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57 Cards in this Set
- Front
- Back
Thrombophlebitis -
causes and S/Sx |
-aka venous thrombosis; vein side
-caused by trauma, immobility, surgery -s/sx incl. leg pain, warm temp, edema, inspect bilaterally with tape measure, risk factors |
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Thrombophlebitis -
prevention |
-elastic stockings
-IPC (intermittent pneumatic compression device) -positioning -exercise -Heparin |
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ANTICOAGULANT
THERAPY for thromboembolism (administration) |
-continuous IV infusion of Heparin
-intermittent injection of heparin SQ -oral anticoagulants (coumadin) -intermittent injection of Lovenox SQ (low molecular wt heparin) |
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ANTICOAGULANT
THERAPY for thromboembolism (precautions) |
-spontaneous bleeding
-heparin induced thrombocytopenia -drug interactions |
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Manifestations of Thrombophlebitis-
Deep Vein Thrombosis |
-usually asymptomatic
-dull, aching pain, especially when walking. -tenderness, warmth, erythema along affected vein. -cyanosis -edema |
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Manifestations of Thrombophlebitis-
Superficial Vein Thrombosis |
-localized pain and tenderness
-redness and warmth -palpable cordlike structure -swelling and redness of surrrounding tissue |
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Heparin Therapy
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Heparin interferes withte clotting cascade by inhibiting the effects of thrombin and preventing the conversion fibrinogen to fibrin. The prevents the formation of a stable fibrin clot. At therapeutic levels, heparin prolongs the thrombin. time, clotting time and activated partial thromboplastin time.
-IV is immediate -SQ onset 1 hr. |
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PT INR
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Inceased to 2.0-3.0 in Warfarin (coumadin) therapy.
Prothrombin time measurements. Normal is 0.9-1.2. |
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aPTT
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the activated partial thromboplastin time (or PTT).
-LMW heparin dosage is calculated to maintain the aPTT at approx twice the normal level. -frequent monitoring is an important responsibility |
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Antedote for Heparin
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Protamine sulfate to treat excessive bleeding
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Antedote for Coumadin (Warfarin)
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Vitamin K
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Coumadin
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Inhibits extension of existing thrombi and the formation of new clots. Its action is cumulative and more prolonged that that of heparin.
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Nursing Diagnoses for prevention of venous thrombosis
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-pain-from inflammation
-Ineffective tissue perfusion:peripheral-deprived tissues leading to ulceration/infection -Ineffective Protection-bleeding -Impaired physical mobility -Risk for ineffective tissue perfusion:cardiopulmonary-low O2 sats therefore initiate O2 therapy and elevate HOB. |
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DVT
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usually asymptomatic; first indicator is a pulmonary embolism in some patients.
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Hypertension
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systolic pressure 140mmHg or highter, diastolic pressure 90mmHg or higher, based on the average of three of more readings taken on separate ocassions.
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Primary Hypertension
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-a persistently elevated systemic blood pressure.
-1:3 people in US and 90% of those have primary HTN -aka essential HTN -140-159/90-99 |
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Risk factors of primary HTN
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Modifiable
-high Na intake -low K, Ca and Mg intake -Obesity -Excess alcohol consumption -insulin resistance, tobacco, stress Nonmodifiable -genetic factors, family Hx, Age, race (blacks significantly higher) |
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Secondary Hypertension (Stage 2)
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elevated blood pressure resulting from an identifiable underlying process.
