What is the difference between arteriosclerosis and atherosclerosis?
– arteriosclerosis: thickening/hardening of arterial wall
- associated with aging
– atherosclerosis: type of arteriosclerosis; formation of plaque within arterial wall
– both of these usually affect the larger arteries
What are some assessments for arteriosclerosis?
- physical:
- BP
- pulses
- cap refill
- temperature of lower extremities
- labs:
- lipid panel
- triglycerides
- homocysteine
- increased levels make cell walls more vulnerable to plaque build-up
What are some interventions for arteriosclerosis?
- diet:
- maintain healthy weight
- consume variety of nutritious foods
- cholesterol management
- fat intake < 30% of total calories
- < 10% from saturated fats
- fat intake < 30% of total calories
- drugs:
- HMG-CoA inhibitors (-statins)
- reduce total cholesterol by reducing processing of cholesterol in liver and increasing clearance of LDL in blood
- ezetimibe (Zetia)
- absorbs cholesterol through small intestine
- HMG-CoA inhibitors (-statins)
How is hypertension defined?
– pts without DM:
- systolic BP greater than or equal to 140
- diastolic BP greater than or equal to 90
– pts with DM:
- BP > 130/90
What are the 5 classifications of blood pressure?
- normal
- systolic < 120
- diastolic < 80
- prehypertension
- systolic = 120 - 139
- diastolic = 80 - 89
- stage 1
- systolic = 140 - 159
- diastolic = 90 - 99
- stage 2
- systolic = 160 - 179
- diastolic = 100 - 109
- stage 3
- systolic greater than or equal to 180
- diastolic greater than or equal to 110
What are the 3 types of hypertension?
– primary (essential) HTN: HTN that does not result from another medical condition
- causes damage to vital organs
- causes thickening of arterioles
- 95% of HTN pts
– secondary HTN: HTN that stems from another disease process or another disorder
- more difficult to treat
- common causes:
- renal disease
- primary aldosteronism
- pheochromocytoma – benign, non-cancerous tumor of adrenal glands
- Cushing’s syndrome
- medications
– malignant HTN: severe, rapidly progressing HTN
- severe problem
- BP > 200/150
What are the risks for primary and secondary HTN?
– primary risks:
- family hx
- African American ethnicity
- age
- excessive sodium intake
- excessive caffeine intake
- obesity
- smoking
- stress
– secondary risks:
- kidney disease
- Cushing’s disease
- brain tumors
- primary aldosteronism
- drugs:
- estrogen
- glucocorticoids
What are some assessments for HTN?
- physical:
- often asymptomatic other than h/a and dizziness
- BP readings for both arms
- fundoscopic examination of eyes
- may have hemorrhages in retina
- hard exudates
- cotton wool spots
- psychological assessment – stress can cause elevated BP
- labs:
- can determine secondary HTN
What are some interventions for HTN?
- reduce weight
- restrict sodium
- consume alcohol sparingly
- exercise
- quit smoking
- reduce stress
- drugs:
- long-acting meds are preferred
- better compliance
- cheaper
- stepped therapy
- diuretics – first line of therapy
- calcium channel blockers
- cause vasodilation
- do not use in pts with HF – already compromised heart contractility
- ACE inhibitors
- cause vasodilation while preserving renal function
- preferred drug for pts with HF or DM
- angiotensin II receptor antagonists
- aldosterone receptor antagonists
- beta blockers (-olol)
- decreases HR and contractility
- causes vasodilation
- preferred drug for pts with ischemic heart disease
- can cause bronchospasm
- careful with pts with asthma
- long-acting meds are preferred
What is peripheral vascular disease (PVD)? What is the most common location for PVD? What are some causes of PVD?
– peripheral vascular disease (PVD): disorders that change the natural flow of blood in peripheral circulation (either arterial or venous)
- usually implies arterial disease – more severe than venous
– most common location = legs
– causes = chronic, systemic atherosclerosis
What are some assessments that might indicate PVD?
