NRSG 2300 unit 10

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77 Terms

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Hypertension

when there is increased wall thickness and it narrows the diameter so it increases bp

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HTN is classified as

systolic bp is at or greater than 130 or diastolic bp is at or greater than 80 for 2 or more assessments of BP at least 2 weeks apart

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What 4 body mechanisms regulate bp

arterial baroreceptors, regulate body-fluid volume, renin-aldosterone system, and vascular autoregulation

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Arterial baroreceptors

receptors that are located in the carotid sinus, aorta, and left ventricle and they control bp by altering the hr. They cause vasoconstriction or vasodilation.Ā 

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Regulate body-fluid volume

properly functioning the kidneys and RETAIN fluid when a pt is hypotensive and EXCRETE fluid when a pt is hypertensive. Increase in bp means it holds onto fluid. Decrease in bp means it lets go of fluid

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Renin-angiotensin aldosterone system

renin that is converted into angiotensin 2 and causes vasoconstriction and controls aldosterone release and causes the kidneys to reabsorb sodium and inhibit fluid loss

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Vascular autoregualtion

maintains consistent levels of tissue perfusion

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Expected bp

systolic is less than 120, diastolic is less than 80

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Elevated bp

systolic is 120-129, diastolic is less than 80

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Stage 1 HTN bp

systolic is 130-139, diastolic is 80-89

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Stage 2 HTN bp

systolic is equal or greater than 140, diastolic is equal to or greater than 90

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Hypertensive crisis bp

systolic is greater than 180, diastolic is equal to or greater than 120

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Prolonged, untreated, and poorly controlled HTN can cause

peripheral vascular disease (effects the heart, brain, eyes, kidneys)

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Essential HTN risk factors

positive genetic history, too much sodium, physical inactivity, BMI more than 25, high alcohol consumption, African Americans, smoking, hyperlipidemia, diabetes, stress, ages older than 60

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Secondary HTN risk factors

Kidney disease, cushings disease, primary aldosteronism, pheochromocytoma, brain tumors, encephalitis, meds, pregnancy

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There are ___ lab findings that diagnose HTN

no/0

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What lab tests can identify the cause of secondary HTN

BUN, creatinine elevation w kidney disease, elevated blood corticoids w Cushings disease

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Diagnostic procedures for HTN

ECG to evaluate cardiac funciton, tall r waves for left-ventricular hypertrophy, chest x-ray show cardiomegaly

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HTN disease prevention

maintain BMI less than 25, pt w diabetes have good glucose range, limit caffeine and alcohol range, use stress-management techniques, stop smoking, have aerobic exercise 3x a week, follow diet, limit sodium and fat

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HTN expected findings

can experience few or no manifestations, monitor for headache, face flushing, dizzy, fainting, retinal changes and vision disturbances

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HTN pt education

report manifestations of electrolyte imbalance, understand treatment, understand SE of meds, schedule doc appointments, monitor bp, treatment involves lifestyle changes

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HTN meds

diuretics (for fluid overload and is first line med), calcium channel blockers, ACE, ARBs, aldosterone-receptor antagonists, beta blockers

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HTN crisis occurs when

occurs when pt does not follow medication regimen

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Manifestations of HTN crisis

severe headache, extremely high bp (systolic bp greater than 180, diastolic greater than 120), blurred vision, dizzy, disorientation, epistaxis, administer IV antihypertensives, monitor ECG

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Periphreal vascular disease includes two types

peripheral arterial disease and peripheral venous disease

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Peripheral arterial disease

have a problem with the artery and blood getting to the tissue

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Periphreal venous disease

blood has gotten there and has issues getting it back to the heart

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Periphreal vascular disease

progressive conditions characterized by altered blood flow through vessels outside of the heart

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PVD conditions

PAD, PVD, chronic venous disease, chronic venous insufficiency, venous thrombosis

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Chronic venous disease

conditions in the lower extremities and blood pools in the legs

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Chronic venous insufficiency

constant increased venous pressure caused by improperly working venous valves or obstruction

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Venous thrombosis

has Virchow triad aka injury or changes to the wall of the vie, abnormalities in the blood clotting components, blood flow within the vein has slowed or stopped

