Cardiovascular Disease Med Surg
Card Set Information
Cardiovascular Disease Med Surg
LCCC MedSurg Nursing Hematology Cardiovascular
For exam 3
What is the range for total serum cholesterol?
What is the normal range for LDL-C?
What is the normal range for HDL-C?
What is the normal range for triglycerides?
What are some ways you can decrease cholesterol with nutrition?
<30% of total carb intake should be fats
Keep cholesterol <300mg/day
Canola oil is best for cooking, followed by sunflower oil (coconut and palm are to be avoided)
Increase fiber to 20-35 g per day
Patients with LDl 130-159 mg/dL are recommended to follow a fat modified diet
How to Statins (antihyperlipoproteinemics) lower cholesterol?
Lowers LDL and triglyceride synthesis in liver
Adverse effects include muscle myopathies and marked decrease in liver function
How does Ezetimibe (Zetia) lower cholesterol?
Inhibits cholesterol absorption in the small intestine
How does the vitamin B complex Niacin (Niaspan) lower cholesterol?
Lowers LDL and VLDL and increases HDl levels
May cause flushing and warmth
How does Lavaza (omega-3 ethyl esters) decrease cholesterol?
FDA approved adjunct to diet
Reduces Triglycerides >500mg/dL
Decreases plaque growth, inflammation and blood clotting
What are the stages of HTN?
: Measures S & D- <120/<80
: S or D- 120-139/80-89
Stage 1 HTN
: S or D- 140-159/90-99
Stage 2 HTN
: S or D- >or=160/100
What is malignant HTN?
A severe type if elevated BO that rapidly progresses
> or = 200/150 or 200/130 with preexisting conditions
What is secondary hypertension?
elevated BP related to a specific disease or medication
What is orthostatic HTN?
A decrease in BP (20mmHg Syst and/or 10mmHg Dias) in the first few seconds after changing from sitting to standing
What are some causes of primary HTN?
African American Heritage
60 year or older or menopause
Excessive sodium & caffeine intake
Excessive Alcohol intake
Excessive and constant stress
Decreased Potassium, Calcium or magnesium intake
What are some medications used for HTN?
Calcium Channel Blockers
What are the S/S of a hypertensive crisis?
Extremely High BP (200/150 or higher)
What are the nursing interventions for a hypertensive crisis?
Assess for Neuro and Cardio complications
HOB in Semi Folwers
Supply O2 as ordered
IV access with NSS at slow rate
Monitor BP q5-15min, make sure BP doesnt drop too fast
Administer meds as ordered
What medications are used in a hypertensive crisis?
Nicardipine (Cardene IV)
: these meds act as rapid vasodilators
: Once BP stabilizes, switch to oral meds
What is the difference between Arterioschlerosis and atherosclerosis?
: thickening or hardening of the arterial wall associated with Aging
: a typer of arteriosclerosis involving the formation of plaque within the arterial wall (*this is the leading risk factor for cardiovascular disease)
What are some risk factors for atherosclerosis?
Genetics (fam hist)
African American or Hispanic Heritage
What are the different kinds of plaque formation?
: inflammation, fatty appearance on intimal surface (inner lining) of the artery, collagen migrates over fatty deposit forming a fibrous plaque
: when rupture, thrombosis and obstruction leading to inadequate perfusion and oxygenation to cell tissue
: prone to rupture, clinically silent until rupture. More severe, platelet adhesion and rapid thrombus formation
: fibrous plaque becomes calcified, hemorrhagic, ulcerated or thrombosed and affect all layers of the vessel
What is considered an elevated LDL-C level?
What is considered a decreased HDL-C level?
Normal is 60-180 mg/dL
What are some nursing assessments for atherosclerosis and cardiovascular disease?
Complete a thorough assessment
All major pulse sites
Note any temp differences in extremities
Capillary refill time
Listen for bruits
Monitor Labs- HDL, LDL, Total serum cholesterol, and triglycerides
What is PVD?
Peripheral vascular disease:
compromise of vessels outside of the heart/brain that is chronic partial or total occlusion of the vessel
: PAD or LEAD (lower extremity arterial disease)
What is the difference between inflow and outflow obstructions?
: Distal end of the aorta, common, internal and external illiac arteries located above the inguinal ligament
Gradual occlusions=no significant tissue damage
: Femoral, popliteal and tibial arteries located below the superficial femoral artery. Gradual occlusions=significant tissue damage
What is the difference in patient pain between inflow and outflow obstructions?
: Claudation pain of the butt and thighs, usually distal to occlusion
: claudation of the leg and calf, feet and toes, usually distal to the occlusion
Rest pain is a significant finding and is an emergency!
What is intermittent claudation?
It is a hallmark sign of PVD
Pain described as aching, cramping and fatiguing or discomfort consistently produced with the same degree of activity or exercise
The pain is relieved by rest
Why is "rest pain" an emergency?
Rest pain means that there is a complete occlusion of blood and this is an EMERGENCY!
