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LSC Vascular
nursing
| Question | Answer |
|---|---|
| Metabolic Syndrome Risk Factors | Abdominal Obesity: Waist >35 (f) or 40" (m)Elevated triglycerides > 150Low HDL < 50(f) or 40 (m)BP > 130/90Elevated Fasting BG > 110Cholesterol < 200mg/dl |
| Nutrition therapy for Vascular Disorders | Quality over Quantity, achieve & maintain healthy wt, make appropriate food choicesNeed for B vitamins: B6 & B12Limit Cholesterol intake to >30mg/dayFat intake >30% Increase omega 3 fatty acids |
| Risk Factors for Atherosclerosis | Low HDL-C High LDL-C Increased Triglycerides Genetic Predisposition DM Obesity Sedentary Lifestyle Smoking Stress AA or Hispanic |
| Common Drugs used for Atherosclerosis | HMG-CoA Reductase inhibitors (statins) and Fibric Acids Advicor - Combo of niacin(fibric acid) and lovastatinzemtimide (Zetia)Lovaza - Omega 3 fish oil |
| Nursing Interventions for Statins | Monitor liver enzymesAvoid Grapefruit juicesMuscle Tenderness - Rhabdomyolosis - skeletal muscle b/d rapidTake w/evening meal due to GI N/V or constipation |
| Nursing Interventions for Fibrates | 30 minutes BEFORE meals (GI)Usually not taken with statins unless combo med |
| Nicotonic Acid | B Vitamin, Lowers LDL, VLDL, cholesterol, raises HDLuse in low dosesflushing and warm sensationHigh doses cause liver damage |
| Omacor | omega 3 fatty acidsreduce triglycerides > 500decrease plaque growth and inflammation |
| BP Classifications | Normal S <120, D <80 Prehypertension S 120-139, D 80 - 89 Stage 1 Hypertension S 140-159, D 90-99 Stage 2 Hypertension S >/= 160 D >/= 100 |
| BP = | CO x PVR |
| CO = | HR x SV |
| BP = | HR x SV x PVR |
| Malignant Hypertension | Systolic > 200mm Hg, Diastolic > 130-150, Sudden onset: HA, Blurred Vision, DyspneaMedical EmergencyIV Med: |
| Essential Hypertension | Unknown Etiology, Risk Factors Age > 60 Family Hx Culture (AA) Excessive Calorie Consumption, Obesity Excessive Na Intake, Caffiene Intake Physical Inactivity Excessive ETOH intake, Stress |
| Secondary Hypertension | Identifiable Etiology, Many of the factors influence CO, SVR, and BP can be primarily disrupted by disease process, Cushing's disease, |
| Medications causing 2ndary HTN | Estrogen-esp oral contraceptives BCP's Glucocorticoids (Cushing's Disease) Mineralcorticoids-fluid & sodium retention, Sympathomimetics-Adrenergic effect, Cyclosporine: SE - HTN, Erythropoetin: can lead to renal failure |
| Diagnostic Tests r/t 2ndary HTN | Renal disease: Urine-RBC's(pus cells, casts), Serum: Increased BUN & Creatinine, 24hr CCR test, 24hr urine for VMA, Serum Corticoids, CXR, ECG |
| Nursing Diagnosis : Knowledge Deficit | Lifestyle Changes: Sodium Restrictions, Weight Restrictions, Moderation of ETOH, Exercise, Relaxation techniques, Tobacco & Caffeine Avoidance, Meds if not effective to lower BP |
| Drug Therapy for HTN | Dosing: Start w/1/2 dose increase in a couple weeks. |
| Diuretics | Thiazide, Loop, and Potassium-sparing SE Hypokalemia, Monitor serum K levels & assess regular pulse and muscle weakness. Teach pt to eat foods high in K ie bananas, OJ. |
| Calcium Channel Blockers | verapamil hydrochloride (Calan) & amlodipine (Norvasc) |
| ACE Inhibitors | end in -pril, captopril (Capoten) & enalapril (Vasotec), teach pt for the 1st time OOB slowly, notify physician of a drop in BP >20, and non productive cough |
| Angiotensin II | end in -sartan, candesartan (Atacand) and losartan (Cozaar) Not as effective in AA unless taken w/beta blocker or calcium channel blockers. |
| Aldosterone Receptor Antagonists | Eplerenone (Inspra) Drug interactions are common, grapefruit juice and st. john's wart can increase SE. Do not get up quickly, drive, climb stairs |
| Beta-Adrenergic Blockers | work only on cardiovascular system SE include fatigue, weakness, depression, and sexual function. Drug of choice for hypertensive pt's w/ischemic heart disease. A long acting Calcium channel blocker can be used instead, sudden stop of med leads to angina |
| Renin Inhibitors | aliskiren (Tekturna) |
| Central alpha agonists | Clonidine (Catapres), is a transdermal patch, use for as long as 7 days, SE sedation, postural hypotension, and impotence. NOT given as a 1st line mgmt of hypertension |
| Alpha adrenergic antagonists | end in -zosin. prazosin (Minipress) doxazosin (Cardura) and terazosin (Hytrin).Frequent and bothersome SE. |