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Peripheral arterial disease what it is

a progressive disorder that affects blood flow to the arteries in the lower extremities. Results from atherosclerosis that usually occurs int he arteries of the lower extremities and has inadequate flow of blood. Basically build up of plaque

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Most common cause of peripheral arterial disease

atherosclerosis, results in the progressive narrowing of the vessel lumen and plaques can form on the walls of there arteries and makes then rough and fragile

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PAD risk factors

HTN, hyperlipidemia, diabetes, smoking, obesity, sedentary lifestyle, family predisposition, female sex, old age, elevated C-reactive protein, hyperhomocysteinemia

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PAD impact on overall health

discomfort, weakness, cramping in feet legs and hips, decline in physical activity, anxiety, stress, depression, neuropathy, ulcers of the foot, increased risk of falls

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PAD physical assessment findings

slow toenail growth, thick toenails, decreased cap refill of toes, decreased hair growth on legs, wounds on toes or foot, skin w pale skin appearance, muscle atrophy, dry and scaly mottled skin, cold and cyanotic extremity, pallor of extremity w elevation, DEPENDENT redness of extremity and ONLY DEPENDENT, muscle atrophy

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PAD other findings

during, cramping, and pain in the legs during exercise aka INTERMITTENT CLAUDICATION, numbness or burning pain in feet when in bed, pain that is relieved by placing the legs at rest in a dependent position

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PAD lab tests

ankle-brachial index, duplex ultrasonography, CT angiography, MRI angiography, peripheral angiogram, segmental systolic bp measurements, exercise tolerance testing, plethysmography

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PAD role of the nurse

look for 6 P’s of acute limb ischemia (pallor, pain, paresthesia, paralysis, pulselessness, poikilothermia)

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PAD nursing care

encourage exercise to build collateral circulation, promote vasodilation and avoid vasoconstriction (warm environment and socks, insulated socks, no heating pads, avoid exposure to cold, avoid stress and caffeine and nicotine), positioning (avoid crossing the legs, refrain form wearing restrictive garments and compression socks, elevate legs to reduce swelling)

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PAD meds

antiplatelet meds (aspirin), statins

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PAD Procedures

  1. Percutaneous transluminal angioplasty (ballon and stent)

  2. Laser-assisted angioplasty (laser to vaporize atherosclerotic plaque)

  3. Mechanical rotational abrasive atherectomy (scapes plaque)

  4. ARTERIAL REVASCULARIZATION SURGERY (is bypass grafts to reroute circulation around the occlusion)

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Arterial revascularization surgery for PAD

priority action is to maintain adequate circuation, location of pedal or doralis pulse is MARKED AND TEST PULSE STRENGTH,Ā  CMS checks regularly, assess for warmth and redness and edema of limb, monitor for pain, monitor for bp (htn leads to clot of graft)

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Potential complications of Arterial revascularization surgery for PAD

graft occlusion, wound or graft infection, and compartment syndromeĀ 

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Graft occlusion for PAD

serious complication of arterial revascularizaiton and occurs in first 24 hours of surgery

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Compartment syndrome for PAD

A MEDICAL EMERGENCY where tissue pressure in a confined body space can restrict blood flow and results in ischemia

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Peripheral Venous Disorders

problems with the veins that interfere with adequate return of blood flow from the extremities and can RESULT IN BLOOD STASIS. They have superficial and deep veins in lower extremities that have valves that prevent back flow of blood as it returns to the heart. Promote venous return from skeletal muscles in lower extremities

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Blood stasis

blood staying in the area of the periphery and not returning to the heart (so it is blood pooling)

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Periphreal venous disorders include

venous insufficiency, venous thromboembolism, varicose veins

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Peripheral Venous Disorder risk factors

abnormal structure in the veins, functional abnormalities that lead to venous reflux, valvular incompetency, genetics, progesterone, family history, obesity, smoking, pregnancy, history of thrombosis

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Venous insufficiency (PVD)

A PVD issue there it occurs in secondary to incompetent valves in the deeper veins of the lower extremities and allows for POOLING OF BLOOD and dilates the veins. Develops into swelling, venous stasis ulcers, and cellulitis. Results from periods of prolonged venous HTN and results in DAMAGE TO THE VALVE which causes backup of blood, edema, and damage of deep tissue from sitting or standing for long periods, obesity, pregnancy, and thrombophlebitis