- intermittent claudication: leg pain that occurs following walking for a short distance
- cramping
- burning
- muscle pain
- pain at rest
- pain worsens over time
- hair loss on lower extremities
- dry, pale, mottled skin
- thickened toenails
- rubor: redness when extremities are lowered
What are some diagnostic tests for PVD?
- arteriography: IV contrast dye to visualize occlusions
- doppler probe: systolic BP readings of thigh, calf, and ankle
What are some interventions for PVD?
- exercise
- start gradually
- walk to point of claudication, then stop and rest
- poistioning
- don’t raise above level of heart
- promote vasodilation
- warmth to extremity
- prevent exposure to cold
- avoid things that cause vasoconstriction
- stress
- caffeine
- nicotine
- drugs
- antiplatelets – increase blood flow to extremities
- vasodilators
- like HTN meds
- percutaneous transluminal angioplasty
- atherectomy: scraping of plaque from artery with a rotoblader
- surgery
- arterial revascularization (bypass)
What are the 6 P’s of arterial insufficiency?
- pain
- pallor
- pulselessness
- paresthesia
- paralysis
- poikilothermia (coolness)
What is an acute peripheral arterial occlusion? What are some interventions?
– acute peripheral arterial occlusion: an occlusion that affects blood flow
- most commonly caused by embolus
- more common in lower extremities
- may occur in upper extremities, especially in pts with IV drug addictions
– interventions:
- drugs
- thrombolytics
- surgery
What is an aneurysm? Where are they likely to occur? What are the 4 types?
– aneurysm: permanent localized dilation of an artery
– likely locations:
- abdominal
- most common
- usually asymptomatic
- > 6 cm = very large and severe
- if left untreated, will rupture within 1 year
- thoracic
- femoral
- popliteal
– 4 types:
- saccular: outpouching
- affects only a distinct area of the artery
- fusiform: affects a lengthy surface of the artery
- ruptured: when the aneurysm bursts
- dissecting: accumulation of blood in the wall of the artery
What are some signs and symptoms of aneurysm? What are some interventions?
– s/s:
- limb ischemia
- diminished/absent pulses
- cool skin
- pain
- for abdominal aortic aneurysm (AAA):
- pain in abdomen
- steady
- gnawing
- unaffected by movement
- may last for hours or days
- pain in flank or back
- abdominal mass with a pulse
- rupture could be life-threatening
- pain in abdomen
- for thoracic aotic aneurysm:
- back pain
- SOB
- difficulty swallowing
- visible mass above suprasternal notch
- sudden excruciating back/chest pain
- indicates thoracic rupture
– interventions:
- monitor growth
- treat HTN
- surgery
- resection
- replace an area of the vessel with a graft
- resection
How are aneurysms diagnosed?
- CT chest
- ultrasound – will have an eggshell-like appearance
- aortic angiography
What is aortic dissection? What are some signs and symptoms? What are some interventions?
– aortic dissection: a tear in the inner layers of the vessel, resulting in blood accumulating in between layers of the vessel (dissecting the vessel)
- life-threatening
– s/s:
- pain
- tearing
- ripping
- stabbing
– interventions:
- drugs
- IV nitropress – vasodilator
- surgery
- removal of tear
- grafting
What is Buerger’s disease? What is it associated with? What are some diagnostic tests? What are some interventions?
– Buerger’s disease (thromboangiitis obliterans): uncommon occlusive disease in which the vessels swelling and prevent blood flow
- common in medium and small arteries and veins
– associated with tobacco smoking due to inflammation and vasoconstriction
– diagnostic tests:
- CT with contrast
- shows very little perfusion
– interventions:
- drugs
- nifedipine (Procardia)
What is Raynaud’s phenomenon? What is the cause? What are some signs and symptoms? What are some interventions?
