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cardio 2
hypertension, shock, aneurysm, aac, pad, burgers , raynauds,
| Question | Answer |
|---|---|
| what is the normal bp? | 120/80 |
| what is considered hypertension? | 140 or >/90 or> |
| what is considered prehypertension? | 120-139/80-89 |
| what makes a person with hypertension prone to developing mi, hf, stroke, and chronic kidney disease? | the higher the bp and the longer it has been high. |
| what are the three factors believed to contribute to primary/essential hypertension? | hyperactivity of the sns, hyperactivity of the renin-angiotensin-aldosterone system, and endothelial dysfunction. |
| what are things that allow you to measure bp accuratly? | no caffine or smoking 30 mins b4, pt rests for 5 mins before, cuff fits and is put on a bare arm, stop inflating once radial ulse is no longer felt, if elevated wait 2 mins then try again, also use other arm, 3 hihg readings for hypertension. |
| what are risk factors for hypertension? | family hx, tobacco use, obesity, physical inactivity, dyslipidemia, diabetes, albumin in urine, age 55 for men and 65 for women. |
| meds that raise bp. | NSAIDS, oral BC, herbal supps. |
| symptoms when bp is on the low side of high. | fatigue, dizziness, dyspnea, palpitations |
| symptoms with very high bp. | occipital HA |
| what are compelling indications | heart failure, post myocardial infarction, high cardiovascular risk, diabetes mellitus, chronic kidney disease, recurrent stroke prevention. |
| without compelling conditions and in stage 1 hypertension drug choices are... | thiazide type diuretics |
| without compelling conditions and in stage 2 hypertension drung choices are.. | two drug combinations, thiazide diuretic and ace inhibitor |
| with compelling indications drugs are.... | other antihypertensive drugs, diuretics, ace inhibitors, bb, ccb as needed |
| lifestyle modifications with hypertension. | lose excess weight, cut back salt, exercise regularly, limit alcohol, adopt Dash, stop smoking |
| DASH eating plan. | eating several servings of fish, plenty of fruit and veggies, increasing fiber intake and water intake. |
| Hypertensive crisis | severe and abrupt increase in bp diastolic of more than 120-130. |
| hypertensive emergency | abrupt rise over hours to days, causes damage to central nervouse system, multiorgan failure |
| hypertensive urgency | develops over days to weeks, no organ damage |
| hypertensive crisis treatment | lower bp gradully to a safe level. |
| hypertensive crisis emergency tx | iv meds/drips of vasodilators (nipride, tridil) monitor bp closely every 5 mins |
| hypertensive crisis urgency tx: | use oral ace inhibitors (captopril), and alpha adrenergic (catapres) |
| what is the definition of shock? | inadequate oxygen and nutrients to cells from impaired tissue perfusion. |
| what occurs in all shock and what can it lead to | cellular hypoxia and leads to multiorgan dysfunction or death |
| what is hypovolemic shock | most common, loss of fluid |
| absolute hypovolemic shock is | when the fluid is lost from the body |
| relative hypovolemic shock is | when the fluid shifts in the body, |
| what is cardiogenic shock and what factors cause it? | problems with the pumping of the heart. systolic dysfunction, diastolic dysfunction, dysrhythmias, structural factors.tx with vasodilators |
| what is neurogenic shock? | spinal cord injury, spinal anestesia, or vasomotor center compression |
| what is septic shock? | systemic infection tx with antibiotics |
| what is anaphylactic shock? | reaction to something, tx with corticosteroids |
| campensatory stage of shock with symptoms. | awake, increased bp and rr, agitated, increased renin, pale, cool, hypoactive bowel sounds. |
| pregressive stage of shock with symptoms | dizzy, groggy, less responsive, sluggish, bp decreased, heart rate increased, arrhythmias, increased resps, urine output decreased, skin cold and clammy. |
| refractatory stage of shock and symptoms | unresponsive, no output, heart rate decreased, code pt, bp bottomed out. |
