PVD unit 4 med surg
A client has just undergone arterial revascularization. Which statement by the client indicates a need for further teaching related to postoperative care?
"my leg might turn very white after the surgery." Pallor is one of the signs of decreased perfusion along with increased pain, poikilothermia, paresthesia, pulselessness, and paralysis
Diuretics watch for
-decrease in BP, Na, Choloride, K, weight, I&O -hyperglycemia -dehydration
BP that is considered hypertensive
140/90 for pts <60 years old
Abdominal Aortic Aneurysm Resection
1st- clamps are placed around the aneurysm 2nd- the aneurysm is opened with a scalpel 3rd- a large gore-tex tube is placed into the aorta to reinforce the walls of the artery
Sounds of Pulmonary Valve are heard in
2nd intercostal space at left sternal margin
Sounds of aortic valve are heard in
2nd intercostal space right sternal margin
Hypertenstion essential (primary)
60 years or older Family history Excessive caloric intake, alcohol Sedentary lifestyle Hyperlipidemia African American High salt, caffeine intake Low intake K, Ca, Mg Obesity Stress Smoking
LDL
< 130 mg/dL healthy, < 70mg/dl CVD/DM
Triglycerides
< 160 mg/dL in men; <135 mg/dL in women
Cholesterol
< 200 mg/dL
HDL
> 45 mg/dL men, >55mg/dl women
Deep venous thrombosis (DVT)
A blood clot or thrombus in a deep vein usually of the leg.
The nurse teaches a client who has had a myocardial infarction (MI) which information regarding diet?
A higher HDL cholesterol level (good cholesterol) is more desirable. Clients need to strive to reduce low-density lipoprotein cholesterol (bad cholesterol) when elevated.
Aneurysm
A localized dilation of the wall of a blood vessel. It may be caused by atherosclerosis and hypertension, or less frequently by trauma, infection, or a congenital weakness in the vessel wall
Paradoxical splitting
Abnormal splitting of the S2 (early closure of pulmonic valve or delay in aortic valve closure
Orthostatic hypotension
Abnormally low BP that occurs when an individual suddenly assumes the standing posture. It can produce dizziness and fainting.
Aneurysm Post op/rational
Activity restrictions- no lifting heaving objects, caution when pulling, pushing, straining-avoid disruption of repair Wound care-avoid infection Pain management
PCSK9 inhibitors- PCSK9 causes elevations in LDLs, SubQ injection, monthly or bimonthly
Alirocumab (Praluent) Evolocumab (Repatha)
Calcium Channel Blockers
Amlodipine Diltiazem Nifedipine Verapamil
Thrombus
An aggregation of platelets, fibrin, and red blood cells that attaches to the interior wall of a vein or artery, sometimes occluding the lumen of the vessel.
Angioplasty post op/ rational
Anticoagulant or antiplatelet therapy- prevent clotting** Teach patients importance of not discontinuing med unless ok with md Monitor for bleeding at site (groin) Monitor for decrease in BP UO-signs of hypovolemic shock Distal pulses in affected leg-ensure adequate prefusion
ACUTE Peripheral Arterial Occlusion interventions
Anticoagulant therapy Surgical thrombectomy / embolectomy Arteriotomy-patch graft
Bet blockers
Assess HR before admin. Do not admin if HR <50-60; hold for sbp <90-100; monitor for orthostatic hypotenstion; use with caution in DM can cause fatigue, depression, sexual dysfunction
Diuretics
Assess for weakness, dizziness, new onset confustion, rise slowly-can cause orthostatic hypotension, K sparing-decrease foods high in K, monitor k levels; loop-eat foods high in K, monitor levels, use with caution in patients with DM and gout
ACUTE Peripheral Arterial Occlusion Postoperative Interventions
Assessment for graft occlusion Promotion of graft patency Vascular monitoring Treatment of graft occlusion Complaints of SEVERE continuous PAIN Monitoring for compartment syndrome Assessment for infection
Aneurysm pre op/rational
Avoid Straining, minimal activity V/S monitoring I&O- LOC Monitor of hemorrhagic shock ---All to monitor for rupture
For a client with an 8-cm abdominal aortic aneurysm, which problem must be addressed immediately to prevent rupture?
