Adult 1 Exam 3 Review

• Kidneys sense hypoxia & release erythropoietin that stimulates bone marrow to produce RBC’s (takes 5days) - live 110- 120 days before apoptosis

• • RBC/erythrocyte = biconcave
• • Size RBC: normal = normocytic;small = microcytic; large = macrocytic
• • Color RBC:normal = normochromic; diminished/pale= hypochromic
• • Decrease in RBC’s = anemia
• • Increase in RBC’s = polycythemia - normally found in older men & COPD

• Number of erythrocytes (RBC's) - 3.5 - 5.5 mm₃

• • Contain hemoglobin Hgb - 12-18 gm/dL
• (O2 carrying protine in blood)

• • Hematocrit (Hct) - volume, expressed as % - 36-50%
• Hct is the packed cell volume -% of RBC's in blood

Hct should be 3x Hgb - and both values should move together with increases and decreases

• • Transports oxyhemoglobin (O₂) to the cells
• • Has an affinity to oxygen
• • Iron is needed for production of hemoglobin
• • RBCs are destroyed about every 120 days
• • After RBC destruction (hemolysis) the hemoglobin turns to bilirubin & is metabolized by the liver -
• Jaundice results if not metabolized by liver

• • Low RBC count or
• • Low Hgb or Hct

• DUE TO:
• • Inadequate production of RBC’s
• • Premature or excessive destruction of RBC’s
• • Blood loss– May be occult

• ETIOLOGY
• • Iron or nutrient deficiency
• • Hereditary
• • Chronic diseases
• • Trauma/bleeding

Iron in diet not absorbed well

• RNA = 15 - 30 mg/day -body absorbs 1-4 mg
• Actual need about 1 mg/day

*#1 cause of anemia in elderly - low iron in diet

Iron supplemsnts - give 1st thing in moring with OJ - better absorbed with Vic C

(Loose 250 mg Iron in each unit of blood donated)

• • Weakness
• • Fatigue/malaise
• • Dyspnea on exertion
• • Tachypnea
• • Pallor
• • Tachycardia
• • Palpitations
• • Systolic murmur
• • Night cramps
• • Chest pain/angina due to increased cardiac workload
• • Bone pain due to increased erythropoietin
• • Headache, dizziness or dim vision due to cerebral hypoxia
• • Heart failure with vent. hypertrophy

• Nutritional Anemias –
• • Lack of iron
• • Lack of vitamin B12
• • Lack of folic acid

• Hemolytic Anemias -
• • Sickle cell
• • Thalassemia
• • G6PD
• • Acquired/extrinsic

Aplastic Anemia -

• Blood Loss/Secondary Anemia - • Acute bleeding with normal size & shape of RBC’s(normocytic) if sufficient iron present
• -Takes 3 – 4 wks. For RBC’s to return to normal after bleeding episode

• • Low serum iron & high total iron-binding capacity
• • Low serum ferritin
• • Low H&H (iron needed for the synthesis of Hgb)
• • RBC’s microcytic, hypochromic & poikilocytosis (malformed RBC's) - small, pale, misshapen

• ETIOLOGY:
• • Inadequate ironintake in diet
• • Malabsorption
• • Chronic blood loss esp. GI bleed & menses
• • Most common type of anemia

• • Brittle spoon-shaped nails
• • Cheilosis/cracks around mouth corners
• • Smooth, sore tongue (glossitis)
• • Pica (unusual cravings for starch, clay, ice, cornstarch, etc.)

• Diet:
• • Heme & nonheme sources of iron should be 50/50 in diet
• Heme - animal sources - beef, chix, eggs, pork
• *aids in absorption of nonheme iron

• Nonheme - bran flakes, brown rice, whole-grain breads, dried beans, dried fruits, greens, oatmeal
• *absorption enhanced by Vit C and hindered by tea and coffee

• • Iron supplements -– Pills with OJ to enhance iron absorption
• – Liquid – use straw as stains teeth
• – 2 hr before taking Tetracycline
• – Don’t take with milk or antacids
• – N & V side effect/toxicity
• – Constipation – increase fiber & fluids
• – Black or dark green stools

