ch. 18- Disorder os blood flow and pressure
Tunica externa
outer layer
The physician's order state, "Calculate the pulse pressure of the clients BP" The blood pressure is as follows: systolic pressure 146 mm Hg and diastolic pressure of 82 mm Hg. The pulse pressure would be? a) 41 mm Hg b) 73 mm Hg c) 228 mm Hg d) 64 mm Hg
d) 64 mm Hg -Difference between the systolic and diastolic is called pulse pressure
Select the statement that best describes Buerger disease? a) Recurring, progressive, atherosclerotic inflammation and thrombosis b) pain is not a prominent feature of the disorder c) peripheral pulse intensity increased d) disease of young, heavy cigarette smokers occurring before the age of 35
d) disease of young, heavy cigarette smokers occurring before the age of 35 -Buerger disease: is recurring progressive, nonatherosclerotic inflammation and thrombosis of small and medium sized arteries and veins. usually disease of young. -Pain is the predominant symptom of the disorder and peripheral circulation is decreased
The nurse is providing education to a client diagnoses with varicose veins. The nurse determines that teaching has been effective when the client states that the most likely cause of the varicosities is? a) prolonged sitting b) weak bone structure c) rapid weight loss d) heavy lifting
d) heavy lifting -Varicose veins: develop from prolonged standing and increased abdominal pressure (heavy lifting). -The risk of development would greatly increase with weight gain and prolonged standing and would not be affected by bone structure
Blood vessel structure
1.) tunica externa 2.) tunica media 3.) tunica intima
Low-Density Lipoproteins (LDL)
Bad cholesterol, and is the main carrier of cholesterol -approximately 60% is transported back to the liver. -10%triglycerides, 50% cholesterol, 25% protein -<100
Endothelium
Endothelia cells form a continuous lining for the entire vascular system, controls the transfer of molecules across the vascular wall and plays a role in the control of platelet adhesion and blood clotting
High-Density Lipoproteins (HDL)
Good cholesterol, it
Tunica intima
Inner layer
Vasa vasorum
Is infiltrated with nerve fibers and, in large vessels, a system of tiny blood vessels -A network of small blood vessels that supply the walls of large blood vessels, such as elastic arteries (aorta) and large veins (vena cava)
Secondary hyperlipidemia
May result from a disease like diabetes, thyroid disease, renal disorder, liver disorders
Hyperlipidemia
Medical condition characterized by an election of any or all lipid profiles or lipoproteins in the blood -can be primary or secondary
Tunica media
Middle layer
The health care provider is reviewing the results of a clients magnetic resonace imaging (MRI). The results indicate a small spherical dilation at the circle of willis. The provider would interpret this as? a) Berry aneurysm b) saccular aneurysm c) dissecting aneurysm d) fusiform aneurysm
a) Berry aneurysm -Berry aneurysm: usually found at the circle of willis. -Sacculara aneurysm: appears sac-like -Fusiform aneurysm: is characterized by a gradual, progressive dilation of the vessel
the nurse is reviewing the lipid result of four clients. Select the client at greatest risk for cardiovascular disease? a) LDL cholesterol 205 mg/dL, HDL 40 mg/dL, and triglyceride level 150 mg/dL b) LDL cholesterol 180 mg/dL, HDL 50 mg/dL, and triglyceride level 100 mg/dL c) LDL cholesterol 160 mg/dL, HDL 30 mg/dL, and triglyceride level 120 mg/dL d) LDL cholesterol 184 mg/dL, HDL 60 mg/dL, and triglyceride level 70 mg/dL
a) LDL cholesterol 205 mg/dL, HDL 40 mg/dL, and triglyceride level 150 mg/dL -Diagnosis of hyperlipidemia depends on the persons complete lipid profile (total cholesterol, LDL, HDL, and triglyceride levels) after overnight fast. -One person may have a favorable lipid profile with a HDL of 110 mg.dL, a triglyceride level of 175 mg/dL, and a LDL of 130 mg/dL. -Where as another person with a HDL of 40 mg/dL, a triglyceride level of 150 mg/dL, and a LDL cholesterol of 205 mg/dL would be at much greater risk for cardiovascular disease
Select the statement that most accurately describe secondary hypertension. select all that apply. a) can be corrected or cured by surgery or specific medical treatment b) kidney disease is one of the most common causes c) and elevation in blood pressure due to unknown cause d) accounts for 5-10% of hypertension cases e) obstructive sleep apnea is an independent risk factor for secondary hypertension f) may be caused by oral contraceptives
a) can be corrected or cured by surgery or specific medical treatment b) kidney disease is one of the most common causes d) accounts for 5-10% of hypertension cases e) obstructive sleep apnea is an independent risk factor for secondary hypertension
A client is very much concerned about his family history of atherosclerosis and asks the nurse if there is anything he can do to decrease his risk. The client has type 2 diabetes. The best response would be? select all that apply. a) control hypertension b) control blood glucose levels c) increase LDL level d) maintain normal weight e) decrease smoking
a) control hypertension b) control blood glucose levels d) maintain normal weight -The major risk factors that can be modified by a change in health care behaviors include cigarette smoking, obesity, hypertension, hyperlipidemia, and elevated LDL cholesterol, and diabetes mellitus.