-kidney disease number one cause |
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Risk factors of secondary hypertension
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-coarctation of the aorta (narrowing)
-renal disease -endocrine-cushing's hyperaldosteronism -sleep apnea -pregnancy -cocaine, BC pill, NSAIDS |
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Diagnostic tests for HTN
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Serial blood pressure readings
Urinalysis IV pyleography BUN and creatinine levels ECG CXR |
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H Y P E R T E N S I O N
Nursing Diagnosis |
-Altered health maintenance R/T lack of knowledge of
Pathology, complications & management of hypertension -Anxiety R/T diagnosis, regimen, complications & lifestyle changes -Sexuality dysfunction R/T HTN & Rx -Ineffective management of regimen R/T -Knowledge deficit -Medication side-effects, Cost of meds, schedule for meds -Body image disturbance |
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Nursing Implementation for HTN
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Administer medications
-Thiazide, loop, and potassium- sparing diuretics -ACE (angiotensin-converting enzyme) Inhibitors -Adrenergic Inhibitors (alpha, beta, central) -Vasodilators -Angiotensin Inhibitors -Calcium Channel Blocker Monitor blood pressure Patient and Family teaching |
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H Y P E R T E N S I O N
CLIENT EDUCATION |
medications
diet weight control lifestyle changes follow-up |
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D I U R E T I C S
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-Decrease volume; inhibit Aldosterone; Negative Sodium Balance
-controls HTN by preventing tubular reabsorption of Na, thus promoting Na and water excretion and reducing blood volume. Types include: -Thiazide Diuretics, Loop Diuretics and K-sparing Diuretics |
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Beta Blockers
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-reduce blood pressure by preventing beta-receptor stimulation in the heart thereby decreasing heart rate and cardiac output.
-assess BP and AP before giving dosage -containdicated with asthma, lung disease, bradycardia and heart block -lopressor® |
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ACE Inhibitors
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-lowers blood pressure by preventing conversion of Angiotensin I to Angio II. This prevents vasoconstriction and Na/H2O retention. Most end with -ril like Monopril®
-Adverse rx-persistent cough, first dose hypetension and hyperkalemia |
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ARBs (Angiotensin II Receptor Blockers)
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ARBS have the same effect as ACE inhibitors but they act by blocking the effect of angiotensin II on receptors.
-Adverse rx-persistent cough, first dose hypetension and hyperkalemia |
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ND r/t Primary HTN
(same for Secondary HTN) |
All patients with primary HTN and families need significant teaching to manage.
-Health Maintenance is a high priority problem. r/t patho, complications, and mgmt of HTN. -Risk for noncompliance -Imbalanced nutrition: more than body reqmts -Excess Fluid volume -for secondary HTN, underlying process is treated. |
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More NDs r/t HTN
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-Anxiety r/t diagnosis, regimen complications and lifestyle changes
-sexuality dysfunction r/t HTN and Rx -Ineffective mgmt of regimen r/t knowledge deficit Rx S/E, cost, and schedule Body image disturbance |
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H Y P E R T E N S I O N
Monitor/Manage Potential Complications |
Assess
-vascular sys, eyes, heart, nervous sys, and kidneys Expected outcomes -maintains adequate tissue perfusion; compliance; free of complications |
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Hypertensive Crisis
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-BP greater than 180/120.
-immediate Tx (within 1 hour) is needed. -usually occur when patients suddenly stop taking meds or poorly controlled -younger pts, AA men, pregnant women with pre-eclampsia, renal disease |
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HTN Crisis Manifestations
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headache
confusion swelling of optic nerve (papilledema) blurred vision restlessness motor and sensory deficits |
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Nursing care for those with HTN crisis
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-focus is on continuous monitoring of BP and titrating drugs as ordered to achieve the desired BP.
-provide psycho and emotional support. -teach measures to effectively manage HTN |
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Pre HTN teaching
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-maintain normal body wt, lose wt.