Procrit/ erythropoietin injections available

Blood transfusions of severe

– B12 is needed to mature RBC's (macrocytic)

• -can be caused by lack of B12 in diet - rare - unually only among vegitarians
• –Animal Sources • Meat/fish (salt water)• Eggs• Dairy (milk & cheese)

• Pernicious Anemia - failure to absorb dietary B12
• – Not absorbed by gastric mucosa due to lack of intrinsic factor or other reasons(malabsorption)

• • Pallor or slight jaundice
• • Sore, beefy red tongue
• • Diarrhea
• • Paresthesias & decreased proprioception

• • Treatment:
• • Increase diet B12 (muscle meats, fish, eggs,dairy)
• • Oral B12 (Kaybovite) if absorption notproblem
• • B12 injections for rest of life if absorption problem(hydroxycobalamin or cyanocobalamin)

• • Poor consumption/diet-
• – Green leafy veggies
• – Fruits
• – Cereals/yeast products
• – Meat

• Older adults, drug users, and alcoholics- ETOH decreases folate metabolism

• • Increased metabolism-
• – Pregnancy need at least 400 mg /d (neural tubedefects)
• – Rapidly growing teens

• Certain medications (methotrexate, pneumopent,oral contraceptives, dilantin)

• • Signs/Symptoms
• • Pallor
• • Weakness/fatigue
• • SOB/dyspnea
• • Palpitations
• • Glossitis
• • Cheilosis
• • Diarrhea
• • No neuro symptoms

• Treatment
• • Correct diet (green leafy veg., organ meats, eggs,milk, cereals)
• • Folic acid supplements(PO or parenteral/IM,SQ, or IV)

• • Intrinsic – disorders within RBC
• – Sickle cell anemia
• – Thalassemia anemia - genetic
• – G6PD (glucose-6-phosphate dehydrogenase)anemia - genetic

• Extrinsic – acquired hemolytic anemia (trauma,drugs, bacteria, toxins)

• Hemolytic = destruction/lysis of RBC’s(normocytic & normochromic)

• Genetic defect (HbS gene)

• • Episodes can be triggered by:
• • Infection,
• • High altitudes (hypoxia)
• • Stress/acidosis
• • Surgery/blood loss/anesthesia
• • Excess exercise

• • Pain is caused by ischemia from the sickled cells clumping and decreasing circulation to organs
• • Can affect all organs (esp. spleen & kidney)

• Sickle cell trait=inherit gene from 1 parent; 40% HbS hemoglobin; asymptomatic unless severe hypoxia

• Sickle cell disease=inherit gene from both parents so at risk for sickle cell crisis

• Sickle cell crisis= severe episode of fever & intense pain with thrombi & ischemia (4-6 days)

• Sequestration crises= blood pooling in liver & spleen esp. in children with sickle cell

• DX: Sickle cell test & hemoglobin electrophoresis

unknown cause or origin

• Malfunctioning bone marrow-no RBC’s, WBC, or Platelets(“Pancytopenia”)
• • Bone marrow replaced by fat
• • Cause: 50% unknown (idiopathic aplastic anemia) Others may be from Chemicals or Radiation (secondary)

• S/S: pallor, fatigue/weakness, dyspnea on exertion, HA,tachycardia, bleeding, infection

• • Tx: remove causative agent, transfusions, bone marrow transplant
• (-allogeneic- from family member
• -autologous -from self)
• corticosteroids,cyclosporine, androgens to stimulate RBC’s

reduction in RBC, WBC and Platelets

ACTIVITY INTOLERANCE R/T anemia

POTENTIAL DECREASED CARDIAC OUTPUT RT bleeding

ALTERED NUTRITION, LESS THAN BODY REQUIREMENTS RT iron, B12, and/or folic acid deficiencies

INEFFECTIVE MANAGEMENT OF THERAPEUTIC REGIMEN R/T diet & medication

SELF-CARE DEFICITS R/T weakness and fatigue

IMPAIRED ORAL MUCOUS MEMBRANES R/T glossitis & cheilosis

• • Increased concentration of RBC’s(erythrocytosis)
• • Red cell count > 6 million/mm3
• • Hgb > 18 g/dl
• Hct > 55%

