Perfusion Basics: Questions and Answers for Guaranteed Success, Exams of Nursing

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Perfusion Basics – Questions With Complete Solutions

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Peripheral vascular disease Right Ans - Circulation disorders that occur when pathologic changes impair blood supply Peripheral vascular diseases Right Ans - Arteriosclerosis, atherosclerosis, chronic venous insuffiiency PVD primarily affects Right Ans - Older adults African americans have increased risk Hispanics have similar or slightly higher rates Risk factors PVD Right Ans - Smoking Diabetes Htn High cholesterol Family history Obesity Lack of physical acticity Prolonged standing Prevention teaching PVD Right Ans - Maintainging healthy weight, regular exercise, healthy diet Medications may be given to prevent or slow progression of disease arteriosclerosis Right Ans - Thickening and decreased elasticity of arterial walls Atherosclerosis Right Ans - Fat and fibrin accumulate and obstruct arteries chronic venous insufficiency Right Ans - Lack of adequate venous flow over extended period of time. Valve leakage blocks blood flow back to heart intermittenet claudication Right Ans - Cramping in calves or thighs with activity. Relieved with rest. Clinical manifestation of PVD PVD manifestations Right Ans - Peripheral pulses diminished or absent

Bruit heard over large arteries Skin coloration of legs changes with elevation Lower extremeties have thin, shiny, hairless skin. Toenails thickened Ulceration and edema may be present PVD skin teaching Right Ans - Teach that skin breakdown is common Increased risk for gangrene and amputation Teach how to assess skin for breakdown and proper foot care arterial ulcer characteristics Right Ans - Toes, feet, shin Deep pale Pallor on elevation Rubor on dependency Cool temp may have mild edema Severe pain Intermittent claudication Rest pain Gangrene may occur Decreased or absent pulses venous ulcer characteristics Right Ans - Over ankle Superficial and pink Skin can br brown, or cyanotic on dependency Complication can include statis dermatitis Normal skin temp May have significant edema Mild aching pain No gangrene Normal peripheral pulses PVD managment Right Ans - Preventative measures to reduce artheriosclerosis development Symptom managment, circulatory support, skin injury prevention CVI diagnosis Right Ans - Segmental pressure measurments Stress testing Doppler ultrasound/ duplex Transcutaneous oximetry

Angiography Segmental pressure measurements Right Ans - Bp between arms and legs are compared PVD leg blood pressure Right Ans - May be lower Stress testing Right Ans - Measures functional limitations Where ankle pressure declines with exercise Doppler ultrasound Right Ans - Can indicate pvd when waveform is flattened compared to normal waveforms Duplex provides images transcutaneous oximetry Right Ans - evaluates oxygenation of tissues Angiography or magnetic resonance angiography Right Ans - Evaluates location and extent of obstruction PVD is not Right Ans - As effectively treated using drugs Drug therapy focuses on antiplatelet and vasodilation Nicotine is Right Ans - vasoconstrictor Smoking cessation is vital for PVD treatment Non-pharmacologic therapy for PVD Right Ans - Preventative measures Smoking cessation Foot care Lower extremity exercise Rest when claudification Control of comorbidities Surgeries for PVD Right Ans - Endarterectomy removes plaque Bypass grafting establishes blood flow distal to blockage with dacron tubing Stent placement PVD education Right Ans - Elevate legs while resting or sleeping Walk as much as possible Avoid sitting or standing for long periods

When sitting do not cross legs/ allow pressure on knees Do not wear anything that pinches legs Wear compression hose, put on after legs have been elevated Foot care Elastic hose should be Right Ans - Tighter over the feet than at the top of the leg PVD nursing diagnosis Right Ans - Inadequate tissue perfusion Chronic pain Comprimised skin integrity Inability to tolerate activity CVI nursing diagnosis Right Ans - Disturbed body image Inadequate health maintenance Potiential for infection Comprimised physical mobility Comprimised skin integrity Inadequate peripheral tissue perfusion Teaching to keep legs and feet clean, dry and comfortable Right Ans - Wash in warm water with mild soap daily Pat dry with soft towel between toes Apply moisturizing cream Powder on feet and between toes Buy shoes in afternoon, must be comfortable and not touch tip of toes Clean cotton socks daily Teaching to prevent accidents and injuries to feet Right Ans - Always wear shoes or slippers Inspect feet and legs daily Podiatrist to trim toenails Check water temp Do not let legs or tops of feet get sunburned Report leg or foot problems Teaching to improve blood supply to legs and feet Right Ans - Do not cross legs Dont wear garters or knee high stockings