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PVD impact on overall health

impaired quality of life, frequent visits to healthcare provider, limited employment opportunities, emotional health affected, age increases risk

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PVD manifestations

varicose veins, brown pigment around ankles from broken down RBCs, edema, pruritus, open sores, restless legs, feeling heaviness in lower extremities

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PVD lab tests

plethysmography and duplex ultrasound (these assess for blood flow)

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PVD role of the nurse

safety w unsteady gait, educate pt on control or decrease manifestations (edema, venous ulcers, hemorrhage, phlebitis, DVT), obtain thorough history and assessment of lower extremities, elevate LEGS for at least 20 minutes 4-5x a day, elevate legs above heart in bed, avoid crossing legs and wear constrictive clothes, wear elastic compression stockingsĀ 

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PVD treatments

elevate legs, exercise, compression therapy, vein-stripping/vein is removed, ultrasound guided foam sclerotherapy, radio frequency and laser ablation, medication therapy

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Arterial lesions are located

end of toes, top of feet, lateral ankle region

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Arterial lesions appearance

very little drainage, little tissue granulation (pale or very light pink or black/necoritc)

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Venous lesions are located

medial parts of the lower legs and medial ankle region

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Venous lesions appearance

swollen w drainage, granulation is present (deep pink to red), edges are irregular, shallow

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DVT

venous thromboembolism (VTE) is a blood clot formed as a result of venous stasis, endothelial injury, or hyper coagulability. THROMBUS FORMATION LEADS to a DVT or a pulmonary embolism which is life threatening.Ā 

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DVT risk factors

endothelial damage caused by trauma and surgery, venous stasis caused by obesity immobility and pregnancy, and hypercoagulability caused by oral contraceptives cancer and heart failure.

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Pulmonary embolism

occurs when a thrombus is dislodged and becomes an embolus and lodges in a pulmonary vessel

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Pulmonary embolism nursing considerations

pt has dyspnea, chest pain, tachypnea, crackles, tachycardia, diaphoresis, low-grade fever, decreased oxygen sat. Nurse needs to notify provider immediate and call a rapid and never leave pt alone. Have O2 support and prepare to administer anticoagulation therapy

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DVT assessment

limb pain (achy or heaviness of legs), calf or groin pain. Warmth, edema, induration, and hardness over involved blood vessel. Changes in circumference of calf and thigh overtime, localized edema

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DVT diagnostic procedures

ultrasound, doppler flow study, impedance plethysmography

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DVT nursing care

encourage ambulation after anticoagulant therapy, dorsiflexion exercises on the foot in bed, OCCASIONALLY elevate legs above heart in bed, avoid putting pillow under knee, use warm and moist compress, DO NOT MASSAGE affected limb, use anti-embolism stockings

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DVT meds

anticoagulants (warfarin and heparin), thrombolytic therapyĀ 

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DVT surgery

inferior vena cava interruption surgery used when pt is unresponsive to medical therapy or anticoagulation therapy is contraindicated (filter is inserted and traps emboli and prevents them from reaching heart or lungs)

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Varicose veins

enlarged and twisted and superficial veins that occur in any part of the body, mainly in the lower extremities and by esophagus

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Varicose veins risk factors

females, older than 30 years, occupation has prolonged standing, pregnancy, obesity, systemic and heart diseases, family history

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Varicose veins assessment findings

distended and superficial veins that are visible below the skin and are torturous in nature. Pt reports having muscle cramping, aches, pain after sitting, and prutitis

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Varicose veins diagnosis

uses a trendelenburg test which you put the pt in a supine position w legs elevated. When they sit up, the veins fill from the proximal end if varicosities are present

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Varicose veins treatments

sclerotherapy, vein stripping, laser treatment, and radio frequency energy

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Sclerotherapy w varicose veins

irritating chemical solution injected into the vein and produces local inflammation and closes the lumen of the vessel. Pt should wear elastic stockings and administer mild analgesics like Tylenol

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Vein stripping w varicose veins

removes a large varicose vein that cannot be treated with less-invasive procedures. Nurse will assist in marking the vein before and monitor the groin and leg for bleeding w bandages, elevate legs above heart and encourage ROM exercises