Ineffective Tissue Perfusion and Hypertension Study Notes

Peripheral Vascular Disease (PVD)

Refers to any disease state affecting the blood vessels located within the extremities.

Atherosclerosis

The most common cause of PVD, characterized by the buildup of cholesterol and lipids along the vessel walls.

Risk Factors for PVD

Includes family history of vascular disease, obesity, sedentary lifestyle, smoking, diabetes, high cholesterol levels, and hypertension.

Peripheral Arterial Disease (PAD)

A specific form of PVD involving the narrowing of the arteries, leading to reduced blood flow to distal extremities.

Intermittent Claudication

The hallmark early sign of PAD, characterized by reproducible ischemic muscle pain during activity, relieved by rest.

Six P’s of PAD

Includes Pain, Paresthesia, Pallor, Pulselessness, Paralysis, and Poikilothermia.

Chronic Venous Insufficiency

Occurs when the venous wall and/or valves in the leg veins do not function effectively, making it difficult for blood to return to the heart.

Manifestations of Chronic Venous Insufficiency

Includes edema, venous stasis ulcers, altered pigmentation, temperature changes, pulse palpability, skin texture changes, and sensation issues.

Arterial Characteristics

Includes intermittent claudication, absent edema, weak or absent pulses, round smooth sores, necrosis, and cool skin temperature.

Venous Characteristics

Includes dull, achy pain, present edema, palpable pulses, drainage from sores, irregular sores, yellow slough or ruddy skin.

Diagnostic Tools for PVD

Includes ultrasound, Ankle Brachial Index (ABI), CT angiography (CTA), angiography, MR angiography (MRA), and contrast phlebography.

Nursing Assessment for PVD

Includes palpation of pulses, health history collection, skin assessment, edema assessment, and monitoring lab values.

Nursing Interventions for PVD

Includes positioning, activity encouragement, thermoregulation, pharmacology, and careful wound and leg care.

Raynaud’s Phenomenon

Characterized by intermittent arterial constriction of small blood vessels, leading to color changes and numbness, triggered by cold or stress.

Deep Vein Thrombosis (DVT)

The formation of a blood clot within a deep vein of an extremity, typically the legs.

Virchow’s Triad

High-risk factors for DVT: endothelial damage, venous stasis, and altered coagulation.

Heparin

Administered as a continuous IV infusion requiring monitoring of aPTT levels.

Warfarin

Administered PO during the heparin infusion; requires INR monitoring.

Hypertension (HTN)

Elevation of blood pressure greater than normal limits, categorized into essential, secondary, white coat, malignant, and pregnancy-induced HTN.

The 4 C’s of Complications of HTN

Includes Coronary Artery Disease (CAD), Congestive Heart Failure (CHF), Cerebral Vascular Accident (CVA), and Chronic Renal Failure (CRF).

DASH Diet

A dietary approach to stop hypertension, emphasizing low sodium intake.

Initial Therapy for HTN

Typically starts with a Thiazide diuretic.

RAAS Pathway

Renin acts on Angiotensinogen to create Angiotensin I, converted to Angiotensin II in the lungs, causing vasoconstriction and triggering aldosterone.

ACE Inhibitors

Mechanism: Inhibit ACE to decrease Angiotensin II levels; common side effects include cough and hyperkalemia.

Calcium Channel Blockers (CCB)

Mechanism: Blocks calcium entry to reduce contraction force and dilate arteries; side effects may include hypotension and flushing.

Hypertension Medications and Heart Rate & Blood Pressure

Certain medications for hypertension can lower blood pressure while others may also lower heart rate. For example, ACE inhibitors primarily lower blood pressure, while beta-blockers lower both blood pressure and heart rate.

Beta-Blockers

This class of antihypertensives lowers both heart rate and blood pressure by blocking adrenaline receptors in the heart.

ACE Inhibitors

These medications lower blood pressure by inhibiting the production of Angiotensin II, but they do not directly reduce heart rate.

Calcium Channel Blockers (CCB)

These can lower blood pressure by relaxing blood vessels and may also reduce heart rate depending on the specific drug.

Thiazide Diuretics

While primarily used to lower blood pressure, thiazide diuretics do not significantly affect heart rate.

Lisinopril

An ACE inhibitor that helps lower blood pressure by inhibiting the production of Angiotensin II.

Atenolol

A beta-blocker that reduces heart rate and lowers blood pressure by blocking adrenaline effects on the heart.

Amlodipine

A calcium channel blocker that lowers blood pressure by relaxing blood vessels and may affect heart rate.

Hydrochlorothiazide

A thiazide diuretic that primarily lowers blood pressure without significantly affecting heart rate.

Losartan

An Angiotensin II receptor blocker that prevents the action of Angiotensin II, helping to reduce blood pressure.