Primary polycythemia vera – rare; European Jewish men ages 40-70; overproduce RBC’s in absence of erythropoietin

• Secondary polycythemia – most common -response to hypoxia (high altitude, smoker, COPD) with increase in erythropoietin

• Relative polycythemia –due to fluid deficit with normal RBC’s; correct by rehydration

• Symptoms caused by Increased blood volume
• • headache
• • dizziness/vertigo
• • blurred vision
• • tinnitus - rining in ears
• • pruritus/itching

• Symptoms caused by Increased blood viscosity
• • hypertension
• • Intermit. claudication - cramping in lower legs due to inadequate blood flow to muscle
• • thrombus formation
• • ruddy complexion(plethora)
• • wt. loss/night sweats

Decreased neutrophil count = < 1,500mm³

• < 1500 = neutropenia
• < 1000 = risk for infection
• < 500 = high risk for infeciton
• < 200 = agranulocytosis (severe -caused by chemo)
• < 100 = guarnateed to get infeciton

• • S/S: opportunistic infections (bacterial, fungal,protozoa) esp. resp., mouth, GI & vaginal
• – Malaise
• – Fever/chills
• – Extreme weakness/fatigue
• *Temperature is most valid assessment of infection - WBC count will be low anyway

• • TX: GM-CSF, granulocyte macrophage colony stimulating factor to produce WBC’s
• – Antibiotics
• – Reverse/protective isolation - strict handwasing

• =DECREASED PLATELETS
• -decreased production of platelets by the bone marrow -increased peripheral destruction of platelets(spleen also sequesters 80%

NORMAL PLATELET COUNT 150,000 - 400,000

• - < 100,000 mm3 thrombocytopenia
• – < 50,000 mm3 symptoms (petechiae, purpura)
• – < 20,000 mm3 spontaneous bleeding
• – < 10,000 mm3 fatal bleeding

• ITP - Immune thrombocytopenia (idiopathic)
• petechiae
• purpura
• nose bleeds/ epistaxis
• hematuria
• bleeding gums

• TTP - Thrombotic Thrombocytopenia (thrombi form)
• Petechiae
• Purpura
• HA
• Seizures
• Altered LOC

• Ineffective Protection
• Impaired Oral Mucous Membranes

• Intervetions
• Assess for bleeding (everywhere)
• Hold finger sticks for 5 minutes
• Hold arterial punctures for 20 minutes
• No sharp objects
• no rectal temps or IM injections
• Spone tip swab for oral hygiene
• No Asprin
• No blood thinners

• • Granulocytes -
• – Neutrophils 60-70% WBC’s, 3000-7000 mm3, phagocytes 1st to arrive at injury, immature bands
• – Eosinophils 1-3% WBC’s, 50-400 mm3, esp. lungs & GI;allergic reactions & parasitic infestations
• – Basophils <1% WBC’s, 25-200 mm3, histamine, heparin & inflammatory mediators in allergic & inflammatory reactions

• • NongranularWBC’s/agranulocytes-
• – Monocytes 3-8% WBC’s, 100-600 mm3
• - -Phagocytes mature into macrophages; bactericidal & proteolytic enzymes

• – Lymphocytes 20-30%, 1000-4000 mm3
• -- Mature in thymus to B & T cells, humoral & cell-mediated immunity

• check Dr’s order & pt. consent
• • check labels - 2 Nurses - check crossmatch
• • Pt arm band
• • MAR
• • Label on blood
• • baseline vitals & q 5 min x3 then q 30 min til 1 hr post
• • #18 gauge needle
• • normal saline only
• • set with filter
• • severe reactions first 15minutes
• • change tubing/filter if giving multiple units
• • return bag to blood bank

• Never add medications to blood products
• Infuse over 2 -4 hours
• Check blood for bubble/ discoloration

Flshing may be normal but stop and check anyway

Diuretics (Lasix) commonly ordered after blood to decrease fluid volume

• - Febrile (1st 15 min.)
• Sensitivity of client’s antibodies to donor’s WBC’s
• • Fever
• Chills
• • Warm flushed skin
• • Headache
• • Anxiety
• • Muscle pain