A client has just been diagnosed with hypercholesterolemia and is asking what treatment will be needed. The best response would be? select all that apply a) dietary measures to reduce LDL levels b) smoking cessation c) increased intake of fats and sodium d) decreasing physical activity e) weight reduction if overweight
a) dietary measures to reduce LDL levels b) smoking cessation e) weight reduction if overweight -The management of hypercholesterolemia focuses on dietary and therapeutic life style changes; when these are unsuccessful, pharmacologic treatment is necessary
A health care provider is teaching a client about modifiable risk factors for atherosclerosis. Th most appropriate information to provide would be? a) hypertension b) male gender c) family history of heart disease d) 55 years of age
a) hypertension
The nurse is teaching a group of clients about hypertension. The nurse determines that teaching was effective when the client states? select all that apply. a) it is most common cardiovascular disorder b) the incidence increases with age c) it is often associated with individuals of normal weight d) the systolic pressure is greater than or equal to 140 mm Hg e) the diastolic pressure is equal to 80 mm Hg
a) it is most common cardiovascular disorder b) the incidence increases with age d) the systolic pressure is greater than or equal to 140 mm Hg -Hypertension: systolic pressure>140 and diastolic pressure >90 is one of the most common cardiovascular disorder -Incidence of essential hypertension increase with age, seen more frequently with African americans, and it may be associated withfamilyi history, metabolic syndrome, obesity, and increased sodium intake
The nurse observes a client care technician obtain a blood pressure on an obese client using a BP cuff that is too small. The nurse is aware that this will result in? a) a decreased pulse pressure reading b) a reading that is too high c) an accurate BP assessment d) a reading that is too low
b) a reading that is too high -The width of the bladder should be at least 40% of arm circumference and the length at least 80%. -Undercuffing (too small) can cause an overestimation of pb, this is because a cuff that is too small results in an uneven distribution of pressure across the arm, such that a greater cuff pressure is needed to occlude blood flow -Overcuffing (too larger) can cause and underestimation of bp
Select the priority of care for the medical management of a client with a dissecting arctic aneurysm? a) administration of medication to increase blood pressure b) administration of sodium nitroprusside and B-adrengic blocking medications c) administration of pain medications and anti anxiety medications d) administration of epinephrine and IV fluids
b) administration of sodium nitroprusside and B-adrengic blocking medications --This would be expected treatment to lessen the force of systolic blood ejection from the heart. -The client would be NPO for immediate surgery (not 1 week later), and the blood pressure needs to be lowered
Select the response that best describes the pressure-sensitive receptors that respond to changes in the stretch of the vessel wall. a) cardiovascular centers b) baroreceptors c) neural pathways d) chemoreceptors
b) baroreceptors -Baroreceptors: are pressure-sensitive receptors located in the wall of blood vessels and the heart. -The arterial chemoreceptors: are cells that monitor the oxygen, carbon dioxide, and hydrogen ion content of the blood. -Cardiovascular center: transmits impulses to the blood vessel -Neural control of the blood pressure is related to the integration and modulation of the ANS response
A client who was diagnosed with hypertension is not taking a medication that decreases heart rate and cardiac output. The nurse determines that the medication is a? a) ACE inhibitor b) beta-adrenergic blocker c) diuretic d) calcium channel blocker
b) beta-adrenergic blocker -This works to decrease the heart rate and CO -Diuretics: lower BP by decreasing vascular volume -ACE inhibitors: work to reduce vasoconstriction calcium channel blockers: reduce BP by decreasing peripheral vascular resistance by inhibiting the movement of calcium into material smooth muscle cells