| shock managment | abc's, o2, bed flat with feet up, ivf-ns or lr-isotonic, trousers, 2 large bore ivs, blood or colloids, drug therapy- dobutrex, dopamine, epinephrine, norepinephrine, |
| what to monitor with shock | hemodynamic monitoring/cv monitoring, i/o, resp status, gi, status, neuros, peripheral vascular status, emotional support. |
| complications of shock | chronic renal failure, acute rest distress syndorme to fibrotic lung disease. |
| what is an aneurysm | localized dilation or ballooning of a vessel wall. mostly in aortic or iliac arteries |
| what areas are aneurysms seen in | abdominal, thoracic, popliteal, femoral, cartoid |
| fusiform aneurysm | dilation that affects the entire circumfrence of a length of vessel |
| saccular aneurysm | distinct localized outpouching of an area of artery wall, aka berry aneurysm |
| dissecting aneurysm | results from a tear in the intimal layer of the vessel that allows blood to accumulate between the vessel walls |
| false/pseudo aneurysm | complete tear of the vessel wall, usually from trauma, needle, puncture, or suture failure, blood comes out of vessel. |
| what is thought to cause aneurysms | constant stress or pressure on the vessel wall, degenerative process from atherosclerosis |
| what are risk factors for aneurysm | increased age, male, uncontrolled bp, infx or inflam condition, family hx, smoking, cad, pad, copd, pregnancy |
| how do they detect aneurysm in someone that is asymptomatic | routine physical exam finds a bruit over the aneurysm, |
| symptoms with aneurysm | most are due to the pressure on other organs from the aneurysm, most common complaint with aaa is vague lower back and abdominal pain, |
| rupture of an aneurysm | medical emergency, presents with sever, sudden, sharp, and continuouse pain that radiates, changes in vital signs associated with hypovolemic shock, mental alteration , and syncope. may or may not have flank eccyhmosis(grey turners sign) |
| aneurysm diagnosis | most common is an abdominal ultrasonogrophy, tells size and location. not used for rupture. |
| interventions for aneurysms less than 4 cm and nonsymptomatic | refered to vascular surgeon for monitoring, lifestyle modifications, maintain normal bp, follow up appts every 6 mo |
| interventions for aneurysms that are 5 cm or larger or asymptomatic | surgical intervention, incise aorta, remove plaque or thrombus, put in graft sutured to aorta proximal and distal to aneurysm, suture vessel wall around graft |
| what makes this aneurysm surgery so dangerouse | cross clamping that blocks blood flow, stress to the heart can cause mi, chf, hypotension, and decrease blood flow to the kidneys |
| what can happen after they release the cross clamping | they can throw a clott so if it is an elective procedure they will use systemic anticoagulants |
| new surgical repair procedure | endovascular graft procedure, placement of sutureless aortic graft through femoral artery, allows blood flow through the graft to prevent further expansion of the aneurysm |
| aneurysm pre op | pts usually put on ventilator after this surgery, pt at high risk for mi, stroke, renal ischemia, and hypovolemic shock, goal for emergency is to maintain sufficient circulating volume. |
| if aneurysm surgery is elective should run theses | cbc, lyes, ua, clotting studies, cxr, ekg, ht, wt, vs, complete h and p. |
| aneurysm post op | maintain hemodynamic and ventilatory stability as well as providing adequate pain control. |
| post op aneurysm surgery monitor for | hypovolemic shock, post op hemorhage, keep bp below 120 but above 90. c&db, check pedal pulses, cap refill, skin temp, color, sensation and can move toes. |
| what levels to monitor post op | return of bs, output, bun/crcbc, lytes, abgs, s/sx of infx |
| what is acute arterial occlusion | sudden obstruction of an artery resulting in a decrease in tissue perfusion distal to the obstruction. |
