New User Special Price Expires in

Let's log you in.

Sign in with Facebook


Don't have a StudySoup account? Create one here!


Create a StudySoup account

Be part of our community, it's free to join!

Sign up with Facebook


Create your account
By creating an account you agree to StudySoup's terms and conditions and privacy policy

Already have a StudySoup account? Login here

Week 4 notes

by: Ashlan Notetaker

Week 4 notes NURS 3205

Ashlan Notetaker
University of Memphis
GPA 3.2

Preview These Notes for FREE

Get a free preview of these Notes, just enter your email below.

Unlock Preview
Unlock Preview

Preview these materials now for free

Why put in your email? Get access to more of this material and other relevant free materials for your school

View Preview

About this Document

Notes over hypertension, CAD, PAD, DVT, angina
Nurs Adult I/Common Hlth Alt
Class Notes
Nursing, Medicalsurgical, Hypertension, CAD, PAD, DVT, angina
25 ?




Popular in Nurs Adult I/Common Hlth Alt

Popular in NURSING

This 20 page Class Notes was uploaded by Ashlan Notetaker on Saturday September 17, 2016. The Class Notes belongs to NURS 3205 at University of Memphis taught by Harrell in Summer 2016. Since its upload, it has received 6 views. For similar materials see Nurs Adult I/Common Hlth Alt in NURSING at University of Memphis.

Similar to NURS 3205 at University of Memphis


Reviews for Week 4 notes


Report this Material


What is Karma?


Karma is the currency of StudySoup.

You can buy or earn more Karma at anytime and redeem it for class notes, study guides, flashcards, and more!

