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Adult Test 3
| Question | Answer |
|---|---|
| What BP findings would indicated hypertension? | a systolic pressure at or above 140 and/or diastolic at or above 90 without DM. |
| What is the preferred BP for a person with diabetes or heart disease? | below 130/90 |
| Reduction in BP will reduce the risk of what? | reduce stroke by 35-45%, reduce MI by 20-25%, reduce heart failure by more than 50% |
| Complications of high BP in the eyes: | retinal damage, reduced vision |
| complications of high BP in the brain | stroke, transient ischemic attack; dementia |
| complications of high BP in the heart: | coronary artery disease, heart failure, enlarged heart |
| complications of high BP in the circulation: | aneurysms, atherosclerosis |
| complications of high BP in the kidneys: | renal failure |
| What are some causes of hypertension? | low K+, Mg, and Ca intake; family hx; overweight; excessive alcohol consumption; stress; physical inactivity; excessive sodium consumption |
| What is BP? | BP= CO x SVR (cardiac output times systemic vascular resistance) |
| Why do men have hypertension more than women? | estrogen keeps the blood pressure down. |
| What is atherosclerosis? | plaque build up in the arteries |
| What type of hypertension is most common? | benign essential hypertension |
| What is the one place in the body you can see arteries and veins without invasive procedures? | eyes |
| What is an example of primary, secondary, and tertiary prevention for HTN? | primary= screenings, secondary= referral to a doctor, tertiary= diet, exercise, smoking cessation |
| What are the different types of hypertension? | benign essential, primary, white coat, isolated systolic, malignant |
| what are some s/s of hypertension? | HA, palpitations, dizziness, blurred vision, easily fatigued, epistaxis (nose bleed), bruit, peripheral edema, facial flushing, retinal changes |
| What is the best way to get an accurate blood pressure reading? | Patient should be sitting quietly for 5 minutes with both feet on the floor. Arm should be supported above heart level, wait at least 15-20 minutes after smoking. |
| What are some ways to help prevent HTN if the patient has risk factors? | DASH diet, exercise, smoking cessation, control of risk factors, etc. |
| What are some treatments of HTN? | routine monitoring, smoking cessation, dietary changes, stress reduction, aerobic activity, caution with OTC meds (such as NSAIDs), compliance is imporant! |
| What BP reading would be considered a hypertensive crisis? | 180/110 or higher |
| What is the difference between an emergency and urgency? | emergency- when there is evidence of organ damage, urgency- without organ involvement |
| What can a hypertensive crisis be caused by? | untreated or inadequately treated high BP, renal disease, intracerebral hemorrhage, pregnancy induced, acute aortic dissection |
| Nursing Interventions for hypertensive crisis? | ABCs, neuro assessments, elevate HOB, continuous BP monitoring, telemetry, IV antihypertensives, get BP down, but slowly |
| Peripheral Vascular Disease includes what three systems? | arterial, venous, lymphatic |
| peripheral vascular disease usually affects which part of the body the most? | legs |
| clinical manifestations and management of PVD differ depending on? | client needs and degree of occlusion |
| which disease is caused by deficient valves? | PVD. (veins have valves, arteries don't) |
| Why does venous insufficiency occur? | prolonged venous hypertension that stretches the veins and damages the valves |
| What does edema and back up of blood result in? | venous stasis ulcers, swelling, cellulitis |
| What type of people are at high risk for PVD? | nurses, truck drivers, toll booth workers (anyone who sits or stands in one position for a long time) |
| what s/s does a person have with PVD? | tingling, itching, heaviness in legs; bilateral edema; stasis dermatitis; stasis ulcers |
| what do ulcers related to PVD look like? | irregular boarders; can take years to heal; reoccurance is common |
| what is the mainstay of treatment for PVD? | compression therapy; if no ulceration TED stockings is the main thing, if there are ulcers they may use Unna boots |
| What is the best therapy to reduce swelling in legs? | walking |
| what are some other nursing interventions r/t PVD? | elevate legs above heart in bed, keep legs elevated for 20 min 4 to 5 times a day, avoid crossing legs, do not stand with legs locked |
| What is virchow's triad? | states to get a venous thrombosis there must be endothelial injury, venous stasis, or hypercoaguablity |
| thrombophlebitis | refers to a thrombus associated with inflammation |
| phlebitis | inflammation of a vein |
| risk factors associated with PVD? | surgery, ulcerative colitis, heart failure, immobility, sitting still for long periods of time, intravenous therapy, infection, lupus, polycythemia vera, contraceptives, trauma, cancer |
| classic signs of DVT? | calf or groin tenderness and pain and sudden onset of unilateral swelling of the affected extremity |
| what assessment tool is not recommended if DVT is suspected? | Homan's sign, can dislodge a clot |
| what blood test is elevated with DVT? | D-Dimer, means somewhere there is a clot breaking up |
| interventions for DVT? | rest and elevation of extremity, compression stockings for prevention, warm moist compress, DO NOT MASSAGE, monitor for signs of pulmonary embolism, anticoagulants (heparin, lovenox, coumadin), thrombolytics, thrombectomy |
| what can cause a pulmonary embolism? | any substance that gets into the blood stream (such as a piece of a IV cath), but it's usually a blood clot |
| What is the prognosis for a pulmonary embolism? | many people die within an hour of onset of symptoms |
| s/s of pulmonary embolism | sudden onset dyspnea, pleuritic chest pain, apprehension, restlessness, feeling of impending doom, cough, hemoptysis, tachypnea, crackles, pleural friction rub, diaphoresis, decreased SaO2 |
| diagnosis of pulmonary embolism | chest x-ray if large, spiral CT (at least 18G IV needed, gives definitive answer), VQ scan (breathe nuclear medicine, does not give definitive answer), transesophageal echocardiography, pulmonary angiography, ABG (pO2 & CO2 decreased, pH normal-increased) |