| what are the causes of acute arterial occlusion | trauma, emboli, thrombi, valvular heart disease, a fib, puncture sites, reconstructive surgery. |
| what are the symptoms of acute arterial occlusion? 6 ps | pain, pallor, parestesia, paralysis, pulslessness, polar |
| how do they diagnose it? | with doppler or arteriography |
| how do they tx acute arterial occlusion | goal is to restore blood flow to area, bedrest(head up feet down), protect limb from trauma, possibly surgical embolectomy. could have permanent paralysis or neuropathy, |
| what is PAD | slow progressive narrowing and degeneration which eventually obstructs arteries. |
| where does PAD occur? | in larger arteries of the legs. |
| What is done for PAD? | no cure, tx is palliative |
| what are s/sx of PAD | intermittent claudication(limping), resting pain, pallor with elevation, dependent rubor, presence of 6p's, gangrene |
| diagnosis of PAD | abi, may also do an angiogrophy. |
| what are the normal abi's | norm 0.9-1.0, mild to moderate 0.4-0.8, less than 0.4 is PAD. |
| PAD tx | palliative, tx s/sx,lifesytle modifications,meds, surgery, |
| what meds to give for PAD | trental, pletal, ticlid, plavix, asa |
| what surgery is done for PAD | bypass or angioplasty(fem pop bypass) |
| post op PAD surgery | preventing or detecting occlusin of the graft, monitor for 6 ps, no not flex hips or knees, increase fluids, protect limb from trauma or pressure, monitor incision, administration of anticoagulants or antiplatelets. |
| what is Buergers disease | vascular disorder that involves small and medium arteries, veins, and capillaries. most common in arteries, gradual onset. |
| what do they think causes burgers disease? | recurrent inflamation of vessels due to insult from direct injury, autoimmune response, infx agents, or secondary to systemic lupus, physical agents, frostbite or exposure to extremely cold temps, irradiation, sunburn, mechanical injury or toxins. |
| what is the strongest association with burgers disease? | cigarette smoking(carbon minoxide triggers inflamatory response. |
| what are s/sx of burgers? | r/t arterial ischemia, pallor, enhanced sensitivity to the cold, PAIN, parastesia(nubness, tingling, burning, excessive sweating) |
| what are the predominant signs or burgers | pain, rest pain, diminished absent pulse, rubor, shiny, thin skin, decreased hair growth, nails thicken and malform, later stages: ulceration , gangrene. |
| dx for burgers disease. | abi, arteriograms |
| burgers disease tx | improvment in circulation, prevention of disease progression and protection. prevent vasoconstriction, promote vasodilation, walking excercises, protections, surgery |
| what meds do they do for burgers disease | asa, ticlid, persantine, plavix, calcium blockers for vasodilation,no strict vasodilators |
| what is raynauds | capillaries in fingers and toes respond to cold temps that leads to intense vasospasms and vasoconstriction. |
| what is raynauds disease associated with | cold temps and emotional stress |
| what is raynauds phenominon due to | secondary disease or disorder rarely percipitated by emotional stress, scleroderma, rheumatiod arthritis, systemic lupus, |
| s/sx of raynauds | fingers or toes become ischemic and blanched turn white or pale, then blue, then reddened. difficulty with fine motor movement, and parestesia. pulses are present. phenomina has worse symptoms than the diesease. |
| interventions for rayneuds | canserve heat, procardia, ca channel blockers, NO BETA BLOCKERS, surgery(sympathectomy), biofeedback to increase skin temp, guided imagrey to reduce stress, cessation of smoking. |
| prevention of ratnauds | reduce smoking, exposure to cold, stress, occupational trauma or occupation,(heavy vibrating tools, typing, piano, butchers, food preparers. |
| what is venous thrombus(thrombophlebitis) | superficial or deep, lower extremities common cause of superficial is r/t vericose veins. upper extremities common cause related to iv therapy. |