BP of 192/102 mm Hg. Elevated blood pressure can increase the rate of aneurysmal enlargement and risk for early rupture.
Atrial fibrillation predisposes a person to the formation of __________inside the heart.
Blood clots
Beta-blockers are widely used but must be cautiously given to patients with respiratory problems because they may cause:
Bronchospasm Congestive heart failure Dyspnea
Raynaud's Phenomenon
Caused by vasospasm of the arterioles and arteries of the upper and lower extremities Lumbar sympathectomy Client education re: reduce cold exposure, no smoking, avoid caffeine Drug therapy: Procardia Cyclospasmol Dibenzyline
The nurse teaches a client who has had a myocardial infarction (MI) which information regarding diet?
Clients would be encouraged to consume 30 g of dietary fiber daily.
Central Alpha Agonists
Clonidine
Commonly used beta-blockers include all but which of the following:
Clonidine
Antiplatelet aggregating agent
Clopidogrel (Plavix) Acetylsalicylic acid (ASA)
Arterial Revascularization Post op/Rational
Deep Breathing Q1-2hours and Incentive Spirometer- to prevent resp. complications NPO 1 day post procedure- to prevent N/V which could increase intra-abdominal pressure Distal Pulses marked- for assessment of affected extremities Monitoring of BP-promote graft patency (identify possible clotting) Bedrest-avoid disruption of suture lines
List interventions for hypertension.
Diet therapy -Sodium restriction Moderation of alcohol intake- no more than one a day from women, 2 a day for men Exercise-3-4 days a week Relaxation techniques-decrease stress Weight reduction Tobacco and caffeine avoidance Smoking cessation Drug therapy
Leg edema is produced by the ____________ of the veins in the legs that allows some of the bloods water content to "leak" out of the vessels into the tissue.
Dilation
Varicose Veins
Distended, protruding veins that appear darkened and tortuous Collaborative management includes: Elastic stockings Elevation of extremities Exercise Sclerotherapy Surgical removal of veins Radio frequency energy to heat the veins
The nurse is caring for a client who is being treated for hypertensive emergency. Which medication prescribed for the client would the nurse question?
Dopamine (Intropin) Dopamine is used for its inotropic and vasoconstrictive properties to raise blood pressure, and would not be used in hypertensive emergency.
Home Care for Patient Receiving Anticoagulation
EDUCATE, EDUCATE, EDUCATE!! Avoid traumatic experiences (bleeding) Instruct on S/S of bleeding Antidotes available Vitamin K (for warfarin), Protamine Sulfate (for heparin) Carry ID card for emergencies Inform dentist Monitor Labs (aPTT, PT, INR)
Secondary hypertension
Elevated BP associated with any of several primary diseases such as renal, pulmonary, endocrine, and vascular diseases.
Essential hypertension
Elevated blood pressure of unknown etiology accompanied by increased total peripheral vascular resistance by vasoconstriction, increased cardiac output, or both.
List and describe common lab and diagnostic test for hypertension.
Estimated GFR- chronic kidney disease Doppler Flow Study- renal artery stenosis CT Angiography- congenital narrowing of the aorta Sleep Study -sleep apnea Drug Screening- medication induced CXR- cardiomegaly Blood test Electrolytes-hyper-aldosteronism BUN- kidney disease Creatinine-kidney disease Glucose-diabetes Fasting lipid profile-hyperlipemia Urinalysis-Protein, blood cells C-Reactive protein Homocysteine <15 mmol/L Coag studies Arteriography MRI
Arteriosclerosis & Atherosclerosis Interventions
Evaluate total serum cholesterol levels and lifestyle changes Nutrition Therapy Smoking cessation Exercise Drug Therapy Complementary and Alternative Therapy (Lovaza-decrease plaque growth)
PAD Severe arterial disease
Extremity is cold and gray-blue or darkened Pallor may occur with extremity elevation Dependent rubor (redness) Muscle atrophy
Azetidinones- inhibits absorption of cholesterol through small intestine
Ezetimible (Zetia)-may be used alone or in combo with statins
Anticoagulants can prevent the formation of new clots, as well as dissolve formed clots and improve blood flow around the clot.
