Med Surg: Cardiac & Vascular Disorders

Front 1

HTN

Back 1

Vascular disorder. Determined by the amt. of pressure inside the artery/amt. of force applied to artery wall from blood flow.

Front 2

Pre HTN

Back 2

Systolic- 120-139

Diastolic- 80-89

Front 3

HTN Stage 1

Back 3

Systolic- 140-159

Diastolic- 90-99

Front 4

HTN Stage 2

Back 4

Systolic: > 160

Diastolic:>100

Front 5

Essential/Primary HTN

Back 5

Idiopathic

Sustained elevated BP r/t thickening of vessel walls, becoming less responsive and less elastic, now the vessels are unable to propel blood through the body

Front 6

Secondary HTN

Back 6

r/t specific disease, endocrine disorder(@adrenals), pregnancy, drugs/herbs

Front 7

Malignant HTN

Back 7

>200/>100

Sever rapid progression

S/S- h/a in the a.m., blurred vision, dyspnea, nosebleed, uremic s/s

May result in renal failure or death

Front 8

HTN Medical Management

Back 8

Evaluate risk factors & addressing changes that need to occur to life style.

3-6 month goals then evaluate.

Front 9

HTN Non Medical Management

Back 9

Typical risk factor modifications

Increase K and fiber

decrease fat and Na

Garlic(reduces BP and cholesterol)

Niacin decreases Cholesterol

Front 10

HTN- Diuretics

Back 10

Thiazides

Loop

Potassium sparing

Front 11

Thiazides

Back 11

HCTZ-hydracorathizide

risk for decreased K, Na & Mg

risk for increases glucose, gout aggravation & dig toxicity

Front 12

Loop Diuretics

Back 12

furosemide(Lasix)

inhibit Na & H2O reabsorption, promote K excretion.

Work fast- a lot of fluid loss

Front 13

K sparing Diuretics

Back 13

spironolactone(Aldactone)

Inhibits Na reabsorption in exchange for K

Used in combination with other diuretics

*Be they aren't receiving K supplement*

Front 14

Beta Blockers Action

Back 14

Block beta(1) receptors in the heart & blood vessels-> decreases HR, contractility and CO

Always check apical pulse not give if less than 50!!

Front 15

BB Side effects

Back 15

Bradycardia

fatigue

depression

Sexual dysfunction

GI issues

CHF

hypotension

Front 16

BB Prototypes

Back 16

metoprolol(lopressor, Toprol)

atenolol(Tenormin)

Front 17

Ca Channel Blockers action(CaCB)

Back 17

block Ca to myocardial& vascular cells ->> causing smooth muscle relaxation

Helps to improve O2 delivery to coronary arteries by decreasing contractility

No grapefruit!

Front 18

CaCB Side effects

Back 18

h/a

nausea

<HR

abdominal pain

Front 19

CaCB prototypes

Back 19

nifedipine(Procardia)

cardizem

verapamil

Front 20

ACE inhibitors

Back 20

Blocks Angiotension I conversion to Angiotension II (a vasoconstrictor Powerful)

causing vasodilation

Reduces preload to <HTN

Can help with improving renal disease

increases K

Front 21

ACE inhibitor side effects

Back 21

nagging dry cough

sever initial hypotension

dizziness

Front 22

ACE inhibitor prototype

Back 22

lisinopril(Prnivil, Zestril)

enalapril(Vasotec)

Front 23

ARB's

Back 23

Blocks vasoconstrictor effects of angiotension II

Front 24

ARB's side effects

Back 24

orthostatic hypoTN

increase in K

(no dry cough)

Front 25

ARB's prototypes

Back 25

losartan(Cozaar)

Front 26

PVD/PAD

Back 26

Slow progression of impaired blood flow, all blood vessels outside of the heart

Front 27

Atherosclerosis

Back 27

Hardening, fat, fibrin obstruction of the arteries

Front 28

Atherosclerosis Risk factors

Back 28

Increased Cholesterol

sedentary

increased fat, Na

decreased fiber intake

HTN

Heredity

gender

tobacco

stress

diabetes

Front 29

PVD s/s

Back 29

​intermittent Claudication(pain brought on by activity)

paresthesias(numbness, decreased sensation)

diminished peripheral pulses

​Pallor with elevation and dependent RUBOR

*advanced stage will cause pain at rest*

Front 30

PVD Interventions

Back 30

Rest-put legs up

compression stockings

smoking cessation

no coffee or soda

anticoagulants for HX of clots

warm compress to promote vasodilatation(order)