-dietary mods -limit ETOH -Aerobic exercise -stop smoking -stress mgmt |
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Venous stasis
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low-blood flow in lower extremeties
Tx: Low molecular weight heparin IPCDs intermittentpneumatic compression devices |
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Buergerʼs disease
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Occlusive vascular disease ; small and midsize peripheral arteries become
inflamed and spastic, causing clots to form It progresses to collateral vessels Occurs in men under 40 that smoke Arterial bypass surgery ND:focus is on smoking cessation |
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Rienauds disease
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Occlusive vascular disease; intense vasospasm in small arteries and arterioles
of fingers and toes; Usually secondarily to another disease (ie: rheumatoid arthritis) primarily young women 20 - 40 |
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Cardiac Catheterization aka Percutanueous transluminal coronary angioplasty (PCTA)
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treatment for angina
-pre- assess for allergies to seafood, iodine or contrast dyes. -intra-supine, hold still, cough and deep breathe frequently -post- heck pulses, warmth, muscle tone, BP, vitals, temp. encourage patient to drink lots of fluids to flush out dye; maintain HOB at 30degrees or less; distal pulses; I & O |
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Coronary Artery Disease
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-Atherosclerosis
fatty streak raised fibrous plaque complicated lesion -Collateral Circulation -Risk Factors Unmodifiable: age, sex, race, family history Modifiable: serum lipids, HTN, smoking, obesity, physical inactivity, diabetes, stress |
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collateral circulation
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-This is a process in which small (normally closed) arteries open up and connect two larger arteries or different parts of the same artery. They can serve as alternate routes of blood supply.
-provides alternate routes of blood flow to the heart in cases when the heart isn't getting the blood supply it needs (myocardial ischemia) |
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Diabetes and CHD (CAD)
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increases the risk of CHD by accelerating the atherosclerotic process.
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Diabetes and HTN
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share common risk factors.
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Peripheral Vascular Diseases -
Atherosclerosis |
Acute: Trauma, Thrombosis or Embolism
Chronic: Atherosclerosis, inflammation, thrombosis, embolism, trauma, autoimmune Administer meds, Vasodilators, anticoagulants, antilipemic, thrombolytics Regular daily exercise is a primary intervention for all types of peripheral arterial disease. |
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smoking
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Contributes to CAD in 3 ways
CO picked up by hemoglobin more readily than 02 then low O2 delivered to tissues Nicotine causes vasoconstriction Smoking increases platelet adhesion →formation of a thrombus |
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Angina Pectoris
-Stable Angina |
Intermittent chest pain
Over long period of time Same or similar circumstances Not usually at rest Meds usually control |
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Unstable Angina - aka. Acute Coronary Syndrome
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Unpredictable
(may previously had Stable Angina) May occur w/minimal or no exercise Increased chance of thromb→MI |
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Prinzmetal’s Angina
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-response to spasm of coronary artery
-hx of migraines or Raynauds -may be at rest -with or w/o CAD -maybe precipitated by Histamine or Epinephrine |
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Causes of Angina
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-physical exertion increases myocardial demand of O2
-cold exposure-vasoconstriction and elevated BP -eating large meal; blood going to GI instead of myocardium |
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S/Sx of Angina
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-chest pain, pressure
-apprehension -neck, jaw, shoulders or extremity pain -choking sensation -Indigestion -diaphoresis |
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Chest pain
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Myocardial hypoxia at the cellular level.
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Angina Tx
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-PCTA
-stent replacement -CABG -Laser angioplasty |
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Drug Therapy for Angina
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ASA - 50% reduction
-prophylaxis; at time of pain Nitrites (vasodilators) -dilate peripheral vessels -decreases cardiac work by reducing venous return to heart -increases myocardial blood flow via vasodilation of coronary vessels |
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Nursing Diagnosis R/T Angina
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High priority ND include:
ineffective cardiac tissue perfusion and mgmt of the prescribed therapeutic regimen. |
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more ND related to Angina
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-decreased cardiac output
impaired gas exchange activity intolerance pain risk for infection sleep disturbance knowledge deficit altered family process |
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Acute Arterial Occlusion S/Sx
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6 P's
pain; pallor; polar; pulselessness; paresthesia; paralysis ND: focuses on protecting affected extremity, managing anxiety and reducing complications r/t anticoagulation therapy |
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Peripheral arterial vascular disease
NDs |
Impaired tissue prefusion:peripheral
Acute and Chronic Pain- ischemia, build up of lactic acid Impaired skin integrity as a result of O2 and nutrient deprivation Activity Intolerance |
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intermittent claudication
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is a clinical diagnosis given for muscle pain (ache, cramp, numbness or sense of fatigue), classically in the calf muscle, which occurs during exercise and is relieved by a short period of rest.
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