False Anticoagulants do not dissolve formed clots, improve blood flow around the clot, or prevent ischemic damage to tissues beyond the clot - these are common fallacies.
High blood pressure ___________ arteries, and can produce progressive _____________________, which dramatically increases the risk of stroke.
Hardens; renal failure
Beta-adrenergic blockers side effects
Hypotenstion sx of CHF drowiness, depression Bradycardia AV block
Intermittent claudication
Ischemic muscle ache or pain precipitated by a consistent level of exercise, resolves within 10 minutes or less with rest, and is reproducible.
Hypertenstion Secondary
Kidney Disease (RAS, CRD) Adrenal medulla or cortex dysfunction Estrogen (oral contraceptives) Glucocorticoids Mineralocorticoids Sympathomimetics Primary aldosteronism Cushing's Brain tumors Coarctation of aorta Encephalitis Pregnancy
The professional nurse and the nursing student are caring for a group of clients with hypertension. Which problem identified by the nursing student correctly identifies the client at risk for secondary hypertension?
Kidney disease is one of the most common causes of secondary hypertension.
The nurse teaches a client who has had a myocardial infarction (MI) which information regarding diet?
Less than 30% of daily calories need to come from fats.
HMG-CoA reductase inhibitors (statins)- lower both LDL and triglycerides
Lovastatin (Mevacor) Simvastatin (Zocor) Atorvastatin (Lipitor)
Which finding in the history of a client with an abdominal aortic aneurysm (AAA) is a risk factor for aneurysm formation?
Marfan syndrome is a risk factor for cardiovascular disorders such as AAA. Marfan syndrome is a genetic connective tissue disorder. It occurs in middle-aged and older people, peaking in adults in their 50s and 60s. Men are more commonly affected than women
VTE: Assessment
May be asymptomatic Calf or groin tenderness or pain Sudden onset of unilateral swelling of the leg Positive Homans' sign Localized edema Warm with possible redness
Alpha-adrenergic agonist
May cause palpiations, orthostatic hypotension, vertigo, sexual dysfuntion
When administering furosemide (Lasix) to a client who does not like bananas or orange juice, the nurse recommends that the client try which intervention to maintain potassium levels?
Melons and baked potatoes are foods high in potassium
Central adrenergic inhibitors include which of the following: (hint: these Rxs are different from Calcium channel blockers)
Methyldopa Clonidine
Calcium Channel Blockers
Monitor HR and BP (drugs slow SA and AV conduction) ; avoid grapefruit juice
Aldosterone receptor antagonists
Monitor for hyperkalemia, renal failure, sodium levels, no grapefruit or st johns wart
ACUTE Peripheral Arterial Occlusion
Most commonly an embolus Assessment: 6 P's of ischemia pain, pallor, pulselessness, paresthesia, paralysis, poikilothermia
Arteriosclerosis
Most theorists believe that a combination of platelet and lipid accumulation following intimal injury is responsible for the process of atherosclerosis
Hypertesnsion Malignant
Noncompliance of bp medications Kidney Disease Medications Pregnancy Spinal Cord injuries
Aortic Dissection
Not common but life threatening Sudden tear in aorta (hypertension being major contributing factor) Assessment: Pain Diaphoresis, N/V, impending doom Interventions: Give IV pain medication and IV antihypertensive Surgical intervention with synthetic graft
alpha adrenergic antagonists side effects
Orthostatic hypotension vertigo sexual dysfuntion palptations
List the six P's of ischemia
Pain, pallor, Pulselessness, Paresthesia, Paralysis, Poikilothermia
The nurse teaches a client who has had a myocardial infarction (MI) which information regarding diet?
Palm oil is higher in saturated fats and needs to be avoided. Nontropical vegetable oils would be encouraged, e.g., canola
PAD physical assessment what pulses should be assessed?
