Unit 2

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Unit 2
2012-04-27 14:39:11
Hypertension vascular disease

unit 2
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  1. what is claudation
    pain in legs when ambulating
  2. what is the best indication of peripheral vascular disease
  3. with peripheral artery disease what would you expect to find on a patient
    thin skin and no leg hair
  4. what does the presence of a carotid bruit indicate
    arterial narrowing
  5. what is an ankle-brachial test
    commonly used parameter for overall evaluation of the extremity status.
  6. what indicates venous obstruction
    unilateral swelling in lower extremities
  7. pt has intermittent claudation, how should nurse position bed
    in reverse trendelenberg
  8. what is the best method to determine if a client has a DVT
    Ultrasonic duplex scan
  9. What is Arteriography
    allows the physician to see arterial lesions.
  10. what is a sign of venous disease
    brown patches on the lower legs near the ankles signify
  11. What is HTN the single most important predictor of
    cadiovascular risk
  12. What will happen if HTN is left untreated
    1/2 will die of heart disease, 1/3 will die of stroke, 10 to 15% will die of renal failure
  13. What is primary HTN
    characterised by type, cause and severity. Most clients with a combination of systolic and diastolic BP elevation have primary. AKA essential or idiopathic HTN. Mulitfactoral etiology with no identifiable cause. more than 90% of cases
  14. what is secondary HTN
    those who develop HTN from an identifiable cause, a specific disease state or problem. Underlying cause is correctable
  15. What is "white coat" HTN
    rise of BP when going to doctor
  16. What is isolated Systolic HTN
    systolic bp is 140 or higher but the diastolic bp remains less than 90. Can result from increased cardiac output or atherosclerosis-induced changes in blood vessel compliance or both
  17. What is persistent severe or resistant HTN
    refractory HTN with persistent systolic or diastolic elevation and/or if diastolic bp is protracted about 110/120. Results when HTN is left untreated or is unresponsive to treatment
  18. What are nonmodifiable risk factors of HTN
    • family Hx
    • Age - typically occurs between 30-50, and increases with age
    • gender - higher in men until age 55. between 55-74 risk equal b/t men and female. after age 74 women more at risk
    • ethnic group - lowest for white women, then white male, then black male, then black female
  19. What are modifiable factors of HTN
    • Stress - increases peripheral vascular resistance and Cardiac output, stimulates sympathetic nervous system activity.
    • Obesity - apple shape, also metabolic syndrome increases risk
    • Nutrients - sodium consumption is factor
    • substance abuse - smoking and drugs
  20. What are the four control systems in the body for HTN
    • arterial baroreceptor and chemoreceptor system
    • regulation of body fluid volume
    • renin-angiotension system
    • vascular autoregulation
  21. what does the arterial baroreceptor do
    they are stretch receptors found in carotid, sinus, aorta, and wall of left ventricle. monitor the level of arterial pressure and counteract increases through vasodilation and slowing of the HR via the vagus nerve
  22. what do chemoreceptors do
    sensitive to changes in concentration of O2, CO2. Decrease O2 and pH = high BP......increase CO2 = low BP
  23. What does the regulation of body fluid volume do with BP
    when sodium and water levels are excessive = increase BP
  24. what happens in the renin-angiotension system
    renin produced and forms Angiotension II and III which inhibit Na+ excretion which results in increase of BP. The more renin produced the higher the BP
  25. How does vascular autoregulation work
    cells of endothelium produce nitric oxide that dilates the arteriole and endothelium that constricts it. dysfunction of the endothelium has been implicated in essential hypertesnion
  26. what is the most common cause of secondary HTN
    chronic renal disease
  27. What are early stage findings in HTN
    no signs or symptoms are noted unless found on routine medical screening
  28. what are later stage clinical manifestations of high BP
    headaches, fatigue, epistaxis, dizziness, double vision, palpitations
  29. What are the stages of HTN
    • prehypertension - 120 - 139 80-89
    • stage 1 - 140-159 90-99
    • stage 2 - 160 and > and 100 >
  30. what are lifestyle modifications for HTN
    • weight reduction
    • sodium reduction
    • dietary fat modification
    • exercise
    • ETOH restriction
    • relaxation techniques
    • smoking cessation
    • potassium supplementation - low sodium high potassium diet
  31. What types of antihypertensive meds are there?
    • Diuretics
    • alpha and beta adrenergic antagonists (beta-blocker)
    • vasodilators
    • calcium antagonists (calcium channel blockers)
    • angiotensin-converting enzyme (ACE inhibitors)
    • angiotension receptor blockers (ARB)
  32. what is the first line choice for BP meds
    diuretics and BB
  33. What modifications are needed for elderly clients with HTN
    • try and lower the pressure gradually to a level sufficient to eliminate target organ damage and to minimize risk for hypoperfusion
    • treat regardless whether both the SBP and DBP are involved or there is evidence of only ISH
    • Monitor for evidence of adverse reactions to antihypertensive drugs
  34. How do diuretics work
    flush excess water and sodium from the body which loewr BP
  35. How do alpha and beta adrenergic antagonists (beta-blockers) work and what is an example of one
    • They reduce the work of the heart. Block the stimulating effects of the hormones epi and norepi on the heart, causing the heart to work less hard and pump less frequently.
    • Ex = lopressor
  36. How do ACE (angiotension-converting enzyme) inhibitors work and what is an examle of one?
    • These widen the small arteries and reduce the amt of blood fluid by blcoking the production of the hormone angiotension II.
    • Ex = captopril
  37. How do calcium channel blockers work and what is an example of one
    • widen the small arteries by blocking calcium entry into the muscle in the wall of the small arteries.
    • ex = procardia
  38. How do vasodilators work and what is an example of one
    • Decreases BP by relaxing the smooth muscle which widens the larger veins, large arteries and small arterioles
    • ex = apresoline