Date Created: 09/17/16
Hypertension An arterial or venous issue or both? What does the heart have to pump against to get blood to the body? - Overcome pressure inside the arteries o Arteries are muscular Arteries are much thick walled, have more ability to expand and contract and made with smooth muscles (compared to how the veins are) Pressure the heart has to pump against is called SVR (systemic vascular resistance) - Systemic meaning body - Vascular meaning vessels - Resistance meaning resistance to press against ICU you can measure SVR by invasive cardiac monitoring techniques - General term what the heart must pump against Hypertension is caused by sometimes thickening and hardening of the arteries will the resistance be increased or decreased? - Increased What causes hardening of the arteries and what is that called? - Arteriosclerosis o Hardening of the artery Causes for hypertension: smoking cigarettes; too much alcohol; stress; family history - All at risk for hypertension or increased SVR Very common 75-80% of patients at his clinic has hypertension Cultural causes for hypertension 1. We are in the south 2. We like to eat 3. We like to smoke 4. We like to drink Why treat? - High way to a heart attack or stroke Pg 712 Table 33-2 – classification of hypertension - Normal blood pressure o Most correct <120 over <80 - Prehypertension – 120-139/80-89 - Primary – 140-159/90-99 – essential hypertension, more commonly seen - Secondary – caused by some other factor disease process >160/>100 Systolic over diastolic - Systolic measures pressure during systole (heart contracting) higher number - Diastole measures (more dangerous) heart resting – lower number Why is diastolic hypertension more dangerous than systolic or combined hypertension? - Increased diastolic means the heart has an increased pressure while at rest If the diastolic number is high there is more pressure while resting - which puts you at higher risk for further disease Cardiac output- stroke volume (SV) x the number of beats per minute - SV – how much blood pumped per beat o Normal cardiac output– 4-8L per minute - Important? o Someone who has long standing hypertension and they got sickness in their vessels that they have had for years their heart gets tired, what will happen to their cardiac output?  It’s going to go down o What vital things depend on cardiac output?  Brain  Cardiac perfusion  Lungs  Organs If someone’s heartrate is fast, what effect does that have on their cardiac output? - Should increase it o If it is severe tachycardia it will actually decrease it - It increases when you exercise, the blood pressure will also increase Nurse teaches the patient who has hypertension about what when they exercise? - Increase blood pressure Table 33-4: Risks for primary hypertension - Alcohol - Age after 50 - Tobacco use - sodium (where sodium goes water follows- with all that water in the vessel the vessels have a higher pressure so it increases blood pressure) - African American population o Also they have a higher acuity because African Americans have higher incidents of secondary renal failure and disease from hypertension o Treat more aggressively to save the kidneys How is hypertension found? - Commonly there are no symptoms associated with hypertension Silent killer because most people who find out that they have high blood pressure don’t know it! It can be asymptomatic. - Some people find out by headaches or dizziness and they just finally go to the doctor for not feeling too well - Important for the nurse to teach on this Nurse should ask (history is extremely important) - Any use of alcohol or tobacco - Any family history of heart issues (high blood pressure, heart attack, stent, heart cath done)!!! o Increase in risk if someone in immediate family has had heart trouble Things that can happen from blood pressure cause by Prolonged exposure to injuries and pressure in arterial system - Long term like Coronary Artery Disease - Retinopathy - Arterial disease issues - Cardio myopathies You are a nurse with a patient who has just been diagnosed with hypertension, how will the nurse teach the patient to eat? (diet considerations) - Low sodium - Dash eating plan (very important) – points in the direction of a healthy heart diet o Fruits o Vegetables o Wheat/ whole grains o Low fat milk and milk products o Fish and poultry, beans, seeds, nuts What would the nurse choose not to eat for the patient related to high sodium? - French fries - Chinese food – soy sauce - Sushi - Processed foods – frozen dinners - Diet coke - V8 juice - Restrict salt intake!! o Look for labels that read lower sodium For those in prehypertension stage we can get rid of it if they change their diet and exercise - Walk 5 or 6 days a week Most adult exceed the average sodium intake 3,400mg !Quit smoking! Take medicaine table 33-7 WWKYP for hypertension medications - First dose effect – common with -prils (ace inhibitors) - Patient takes first pill stands up faints falls on the floor hits their head and dies o Clonidine (central acting alpha adrenergic antagonists) o Take medicine and go to bed o Hydrochlorothiazide – diuretic (still cause orthostatic hypotension) got to take in the morning because it makes you use the bathroom  Take diuretics in the morning o Take medicine and SIT DOWN for first dose effect Risks- pril, ide Labs to watch - Hydrochlorothiazide (hypokalemia) + hypertension+ diuresis = potassium (heart needs potassium) - Low side – we are going to notify the provider Hypokalemia – heart goes into a ST rhythm and you need to notify provider - Not the answer to note the value and continue care Hypertensive crisis - Hypertensive emergency develops over hours to days, 220/140 with clinical evidence of target organ disease o Is high blood pressure + organ affected?  Pressure is high and kidneys, heart, or abdominal pain is also happening  The evidence of an organ - Urgency develops over days to weeks, 180/110 BP and no clinical evidence of target organ disease o ER goes to triage non-urgent, urgent, and then emergent  Emergent is immediately  Urgent is something needs to be done in the next couple hours Nurse caring for a patient with hypertensive urgency, what shall thou do? - Want to get BP down - Do this by giving something IV (you can drop BP too fast, so watch out) o Lower the BP slowly – usually IV as IV push o May not get to the goal of <120/<80 (in 30 minutes), but get out of urgency age - Can IV for emergency or urgency Clonidine is affective of lower BP through PO pretty fast, but it acts for about 30min to an hour and then the BP shoots back up - Look out for rebound hypertension - We would want to use instead an IV beta blocker that lasts a longer amount of time Teach your patient to take their medication - Most places (like hospitals) can give so many free - Connect to resources - Find coupons and samples Side effects of hypertension drugs - Drowsy - Fatigue effect- beta blockers, ace inhibitors, calcium channel blockers CAD ACS is really a result of CAD CAD is a result of long standing hypertension If we are teaching a patient with risk of long standing hypertension what would we include in teaching? - CAD DO you know the anatomy of the blood vessels that are