• Hypersensitive (during or after transfusion)
• • Mild Allergic
• • Sensitivity of client’s antibodies todonor’s plasma proteins (IgA)
• • Itching
• • Flushing
• • Urticaria/wheals
• • Bronchial wheezing
• • Severe Allergic(Anaphylactic)
• • Antibody – Antigen Reaction
• • Dyspnea
• • Chest pain
• • Circulatory collapse
• • Cardiac arrest

• Acute Hemolytic = Discontinue Blood
• ABO incompatibility between client & donor
• • Chills
• • Fever
• • Headache
• • Backache
• • Dyspnea
• • Tachypnea
• • Cyanosis
• • Chest pain
• • Tachycardia
• • Hypotension

• Circulatory Overload
• Blood running too fast for body to accommodate
• • Cough
• • Dyspnea
• • Crackles
• • Distended neck veins (+JVD)
• • Tachycardia
• • Hypertension

• Sepsis
• Contaminated blood was administered
• • High fever
• • Chills
• • Vomiting
• • Diarrhea
• • Hypotension
• 21
• Blood Reactions Acute Hemolytic
• ABO incompatibility between client & donor
• • Chills
• • Fever
• • Headache
• • Backache
• • Dyspnea
• • Tachypnea
• Discontinue Blood
• • Cyanosis
• • Chest pain
• • Tachycardia
• • Hypotension
• Blood Reactions - Circulatory Overload
• Blood running too fast for body to accommodate
• • Cough
• • Dyspnea
• • Crackles
• • Distended neck veins (+JVD)
• • Tachycardia
• • Hypertension
• Blood Reactions - Sepsis
• Contaminated blood was administered
• • High fever
• • Chills
• • Vomiting
• • Diarrhea
• • Hypotension

• • Stop the Blood ( tubing & KVO with .9NS IV)
• • Call MD
• • Monitor Vitals, I & O
• • Give Antipyretics, antihistamines as ordered
• • Treat shock if present
• • Recheck crossmatch

• Hemolytic Reactions:
• • blood samples
• • urine sample
• • monitor fluid / lytes
• • evaluate cause of reaction

• Normal <120/ <80
• - Recheck 2 yrs & cont lifestyle practices

• High Normal (pre-hypertensive)
• 120-139 / 80-89
• -recheck in 1 year - lifestyle changes

• Stage 1 Hypertension
• 140-159 / 90-99
• -confirm in 2 months - lifestyle changes & diuretic

• Stage 2 Hypertension
• >160/ >100
• -evaluate or refer within 1 month - lifestyle changes, diuretic, and anti-HT drigs

• Persistent high blood pressure
• Systolic pressure above 140 mm Hg
• Diastolic pressure above 90 mm Hg

Based on average of 3 readings sep. occasions

• Major cause of:
• Heart failure/CAD
• Stroke/CVA
• Kidney failure

Primary/essential – 90%

Secondary to another problem(renal disease, adrenal tumors,drugs like antihistamines orcorticosteroids, pregnancy) –10%

• Onset Age 30-50
• No known cause but Risk Factors are:
• Overactive renin angiotensin,aldosterone with Na & H2O retention

• Diabetes Mellitus
• -Increased fat & plaquein arteries
• - Increased vascular resistance

• Overactive sympathetic
• -causes vaso/ veno constriction

• Obesity (central)
• - Apple vs. Pear

• Insulin Resistance
• - Increases blood clots

• ↑ Alcohol Intake
• - 3 or more drinks/day

• Smoking
• - Nicotine vasoconstricts

• Stress
• - Vascular smooth muscle hypertrophy

• look for secondary if < 20 yr or > 50 yr with sudden onset Causes of Secondary HT:
• Narrowing of Aorta
• Renal Disease
• Spinal Cord Injury
• Pheochromocytoma
• Pregnancy
• Cushing’s Syndrome
• Medications:
• - Cocaine
• - Methampheta.
• - BC Pills/estrogen
• - Pseudophedrine

• Hypertension:
• Asymptomatic except elevated BP
• Headache (back head & neck)
• Nocturia
• Confusion
• Nausea & vomiting
• Visual disturbances
• Retinal hemorrhages
• Papilledema/swelling optic nerve