Palpate pulses in both legs, specifically quality of posterior tibial Pedal pulse often not palpable
VTE: Diagnosis
Physical exam findings Venous duplex U/S Doppler flow studies Impedance plethysmography MRI D-Dimer PT/PTT, CBC for Heparin protoco
Angioplasty pre op/ rational
Possible anticoagulant or antiplatelet therapy
Alpha-adrenergic agonist
Prazosin, Doxazosin
Arterial Revascularization Pre op/Rational
Preop Antibiotics- Prevent infection Documentation of VS and peripheral pulses- Provide baseline IV, Foley, possible central line and/or arterial line- To monitor post op vitals/urine output
Heparin Protocol anitdote is
Protamine Sulfate
Assessment of Thoracic Aortic Aneurysm
Pulsating mass above substernal notch May not have symptoms Pain Bronchospasms Dysphagia Hoarseness SOB
Nursing Diagnoses for Atherosclerosis
Risk for Decreased Cardiac Tissue Perfusion Deficient Knowledge Readiness for Enhanced Self Health Management Ineffective Peripheral Tissue Perfusion Risk for Ineffective Cerebral Tissue Perfusion Readiness for Enhanced Nutrition Risk for Impaired Liver Function
Assessment of Abdominal Aortic Aneurysm (AAA)
Severe pain in lower back and abdomen Patients that rupture may exhibit signs of shock
Aldosterone receptor antagonists
Spironolactone Eplerenone
Often, hypertension is first diagnosed when seeking treatment for:
Stroke Congestive heart failure Renal disease
The nurse in the cardiology clinic is reviewing teaching about hypertension, provided at the client's last appointment. Which actions by the client indicate that teaching has been effective?
Teaching about hypertension has been effective when the nurse notes that the client has been on a low-sodium, no-added salt diet, has lost 3 pounds (1.4 kg) since the last clinic visit, and has cut down on caffeine. Clients with hypertension need to consume low-sodium foods and would avoid adding salt. Weight loss can result in lower blood pressure. Caffeine promotes vasoconstriction, thereby elevating blood pressure
The nurse is teaching a client the precautions to take while on warfarin (Coumadin) therapy. Which statement made by the client demonstrates that teaching has been effective?
Teaching about the precautions of warfarin has been effective when the client says "that eating foods like green beans won't interfere with my Coumadin therapy." Vitamin K is not found in foods such as green beans, so these foods will not interfere with the anticoagulant effects of Coumadin.Warfarin
The nurse is caring for a client with dark-colored toe ulcers and blood pressure (BP) of 190/100 mm Hg. Which nursing action does the nurse delegate to the LPN/LVN?
The action the nurse delegates to the LPN/LVN caring for a client with dark-colored toe ulcers and a BP of 190/100 mmHg is to administer a clonidine patch for hypertension. Administering medication is within the scope of practice for the LPN/LVN.The RN is responsible for physical assessments, making referrals for other services, and developing the plan of care for the hospitalized client.
The nurse is assigned to all of these clients. Which client would be assessed first? A- The client who had percutaneous transluminal angioplasty (PTA) of the right femoral artery 30 minutes ago B-The client admitted with hypertensive crisis who has a nitroprusside (Nipride) drip and blood pressure of 149/80 mm Hg C-The client with peripheral vascular disease who has a left leg ulcer draining purulent yellow fluid D-The client who had a right femoral-popliteal bypass 3 days ago and has ongoing edema of the foot
The client who would be assessed first is the client who had a PTA of the right femoral artery 30 minutes ago. This client must have checks of vascular status and vital signs every 15 minutes in the first hour after the procedure.
While caring for a client who has received recombinant tissue plasminogen activator (t-PA) for a large deep vein thrombus, the nurse becomes most concerned when the client develops which condition?