| Hypertensive Crisis | Increase 200mm Hg Systolic, Severe HA, dizziness, blurred vision, disorientation |
| Nursing Interventions for Hypertensive Crisis | Semi - Fowler's Position, Admin 0xygen, administer IV nitroprusside (Nitropress), nicardipine, (Cardene IV), monitor BP every 5-15minuntil diastolic pressure is under 90, then monitor every 30 min, do nv status checks |
| Stages of Peripheral Artery Disease | Stage I: AsymptomaticStage II: ClaudicationStage III: Rest PainStage IV: Necrosis/Gangrene |
| Inflow Disease | discomfort in the lower back, butt, or thighs, mild disease: discomfort walking 2 blocks can have moderate to severe pain w/rest pain occlusions - no significant tissue damage |
| Outflow Disease | burning or cramping in calves, ankles, feet and toes. Popliteal, femoral, and tibial arteries. Pain relieved by rest, leg in dependent position. NV Checks color, pulse, paralysis, temp & pain |
| Ankle Brachial Index | Should be similar/same, Ankle BP/Brachial BP, Ex: 110/140 = 0.8, pressures < 0.9 = PAD, lower number = greater pressure |
| Segmental Arterial BP's | Normally BP readings are Higher in the thighs and calves than those in the upper extremities, Lower pressure in LE = arterial disease |
| Nursing Dx for PAD | Chronic Pain w/Exercise r/t ineffective tissue perfusionRisk for injury-small foot injury leading to toe ulcer |
| Medical Interventions for PAD - Exercise | Walking to point of claudication, rest, walkImprove arterial flow, Develop collateral circulation |
| Medical Interventions for PAD - Arterial | Dependent (down): Gravity, Elevate, don't cross legs, don't wear constrictive clothing |
| Medical Intervention for PAD - Promote Vasodilation | Warm clothes/lap blankets, Do not use hot H20 bottles or direct heat to warm feet - causes further damage, avoid exposure to cold, drink fluids, avoid ETOH, caffeine, stress, nicotine |
| Medical Interventions for PAD - Infection & Trauma | Wear shoes, Inspect feet daily |
| Hemorheologic agent for PAD | Trental increases flexibility of RBC's, decreases platlet aggregation, 2-3 months for signs of improvement |
| Antiplatlet Agents for PAD | ASA and Plavix |
| Anticoagulants for PAD | Decrease Blood Clotting |
| PTCA And Stents | Cath inserted into femoral artery, Balloon inflated, Re occlusion may occur, Stent can be added over balloon, Best sites Iliac Arteries, Laser atherectomy distal sites |
| Post Care Angioplasty/gram | Supine for 4-8 hours LIE FLAT, Heparin IV drip, Monitor Pulses, Color, Warmth, Sensation, Site, Pressure to Femoral artery for 20 minutes, Bands to relieve pressure |
| Arterial Revascularization | Aortic Iliac, Axillo Femoral, or Femoral Popliteal Grafts. Saphenous vein may save for CABG, Synthetic Dacron |
| Post Op Care Artial Revascularization | Monitor Graft Site, Pulses and VS q15min, warmth, color, throbbing pain NL, No bending of hip or knee x24hrs, Return of ISCHEMIC PAIN-NOTIFY Physician! Graft occlusion Administer Thrombolytics and/or antiplatlets (Repro) monitor for bleeding |
| Acute Arterial Occlusion | Embolus located in vessel narrowed by atherosclerosis, ACUTE PAIN, Sudden onset, Leg color, very pale, no pulses, paresthesia/paralysis, cool |
| Interventions for Acute Arterial Occlusion | Immediate Tx, Risk loss of limb/foot, IV Heparin, Local IV Thrombolytic directly into clot, Thrombectomy, Angiogram, angioplasty or surgicl bypass, monitor |
| AAA and TAA | Causes *Atherosclerosis, *HTN, Hyperlipidemia, Cigarette Smoking, Family Hx |
| Assessment Data of Aneurysm | Most are asymptomatic, symptoms if pt has include: Pain in ab, back, flank, gnawing, pulsating mass DO NOT PALPITATE! Monitor BP, slow leak = lower BP, Sudden onset of pain = RUPTURE Hemorrhagic Shock TAA Hoarseness, Backpain and difficulty swallowing |
| Post Op Care for Aneurysm | Assessment for Graft Occlusion or Rupture, changes in pulses, cool to cold extremities below graft, severe pain, abd distention, decreased u/o Throbbing pain Normal Ischemic = occlusion, |
| Post Op Care for Aneurysm Continued | Monitor BP falling = Bleeding, No bending hip or knee x24hrs, Bed Rest x24hrs, Monitor abd distention - bleeding, NG tube NPO x1day |
| Intra Arterial Thrombolyic Therapy | TPA Tissue plasminogen activator, Reo-Pro, (abciximab), Monitor closely for bleedingCONTRAINDICATED in Hemorrhages and Stroke |
