Vascular

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Author:
tiffanydawnn
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133159
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Vascular
Updated:
2012-02-06 00:32:35
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Vascular
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Vascular
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  1. blood pressure
    • pressure exerted against arteries as blood is pumped from the heart
    • pressure is necessary to keep vessels open and perfuse tissues
    • pressure differences allow blood to move forward
    • excess pressure increases workload of heart, alters structure of vessels
    • pressure is created by:
    • --cardiac output - ejection of blood during systole
    • --systemic vascular resistance - resistance to blood flow
    • systolic: pressure when heart contracts
    • diastolic: pressure when heart is filling
  2. MAP
    • mean arterial pressure - average arterial pressure
    • **MAP = (SBP = 2DBP)/3**
    • MAP > 60 = adequate perfusion
    • measures kidney perfusion (also urinary output)
    • can use DBP to estimate perfusion - if DBP <60, calculate MAP
  3. pulse pressure
    • difference between SBP and DBP
    • normal PP = 30-50
  4. vasoconstrictors
    • increase BP
    • SNS - epi/norepi - vasoconstriction of arterioles -> increased peripheral resistance -> increased BP
    • renin-angiotensin system - initiated with decrease in BP
    • vasopressin (ADH) from pituitary - water retention -> increased blood volume -> increased CO and BP
  5. renin-angiotensin system
    • hormone system that regulates blood pressure and water (fluid) balance
    • inadequate kidney perfusion causes release of renin
    • renin acts on angiotensinogen (from liver) to form angiotensin I
    • angiotensin converting enzyme (ACE - from lungs) converts angiotensin I into angiotensin II
    • angiotensin II causes:
    • --vasoconstriction of arterioles - increased BP
    • --stimulates secretion of ADH from pituitary - increase blood volume and BP
    • --stimulates secretion of aldosterone from adrenal cortex - reabsorb more H20 and Na (K is excreted) - increased blood volume and BP
  6. vasodilators
    • PNS - vasodilation of arterioles -> decreased peripheral resistance -> decreased BP
    • ANP/BNP - hormones released by heart
    • adrenomedullin - peptide released by smooth muscle
    • inflammation
  7. atrial natriuretic peptide (ANP)
    • hormone secreted by atria of heart in response to atrial stretch from fluid overload
    • regulates blood volume
    • opposes renin-angiotensin system
    • decreases Na, H20 - increased urine output
  8. brain natriuretic peptide (BNP)
    • hormone secreted by ventricles of heart in response to ventricle stretch from fluid overload
    • normal < 100 - rules out heart failure
    • 300 - mild
    • 600 - moderate
    • 900 - severe
  9. arterial circulation
    • higher pressures
    • thick, elastic vessel walls
  10. venous circulation
    • lower pressures
    • thin vessel walls
  11. primary HTN
    • aka essential HTN
    • SBP > 140 or DBP > 90 (3 or more readings)
    • unknown etiology
    • risk factors: obesity, smoking, high lipids, diabetes, high sodium intake, sedentary, genetics, AA
    • leads to heart disease, heart failure, stroke, renal failure
    • usually asymptomatic - sometimes HA, nocturia, confusion, N&V, visual disturbances
  12. primary HTN complications
    • artherosclerosis -> coronary heart disease, stroke
    • ventricular hypertrophy -> dysrhythmias, heart failure
    • hypertensive encephalopathy -> HBP, AMS, increased ICP, papilledema (optic nerve swelling), seizures
    • nephrosclerosis, renal insufficiency -> proteinuria, hematuria (microscopic)
  13. primary HTN dx
    • ECG
    • UA - protein, blood
    • glucose
    • hematocrit - evaluate kidney perfusion
    • K, Na, Ca - kidney perfusion
    • creatinine - kidney function
  14. primary HTN lifestyle modifications
    • diet - DASH - low Na, increased K and Ca, low fat