It make wake the patient in the middle of the night
Only relief is lowering the leg into a dependent position (may show rubor)
This is an indication of life-threatening disease and often leads to gangrene and amputation of the limb
What are some important physical assessment findings for PAD?
Progressive pain on the extremity as the disease advances
Sensation of cold or numbness in the extremities
Skin is pale when elevated and cyanotic/ruddy when placed in the dependent position
Hair loss and dry, scaly, pale or mottled skin and thickened toenails
Muscle atrophy, leg ulceration and gangrene
Unequal pulses between the extremities
What is the best pulse point to check for PAD in the lower extremities?
The tibial pulse should ALWAYS be present
Some people do not have palpable pedal pulses, but everyone should have a tibial pulse
What is the Ankle Brachial Index?
: BP cuff, stethoscope, doppler and gel
: take bilateral BPs. Using the doppler, get the systolic BPs on each leg at the tibial point and the pedal point
Be careful not to pump the cuff too high and rupture any occlusions
Why does the ABI work?
Usually, the BP is higher in the extremities due to resistance
A decrease in BP indicated decreased blood flow in these extremities
What are some teaching interventions for PAD?
STOP SMOKING!!-smoking accelerates PAD
Lose weight-decreases stress on extremities and decrease plaque formation
Healthy nutriton- DASH diet, low cholesterol, adequate protein and vitamins A,C and Zinc
What are some Hmg-coa-reductase inhibitors?
What are some non-surgical interventions for PAD?
Exercise (promotes collateral circulation) and positions
Promote vasodilation with warmth and medications (no massage!)
What are two drugs that pharmacologically manage PAD along with the statins?
: reduces blood viscosity and improves supply of 02 blood to muscles
: inhibits platelet aggregation and increases vasodilation
What are some surgical interventions for PAD?
Percutaneous transluminal angioplasty
What is a DVT?
Deep Vein Thrombosis
: Most common type of thrombosis. Also known as Thrombophlebitis
Blood clot resulting from virchows Triad
Embolus- the formation of a traveling clot
Who is at risk for a DVT?
Total Knee Replacement
Open Prostate surgery
What are the s/s of a DVT?
Warmth, edema, erythema, induration and pain of one limb
Non symmetrical lower extremity pulses
Homan's sign is not considered a good way to diagnose DVT
What diagnostic tests are used for DVT?
Venous Duplex Sonography
D-Dimer lab is a marker for coagulation activation
Doppler Study of venous circulation sounds
What is the treatment for DVT?
Thrombectomy and IVC filter
IV Heparin & Oral Coumadin
Warmth and elevation of legs to promote vasodilation (no massage)
SCDs and Compression stocking
What is some teaching to prevent DVT?
Do not cross legs
Limit Salt intake (water retention)
What is the difference between a venous and arterial ulcer?
Venous are more common on areas of pressure
Arterial tend to be more painful
Arterial have a deep, cut out look to them
Venous are covered in slough, edges are not well defined and may have pigmentation around edges
What is the preoperative and postoperative nursing actions for Surgical management of PAD?
: education and baseline vitals
: Deep breathing every 1-2hr
Monitor for graft occlusion (emergency!)
Monitor for compartment syndrome
access for infection
What are the 6 P's of Arterial Insufficiency?
: Sudden acute pain
: With a clear demarkation
: decreased below occlusion
: decreased sensation in limb, tingling and the feeling of it "falling asleep"
: decreased sensory and motor function
: coldness in the limbs
How would you identify compartment syndrome and how is it treated?
Compartment syndrome is a swelling of the fascia in the muscles that swells the muscles more than the skin can hold
This is seen by tight, shiny skin and unrelieved pain
The blocks off blood flow and may lead to an amputation
Treatment is a fasciotomy to return blood flow
The wound may remain open as swelling subsides and stitched back together over a certain amount of time
What is virchow's triad?
Endothelial injury (vessel injury)
*perfect condition for a thrombus and thromboembolism
What are the two types of Aneurysms?
: The entire segment of the vessel becomes dilated
: One side of the vessel is effected
What is a dissecting aneurysm?
A tear in the intima of the vessel allows blood in between the layers of the vessel
This often leads to rupture
What are the Risk Factors for an aneurysm?
Infection, such as syphilis
Connective tissue disorder, such as Marfan's syndrome
Genetic disorder, such as Ehler's-danlos Syndrome
What is an aneurysm of the Peripheral Arteries?
Femoral and popliteal arteries
Symptoms include limb ischemia, diminished or absent pulses, cool to cold skin and pain
Treatment is surgery
What is an aneurysm of the Central Arteries?
AAA and TAA most common
What are the S/S of an aortic dissecting aneurysm?
May be asymptomatic until rupture, at which point acute pain as tearing, ripping or stabbing may be described
Generally ruptures when the aneurysm is larger than 5cm
Palpable pulsatile mass (do not palpate too hard or you may cause a rupture!)
Bruit may be detected for an AAA left of the abdominal midline
Results in retroperitoneal bleed and may show Turner's sign
What are the emergency care goals for an aortic dissecting aneurysm?
