DL is good
total HDL levels greater than 40 MG/DL is good
Triglycerides A level higher than 150 mg/dL is bad 135 or higher is bad for women
SCREENING FOR ATHEROSCLEROSIS those older than 20 should get a cholesterol check
High risk category termed “coronary heart disease equivalents.” • Patients with diabetes but no sign • Patients with a Framingham Heart Study 10-year absolute risk score of over 20% for coronary heart disease events • Patients with risk factors
fat intake less than 30% of total calories up to 10% of total calories should be from polyunsaturated fat, and 10% to 15% should come from monounsaturated fat.
Cholesterol intake intake should also be less than 300 mg daily.
Recommended oils Recommend canola (rapeseed) oil (rich in monounsaturated fat) and safflower and sunflower oil (rich in polyunsaturated oils) over highly saturated oils such as palm or coconut oil.
Cholesterol management increase fiber of 25 to 35g ldl needs to be lower than 100. above 130-159, follow a fat-modified diet and regular exercise regimen and increase omega-3 fatty acids in their diet or as a supplement.
NCEP–TLC limits saturated fat to less than 7% of total calories and cholesterol to less than 200 mg/day.
Drugs for cholesterol level not responding to lifestyle changes All the drugs ending in "statin" as well as: • Gemfibrozil (Lopid) • Fenofibrate (Tricor) • Ezetimibe (Zetia) • Omega-3 ethyl esters (Lovaza)
Statins reduce cholesterol synthesis in the liver and increase clearance of LDL-C from the blood. discontinued there is muscle cramping or elevated liver enzyme levels.
Vytorin ( combination ) his drug works two ways—by reducing the absorption of cholesterol and by decreasing the amount of cholesterol synthesis in the liver
ezetimibe inhibits the absorption of cholesterol through the small intestine.
Nicotinic acid or niacin decrease LDL-C and VLDL increase HDL-C patients experience flushing and a very warm feeling all over.
Hypertension definition systolic blood pressure at or above 140 mm Hg and/or a diastolic blood pressure at or above 90 mm Hg in people who do not have diabetes mellitus. with diabetes: 130/90.
systemic arterial pressure product of cardiac output (CO) and total peripheral vascular resistance (PVR)
maintenance of systemic arterial pressure maintained by the autonomic nervous system and circulating hormones, such as norepinephrine and epinephrine.
Four control systems play a major role in maintaining blood pressure: • The arterial baroreceptor system • Regulation of body fluid volume • The renin-angiotensin/aldosterone system • Vascular autoregulation.
BP elevation signs headaches, facial flushing (redness), dizziness, or fainting as a result of the elevated blood pressure
forearm BP is valid. True or false: True. especially for obese patients. Wrist BP can also be used.
Orthostatic Hypotension BP reading while sitting or lying BP reading standing 2 min later drop of 20mmhg systolic and or 10mmhg diastolic
Funduscopic examination of the eyes indicates severity and prognosis of hypertension.
Tachycardia, sweating, and pallor pallor may suggest a pheochromocytoma
Coarctation of the aorta evidenced by elevation of blood pressure in the arms, with normal or low blood pressure in the lower extremities. Femoral pulses are also delayed or absent.
creatinine clearance test normal 107 to 139 mL/min for men and 87 to 107 mL/min for women decreased level indicate kidney disease
presence of catecholamines patients with a pheochromocytoma are positive for it. --indicative of hypertension
elevation in levels of serum corticoids and 17-ketosteroids in the urine diagnostic of Cushing's disease.
X-ray Routine chest radiography may help recognize cardiomegaly (heart enlargement).
ECG Left atrial and ventricular hypertrophy is the first ECG sign of heart disease resulting from hypertension.
Garlic can low BP can also affect liver and cause bleeding
hypokalemia signs assess for irregular pulse and muscle weakness
CCBs most effect AA
ACE and ARBs Not effective in treating HTN in AA
Diebetes patients taking betablocker hypoglycemia signs not seen
Beta blockers side effects excessive fatigue, cough, or sexual dysfunction.
ambulatory blood pressure monitoring (ABPM) device device that measures and record BP every 15 to 30 minutes
Peripheral vascular disease (PVD) disorders that change the natural flow of blood through the arteries and veins of the peripheral circulation.