The most serious complication from thrombolytic therapy is intracerebral bleeding, manifested by changes in the level of consciousness
ACUTE Peripheral Arterial Occlusion drug therapy
Thrombolytic Anticoagulant
Venous Thromboembolism (VTE)
Thrombus: a blood clot Associated with Virchow's triad Stasis of blood Endothelial injury Hypercoagulability Deep vein thrombosis-most common Pulmonary embolism High rate of death
The renin-angiotensin-aldosterone system regulates arterial _________ and circulating blood volume to maintain blood pressure when the enzyme renin is released by the ____________ in response to low renal blood flow.
Tone; kidney
Vascular Trauma
Trauma that results in vascular injury such as: punctures, lacerations, and transections History & Physical assessment Management: Maintain airway Control bleeding Restore blood flow Repair Vein bypass grafting Lateral suture repair Thrombectomy Resection Vein patch grafting
ACE inhibitors are desirable in treating high blood pressure in patients suffering from congestive heart failure because they decrease vasoconstriction thereby reducing vascular resistance and cardiac workload.
True
Antiplatelet agents are starting to play an increasingly important role in improving outcomes in patients with unstable angina and brain attacks
True
Calcium channel blockers are primarily used for the treatment of angina, tachycardias, and hypertension.
True
Hair loss and dry, scaly, mottled skin and thicken toenails is s/s of PAD true or false
True
Aneurysms: Diagnosis and Management
Ultrasonography CT scan MRI X-rays Aortic angiography Goal of nonsurgical management Monitor growth of the aneurysm Maintain blood pressure at normal level.
Buerger's Disease (Thromboangiitis obliterans)
Uncommon occlusive disease limited to the medium and small arteries and veins Spasms, vasoconstriction Etiology: Smoking Prevent progression of disease Nursing interventions Smoking cessation Pain Managemnt Wound care
Patients taking beta-blockers should be assessed closely for all but which of the following:
Vasoconstriction
If reversal of warfarin is needed, ____________ either given orally or, if necessary, by intramuscular injection or intravenously, is the antidote.
Vitamin K
Combination drugs lipid lowering agents
Vytorin (Ezetimibe and Simvastatin)
______________is the most common oral anticoagulant agent currently in use.
Warfarin
A client is receiving unfractionated heparin (UFH) by infusion. Of which finding does the nurse notify the primary health care provider (PCP)?
When caring for a client receiving UFH, the nurse notifies the PCP of a platelet level of 32,000/mm3 (32 × 109/L). UFH can decrease platelet counts. The PCP must be notified if the platelet count is below 100,000 to 120,000/mm3 (100 to 120 × 109/L). Heparin-induced thrombocytopenia, an immune disorder, presents with platelets less than 150,000/mm3 (150 × 109/L)
secondary hypertension is caused by
a disease process or drugs (or both)
PAD physical assessment inflow disease
affecting the lower back, buttocks, or thighs (distal aorta, iliac arteries )
VTE nonsurgical management watch for
allergic reaction, spontaneous bleeding, and oozing from any fresh would site
Beta blockers
antenol, metoprolol
ACUTE Peripheral Arterial Occlusion surgery therapy
arterial revascularization
Chronic PAD stage 1
asymptomatic
Hypertension presents risk for
atherosclerosis
Angiotensis II receptor blockers
avoid foods high in K, watch for orthostatic hypotenstion, hold for SBP < 100
A client with hypertension is started on verapamil (Calan). What teaching does the nurse provide for this client?
avoid grapefruit juice. Grapefruit juice must be avoided with calcium channel blockers, such as verapamil, because it can enhance the action of the drug.
Dairy products are high in
calcium
PAD physical assessment outflow disease
causing cramping in calves, ankles, and feet. More tissue damage. (femoral, popliteal arteries)
Chronic PAD stage 2
claudication
Which symptom reported by a client who has had a total hip replacement requires emergency action?
client reports shortness of breath and cheat pain. Shortness of breath and chest pain indicate a possible pulmonary embolism (PE), which can be life threatening. Orthopedic procedures create high risk for deep vein thrombosis (DVT) and PE
PAD s/s
coldness (in hands and feet) week pulse painful muscle cramping after activity change in color (hands feet) numbness (hands feet) weakness Sores that won't heal Hair loss or slower hair growth slower nail growth ED
Ventricular gallops and Atrial Gallops are
decreased compliance of either or both ventricles
With PAD, pain decreases with legs in the
dependent position
ACE inhibitors side effects
dizziness, orthostatic hypotension, GI distress, non productive cough, headache
s2
dub
Which sign/symptom is essential for the nurse to report to the primary health care provider (PCP) when caring for a client with Raynaud's phenomenon?
essential for the nurse to report to the PCP an affected extremity that becomes purple and cold. Reynaud's phenomenon is described as painful vasospasms of arteries and arterioles in extremities, especially digits.