Front 31

Thrombophlebitis risk factors

Back 31

Prolonged bed rest, trauma, birth control

obesity

hip/leg fracture

IV cath, IV meds(K, antibiotics)

Superficial vein location-redness

DVT- leg pain, warmth, swelling, cyanosis

Front 32

Thrombo prevention

Back 32

Activity

avoid crossing legs

Anticoagulants-if they have a hx of DVT

SCD's and TED hose

*proper IV therapy technique*

Front 33

Thrombo MEDICAL tx

Back 33

Bed rest

heat(with order)

INR 2-3(warfarin)

NSAID's for pain

Elevate limb

HYDRATE**

THROMBECTOMY

FILTER IN VEIN

Front 34

Thrombo NI

Back 34

Never massage legs if cramping!

bedrest

support hose

monitor labs

measure limb circumference daily

Front 35

Buerger's Disease

Back 35

Chronic reoccurring inflammatory vascular occlusive disease of peripheral arteries and vein of distal extremities

Front 36

Buerger's Cause & s/s

Back 36

males 20-40 y/o that smoke

Intermittent claudication

tingling, burning or numbness, edema

purple distal finger with necrotic tips

Mottled;red-purple hue when dependent

Pale when elevated

Ulceration may occur

Front 37

Buerger's TX

Back 37

NSAID's

Exercise if able

Avoid anything that causes vasoconstriction SMOKING and COLD

Front 38

Raynaud's Phenomenon

Back 38

Vasospastic disease of arteries(toes and fingers)

Idiopathic

Exaggerated response of vasomotor controls to COLD or EMOTIONS

Front 39

Raynaud's Phenomenon s/s

Back 39

Random vasospastic attacks varying in severity and frequency(in hands)

Color change sequence:

PALLOR, BLUE, RED(when blood returns)

Front 40

Raynaud's Phenomenon tx

Back 40

Maintain warmth

avoid contact and exposure to cold

avoid tobacco

Vigorous exercises of the arms

use mitten to take something out of the freezer

Front 41

Varicose veins

Back 41

weakened valves, allowing blood to pool

*r/t prolonged standing, obesity &/or heart disease

Front 42

Venous ulcer

Back 42

Ulcerations over medial ankle

no pain unless dependent

-brown leathery skin

-irregulars shape and edges

-granulated w/pink wound bed

-slow to heal/chronic

-edema in leg and ankle

Front 43

Arterial ulcer

Back 43

-decreased blood flow

-painful

-perfect margins, little drainage & granulation

-ischemic:over boney areas(toes, ankles)

-pain with exercise, relief with rest

-dependent pain relief

-pale extremity when elevated

-slow capillary refill time

Front 44

Aneurysm

Back 44

Dilated weakened area in wall of vessel, resulting in ballooning more 50% diameter

-most often in an artery

Front 45

Aneurysm Risk Factors

Back 45

Older age

Male

Family hx

genetic factors

Hyperlipidemia( increased lipids in blood)

Hypertension

Smoking

Diabetes

Trauma

Atherosclerosis

Front 46

Saccular Aneurysm

Back 46

bulges onside of the artery

Front 47

fusiform Aneurysm

Back 47

bulges complete circumference of the artery

*most common*

Front 48

Abdominal aortic aneurysm

Back 48

pain or tenderness below stomach

decreased appetite

upset stomach

Front 49

Aortic aneurysm s/s

Back 49

SOB

Froggy or Raspy voice

Backache btwn shoulder blades

*no symptoms at all*

Front 50

Cerebral aneurysm

Back 50

No symptoms

h/a

pain in neck & face

trouble talking or seeing

Front 51

Aneurysm TX

Back 51

control lipids(anti-lipid meds)

no tx-just watch it to see if it grow in size

surgery to remove it then insert stent

meds to decrease BP...BB or Ca CB's

Front 52

Valvular Heart Disease

Back 52

Stenosis:

Narrowing value tissue decreases blood flow

Insufficiency or Regurgitation:

Failure to close completely

Front 53

Valve Disease Causes

Back 53

#1 Rheumatic Heart Disease- mitral valve calcification

Inflammation-post strep

Congenital (no symptoms)

Trauma

Ischemic damage

Degenerative diseases r/t HTN

Front 54

Mitral Valve Stenosis

Back 54

*leaky faucet*

can't close due to scarring

won't open all the way

progressive fatigue

hemoptysis

dyspnea

Front 55

Mitral Valve Insufficiency

Back 55

Comes when valve doesn't close

back flow occurs

less blood is pumped to LV= less systemic vol

palpitations, dyspnea, cough

Front 56

Mitral Valve Prolapse

Back 56

Wall of valve is pushed back into LA or prolapses back into LA

-Congenital

-similar symptoms to mitral valve insufficiency

extra heart sound mitral click

Front 57

Aortic Stenosis

Back 57

b/c stenosis causes decreased opening less blood enters the systemic blood stream