– Raynaud’s phenomenon: condition in which the extremities feel numb or cool in response to temperature or stress
– caused by vasospasm of arteries and arterioles in extremities
– s/s:
- numbness and coolness in extremities
- changes in color of extremities
- redness
- pallor
- cyanosis
– interventions:
- drugs
- calcium channel blockers
- nifedipine
- Cyclospasmol
- Dibenzyline
- calcium channel blockers
- surgery
- lumbar sympathectomy
- cutting of sympathetic nerve fibers that cause vasoconstriction in lower extremities
- sympathetic ganglionectomy
- cutting of sympathetic nerve fibers that cause vasoconstriction in upper extremities
- lumbar sympathectomy
- avoid smoking
- keep feet/hands protected and warm
- avoid stressors
- wear loose, warm clothing
What is venous thromboembolism (VTE)? What population experiences VTEs more frequently? What are some risk factors for VTEs? What are some signs and symptoms? What are some interventions?
– venous thromboembolism (VTE): clot formation and venous inflammation
– population = common in pregnant women
– risk factors:
- pregnancy
- varicose veins
- venous stasis
– s/s:
- pain in extremities
- warmth
- edema
- patchy redness of legs
- generalized weakness
- may have weaker pulses in extremities
– interventions:
- bedrest
- drugs
- antiplatelets
- analgesics
Differentiate between deep vein thrombosis and pulmonary embolism. How are they related? What is an important assessment to make for pts with DVT?
– deep vein thrombosis (DVT): the most common type of thrombophlebitis (thrombus with inflammation)
– pulmonary embolism (PE): a dislodged blood clot that travels to the pulmonary artery
– DVT and PE are related:
- a thrombus from a DVT can become dislodged and cause a PE
- 50% of pts with DVT will develop an occult PE
– ALWAYS assess for respiratory status for DVT pts for ^this reason
What are some signs and symptoms of DVT? How is it diagnosed? What are some interventions for DVT and PE?
– s/s:
- calf/groin pain
- sudden unilateral swelling of leg
- localized edema
- Homan’s sign (pain with dorsiflexion of ankle)
- NOT advised
– diagnosis:
- venous flow studies
- MRI
- D-dimer
- marker for coagulation
- measures degradation of fibrin by-products
- used when pt has few s/s
- higher D-dimer and high fibrinogen = more likely to form clots and VTE
– interventions:
- use a doppler to determine if there is occlusion
- drugs
- antiplatelets
- Lovenox subq (low-molecular weight heparin)
- preferred treatment
- longer half-life than heparin
- heparin bolus followed by heparin infusion
- make sure to obtain a baseline aPTT
- administer heparin bolus
- begin heparin drip
- after 6H, reassess aPTT
- should be 1.5 - 2x baseline
- antiplatelets will prevent aggregation and worsening of the thrombus/emboli
- Lovenox subq (low-molecular weight heparin)
- anticoagulants
- warfarin
- measure therapeutic effectiveness with PT and INR
- factor Xa inhibitors (Eliquis, Zeralta)
- Plavix
- warfarin
- thrombolytics
- antiplatelets
- surgery
- thrombectomy
- inferior vena caval interruption
- insertion of a filter device in femoral vein
- not common b/c filter legs can break off and become thromboli
-
Orem's Self-Care Theory9
-
Clients with Infection9
-
Fluid & Electrolyte Imbalance24
-
Inflammation and Immune Response11
-
CBC Lab Values5
-
Arthritis and Autoimmunity Disorders41
-
Perioperative Patients43
-
Acute and Chronic Kidney Disease27
-
Endocrine System64
-
Diabetes Mellitus41
-
CAM6
-
Pain17
-
Integumentary Disorders41
-
GI Disorders45
-
Hepatic and Pancreatic Disorders42
-
Respiratory Disorders49
-
Cardiac69
-
Hearing Problems9
-
Vascular Problems25
