Raynaud's: What are the common triggers so that you can educate patients on what to avoid? - ANSRaynuad's is form of intermittent arteriolar vasoconstriction that causes cold, pain and pallor of fingertips and toes Avoid stimuli like cold, tobacco and stress; wear gloves or socks to keep warm PAD (Peripheral Arterial Disease): Why is exercise helpful and important for these patients? How does it help their pain? Which patients with PAD should NOT exercise? What are some nursing interventions for patients with PAD? - ANS-PAD is the result of systemic atherosclerosis, it alters natural flow of blood through arteries and veins of peripheral circulation Blood flow to lower extremities needs to be enhanced, neutral and dependent positioning helps Encourage movement (walking) to point of pain, then rest, then resume. CAUTION- the following worsen with exercise: cellulitis, leg ulcers, gangrene and acute thrombotic occlusion Avoid hot water bottles and heating pads on extremities: can cause reflex vasodilation in extremities, but too cold can cause vasoconstriction. A hot water bottle could be used with caution on the abdomen to warm a cold patient. Emotional stress can result in peripheral vasoconstriction Avoid constrictive clothing What is intermittent claudication? - ANS-Intermittent claudication is Arterial insufficiency Hallmark signs: aching, cramping, inducing fatigue or weakness occurs with activity and relieved at rest Pain commonly in muscles that are distal to area of stenosis or occlusion (Ex if pain is in foot, blockage would be at knee) Dependent position can relieve pain. Color: pale and cool when elevated, ruddy and cyanotic when dependent BRUITs, nail changes, skin changes, gangrene, ulcerations and muscle atrophy may all be present. What are common skin characteristics for patients with vascular problems? What is the difference between Rubor and Cyanosis? - ANS-Color: pallor, Temperature - warm or cold Loss of hair, brittle nails, dry or scaling skin, atrophy and ulcerations Edema unilateral or bilateral Gangrenous changes in setting of tissue necro Rubor: reddish blue discoloration of extremities after 20sec-2min dependent position showing severe peripheral arterial damage Cyanosis: bluish tint of skin showing hgb reduced What are the 6 Ps of arterial insufficiency? - ANS-Pain Pallor Pulselessness Paratheisa (sensation change) Paralysis (unable to move) Poikilothermia (coolness to touch) What is warfarin used for and how is it managed? - ANS-Warfarin is used for extended anticoagulation therapy, managed by routine monitoring of the INR (Therapeutic range 2-3) Usually bridged with Heparin in beginning until INR is therapeutic Vitamin K is antidote What are varicose veins? - ANS-Varicose veins are Venous stasis, distended, protruding superficial veins that appear darkened and tortuous. Usually in lower extremities. Varicose veins risk factors - ANS-Risks: familial history, standing jobs, pregnancy Symptoms- dull aches, nocturnal cramps, muscle cramps, ankle edema, heaviness. Varicose Veins Management & Avoidance - ANS-Management and Avoidance: Graduated compression stockings (avoid tight clothes) Elevation of extremities and frequent position changes Exercise (walking, swimming, stairs) Sclerotherapy- injection of irritation chemical clear lumen Surgical removal of veins (vein stripping) Radiofrequency energy to heat veins HTN: What lifestyle modifications can make a difference in improving high blood pressure? What are the top three? What are the typical manifestations for patients with HTN? What are the typical meds that are prescribed for HTN? What med class is contraindicated for patients who are Black and why? - ANSLifestyle modifications include physical activity, dash diet, weight loss (top three), moderate alcohol intake, restrict sodium intake, stress reduction, smoking cessation Headaches (worse in AM), facial flushing, dizziness, fainting, retinal changes or visual disturbance, nocturia Thiazide diuretic, Loop Diuretic, ACE inhibitors, Angiotensin II Receptor blocker (ARBs) Calcium channel blockers, direct Renin inhibitor ACE 1 and slightly ARBs are contraindicated in black patients because they have increased risk of cough and angioedema Orthostatic Hypotension: What is it? How do you assess for it? Who would be at risk for it? - ANS-Low blood pressure of a drop of at least 20 mm Hg systolic or 10 mm Hg diastolic in blood pressure (BP) when someone stands quietly within 3 minutes after rising from a reclining position. Take vital signs when laying down, then once sitting up, then again while standing Orthostatic Postural Hypotension- sustained decrease of >/= 20 m HG in Systolic BP or 10 mm HG in Diastolic within 3 min from lying or sitting to standing. Commonly also dizzy, lightheaded ACE-Inhibitors: What are they used for? What common adverse effects occur and what would your nursing interventions be for a patient who had their first dose vs long term? - ANS-Used to lower Blood pressure BP, Pulse, change position slowly (hypotension A/E), can cause heart and kidney issues (HF). Cough can be S of angioedema (higher risk in Black population) Hemoptysis: what is it and what is it associated with? (slide 14 of cardiac assessment lecture) - ANSHemoptysis is pink frothy sputum is indicative of pulmonary edema Atrial Fib: - ANS-Ventricle rate (frequency of QRS complexes) is variable and irregular, the normal P wave is absent. Atrial Flutter: - ANS-ventricular rate is variable but REGULAR, Sawtooth pattern. PVCs: What is a PVC and what does it look like on a waveform? What are common causes of PVCs that a person who experiences them should know to avoid? - ANS-PVC is an Impulse that initiates the contraction comes from ventricles and ventricular contraction occurs before the next sinus beat, remember the contraction is supposed to start in the SA node (right atrium).