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perfusion B
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Hypertension
when there is increased wall thickness and it narrows the diameter so it increases bp
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
What 4 body mechanisms regulate bp
arterial baroreceptors, regulate body-fluid volume, renin-aldosterone system, and vascular autoregulation
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
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
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
Vascular autoregualtion
maintains consistent levels of tissue perfusion
Expected bp
systolic is less than 120, diastolic is less than 80
Elevated bp
systolic is 120-129, diastolic is less than 80
Stage 1 HTN bp
systolic is 130-139, diastolic is 80-89
Stage 2 HTN bp
systolic is equal or greater than 140, diastolic is equal to or greater than 90
Hypertensive crisis bp
systolic is greater than 180, diastolic is equal to or greater than 120
Prolonged, untreated, and poorly controlled HTN can cause
peripheral vascular disease (effects the heart, brain, eyes, kidneys)
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
Secondary HTN risk factors
Kidney disease, cushings disease, primary aldosteronism, pheochromocytoma, brain tumors, encephalitis, meds, pregnancy
There are ___ lab findings that diagnose HTN
no/0
What lab tests can identify the cause of secondary HTN
BUN, creatinine elevation w kidney disease, elevated blood corticoids w Cushings disease
Diagnostic procedures for HTN
ECG to evaluate cardiac funciton, tall r waves for left-ventricular hypertrophy, chest x-ray show cardiomegaly
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
HTN expected findings
can experience few or no manifestations, monitor for headache, face flushing, dizzy, fainting, retinal changes and vision disturbances
HTN pt education
report manifestations of electrolyte imbalance, understand treatment, understand SE of meds, schedule doc appointments, monitor bp, treatment involves lifestyle changes
HTN meds
diuretics (for fluid overload and is first line med), calcium channel blockers, ACE, ARBs, aldosterone-receptor antagonists, beta blockers
HTN crisis occurs when
occurs when pt does not follow medication regimen
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
Periphreal vascular disease includes two types
peripheral arterial disease and peripheral venous disease
Peripheral arterial disease
have a problem with the artery and blood getting to the tissue
Periphreal venous disease
blood has gotten there and has issues getting it back to the heart
Periphreal vascular disease
progressive conditions characterized by altered blood flow through vessels outside of the heart
PVD conditions
PAD, PVD, chronic venous disease, chronic venous insufficiency, venous thrombosis
Chronic venous disease
conditions in the lower extremities and blood pools in the legs
Chronic venous insufficiency
constant increased venous pressure caused by improperly working venous valves or obstruction
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
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
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
PAD risk factors
HTN, hyperlipidemia, diabetes, smoking, obesity, sedentary lifestyle, family predisposition, female sex, old age, elevated C-reactive protein, hyperhomocysteinemia
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
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
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
PAD lab tests
ankle-brachial index, duplex ultrasonography, CT angiography, MRI angiography, peripheral angiogram, segmental systolic bp measurements, exercise tolerance testing, plethysmography
PAD role of the nurse
look for 6 Pās of acute limb ischemia (pallor, pain, paresthesia, paralysis, pulselessness, poikilothermia)
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)
PAD meds
antiplatelet meds (aspirin), statins
PAD Procedures
Percutaneous transluminal angioplasty (ballon and stent)
Laser-assisted angioplasty (laser to vaporize atherosclerotic plaque)
Mechanical rotational abrasive atherectomy (scapes plaque)
ARTERIAL REVASCULARIZATION SURGERY (is bypass grafts to reroute circulation around the occlusion)
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)
Potential complications of Arterial revascularization surgery for PAD
graft occlusion, wound or graft infection, and compartment syndromeĀ
Graft occlusion for PAD
serious complication of arterial revascularizaiton and occurs in first 24 hours of surgery
Compartment syndrome for PAD
A MEDICAL EMERGENCY where tissue pressure in a confined body space can restrict blood flow and results in ischemia
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
Blood stasis
blood staying in the area of the periphery and not returning to the heart (so it is blood pooling)
Periphreal venous disorders include
venous insufficiency, venous thromboembolism, varicose veins
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
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
PVD impact on overall health
impaired quality of life, frequent visits to healthcare provider, limited employment opportunities, emotional health affected, age increases risk
PVD manifestations
varicose veins, brown pigment around ankles from broken down RBCs, edema, pruritus, open sores, restless legs, feeling heaviness in lower extremities
PVD lab tests
plethysmography and duplex ultrasound (these assess for blood flow)
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
PVD treatments
elevate legs, exercise, compression therapy, vein-stripping/vein is removed, ultrasound guided foam sclerotherapy, radio frequency and laser ablation, medication therapy
Arterial lesions are located
end of toes, top of feet, lateral ankle region
Arterial lesions appearance
very little drainage, little tissue granulation (pale or very light pink or black/necoritc)
Venous lesions are located
medial parts of the lower legs and medial ankle region
Venous lesions appearance
swollen w drainage, granulation is present (deep pink to red), edges are irregular, shallow
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
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.
Pulmonary embolism
occurs when a thrombus is dislodged and becomes an embolus and lodges in a pulmonary vessel
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
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
DVT diagnostic procedures
ultrasound, doppler flow study, impedance plethysmography
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
DVT meds
anticoagulants (warfarin and heparin), thrombolytic therapyĀ
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)
Varicose veins
enlarged and twisted and superficial veins that occur in any part of the body, mainly in the lower extremities and by esophagus
Varicose veins risk factors
females, older than 30 years, occupation has prolonged standing, pregnancy, obesity, systemic and heart diseases, family history
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
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
Varicose veins treatments
sclerotherapy, vein stripping, laser treatment, and radio frequency energy
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
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