Finalz

• Hypertension


  Elevated blood pressure
• PAD/PVD


  Peripheral arterial/venous disease
• Priorities??? Monitoring for hypertensive emergencies and signs of end organ damage (elevations in Creatinine indicate renal damage!)
• Monitoring for hypotension related to medications
• Elevated Hypertension

  120-129 / Less than 80
• Stage 1 Hypertension

  130-139 / 80-90
• Stage 2 Hypertension


  140-149/ 90+
• Hypertensive Urgency

  A person who already has a history or HTN, blood pressures raises to 180/110 but they are not showing signs of end-organ damage
• Hypertensive Emergency

  Elevated blood pressure of 180/110 and showing signs of end-organ damage
• Signs of End Organ Damage

  • Cyanosis
  • Tachypnea, Dyspnea
  • Elevated Creatinine Levels
  • Any signs that an organ being poorly perfused
• Hypertension Medications

  • ARBs
  • ACE inhibitors
  • Vasodilators
• Hypertension Lifestyle Changes


  • Exercise
  • Stress relief
  • Smoking cessation
  • DASH diet
  • Limit alcohol consumption
• Priorities??? Check pulses and circulation to ensure adequate perfusion! Be alert to intermittent claudication
• PAD

  Peripheral arterial disease
• PVD


  Peripheral venous disease, failure of valves in the veins to move blood back to the heart from the extremities
• PAD Signs and Symptoms

  • Pain with movement (intermittent claudication), improves by dangling legs and rest
• PVD Signs and Symptoms


  • Swelling in lower extremities, improves by elevating legs
• PAD Assessments

  • Check pulses (doppler for very weak pulses)
  • Temperature (cold extremities)
• PVD Assessments

  • Elevate legs, monitor for weeping/skin breakdown due to edema
• PAD Treatments

  • Anticoagulants
  • Removal of blockages
• PVD Treatments

  • Diuretics
  • Elevation
  • Wrapping with ACE bandages
• Priorities??? Airway and Breathing! (PE) Circulation (DVT) Peripheral pulses Assess swelling, redness and warmth in one extremity Treat with IV heparin infusion!
• PE


  Clot in the blood vessels in the lungs, the blood clot develops, loosens, then travels and causes an obstruction in a pulmonary artery, impairs gas exchange & circulation
• DVT

  Clot in the deep veins that return to the heart, typically in the lower extremities
• Conditions that can lead from PE/DVT

  • Myocardial Infarction
  • Ischemic stroke
• DVT Signs and Symptoms


  • Unilateral lower extremity edema/redness/warmth
• PE Signs and Symptoms


  • Shortness of breath
  • Hyperventilation
  • Low SPO2
• DVT/PE Treatments

  • Anticoagulants
  • Heparin
  • Warfarin
• Priorities??? TIME IS MUSCLE! MI indicates decreased cardiac output and impaired tissue perfusion. Remember OLDCARTs for chest pain. Implement MONA STAT!
• STEMI


  ST-Elevation Myocardial Infarction
• MONA


  • Morphine
  • Oxygen
  • Nitroglycerin
  • Aspirin
• Nitroglycerin Use


  Can use up to 3 times, 5 minutes apart. If it does not work after the 3 uses, you need to go to the ED. Monitor BP and HR in between each dose. Sit/lay down to avoid orthostatic hypotension.
• Myocardial Infarction Pathophysiology


  Blood clot in the coronary arteries blocks the blood vessels that feed blood to the heart muscle, causes heart muscle ischemia
• Stable Angina


  Pain with physical exertion that goes away with rest
• Unstable Angina

  Pain with physical exertion that does NOT go away with rest
• MI Lab Values


  • Troponin
  • CK-MB
  • Myoglobin (more non-specific)
  • LDL and HDL cholesterol
  • Triglycerides
  • Total cholesterol
• MI Signs and Symptoms

  • Chest pain/angina unresolved by rest or nitroglycerin
  • Nausea
  • Indigestion
  • Shortness of breath
  • Increase BP, increase HR
  • Anxiety
  • Diaphoresis
• Females may have less noticeable symptoms than men, MI is more deadly in females, but more common in men!
• MI Treatments

  • Cardiac catheterization (PCI): Stenting of blocked vessel in the heart
  • CABG: grafting of another vessel over heart
• MI Prevention: Diet, exercise, medication adherence