Physical inactivity is a risk factor for
essential hypertension
Psychiatric disturbance can exacerbate
essential hypertension
High sodium intake is a risk factor for
essential hypertension, not for secondary hypertension, which is caused by disease states or medications
If a pt suffers from peptic ulcer disease, DVT, and osteoarthritis this increases the risk of the pt acquiring an AAA- true or false
false
Sounds of mitral valve are heard are heard over
heart apex, in 5th intercostal space in line with middle of clavicle
Pulse oximetry readings reflect the amount of oxygen bound to
hemoglobin
Diuretics
hydrocholorothiazide furosemide Spironotactone
Sounds of tricuspid valve are typically heard
in right sternal margin of 5th intercostal space; variations include over sternum or over left sternal margin in 5th intercostal space
Which are risk factors that are known to contribute to atherosclerosis-related diseases?
include LDL-C of 160 mg/dL (4.14 mmol/L), smoking, and type 2 diabetes.
The nurse suspects that a client has developed an acute arterial occlusion of the right lower extremity based on which signs/symptoms?
include cold right foot, numbness and tingling of the right foot, and mottling and tingling of the right foot. Pain, pallor, pulselessness, paresthesia, paralysis, poikilothermia (cool limb), and mottled color are characteristics of acute arterial occlusion
Homocysteine
increase levels permit plague build up
Leg swelling may be related to
injury and thromboembolism.
Cereals are fortified with
iron
Absence of pulse, rather than bounding pulse
is a symptom of acute arterial occlusion.
LDL-C of 160 mg/dL (4.14 mmol/L)
is advised to modify diet and exercise. Smoking is a modifiable risk factor and needs to be avoided or terminated. Diabetes is a risk factor for atherosclerotic disease.ASA (asprin) is used as prophylaxis for atherosclerotic disease/coronary artery disease to prevent platelet adhesion. A diet high in whole grains, fruits, and vegetables is desirable to prevent atherosclerosis. Vegetarians usually consume fruits, vegetables, and nonanimal sources of protein.
LDL-C 130 to 159 mg/dL (3.37 to 4.12 mmol/L)
is borderline high.
100 to 129 mg/dL (2.59 to 3.34 mmol/L)
is near or less than optimal.
Having an LDL-C value of less than 100 mg/dL (2.59 mmol/L)
is optimal
A client has undergone an embolectomy for acute arterial occlusion after creation of a lower arm arteriovenous fistula for dialysis. Which finding does the nurse report to the primary health care provider (PCP) immediately?
is swelling and tenseness in the affected arm. Compartment syndrome may develop after an embolectomy, with swelling of skeletal muscle fibers causes increasing pain, swelling, and tenseness. A fasciotomy may be needed to preserve the limb
A client with peripheral arterial disease (PAD) has undergone percutaneous transluminal angioplasty (PTA) of the lower extremity. What is essential for the nurse to assess after the procedure?
it is essential for the nurse to assess for pedal pulses. Priority nursing care focuses on assessment for bleeding at the arterial puncture site and monitoring distal pulses to ensure adequate perfusion.