    • weight loss
    • exercise - no weight lifting (raises BP)
    • limit ETOH, smoking
    • stress reduction
  15. primary HTN meds
    • diuretics
    • beta-adrenergic blockers
    • ACE inhibitors/angiotensin receptor blockers (ARBs)
    • calcium channel blockers
    • alpha adrenergic blockers
    • centrally acting sympatholytics
    • vasodilators
  16. thiazide diuretics
    • decrease absorption in distal tubule
    • excrete Na, K, Cl, H20
    • HCTZ
  17. loop diuretics
    • decrease absorption in loop of Henle
    • excrete Na, K, Cl, H20
    • furosemide (Lasix)
  18. potassium-sparing diuretics
    • inhibit Na-K exchange in distal tubule
    • excrete Na, H20
    • spironolactone (Aldactone)
  19. beta-adrenergic blockers
    • block beta 1 receptors to reduce peripheral vascular resistance
    • decrease HR, CO
    • assess HR, BP, breath sounds
    • contraindicated for asthma/COPD (increased bronchial constriction)
    • S/E: fatigue, depression, impotence, rebound HTN
    • LOLs (Tenormin, Lopressor)
  20. ACE inhibitors/ARBs
    • block angiotensin II by inhibiting ACE and blocking receptors
    • prevents vasoconstriction and Na/H20 retention (by blocking aldosterone)
    • can cause increased K, cough
    • ACEs: PRILs
    • ARBs: SARTANs
  21. calcium channel blockers
    • inhibit flow of calcium across cell membranes to relax arterial smooth muscle (vasodilation)
    • can be used for vasospasms (printzmetal angina)
    • s/e: reflex tachycardia
    • PINEs (Norvasc), diltiazem (Cardizem), verapamil (Isoptin)
  22. alpha-adrenergic blockers
    • block alpha receptors in smooth muscle to increase vasodilation
    • s/e: ortho hypo, tachycardia, palpitations, dizziness
    • ZOSINs (Cardura, Minipress)
  23. centrally acting sympathopathetics
    • stimulate alpha-2 receptors to decrease CO and increase vasodilation
    • s/e: dry mouth, sedation, rebound HTN
    • clonidine (Catapres)
  24. vasodilators
    • relax smooth muscle in arterioles -> decrease peripheral resistance -> vasodilation
    • s/e: tachycardia, fluid retention
    • hydralazine (Apresoline), minoxidil (Loniten)
  25. primary HTN nursing dx
    • ineffective health maintenance r/t unhealthy behaviors
    • risk for noncompliance
    • imbalanced nutrition (more) r/t obesity
    • excess fluid volume
  26. secondary HTN
    • elevated BP from identifiable underlying process
    • causes:
    • kidney disease - renal failure stimulates RAA and decreases elimination of Na and H20
    • coarctation of the arteries - narrow aorta, stimulates RAA
    • Cushing's - excess aldosterone
    • pheocromocytoma - tumor of adrenal medulla
    • neuro disorders - increased ICP -> increased BP (body attempts to maintain cerebral blood flow)
    • drug use
    • pregnancy
  27. hypertensive crisis
    • BP > 180/120
    • rapid onset
    • blurred vision, HA, confusion, motor/sensory deficits
    • avoid rapid reduction in BP
    • can cause renal failure, cerebral edema, vascular damage
  28. peripheral artery (vascular) disease (PAD/PVD)
    • impaired blood supply to peripheral tissues caused by arteriosclerosis
    • arteriosclerosis: thickening, loss of elasticity, and calcification of arterial walls
    • atherosclerosis: fat deposits harden arteries
    • increased plaque at arterial biforcations
  29. PVD s/s
    • pain
    • intermittent claudication - cramping/aching pain in calves, thighs, butt
    • rest pain (burning) when legs elevated
    • decreased/absent peripheral pulses
    • bruit over large arteries (femoral, AA)
    • dependent rubor (red feet)
    • thin, shiny, hairless skin with discoloration
    • thick toenails
    • skin breakdown/ulceration
    • 6 Ps: pain, pallor, polar, pulses, paresthesia, paralysis
    • complications - gangrene, amputation, AAA rupture, infection, sepsis
  30. PVD dx
    • Ankle-brachial index - lower BP in leg than arms
    • --BP both arms -> use highest SBP
    • --BP foot with doppler using dorsalis pedis and post. tib -> use highest SBP
    • --divide foot/arm
    • stress testing
    • ultrasound to eval blood flow
