Exam (elaborations) Chapter 36:Care of Patients with Vascular Problems Test Bank,100% CORRECT

Chapter 36 care of patients with vascular problems Arteriosclerosis & atherosclerosis • Arteriosclerosis o Thickening or hardening of arterial wall o Often associated with aging • Atherosclerosis o Type of arteriosclerosis involving formation of plaque within arterial wall o Leading risk factor for CVD o Usually affects LARGER arteries: Aorta, Carotids & Vertebral, Renal, Iliac, & Femoral o CAUSE: Damage to the blood vessel causing an INFLAMMATORY response-->A Fatty Streak then appears on the surface of the artery-->Collagen forms over the streak-- >Forming a Fibrous Plaque • Atheroclerosis: The fibrous plaque o Elevated and protrudes into the vessels lumen o Partially or completely obstructs blood flow o Unstable or stable o Unstable plaques are prone to rupturing & are often clinically silent until they rupture o Plaques become calcified, hemorrhagic, ulcerated, or thrombosed--affect all layers of the vessel o Chronic diseases, genetic factors, & lifestyle habits (smoking, diet, exercise) can contribute to the progression of atherosclerosis • Atheroclerosis: stable and Unstable plaques o *Stable: when it ruptures thrombosis (clots) & constriction obstruct the vessel lumen o -This Causes: Inadequate tissue perfusion & oxygenation to distal tissues o *Unstable: Rupture causes Serious damage! o -after rupture the exposed underlying tissue causes PLATELET adhesion & Rapid THROMBUS formation o -Thrombus may BLOCK a blood vessel resulting in ISCHEMIA & INFARCTION • Risk factors o LOW HDL (below 40; Norm: greater than 40) o HIGH LDL (Above 100; Norm: Below 70 in High risk & below 100 in low risk)  Total cholesterol should be less than 200 o INCREASED Triglycerides (Above 150; Norm: Below 150) o Genetic predisposition o Diabetes Mellitus-promotes increases in LDL & Triglycerides; Hyperglycemia can also damage lining* o *Obesity *Sedentary lifestyle *Smoking *Stress *African American or Hispanic ethnicity *Older adult • Assessment Check Capillary refill (prolonged-longer than 5 seconds in older and 3 in younger adults)if prolonged indicates poor circulation o Extremities in severe cases may be COOL or COLD with Diminished or ABSENT pulse o Auscultate for Bruits (turbulent swishing sound; high or low pitched) o Bruits occur in the carotid, aortic, femoral, or popliteal arteries most often • Nursing alert o *Increased LDLs (want below 100 in low risk & below 70 in high risk and diabetic pts.) *Decreased HDLs (want above 40) *Increased Triglycerides (want below 150 in men & 135 in women; if ABOVE 150 is hypertriglyceridemia) -Increased Triglycerides could also indicate metabolic syndrome which INCREASES risk of Coronary Heart Disease • Interventions  *LOW risk people (20-40 yrs old) should have serum cholesterol evaluated q5 years *HIGH risk (greater than 40 and multiple risk factors) should be checked more often *HIGH risk groups include: -Pts with DIABETES but NO signs of vascular disease -Pts with multiple metabolic risk factors *Can make lifestyle changes, nutrition therapy, & drug therapy *Patient MUST QUIT smoking !!! o Assess labs:  Cholesterol • HDL and LDL  Homocysteine levels  *Increased LDLs (want below 100 in low risk & below 70 in high risk and diabetic pts.) *Decreased HDLs (want above 40) *Increased Triglycerides (want below 150 in men & 135 in women; if ABOVE 150 is hypertriglyceridemia) -Increased Triglycerides could also indicate metabolic syndrome which INCREASES risk of Coronary Heart Disease o Nutrition therapy  -should consume Fruits, Veggies, Whole grains, fat-free, & low-fat dairy products, & lean meat -Decrease cholesterol and bad fats (increase OMEGA 3s)-so full fat dairydecrease red meat -Cholesterol needs to be LESS than 300 mg/day -Use oils such as Rapeseed (canola) & Sunflower OVER palm or coconut oils -Increase OMEGA 3s and Fiber (by 25-35 g/day) o Drug therapy  HMG-CoA reductase inhibitors (statins)  Fibrinic Acids  Ezetimibe (zetia)  *Pts with ELEVATED LDL that do NOT respond to diet and lifestyle changes the pt is put on lipid