| Aortic Disection | Pt Reports Ripping, Stabbing Pain, Diaphoresis, N/V, BP Elevated then Falls, Weak or absent peripheral pulse, CXR, CT, Angiogram |
| Interventions for Aortic Disection | Emergency Care, IV Sodium Nitroprusside (Nitropress), Maintain BP < 130 - 140, Surgical procedure, Neuro checks post op |
| Beurger's Disease | Smoking strongly associated disease, occlusive disorder small & medium arteries and veins inflammation, sclerosing, scaring binding arteries, veins, and nerves together, smoking cessation stops disease process |
| Interventions for Buerger's disease | Smoking cessation, Avoid extreme cold, Vasodilator drugs(Calcium Channel blockers), nifedipine (Procardia) prevents constricting, Similar interventions for PAD |
| Raynaud's Phenomena | Vasospastic disease of arterioles/arteries of upper & Lower limbs, Occurs bilaterally, superficial vessels constrict and blance then cyanotic, fingers, toes ears and nose |
| Interventions for Raynaud's Phenomena | Calcium channel Blockers Nifidipine (Procardia), SE Facial flusing, HA, Hypotension, dizziness, Procedure Lumbar sympathectomy, sympathetic gangionectomy more effective, Avoid cold, caffeine, and decrease stress, no smoking |
| Subclavian Steal | subclavian artery stenosis or occlusion - pain, Difference in BP between arms > 20mm Hg |
| Thoracic Outlet Syndrome | Compression of subclavian artery by rib or muscle, neck, shoulder, arm pain, numbness and edema, Tx: PT Exercises and avoid elevating arms, severe pain - reset structure |
| Popliteal Entrapment | Compressed artery behind knee Nsg Int. NV Checks |
| DVT Prevention | In Community - Avoid BCP's Drink Adequate Fluids, Leg exercises during long periods of bed rest, sitting (travel), avoid constrictive stockings HOSPITAL - As above, Early Ambulation, Compression stockingsPneumatic compression, Lovenox or heparin |
| Diagnostic Tests for DVT | Ultrasound most accurate, Homan Sign not used as much, causes pain |
| Interventions for DVT | Prevent enlargement of thrombus or dislodgement of thrombus PE, Non surgical: BED REST, Elevation of extremity above heart, DO NOT MASSAGE, Compression stokings after clot is disolved, Eval for signs of PE |
| Heparin Therapy for DVT | Heparin Unfractionated Requires Hospitalization, Coagulation studies daily, CBC, creatinine, Stools for Occult Blood, Monitor Platlet count 120,000 - Notify Physician, PTT > 70 seconds Antidote Protamine Sulfate |
| Low Molecular Heparin | Lovenox, does not require hospitalization Less risk of thrombocytopenia |
| Warfarin Coumadin | Monitor PT & INR, INR values 1.5-2x(higher if cardiac problems), taken for 3-6mo if no cardiac problems, ANTIDOTE - Vitamin K, Monitor for bleeding for all anticoagulants |
| Thrombolytic Therapy for DVT | Alteplase and Reteplase for peripheral occlusion won't damage the valveContraindications - bleeding disorders, recent surgery or trauma, head injuries, strokes, spinal injuries |
| Surgical Mgmt for DVT | Not preferred tx, thrombectomy, use of an umbrella filter femoral vein, ligation or external clips on inferior vena cava |
| Education on anticoagulation therapy | Hazards, Coagulation monitoring, Signs of bleeding, gums, stools, bruising, For injury, apply pressure/ice immediatly, inform dentist,limit high fat foods and Vit K rich foods ie green leafy vegies, broccoli cauliflower, kale spinach, liver, NSAIDS, Exerc |
| Venous Insufficiency | bilateral leg edema, Ulcers around ankle, chronic, diff to heal, long term, risk amputation RBC leak out cause bilirubin, valves not closing to promote blood flow to heart |
| Interventions for Venous Insufficiency | Decreas edema (promote bloodflow), Promote venous return, Promote healing, Compression stokings, elevate legs above heart 4x/day |
| Venous Stasis Ulcers Non Surgical Mgmt | Chronic: heal/reoccur, Whirlpool therapy, Oxygen permeable dressing polyethlene film, aseptic technique, artifical skin, unna's boot zinc oxide and calamine on wound wrapped on leg |
| Education on Venous Ulcer | Positioning Elevation above heart, Prevent Injury prevent Infection, wound care dressings and unna's boot |
| Phlebitis Interventions | Warm moist packs Leg Elevation, Compression stockings, |
Created by:
ginabeana
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