Venous thromboembolism DVT clinical picture
leg swelling, leg pain increases with walking or standing, visible surface leg veins, warmth and redness of the affected leg skin, leg fatigue
Ace Inhibitors
lisinopril, enalapril, captopril
Angiotensis II receptor blockers
losartan, valsartan
side effects of CCBs
low BP bradycardia May precipitate A-V block HA abdominal discomfort (constipation, nausea) Peripheral Edema
s1
lub
Chronic PAD stage 4
necrosis/gangrene
pericardial friction rub
originates from pericardial sac (often sign of inflammation or infection such as pericarditis, cardiac tamponade, post-thoracotomy)
Crackles may be present in a variety of conditions including
pneumonia, heart failure, and pulmonary embolism
Oatmeal contains fiber but not
potassium
A negative hCG indicates that the client is not
pregnant, removing risk for thromboembolism. This test does not confirm thromboembolism.
The pulse rate indicates
quality
Ace Inhibitors
report presistant dry cough, cause vasodilation on and decrease BP- watch orthostatic hypotension, hold for SBP <100; monitor K levels
The nurse is caring for a client with peripheral arterial disease (PAD). For which symptoms does the nurse assess?
reproducible leg pain with exercise. Claudication (leg pain with ambulation due to ischemia) is reproducible in similar circumstances.
Chronic PAD stage 3
rest pain
Central Alpha Agonists
s/e - dry mouth, skin react on (with patch) sedation remove patch before MRI (burns)
Ventricular gallops
s3
Atrial Gallop
s4
Chronic high BP (hypertension ) left untreated can lead to:
stroke, blood vessel damage (arteriosclerosis) MI, or heart failure, Kidney failure
questionable assignment made by the charge nurse is assigning the LPN/LVN with 20 years' experience to care for a client with a headache whose BP is 210/150 mm Hg. The client with a headache and high blood pressure has unstable hypertension and is at risk for complications such as
stroke, heart failure, or renal failure. This client must be assigned to an experienced RN, who can assess for end-organ damage and administer IV medications
Vascular changes that occur during acute raynaud's disease
the arteries constrict and prevent blood flow to the fingertips. The insufficient blood flow results in hypermia followed by pallor and cyanosis. Other areas that can be affected in acute attack are the toes, nose, ears, lips, and nipples
Malignant hypertension
the most lethal form of hypertension. It is a fulminating condition characterized by severely elevated bp that commonly damages the intima of small vessels, the brain, the retina, the heart, and the kidneys. Many patients with this condition exhibit signs of hypokalemia and alkalosis and have aldosterone secretion rates even higher than those associated with primary aldosteronism.
Which teaching point does the nurse include for a client with peripheral arterial disease (PAD)?
the nurse include for a client to walk to the point of leg pain, rest, and then resume when pain stops. Exercise may improve arterial blood flow by building collateral circulation. Instruct the client to walk until the point of claudication, stop and rest, and then walk a little farther.
A client's medical record shows these data:Physical Assessment FindingsDiagnostic Findings Provider PrescriptionsCrackles at basesPTT 55 secondsLovenox 40 mg twice dailyRight leg swellingPOSITIVE, D-dimerElevate right legRight calf painhCG negativeDoppler study right leg
the presence of thromboembolism is positive D-dimer (>0.5mg/L). A D-dimer test is a global marker of coagulation activation, and measures fibrin degradation products produced from fibrinolysis (clot breakdown). The test is often used for the diagnosis of deep vein thrombosis when the client has few clinical signs, and stratifies clients into a high-risk category for reoccurrence
The nurse in the cardiology clinic is reviewing teaching about hypertension, how often should the pt exercise?
three times a week
Venous thromboembolism DVT etiology
trauma, hormones-OCPs, road traffic accidents, operations - cholecystectomy, malignancy, blood disorders- polycythemia, Obesity, old age, orthropedic surgery, serious illness, immobilization, splenectomy
Murmurs
turbulent blood flow through normal or abnormal valves
Atherosclerosis
type of arteriosclerosis, involves formation of plaque within arterial wall
Streptokinase and Activase (tPA)
used for MI, ischemic stroke and PE, may be used to open arteriovenous cannulas
Unilateral swelling is typical of
venous problems such as deep vein thrombosis
Arteriography
watch for bleeding, thrombosis, emboli
PAD can develop in pts with DM and atherosclerosis it can lead to tissue death
watch out for gangrene!