    • transcutaneous oximetry to eval oxygenation of tissues
    • angiography - contrast dye (MRA no dye)
  31. PVD meds/tx
    • aspirin
    • clopidogrel (Plavix) - inhibit platelet aggregation
    • cliostazol (Pletal) - improves claudication
    • pentoxifylline (Trental) - decreaes blood viscosity, increase red cell flexibility, improve microvascular circulation
    • smoking cessation (nicotine promotes atherosclerosis, vasospasm)
    • foot care
  32. revascularization
    • PTA (percutaneous transluminal angioplasty) - nonsurgical stent
    • endarterectomy - surgery to remove plaque
    • --fempop
    • --femtib
  33. PVD nursing dx
    • ineffective tissue perfusion
    • pain
    • impaired skin integrity
    • activity intolerance
  34. thomboangiitis obliterans
    • small artery inflammation (feet, hands) -> vessel spasm -> clots -> impaired blood flow -> tissue hypoxia -> gangrene
    • men < 40 who smoke, genetics
    • causes pain (claudication, rest pain), diminished sensation, thin, shiny skin
    • tx: CCBs, antiplatelets
  35. raynaud's disease/phenomenon
    • intense vasospasm of arteries/arterios of fingers (sometimes toes)
    • disease: no identifiable cause
    • phenomenon: 2/2 RA, scleroderma (autoimmune)
    • tx: prevent aggrevation
    • meds: CCBs
  36. venous system
    • lower pressure
    • SNS stimulation causes veins to contract
    • skeletal muscle contractions and pressure changes move blood back to heart
    • valves to prevent backflow
  37. venous thrombosis
    • blood clot forms on wall of vein
    • causes inflammation and obstruction
    • DVT: thrombi in a deep vein
    • leads to chronic venous insufficiency
  38. Virchow's triad
    • pathologic factors of venous thrombosis
    • --stasis of blood
    • --increased coaguability
    • --vessel damage (inflammation) - clotting cascade is stimulated
  39. DVT manifestations
    • calf pain
    • tenderness
    • warmth
    • swelling
    • erythema
    • cyanosis
    • Homan's sign - flexing foot causes pain
  40. pulmonary embolism
    • clot breaks loose and travels to lungs
    • occludes arterial flow to lungs
  41. DVT dx
    • duplex venous US
    • plethysmography - measures changes in blood flow
    • MRI
    • contrast venography - injected dye
  42. DVT meds
    • anticoagulants
    • NSAIDs
  43. DVT tx
    • leg elevation
    • TEDs/compression boots on unaffected leg
    • quit smoking (esp c birth control)
    • thrombectomy: surgical removal
    • Greenfield filter to prevent clot from reaching lungs
  44. DVT nursing dx
    • pain r/t venous inflammation
    • ineffective tissue perfusion
    • ineffective protection
    • impaired physical mobility
    • risk for ineffective tissue perfusion - cardiopulmonary
  45. chronic venous insufficiency
    • inadequate venous return over a prolonged period of time
    • caused by DVT, varicose veins, leg trauma
    • patho:
    • --venous stasis
    • --increased venous pressures impairs arterial circulation
    • --tissue hypoxia
    • --atrophy of skin
    • --necrosis of fat
  46. chronic venous insufficiency manifestations
    • brown skin pigmentation (RBC breakdown)
    • edema
    • itching
    • cyanosis
    • stasis ulcers
    • dermatitis
  47. chronic venous insufficiency tx
    • reduction of edema
    • wound healing
    • conpression hose
    • elevate legs
    • walk and rest
    • do not cross legs
  48. chronic venous insufficiency nursing dx
    • disturbed body image r/t edema, stasis ulcers
    • risk for infection
    • impaired physical mobility
    • impaired skin integrity
    • impaired tissue perfusion
  49. varicose veins
    • irregular veins with incompetent valves
    • aka hemorrhoids (rectum) and varices (esophagus)
    • increased venous pressure stretches vessel which affects valve closing
    • prolonged standing, lack of exercise
    • s/s: leg pain, heaviness, fatigue
    • complications: venous insufficiency, stasis ulcers
    • dx: US, trendelenberg test
    • tx: compression stockings

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