• Hypertensive Crisis:
• Sudden & severe ↑ in BP (Systolic > 180 mmHg /Diastolic > 120 mmHg)
• S/S: HA, blurred vision, confused, neuro deficits
• Due to:
• under medicated for HTN
• or lack of compliance with regimen
• or from crack, cocaine, PCP, LSD

Causes organ damage: MI, Renal Failure, Pulm.Edema, Aortic Aneurysm, Intracranial Hemorrhage,CVA, or DIC

TX: IV drugs: NTG, Nitroprusside, Hyperstat,Apresoline, Brevibloc, Vasotec, Lasix, Cardene etc.

(hypertension) is an important risk factor for the development and worsening of many complications of diabetes, including diabetic eye disease and kidney disease. It affects up to 60% of people with diabetes.

• Having diabetes increases your risk of developing high blood pressure and other cardiovascular problems, because diabetes adversely affects the arteries, predisposing them to atherosclerosis (hardening of the
• arteries)

Dietary Approaches to Stop Hypertension

• Eat fruits and vegetables (up to 10 servings/ day)
• Use low-fat dairy products
• Reduce sodium intake
• Reduce cholesterol, fat and saturated fat intake
• Grains - 7 -8 servings / day
• Meats/ Fish/ Poultry - 2 or less 3 oz servings/day

• H Y P E R T E N S I O N
• Nursing Diagnoses
• Ineffective Health Maintenance RT lack of knowledge of pathology, medications & diet
• Risk for Noncompliance RT medications
• Anxiety RT diagnosis, regimen, & lifestyle changes Sexual Dysfunction RT HTN medications
• Excess Fluid Volume RT renin angiotensin aldosterone system
• Decisional Conflict RT smoking
• Imbalanced Nutrition (More) RT obesity
• Risk for Injury RT Hypertensive Crisis

• Monitor:
• BP at frequent intervals
• Vision (retinal changes)
• I & O
• Renal Studies
• Weight
• Medication compliance

• Diet-DASH
• Low fat
• Low salt

Stop smoking

• Limit alcohol to
• 1 beer (12oz)
• 5 oz of wine
• 1 oz alcohol

• Physical activity
• Stress reduction
• Exercise
• Biofeedback
• Therapeutic touch
• Yoga
• Meditation

• Decrease Volume
• Inhibit Aldosterone
• Negative Sodium Balance

Thiazide Diuretics- distal tubule 70-80% Na reabsorbed; safe (hypokalemia, skin rashes,gout & hyperglycemia)

• Hygroton, Diuril, Hydrochlorothiazide (HCTZ)
• Loop (of Henle) Diuretics – 10-20% reabsorbed (more potent than thiazides)
• Lasix (hearing loss & hypokalemia), Bumex, Edecrin

Potassium-Sparing Diuretics- inhibit aldosterone Aldactone (gynecomastia over long time)

decrease heart rate & cardiac output & interfere with renin release by kidneys

• Atenolol
• Toprol XL
• Lopressor
• Levatol
• Cartrol
• Corgard
• Inderal

Assess for asthma,chronic lung disease, bradycardia Assess BP & apical pulse b/4 giving & hold HR< 50 b/m Report bradycardia,fatigue, dyspnea,altered gluc. levels Chg. positions slowly to prevent dizziness

• Inhibit conversion of Angiotensin I to Angiotensin II;prevents vasoconstriction & NA & H2O retention or blocks Angiotensin receptor sites
• Captopril
• Lotensin
• Vasotec
• Monopril
• Univasc
• Altace
• Cozaar
• Diovan

• Ck. BP b/4 giving
• Monitor BP for 2 hr post first dose
• Report peripheral edema or cough
• Can cause hyperkalemia & impotence
• Monitor for renal &hematologic changes
• Not if pregnant

• Inhibit calcium influx therefore causing vasodilation & reducing peripheral resistance
• Cardizem
• Procardia
• Cardene
• Norvasc
• Verapamil
• Plendil