Reduce Blood Pressure
Decrease Velocity of left ventricular ejection
Surgical treatment to close rupture or put in a stent to relieve pressure on vessel
What is the assessment for an AAA?
Patient may feel their pulse in their belly
Pulsating mass may be visible in the upper middle abdomen
Gently feel for thrill and listen for bruit
Patient may have gradually increasing gnawing pain in abdomen, back and flank
Ultrasound and CT to confirm location and size of aneurysm
What is the nursing management for an AAA?
Administer meds as ordered
Emphasize need to decrease abdominal pressure
No sneezing, coughing, pushing to poo or deep abdominal palpation
Remind the patient that they will need regular ultrasounds to monitor aneurysm
Maintain BP at a normal level to decrease risk of rupture and clotting
What is Grey-turner's sign?
It is visible hemorrhage in the flanks of the patient
Usually a sign of a retroperitoneal bleed
How would you assess for a TAA?
Assess for back pain and pain from compression in surrounding structures of chest
Assess for SOB, hoarseness and dysphagia
Mass may be visible above the suprasternal notch
Sudden excruciating chest or back pain may signal a rupture
What are the S/S for a TAA?
*This is the most common site for dissection
Lower airways symptoms include
: SOB, cough, hoarseness, stridor, dysphagia, pain that is constant (esp when supine)
What diagnostic tests are used for an Aneurysm?
: will show an "egg shell appearance"
CT Aortic Arteriograpy
What is the Pre-op prep for an Aneurysm repair?
Coronary Artery Studies
Pulmonary function tests
Corotid duplex (speed and direction of blood flow)
Blood Studies (T & C)
What is the Post-Op care for Aneurysm repair?
LOTS OF ASSESSMENTS! THINK ABCs
May have endotracheal tube and vent
Coughing and Deep breathing
Should be A+Ox3 and watch for increased ICP
Watch for occlusion in the spine, sensation and movement of all limbs should be intact
CMS checks and continuous peripheral pulses
Continuous EKG monitoring (telemetry)
They will have a central line to measure CO
Arterial Line to continuously monitor BP (BP too high, it can rupture. BP too low, it can clot)
Two large bore IVs
Daily weights and I/Os (UO at least 60ml/hr)
PCA for pain control
Assess for signs of infection
ASSESS FOR OCCLUSION OR HEMORRHAGE
What is Buerger's Disease?
: relatively uncommon occlusive disease of arteries and veins in distal portion of upper and lower extremities
Disease is characterized by recurring inflammation of the medium and small arteries and veins
Often identified with tobacco smoking
Family or genetic predisposition and autoimmune etiological process possible
What are the assessment findings for Buerger's Disease?
Instep (of the foot) claudation after exercise, relieved by rest
Aggravated by smoking, emotional disturbances and cold chilling
Distal rest pain not changed by activity of rest
Intense rubor preogresses to cyanosis as disease progresses
Tissue often dies due to occlusion and amputation is necessary
What are the nursing interventions for Buerger's Disease?
Even a small wound can pose a huge problem
Avoid soaking limbs-pat dry
Lanolin based lotion- not between toes
Keep skin clean and dry
Wear loose, dry cotton socks
Avoid chemicals and heat/cold
File toenails straight see a podiatrist
Avoid sitting with legs crossed
Avoid tight clothing
NO bare feet
Control HTN and cholesterol
Encourage daily exercise and activity
Decrease sodium and fatty foods
How is Buerger's Disease pharmalogically managed?
: reduces blood viscosity and improves supply of 02 blood to muscles
Cilostazol (Pletaal) inhibits platelet aggregation and increases vasodilation
Calcium Channel blockers
: promote vasodilation
: decrease work of heart
Ticlopodine (Ticlid) and Clopidogrel
: anti-platelet aggregation
What is the nursing care following an amputation?
Elevate stump for the first 24 hours to minimize edema and promote venous return
Assess skin for bleeding and hematoma
Wrap the extremity with elastic bandage
What is Raynaud's Phenomenon?
Caused by vasospasm of the arterioles and arteries of upper and lower extremities
How is Raynaud's treated?
: calcium channel blocker that promotes vasodilation
: lowers BP
Restrict cold exposure
What is Raynaud's Disease?
A form of intermittent arteriolar vasoconstriction that results in coldness, pain and pallor of the fingertips and toes
Cause is unknown, most commonly seen in women
What are the assessment findings for Raynaud's?
*Think American Flag
: white due to vasoconstriction
: Due to pooling of deoxygenated blood
: due to exaggerated reflow/hyperemia
Patient may have a tingling sensation or burning in the hands nad feet
How is Raynaud's pharmacologically managed?
Calcium channel blockers are most commonly used to prevent vasospasms and promote vasodilation
What are the nursing interventions for Raynaud's?
Teach patient safety as they may not feel fingers or toes
Teach patient to avoid cold, nicotine, and stressful situations which may precipitate an attack
What is a Subclavian Steal?
Occlusion of the subclavian artery
Affected arm will have a significant decease in BP
Bruit may be heard below clavicle
Surgical intervention is necessary