| interventions of pulmonary embolism | promote oxygenation, reassurance, keep calm, don't leave them alone!, HOB elevated, oxygen therapy, anticoagulants, embolectomy, vena cava filter |
| what is associated with metabolic syndrome (syndrome X)? | central obesity, high blood pressure, high triglycerides, low HDL, insulin resistance. At high risk for PAD, CVD, DM |
| PAD includes what three disorders? | arterial insufficiency, Raynauds disease, thromboangitis obliterans |
| anyone can get an acute arterial occlusion which can be caused by what? | ABGs |
| chronic arterial occlusive disease includes what mechanisms? | arteriosclerosis, atherosclerosis, plaque that affects blood flow |
| arteriosclerosis | thickening and decreased elasticity of arterial walls; occurs with aging |
| atherosclerosis | accumulation of plaque, lipids, fibrin, platelets, and cellular debris; related to increased cholesterol, triglycerides, blood clots; causes blood to build up and inhibits blood flow which puts them at a high risk for clots. |
| What happens if plaque breaks off? | stroke can occur |
| in PAD, at rest a person may tolerate a ___% occlusion without symptoms | 70% |
| contributing factors of PAD | smoking, diabetes, hyperlipidemia, high C reactive protein, age, HTN, obesity, familial predisposition, 60 years or older, african american |
| s/s of PAD | absent or diminished pulses, intermittent claudication, non painful ulcers, nocturnal foot pain, cool skin, dependent rubor, elevated pallor, loss of hair on extremity, thick brittle nails, |
| what are the characteristics of ulcers related to PAD? | may not be painful; usually on the toes, foot, malleolus; rounded and smooth edges, minimal drainage, black eschar and pale pink granulation tissue |
| diagnostic exams for PAD | doppler ultrasound, ankle-brachial index, duplex imaging, angiograms, MRI |
| what is an ankle-brachial index? | place patient in supine position, using hand held doppler measure the ankle systolic pressures and brachial systolic pressures bilat; divide the ankle systolic BPs by the HIGHER brachial measurements; gives relative idea of circulation |
| ABI results: | Normal- 0.91-1.30 Mild PAD- 0.71-0.90 Moderate PAD- 0.41-0.70 Severe PAD- 0.40 or less |
| Why is a 40 year old's heart attack more dangerous than an 80 year old's? | the 40 year old lacks collateral circulation |
| what occurs with collateral circulation? | with age the body is able to use minor arteries to bypass an arterial blockage, it takes longer but still allows the blood to reach the site, it helps survival |
| What is intermittent claudication? | when the person with PAD is walking and get a pain in the leg and when they sit down the pain subsides but it will return; it occurs related to intermittent blockage of blood flow; at first it only occurs during activity but later it also occurs at rest |
| non-surgical management of PAD? | risk factor modification, smoking cessation, aggressive lipid management (statins), management of HTN, exercise therapy, DASH diet, antiplatelets, proper foot and skin care |
| evidenced based care shows correlation between ________ levels and PAD | homocysteine levels; folic acid B12 and B6 |
| What teaching would you do with PAD patients? | control risk factors; protect from trauma; prevent and control infections; improve collateral circulation; keep feet below the level of the heart; keep extremities warm, NO heating pads; avoid chilling, caffeine, nicotine, emotional outbursts, etc |
| surgical management of PAD | arterial bypass procedure, endarterectomy, balloon or artherectomy, patch grafting |
| What is an arterial bypass procedure? | it can use autogenous veins from the person or a synthetic graft and in this procedure they take the vein and strip it of the valves and place it over to bypass the blockage |
| What is an endarterectomy and what is a complication that can occur after? | They go in and clean out the plaque build up in the artery, can cause a stroke if plaque moves to brain |
| Nursing care after surgical procedure for PAD? | ICU x1 day; frequent VS; CSM checks (circulation, sensation, movement); analgesia (carefully); no knee flexed positions except for exercise; turn and reposition frequently; pillows for incision; discourage prolonged sitting with leg dependency |
| When are people encouraged to ambulate after surgical procedure of PAD? | post op day 1 up several times |
| what is the first sign of reocclusion after surgery? | pain; this is why analgesia is administered carefully |
| what are some possible complications of surgical intervention? | reocclusion, hemorrhage, colon ischemia, prolonged ileus, renal artery embolism, ischemic decubiti, infection of graft, renal failure, compartment syndrome, DVT |
| Why is Raynaud's known as the patriotic disease? | fingers become white due to lack of blood flow, then blue as vessels dilate, and then red as blood flow returns |
| What is Raynaud's disease? | episodic vasospastic disorder of cutaneous arteries of fingers and toes |
| Who is Raynaud's common in? | women between 15 and 40 years of age |
| what can cause Raynauds? | may be because of an exaggerated response to sympathetic nervous system stimulation, occupational related trauma and pressure, exposure to heavy metals, secondary to other diseases such as RA and SLE |
| How can a person manage Raynauds? | keep fingers and toes warm and injury free; use gloves when getting in fridge or freezer or handling cold drink, etc; avoid stressful situations; smoking cessation; calcium channel blockers; nitroglycerin patches; sympathectomy |
| thromboangitis obliterans (Buerger's disease) | Affects men under the age of 40 with a long history of tobacco use without comorbidities, they have high rates of peridontitis, diagnosis is based on symptoms and risk factors, they have the same signs of PAD but they are intermittent |
| treatment for Buergers? | stop smoking, do not use nicotine patches, amputation is common |
Created by:
mcguirex3
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