LEAD lower extremity arterial disease
Inflow vs. Outflow obstructions damage level: Inflow obstructions cause less damage than outflow obstructions Inflow obstructions involve the distal end of the aorta and the ---*common, internal, and external iliac arteries.
PAD (peripheral arterial disease) result of systemic artherosclerosis
Stage 1 of PAD Asymptomatic, bruit may be present, decrease or absent pulse
Stage 2 of PAD :Claudication •Muscle pain, cramping, or burning occurs with exercise and is relieved with rest. •Symptoms are reproducible with exercise.
Stage III: Rest Pain •Pain while resting •Pain is numbness, burning, toothache-type pain. •Pain usually occurs in the distal portion(toes, arch, forefoot, or heel), rarely in the calf or the ankle. •Pain is relieved by placing the extremity in a dependent position.
Stage IV: Necrosis/Gangrene •Ulcers and blackened tissue occur on the toes, the forefoot, and the heel. •Distinctive gangrenous odor is present.
PAD stages summary stage 1: no symptoms, some bruit stage 2: pain in legs with exercise (walking a certain distance) stage 3: pain at rest stage 4: ulcer on toes
Patient with inflow disease -- have discomfort in the lower back, buttocks, or thighs. mild inflow: pain after walking two blocks moderate inflow: pain after walking one or two blocks severe inflow: less than a block walking causes pain.
Patients with outflow disease mild: can walk 5 blocks moderate: can walk 2 blocks severe: 1/2 block
PAD diagnoses use of doppler probe to get BP (thigh and calves pulse higher than brachial pulse is good) 30mmhg less is mild inflow 40-50 mmhg less in severe inflow
ankle-brachial index (ABI) (used for outflow diagnoses) An ABI of less than 0.9 in either leg is diagnostic of PAD. Patients with diabetes are known to have a falsely elevated ABI.
Exercise tolerance testing there is a decrease in the ankle pressure of 40 to 60 mm Hg for 20 to 30 seconds in the affected limb. If the return to normal pressure is delayed (longer than 10 minutes), the results suggest abnormal arterial flow in the affected limb.
acute arterial insufficiency signs (6 Ps) • Pain • Pallor • Pulselessness • Paresthesia • Paralysis • Poikilothermy (coolness)
acute arterial occlusion clot in the arteries
treatment of acute arterial occlusion anticoagulant therapy thrombectomy or embolectomy watch for spasms or swelling of muscles after surgery
local treatment of occlusions Local intra-arterial thrombolytic therapy with alteplase (Activase) or t-PA and the use of platelet inhibitors, such as abciximab (ReoPro), have emerged as alternatives to surgical treatment in selected settings.
nursing responsibilities if thrombolytics or platelets are given assess for signs of bleeding, bruising, or hematoma monitor platelet counts for the first 3, 6, and 12 hours after the start of the infusion if below 100,000/mm3, the abciximab infusion reajusted or stopped can rapid response for any of the above
aneurysm permanent localized dilation of an artery, which enlarges the artery to at least two times its normal diameter
fusiform vs saccular (a diffuse dilation affecting the entire circumference of the artery) (an outpouching affecting only a distinct portion of the artery)
true vs. false aneurysm true aneurysm is the result of vessel weakening, while false aneurysm is caused by trauma or injury to the tissue
where do you get aneurysm mostly in the abdominal aorta, and vessels not supported by skeletal muscle or on the lines of curves or flexion in the arterial tree.
some causes of abdominal aorta aneurysm: Syphilis (a sexually transmitted disease), Marfan syndrome (a connective tissue disease), and Ehlers-Danlos syndrome (a rare genetic disorder) are other causes of AAAs.
assessment postop aneurym of urinary output below 50 ml/hr requires what intervention: immediately notify the surgeon
Buerger's Disease uncommon occlusive disease of the arteries and veins in the distal portion of the upper and lower extremities.
Raynaud's phenomenon caused by vasospasm of the arterioles and arteries of the upper and lower extremities, usually unilaterally. Raynaud's disease occurs bilaterally.
Drugs to avoid when on warfarin • Allopurinol • NSAIDs • Acetaminophen • Vitamin E • Histamine blockers • Cholesterol-reducing drugs • Antibiotics • Oral contraceptives • Antidepressants • Thyroid drugs • Herbs, such as St. John's wort, garlic, ginseng, Gin
Created by: ekm