-LV may have to pump harder b/c the opening is narrowed

dyspnea, angina, loud rough murmur

Front 58

Aortic Insufficiency

Back 58

Back flow to LV can't hold all of the blood, so blood flows back to LA and into the lungs

Increased force of hrt beat

breathing difficulty and dyspnea

arterial pulse in neck

Front 59

Heart Valve Disease NI

Back 59

LOC

VS

Peripheral pulses

skin color & temp

I&O

O2 prn

Semi-High Flowers

help with sleep disruption( sleep elevated)

Front 60

Heart Failure

Back 60

R/t preload(amt. of blood in LV at end of diastole) & afterload (amt. of pressure the LV has to push against to get the blood thru the aortic valve)

Front 61

CHF

Back 61

L-sided: primarily congestion in the lungs(increased hydrostatic pressure= more fluid)

R-sided: systemic, increases hydrostatic pressure causing peripheral and dependent pitting edema

Front 62

Left-sided Assessment findings

Back 62

*All respiratory related***

dyspnea

moist crackles

tacky HR-compensation for decreased CO r/t decreased SV

easily fatigued

Insomnia-b/c they can't sleep if they can't breath

HTN

Cough

frothy sputum

Front 63

Right-sided Assessment findings

Back 63

Pitting edema-ankles, legs, sacrum

Wt gain

nausea

JVD

ascites-abdominal distention

liver enlargement

weakness

COPD

Pulmonary fibrosis

Front 64

CHF diagnostic tests

Back 64

Chest xray

Echocardiogram-will show EF normal is 50-75%, CHF=30%

BNP-identifies heart failure. Normal is less than 100g/ml

ABG's=hypoxia

Front 65

CHF TX

Back 65

Diuretics=used to decrease preload and take off extra fluid

Digoxin-Slows heart this will control pumping and improve CO

Activity

weight-only if over weight(if it increase call doctor)

diet-no salt may limit fluids

Front 66

Coronary Artery Disease (CAD)

Back 66

Focal narrowing of large and med sized coronary arteries due to plaque formation:

(atherosclerosis)-cholesterol plaque build up, results in deminished blood flow to heart muscle...causing angina b/c no O2 present

(arteriosclerosis)-"hardening" of arteries or thickening

progressive with age

Front 67

CAD diagnostics

Back 67

Stress Test

Echo

Exercise Echo

Cardiac Cath:will show coronary artery blockage

Holter monitor for 24-48 hrs

Front 68

CAD risk factors

Back 68

Older

Male or postmenopausal female

High lipids

Smoking

HTN

Diabetes

Obesity

Sedentary

Family HX

Chronic stress

Birth control

Front 69

Angina

Back 69

Stable-occasional pain with exercise

Unstable-pain at rest, severely limits activity

New onset-1st has symptoms, usually with exertion

Prinzmetal- ​chest pain resulting from coronary artery SPASMS

*ALL Major symptoms of CAD. Increased need for O2 during exercise, causes pain when the O2 levels can't be met, may be r/t blockage or plaque)*

Front 70

Angina Subjective Data

Back 70

Chest pain, heaviness, tightness

clutching fist to sternum

neck pain

jaw pain

shoulder pain

radiating left arm pain

SOB

Front 71

Angina Objective Data

Back 71

VS- HR irregular, Tachycardia, weak low BP

Pale/pasty/ashen gray skin

sweaty

cyanotic

Anxiuous

Restless

Front 72

Cardiomegaly

Back 72

enlarged heart ventricle

Front 73

Cardiomyopathy

Back 73

Infection of the heart, muscle enlarged squared shape

Front 74

Cardiac Enzymes for MI

Back 74

myoglobin

creatine kinase-MB

Troponin I & T

Inverted T-wave r/t ischemia

Front 75

Angina Plan of Care

Back 75

Goal: reduce O2 demands of heart by: rest, stop activity or stressor

-nitro(NTG)x 3(total of 15mins)no relief =MI call 911

S/E nitro-drop in BP & H/A

Front 76

MI

Back 76

Complete blockage of 1 or more coronary arteries that provide blood to heart muscle.

-same s/s as angina, plus feeling impending doom

-MI damage is permanent damage to muscle=decreased function