Dont swim in cold water Implementations to promote tissue perfusion with PVD Right Ans - Assess lower extremities: peripheral pulses, pain, color, temp, and cap refil q4hrs Elevate extremity Promote regular exercise Maintain extremity temperature: lightweight blankets, socks, slippers Stress importance of positioning Implementations to promote skin integrity Right Ans - Skin care Bed cradle Provide pressure reducing surface Implementations to encourage activity Right Ans - Instruct and encourage active ROM and position change Activity assistance as needed Include diversions when bedrest is perscribed Hypertension Right Ans - high blood pressure Normal BP Evelated Stage 1 Stage 2 Hypertensive crisis Right Ans - Less than 120/ 120-129/less than 80 130-139/ 80- 140+/ 180+/ 120+ HTN is a major risk factor for Right Ans - Cardiac comorbidities, stroke, renal disease HTN prevalance in race Right Ans - Black adults highest White adults Asian adults Hispanic adults Mean Arterial Pressure (MAP) Right Ans - 1/3 systolic + 2/3 diastolic

Primary hypertension Right Ans - no known cause secondary hypertension Right Ans - high blood pressure with a known cause 5-10% of all cases Secondary hypertension causes Right Ans - Kidney disease Endocrine disorders Coarctiation of aorta Neurologic disorders Drug use Pregnancy Hypothyroidism Sleep apnea Hypertension etiology Right Ans - Middle age and older adults 3/4 ppl over 60 have htn Higher in black patients White males Black and hispanic females Hypertension risk factors Right Ans - Family history Age Race Mineral intake Obesity Insulin resistance alcohol consumption Physical inactivity Vitamin D deficiency Depression Most common cause of hypertensive crisis Right Ans - Abrupt cessation of antihypertensives prevention of hypertension Right Ans - Lose excess weight, follow a "DASH" diet, exercise daily, limit sodium, limit alcohol Primary htn is Right Ans - Asymptomatic

Sustained HTN effects Right Ans - Increased left ventricular workload (ventricular hypertrophy) Atheriosclerosis rate accelerates (increasing risk for CAD) Triggers further development of CAD, dysrythmias, HF diastolic blood pressure Right Ans - Significant risk factor under 50 Systolic blood pressure Right Ans - Significatn risk factor over 50 Cerebral vessel hypertension Right Ans - Produces microanneurysm development Increases risk for cerebral hemmorhage Hypertensive encephalopathy symptoms Right Ans - Extremely high bp Altered loc Increase ICP Optic nerve edema Seizures Hypertension renal affects Right Ans - Nephrosclerosis and renal insufficiency Protienuria and microscopic hematuria Clinical manifestations hypertensive crisis Right Ans - Neurologic visual motor or sensory deficits Rapid onset Papolledema Headache Confusion Hypertensive crisis clincial therapies Right Ans - Administer meds Lower bp gradually to prevent schock Monitor bp continuously Reduce patient anxiety Stroke Clinical Manifestations Right Ans - Sudden onset loss of sensation or movement Hemiplegia

Hemiparesiss Flaccidity Spasticity Sensory loss Stroke clinical therapies Right Ans - Monitor patient's LOC. Administer medications Prepare for surgery Reduce patient's ICP to prevent further damage HTN diagnosis Right Ans - Evaluation of causes Tests done after HTN diagnosis Right Ans - Renal function and urinalysis Serum potassium level Blood chemistry IV pyelography Renal ultrasonography Renal arteriography CT MRI Children should have bp checked Right Ans - On a regular basis past age 3 Primary htn is often found Right Ans - In older children or adolesents Secondary htn is often found Right Ans - In younger children Many older adults develop Right Ans - Isolated systolic hypertension Perferred treatment for older adults with htn Right Ans - Duiretics and CCBs Nursing diagnosis htn Right Ans - Inadequate health maintenance Difficulty adhering to treatment plan Lack of knowledge about nutrition Fluid volume excess Implementations to promote health maintenance Right Ans - Encourage patients to adopt healthy lifestyle changes

Help patients understand progressive nature of disease Implementations to promote adherence to treatment plan Right Ans - Follow up and consistent review of modifications and therapies Assess and address any noncompliance Angina Precipitating Factors Right Ans - Exercise Strong emotion Stress Cold Heavy meal Angina relieving factors Right Ans - Rest Position Nitroglycerin Angina pain location Right Ans - Across chest wall May radiate to arms, neck, shoulders, jaw Angina length of pain Right Ans - 2-5 minutes Angina descriptions Right Ans - Tight Squeezing Heavy sensation Burning Aching Choking Other manifestations of angina Right Ans - Dyspnea Pallor Tachycardia Anxiety Fear Atypical manifestations of angina Right Ans - Indigestion N/v Upper back pain Rest pain gets Right Ans - Worse when legs elevated

Drinks per day that becomes threshold for bp Right Ans - 3 DASH diet Right Ans - Rich in fruits vegetables low fat dairy foods Angina causes Right Ans - coronary artery narrowing, atherosclerosis Exertional angina Right Ans - Stable,sit down and it goes away