• Assess BP, pulse, &liver functions (hold if HR <50 b/m) Report signs of bradycardia or SOB
• Force fluids to prevent constipation
• Watch for reflex tachycardia & CHF

• Decrease vasomotor tone, reduce LDL
• Cardura
• Minipress
• Hytrin

• Give 1st dose at night to prevent “1st dose syncope”
• Assess BP & pulse before each dose for orthostatic hypotension, tachycardia& palpitations

• stimulate alpha-2 receptors to suppress sympathetic out flow to heart & vessels, causing vasodilation & ↓ cardiac output
• Catapres
• Tenex
• Aldomet
• Reserpine

• Baseline BP, CBC,Liver Functions
• Give at night(sedates)
• Give gum or fluids for dry mouth
• Severe reflex hypertension if abruptly discontinued

• Decrease peripheral resistance, peripheral vasodilation, relaxation of smooth muscles
• Apresoline
• Nitroglycerin
• Hyperstat
• Loniten

• Assess BP & Pulse b/4 giving
• Report peripheral edema
• Report muffled heart sounds (Loniten) due to possible cardiac effusion/tamponade
• Report joint pain,fever (signs of SLE)

Angina is chest pain resulting from reduced coronary blood flow, which causes a temporary imbalance between myocardial blood supply and demand (ischemia)

• May be caused by:
• CHD - coronary heart disease
• Atherosclerosis
• vessel constriction that impairs myocardial blood supply

• S & S
• Chest Pain - substernal or precordial - may radiate to neck, arms, shoulders or jaw - tight squeezing, constricting, burning, aching,
• Dispnea
• pallor
• tachycardia
• anxiety
• fear

• Relieved by
• rest,
• position change
• nitro

More than 30 minutes of ischemia causes irreversable damage to myocardial cells

Coronary Artery Disease also called CHD -Coronary heart disease

• caused by impaired blood flow to the myocardium
• Atherosclerotic plaque is the usual cause

• Nonmodifiable
• Age
• - Men >45
• -Women >55
• Gender
• Heredity

• Modifiable
• Smoking
• Obesity
• Physical inactivity
• Atherogenic Diet
• Hyperlipidemai
• Hypertension
• Diabetes

• Stable angina - most common & predicatable - occurs when the work of the heart is increased by physical exertion, exposure to cold, or by stress
• -relieved by rest and nitrates

• Unstalble angina - occurs with increasing frequency, severity, and duration - pain is unpredictable and occurs with decreasing levels of activity and may occur at rest
• -at risk for MI

• Prinzmetal's (variant) angina - atypical -occurs unpredictable (unrelated to activity) and occurs often at night
• -caused by coronary artery spasm with or without atherosclerotic lesion

• Total serum cholesterol
• C-reactive protein - elevated levels in CAD
• ABI - ankle-brachial blood pressure index
• Exercise ECG testing
• Electron beam computed tomography
• Myocardial perfusion imagin

• Electrocardiography ECG
• Stress ECG
• Radionucline Testing
• ECHOcardiography
• Coronary angiography

Goal of treatment is to reduce oxygen demand and increase oxygen supply to myocardium

• Nitrates - Nitroglycerin - fast
• venous and arterial dialation

• Beta Blockers -prophilaxis - first line to treat stable angina
• propranolol
• metoprolol
• nadolol
• atenolol
• block EPI & NOR (cardiac stimulators) -reduce heart rate, contractility, and blood pressure

• Ca Channel Blockers - slow acting - prophilixis
• verapamil
• dittiazem
• nifedipine
• act on cardiac muscle -coronary vasodialtors- lower BP, reduce contractility,

• Ineffective tissue perfusion: Cardiac
• Risk for ineffective therapeutic regimen managment

• Intervetions:
• Keep Nirto on you
• space activity with rest
• smoking cesation
• Modifiable risk factors:
• smoking
• obesity
• physical inactivity
• diabetes
• hypertenion

• Immobility
• Abdominal surgery
• Orthopedic surgery (50% esp. hip & knee)
• Use of hormones (HRT, BC Pills, or ERT)
• Pregnancy
• Certain cancers (pancreas, lung, ovarian,testes, breast, stomach)
• Coagulation disorders/polycythemia