| factors that increase risk factors for venouse thrombosis | surgical procedures, cancer, trauma, immobility/stasis, pregnancy, estrogen use, hypercoagulable states, burergers disease, iv therapy, vericose veins, prolonged sitting or standing smoking |
| superficial venous thrombosis s/sx | palpable, firm cordlike vein, area around may be tender to touch, red, warm, swollen, |
| deep venous thrombosis s/sx | no symptoms, most common, have unilateral leg edema, pain, warm skin, tenderness, |
| complications with venouse thrombosis | pe, chronic venouse insufficiency. |
| diagnositic for venous thrombosis | doppler, d dimer, duplex scanner, |
| venous thrombus tx | prevent new thrombi from forming and from becoming and emboli, bedrest, non wt bearing on affected limb, warm moist pack 4x/day, antiembolism stocking, nsaids, anticoagulants, surgical-put in the filter, |
| venous thrombus pervention | ambulation, support hose, keep hydrated, no crossing legs, no constrictive clothing, if traveling exercise every 2 hrs, |
| venous stasis ulcers occur because | of previouse phlebitis with end result of incompetent valves and veins, |
| when does venous stasis ulcers occur | pregnancy, obesity, chf, dvt, varicose veins |
| pathophisiology of venous stasis ulcers | due to incompitnet valves stasis occurs and pressure increases, increase of pressure prevents reabsorption of fluid into the capillaries resulting in edema, rbcs in the capilaries release HEMOSIDERIN which causes brownish coloration in skin |
| what does chronic edema lead to in the sub q tissue with venous stasis ulcers | tissue inflames, fibrosis, atroph, there for nutrients dont get to skin and cells and microorganisms thrive which leads to cellulitis and dermatitis then to ulceration. |
| where do venous stasis ulcers happen at most | 1/3 lower extremities and malleolar(right above and around ankle) area |
| venous stasis s/sx | have pulses, swollen, indurated, discolored scaley, ulcerated, dermatitis, hair present, dull ache or heaviness, nails normal, cyanotic if dependant. |
| venous stasis tx | heal ulcer and prevent reoccurance, dressings, SEQUENTIAL COMPRESSION,atb if infx, elevate legs when sitting, walkin, nutritional support, foot wear and care, compression stockings |
| SEQUENTIAL COMPRESSION WITH VENOUSE STASIS | job stockings, scds, wraps, pushes blood back up towards the heart |
| PE s/sx | chest pain, dyspnea, increased hr, increased resps, bloody speutum |
| dx with PE | pulmonary arteriography-angiography-definitive test for PE, lung scan, ct angiography |
| PE tx | anticoagulants, thrombolytics, surgical interventions, |
| four disturbances in blood | decreased number of cells, overproduction of cells, defects in coagulation mechanism, disorder of the spleen |
| general sx of blood dyscrasia | fatigue, weakness, hemmorhagic tendancies, ulcertive lesions in mouth on tongue, anorexia, indigestion, wt loss, dyspnea, bone and joint pain and deformity, fever , puritis, skin eruptions, jaundice, anxiety, enlarged liver and spleen |
| when are neutrophils increased | in acute infection, gout, acute stress, trauma, rheumatiod arthritis |
| when are neutrophils decreased | in aplastic anemia, influenza, chemo |
| when are lymphocytes increased | in mono, viral hepatitis, viral infx, chronic infx, multiple myeloma |
| when are lymphocytes decreased | aids, acute infx, hodgkins disease, leukemia, sepsis, systemis lupis, renal failure |
| when are esinophils increased | allergic disorders, parasitic infx, tb, viral infx, |
| when are monocytes increased | in chronic inflamatory disease, parasitic infx, tb, viral infx, |
| granulocytes are these 3 things | neutrophils, eosinophils, basophils |
| agranulocytes are these 2 things | lymphocytes, monocytes |
| general managment of blood dyscrasia | bedrest, diet, meds, radiation and radioscopic therapy, reverse isolation, mouth care, possible blood transfusion |
| why do you have anemia | decreased erythrocyte production, blood loss, destruction of erythrocytes |
| iron deficiency anemia |
Created by:
marie52588
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