Integrated Care Exam 2

Comprehensive vocabulary flashcards covering Peripheral Vascular Disease, Deep Vein Thrombosis, Pulmonary Embolism, Coronary Artery Disease, Myocardial Infarction, and Hypertension based on the provided lecture materials.

Arteriosclerosis

The thickening, loss of elasticity, and calcification of the arterial walls.

Atherosclerosis

A form of arteriosclerosis characterized by deposits of fat and fibrin that obstruct and harden the blood vessels, leading to decreased tissue perfusion.

Peripheral Arterial Disease (PAD)

A condition involving the narrowing of peripheral arteries (commonly in the pelvis and lower extremities), preventing adequate oxygenated blood flow to the distal toes and feet.

Chronic Venous Insufficiency

Inadequate return of venous blood from the lower extremities back to the heart, leading to venous stasis and pooling of blood in the legs.

Intermittent Claudication

Ischemic muscle pain, cramping, or aching in the legs (typically the calf) triggered by predictable exercise or activity and subsiding with rest.

Rest Pain (Arterial Insufficiency)

Severe burning or aching pain in the foot or toes that occurs at rest, worsens with leg elevation, and is temporarily relieved by lowering the leg.

Arterial Ulcers

Painful, dry, 'punched out' lesions without drainage located on the feet or toes; managed without leg elevation or compression.

Venous Ulcers

Shallow, irregularly shaped, generally painless but heavy-feeling ulcers with drainage located above the ankle; managed with leg elevation and compression stockings.

Ankle-Brachial Index (ABI)

A non-invasive diagnostic test that compares blood pressure measurements taken at the upper extremities to those at the lower extremities to evaluate peripheral arterial disease.

Revascularization Procedures in PAD

Surgical and endovascular treatments used to restore arterial perfusion, including balloon angioplasty, expandable stent placement, atherectomy, and infrainguinal bypass grafting using the great saphenous vein.

Virchow's Triad

The three primary factors contributing to thrombosis: circulatory stasis, vascular wall damage/injury, and hypercoagulability.

Deep Vein Thrombosis (DVT)

The formation of a blood clot (thrombus) within a deep vein, most commonly occurring in the large veins of the lower leg and thigh.

Signs and Symptoms of DVT

Unilateral calf swelling, erythema, localized leg warmth, tenderness, and a dull ache in the affected extremity, though some clients remain asymptomatic.

Pulmonary Embolism (PE)

Obstruction of the pulmonary arterial bed by a detached clot (thromboembolus), fat, air bubble, or foreign material, most commonly originating from a DVT.

Clinical Features of PE

Sudden onset of dyspnea, tachypnea, pleuritic chest pain, coughing up blood (hemoptysis), fever (pyrexia), tachycardia, and potential signs of shock or hypotension.

D-Dimer Test

A blood test used to rule out active blood clots; a normal result is less than $0.50$  or $< 500\text{ ng/mL}$, while elevated levels indicate active thrombus formation.

Enoxaparin Injection Protocol

A low-molecular-weight heparin administered subcutaneously in prefilled syringes without expelling the air bubble prior to injection to prevent drug leakage and guarantee correct dosage.

Thrombolytic Therapy Contraindications

Absolute/relative contraindications to clot-dissolving therapy including active internal bleeding, intracranial bleeding/disease, recent stroke, severe hypertension, pregnancy, and recent major trauma or surgery.

Ischemic Stroke vs. Hemorrhagic Stroke

Ischemic stroke is caused by a blood clot blocking arterial flow to the brain (most common); Hemorrhagic stroke occurs when a brain blood vessel leaks or ruptures (most fatal).

Tissue Plasminogen Activator (tPA)

A powerful thrombolytic drug administered within a $3\text{-hour}$ window of symptom onset for cleared patients presenting with acute ischemic stroke.

BE-FAST Mnemonic

An acronym identifying stroke assessment priorities: Balance loss, Eyesight changes, Face drooping, Arm weakness, Speech difficulty, and Time to call emergency services.

Myocardial Ischemia

A condition in which oxygen supply to cardiac muscle cells is inadequate due to reduced blood flow through the coronary arteries.

Types of Angina Pectoris

Stable angina (predictable, induced by activity/stress, relieved by rest/nitroglycerin), Unstable angina (unpredictable, occurs at rest, heralds MI risk), and Variant/Prinzmetal angina (caused by coronary artery vasospasm).

Sublingual Nitroglycerin Protocol

Sublingual organic nitrate taken at the onset of chest pain; $1\text{ tablet}$ under the tongue every $5\text{ minutes}$ for up to $3\text{ doses}$ total while monitoring for vasodilation effects.

MONA TASS Mnemonic

Mnemonic summarizing immediate pharmacologic management for acute Myocardial Infarction: Morphine, Oxygen, Nitroglycerin, Aspirin, Thrombolytics, Anticoagulants, Stool softeners, and Sedatives.

Cardiac Biomarkers (Troponin & CK-MB)

Troponin is the most reliable early indicator for MI, elevating within $1-3\text{ hours}$ post-injury; CK-MB elevates within $4-6\text{ hours}$.

Door-to-Balloon Goal for MI

The emergency goal of getting an acute MI patient from hospital entrance to the cardiac catheterization lab within $90\text{ minutes}$ for percutaneous coronary intervention (PCI).

Determinants of Vascular Resistance

Vascular resistance increases directly with higher blood viscosity ($\eta$) and longer vessel length ($l$), and increases significantly with a smaller vessel radius ($r$).

Primary vs. Secondary Hypertension

Primary (essential) hypertension is chronic high blood pressure with an unknown cause ($90\%-95\%$ of cases); Secondary hypertension results from an identified cause like kidney disease ($5\%-10\%$ of cases).

Blood Pressure Classification Categories

Blood pressure criteria defining Normal ($< 120\text{ and } < 80\text{ mmHg}$), Elevated ($120-129\text{ and } < 80\text{ mmHg}$), Stage 1 HTN ($130-139\text{ or } 80-89\text{ mmHg}$), Stage 2 HTN ($\ge 140\text{ or } \ge 90\text{ mmHg}$), and Hypertensive Crisis ($> 180\text{ and/or } > 120\text{ mmHg}$).

Hypertensive Emergency Goal

Initial treatment goal to lower Mean Arterial Pressure (MAP) by no more than $20\%-25\%$ within a few hours to prevent cerebral hypoperfusion while maintaining Diastolic BP at $100-110\text{ mmHg}$.

Blood Pressure Cuff Bladder Sizing Rules

Guidelines requiring the cuff bladder length to be $80\%-100\%$ of arm circumference and width about $40\%$; bladders that are too large underestimate BP, while bladders that are too small overestimate BP.

Minimum Normal Renal Output

A urine output threshold of at least $30\text{ mL/hr}$ necessary to indicate adequate renal tissue perfusion and adequate cardiac output.

Echocardiogram

An ultrasound procedure used to measure left ventricular pumping ability and ejection fraction (normal ejection fraction rate is $50\%-70\%$).