lowering agents *Most common drugs: 1.) HMG-CoA Reductase Inhibitors (Statins): -Lovastatin, Atorvastatin, Simvastatin, Pravastatin 2.) Other drugs: -Gemfibrozil (Lopid), Fenofibrate (Tricor), Ezetimibe (Zetia) 3.) Combination drugs -Ezetimibe and simvastatin (vytorin), Amlodipine and Atorvastatin (Caduet), & Niacin and Lovastatin (Advicor-causes flushing redness) • Stating drug alert o *Reduce cholesterol synthesis in the liver and increase clearance of LDL from the blood o *CONTRAINDICATIONS: Pregnancy, Liver failure/disease o *Cause marked decrease in liver function o *Pts may also report: Abdominal bloating, flatulence, diarrhea, and constipation as a side effect o Smoking cessation o Exercise o Complementary and alternative therapies Desired Blood Pressure • For people over 60: o Below 150/90 • For people younger than 60: o Below 140/90 • According to joint national committee 8 (JNC8) guidelines, patients whose blood pressures are above these goals should be treated with drug therapy Hypertension (Essential/Primary)  *A Systolic Blood pressure at or above 140 mm Hg and or a Diastolic blood pressure at or above 90 mm Hg in people who DON'T have diabetes *Pts with diabetes need a BP below 130/90 • Mechanisms that influence BP o *Arterial Baroreceptors:  -Found in the carotid sinus, aorta, and wall of the LV  -Monitor the level of arterial pressure and counteract the rise in arterial pressure through VAGAL STIMULATION (which brings HR and BP down by vasodilation)  -Raises pressure when it drops and drops it when it rises  *Regulation of Body Fluid Volumes:  -When there is excess Sodium/Water in the body the BP rises through complex physiological mechanisms that change the venous return to the heart producing a rise in cardiac output  -If kidneys are working properly a rise in systemic arterial pressure produces diuresis which gets the excess sodium and water out DECREASING pressure & It doesn't work when pressure is low *Renin Angiotensin Aldosterone:  -Kidneys produce renin which causes a vasoconstriction action on blood vessels & is the controlling release of Aldosterone  -Aldosterone then works on the collecting tubules in the kidneys to reabsorb sodium  -The sodium retention INHIBITS fluid loss--increasing blood volume and subsequent blood pressure • Results in damage to vital organs • BP classifications o *Normal: Systolic and Diastolic <120/80 o *Prehypertension: 120-139/80-89  Prehypertension: make lifestyle changes bc increased BP can lead to cardiac complications, coronary, cerebral, renal, & peripheral vascular disease o *Stage 1 Hypertension: 140-159/90-99 (Essential/Primary)  *Essential (Primary BP): sustained rise in BP in these pts leads to damage of vital organs by causing thickening of the arterioles--as they thicken perfusion decreases and body organs are damaged  -this can lead to MI, strokes, PVD, or renal failure o *Stage 2 Hypertension: >160/100  *Secondary Hypertension: When specific disease states and drugs cause hypertension  *Isolated Systolic Hypertension: MAJOR HEALTH THREAT  -BP of >140/<90  -Most common form of hypertension in older adults o Malignant Hypertension:  -Severe type of Hypertension that rapidly progresses  -Symptoms-morning headaches, blurred vision, and dyspnea & symptoms of uremia  -Pts are usually in 30s, 40s, & 50s  -BP is >200/150  -Pt may experience renal failure, left ventricular failure, or stroke • Causes medial hyperplasia (thickening) of arterioles • Common risk factors o Obesity o Smoking o Stress o Family history o *Essential (Primary):  -Family Hx  -African American Ethnicity  -Hyperlipidemia and Smoking  -Older than 60  -Excess Sodium and Caffeine intake  -Overweight/obese  -Inactivity/Sedentary lifestyle  -Low potassium, calcium, or magnesium intake  -Excess or continuous stress • Secondary Hypertension o Etiology and Risk:  -RENAL/Kidney disease (leading cause) -Cushing disease -Brain tumors/ encephalitis -Pregnancy -Drugs: --estrogen, glucocorticoids, sympathomimetics o Common causes  Renal disease  Primary aldosteronism  Pheochromocytoma  Cushing’s syndrome  Medications • Assessment