• Asymptomatic
• Leg pain, Homan’s sign - leg pain when examiner dorsiflexes foot (knee at 90 degrees)
• Edema
• Inspection compare bilaterally-measure calf
• Tenderness, warmth &red/erythema

• PREVENTION:
• Elastic stockings TEDS
• IPC (intermittent pneumatic compression devices)
• Positioning-elevate legs
• Exercise/ROM
• Heparin, Coumadin/INR assess for bleeding

• Intervetions:
• Bedrest – NO Ambulation
• Encourage diversional activities
• Legs elevated 15-20 degrees with knees slightly bent Warm moist packs (Aqua K Pad)
• Check for bleeding on anticoagulant therapy & monitor PT, PTT, INR
• Check pulses in extremities
• Monitor for signs of pulm. emboli

blood thinners - used for DVT

• heparin
• prevents conversion of firbrinogen to firbrin
• started first - IV - test with PTT
• side effects - bleeding
• antidote - protamine sulfate

• warfarin (coumadin) PO started - inhibits synthesis of Vit K dependnet clotting factors
• overlap of 4 to 5 days important
• warfarin full anticoagulant effect is delayed and may actually promote clotting for the first few days of therapy
• -monitired with INR
• -Side effects - bleeding
• antidote - Vitamin K

While on coumadin therapy avaid food high in Vit K - green leafy vegetables (kale, spinach, parsley, etc)

used to restore blood flow to the ischemic myocardium in patients with CHD

catheter into arterial circualtion - guide wire used

PCTA - ballon tipped catheter - get to point of athersclerotic plaque & ballon is inflated to force plaque into vessel walls - stint may also be inserted

• ARTERIOSCLEROSIS
• Hardening of the arteries
• Walls become thickened,inelastic & calcified

• ATHEROSCLEROSIS
• Obstruction of arteries(atheromas or plaques)
• Accumulation of lipids,calcium, blood components,carbohydrates and fibrous tissue

• Age 60-70 yrs.
• Gender/males
• Diet (cholesterol)
• Hypertension
• Diabetes
• Smoking
• High homocystine levels esp. menopause
• Race/Afr. Amer.

• Total cholesterol
• < 200= low risk
• 200-239=mod. risk
• 240+ = high risk

• Cholesterol Fractionation
• Triglycerides less than 150
• HDL more than 45 for males
• HDL more than 55 for females
• LDL less than 100 for all people especially those with risk factors

• Pain with exercise/Intermittent Claudication due to lack of circulation(goes away with rest)
• Bruit (audible flow through partially blocked vessel)
• Rest Pain – more of a burning when legs elevated(better when dependent)

• ASSESSMENT
• Pallor with elevation but rubor if dependent
• Paresthesia, decreased sensation
• Peripheral pulses (↓ )
• Nails (cyanosis,clubbing)
• Skin (shiny, thin)
• Hair distribution (↓)
• Cool extremity

cramping or pain in the leg muscles brought on by exercise and relieved by rest

due to decreased blood flow to the lower extremity

- possible sign of PVD

• Vasospasm of small arteries & arterioles of fingers & toes (bilat.)
• Esp. young women20-40 yrs.

• Due to -
• Exposure to cold or stress
• Genetic predisposition ??

• Signs & Symptoms-
• Blue, White, & Red progression
• Numbness, stiffness,pain
• Brittle nails

• Treatment –
• Ca+ chan. blockers
• NTG transdermal
• Reserpine
• Keep warm (gloves,socks)
• Stop smoking

• BUERGER’S
• * Small & midsize arteries become inflamed & spastic causing clots (unilat)
• * Young men <40 who smoke (stop smoking)
• * Painful ulcers &gangrene may develop
• * Regular exercise
• * Avoid exposure to cold
• * Prevent injury
• * Stress management

• RAYNAUD’S
• * Vasospasms of the fingers and toes(bilat)
• * Young women 20-40
• * Autoimmune condition
• * ?? Genetics
• * Blue, white, & red colors
• * Avoid exposure to cold, heat and trauma
• * Medications may help
• * Stress management

• manifestations similar to MI
• chest pain
• SOB
• anxiety
• sence of impending doom