A pregnant female client is at risk for the development of preeclampsia-eclampsia. Select the most important data to assess? a) blood pressure 140/90 and glucose in the urine during the 36 week of pregnancy b) blood pressure 160/100 and proteinuria during the 30th week of pregnancy c) blood pressure 130/88 and hyperglycemia occurring during the 22nd week of pregnancy d) blood pressure 90/60 and proteinuria in the second trimester
b) blood pressure 160/100 and proteinuria during the 30th week of pregnancy -Preeclampsia-eclampsia: is defined as an elevation in blood pressure (systolic> 140 mm Hg or diastolic > 90 mm Hg) and proteinuria (300 or greater in 24 hours) developing after 20 weeks of gestation
A client has been diagnosed with deep vein thrombosis (DVT). The nurse is planning care and recognizes that the client is most at risk for? a) arterial insufficiency b) pulmonary embolism c) vaculitis d) polyarteritis nodosa
b) pulmonary embolism -DVT most commonly occurs in the lower extremities. DVT of the lower extremity is serious disorder, complicated by pulmonary embolism, recurrent DVT episodes, and development of chronic venous insufficiency.
A female client tells the health care provider that she has recently been experiencing episodes of changes occurring in the color of her fingertips especially when she experiences cold temps. She further states that the tips become pale, turn a bluish color, then become reddened. The client is most likely experiencing? a) vasculitis b) raynaud phenomenon c) atherosclerosis d) thromboangitis obliterans
b) raynaud phenomenon -Raynaud phenomenon: is seen in otherwise healthy young women, and it often is precipitated by the exposure to cold or strong emotions and usually is limited to the fingers. -The ischeic phase of raynaud is manifested by changes in skin color that progresses from pallor to cyanosis and progress to hyperemia.
The nurse is developing a plan of care for a post surgical client. A major goal is to prevent the formation of prevent DVT. The more important intervention for the nurse to implement would be? a) apply ice compresses to the site of the DVT hourly b) massage legs to maintain blood flow c) apply sequential pneumatic compression devices to lower extremities d) ensure that the client remains on bed rest
c) apply sequential pneumatic compression devices to lower extremities -Early ambulation is encourage. and ice would not be recommended due to the venous constriction is causes
A client reporting a headache is diagnosed with giant cell arteritis. The nurse is aware that the vessels most commonly affected are the? a) vetebral b) ophthalmic c) temporal d) carotid
c) temporal -Giant cell (temporal) arteritis: the most common of the large vessel vasculitides, is an acute and chronic inflammation of large to small arteries.. it mainly affects arteries of the head especially the temporal arteries, but may include the vetebral and ophthalmic arteries -Most common clinical presentation are headache and tenderness over the superficial temporal artery
A client has been diagnosed with a dissecting aortic aneurysm. It is most important for the nurse to assess the client for? a) tonic-clonic sezures b) late hypertensive crisis c) chest pain radiating to the right arm d) tearing or ripping-type pain in the chest or back
d) tearing or ripping-type pain in the chest or back -A major symptom of a dissecting aneurysm is the abrupt presence of excruciating pain, described as tearing or ripping. Pain associated with dissection of the ascending aorta frequently is located in the anterior chest, and pain associated with dissection of the descending aorta often is located in the back -In early stages, blood pressure typically is moderately or markedly elevated
Primary hyperlipidemia
genetic based
Endothelia dysfunction
several types of potentially reversible changes in endothelia function that occur in response to environmental stimuli derived from cardiovascular risk factors such as smoking, hypertension, diabetesities, obesity -Implicated in a number of pathologies including thrombosis, atherosclerosis, and hypertensive vascular lesion
Vascular smooth muscle cells
which form the middle layer of blood vessels, control the dilation and constriction of blood vessels, elaborate growth factories, and synthesize collagen, elastin, and other components of extracellular matrix. -Important in both normal vascular repair and pathologic process such as atherosclerosis