sitting on the heart? - Coronary artery is not a great vessel, it’s not the vena cava, not the aorta, not the pulmonary artery - These vessels that feed the heart muscle When the heart beats and contract that is called systole, it relaxes and it is called diastole – ventricles So when the ventricles contract without systole, when is the heart muscle perfused in the cardiac cycle? - Take the common sense path... if the muscle is contracted tightly do you think it can receive blood flow? NO but we learn when the heart contracts it pumps blood, so it should be pumped during systole (but it’s not). The heart muscle is perfused during diastole. Heart pumps and heart relaxes. The aortic valve sits at the aorta that comes out of the left ventricle and the pressure in the aorta as the heart relaxes causes some retro grade flow Sitting above the aortic valve- coronary ostia - Little wholes that feed the coronary artery Retro grade flow that comes back during diastole flows into the coronary artery and feeds the heart muscle How big are the arteries? - Pull up an open heart surgery and see them -mm wide at the widest (very small) What causes hypertension? - Arteriosclerosis A little artery that is hardens what happens? - Increased pressure and flow doesn’t happen Second huge risk factor for CAD is diet - Saturated fat o Chemistry saturated vs Unsaturated  Has to do with the number of hydrogen ions that compound carries  Unsaturated is not loaded with hydrogen ions o Bad about saturated fats egg, bread, meat, bacon  Where does it go?  Pumps around our blood vessels  Triglycerides, Cholesterol – pump around out blood vessels and cannot stick (Lipemic blood specimen)  Someone who has a lot of triglycerides in their blood and you draw the blood and then send it down, it will look like milk on the top, so much fat is in it What happens in you like it for too long, and a nick that sometimes occurs because you are getting older, or you’ve smoked or drank too much, or may have had an injury prior that you didn’t know about and that nick inside the blood vessel (endothelium) starts catching the fatty stuff. How many times does your heart beat a minute? - 60-100 Circulation circulates entirely and the fat is in there and starts sticking where the nick is. That is what is called atherosclerosis. Over time that little place where that cholesterol and triglyceride and fatty stuff sticks it gets hard, and the hard stuff is called plaque. Plaque is very hard, calcification, not a fatty soft stuff. If Atherosclerosis develops in a coronary artery, what’s going to happen? - Blood flow is affected, atherosclerosis can happen anywhere in the arterial system - If it happens specifically in the coronary artery, then we have CAD o Decreased blood flow through the coronary artery  What happens to the muscle distal to that plaque?  Not getting enough blood  Leads to cardiac Ischemia Risk factors for CAD are same as hypertension - Plus add fat to that diet and cholesterol , family history Nonmodifiable risk factors pg 732 (cannot change) - Age - Gender (though….maybe not anymore) - Ethnicity Modifier risk factors (we can change) - Elevated serum lipids pg 733 - Hypertension Elevated serum lipids – fat - Types of fat o Cholesterol - > 200  LDL – >160  HDL- <40 o Triglycerides - >150 Cholesterol or triglyceride, which changes faster - Triglyceride changes faster after a high fatty meal - Cholesterol is a sustained measure of the fat in your blood - Don’t worry about VLDL We can modify hypertension– - Treat your hypertension o medicine, diet, exercise o reduce risk factors Obesity modify by exercise Diabetes modify by making sure blood sugar in check Stress modify, it is modifiable but he didn’t say how… and went on to a new topic - Table 34-2 You are a nurse preparing to give a diet to a patient with coronary artery disease , what might you include in that diet? - Low fat (in saturated fat) - Need fish fat o Omega 3 fatty acids are good o It is recommended to take Omega 3 pills since we don’t live in a fish area o Cheap fish is bad Table 34-5 Drug therapy pg 739 - Specifically, to get those fatty acids down 1. Exercise and diet upon findings (improve diet) 2. After a few months and nothing has help we have to have a talk with the patient (could be they have genetic predisposition to hyperlipidemia) a. Start on medicine like the -statin drugs i. Expected outcome of these drugs are decrease in cholesterol in some sort of fashion WWKYP of -statin drugs (which decreases cholesterol) - Statins will kill the Liver - Monitor LFT (remember from pneumonia) o if the tests are elevated then we need to act upon this!! - Common side effect myopathy (myalgia) o Muscle pain Niacin - Side effect: flushing usually early on within the first few doses - Supplements – o Omega 3 o Rice Why do we care? - Uncontrolled cholesterol + hypertension = CAD Females are at higher risk for developing heart disease earlier, specifically if they have predisposing risk such as diabetes, first relative has heart disease, we might put them on antiplatelet therapy which is most commonly – acetic salicylic acid -aspirin 81 mg every day Aspirin platelets (NSAIDS) - keep platelets from sticking together o antiplatelet or inhibits platelet aggregation - WWKYP aspirin o Bleeding - It suppresses inflammation and reduce inflammatory affects that cause CAD o That why we think there is a twofold benefit to aspirin - Difference between baby aspirin at 81mg (keep platelets from sticking) and big aspirin at 325mg (headache) Angina What does CAD look like? Has Chest Pain… may How do we know if it is a cardiac issue when the patient complains of chest pain? - Pg 741 the different types of chest pain - We don’t know. Always assume that it is a cardiac problem until proven otherwise Typical manifestations of CP - Tight, squeezing, pain in the center of the chest (hallmark – sternal, squeezing tightness) - Pain can radiate o Jaw (toothache) o one side of the chest or other o back o arm  left arm would indicate a pathology on the left side of the heart Atypical presentations are - women (middle aged and higher) - patients that have diabetes What affect does diabetes have on the nerves? - Neuropathy’s develop (nerves don’t connect and impulse like they used to) - They may never know they have CP or having an MI because their nerves are not working correctly Why is this pain occurring? - Plaque is there, blood flow can’t go so you have ischemic heart muscle, and there is no oxygen in the tissue and so it hurts Table 34-9 – summary comparison of the angina’s Chronic stable angina - Usually bought on by exertion, stress, drugs - Relieved by nitroglycerin - Had angina for years, but lives with it and knows how to live with it Prinzmental’s angina - Caused by vasospasm, not usually plaque, but still have ischemia that occurs - Comes and goes whenever Unstable angina - Hallmark: episode of CP that is not relieved by nitroglycerin or rest - Wait 5 minutes between each dose of nitroglycerin - 3 times then call 911 - This will kill your patient quicker - This is a heart attack - WWKYP with heart attack o Dysrhythmia after episode of ischemic occurs o If we have unstable angina that is untreated it will take it down the read to a MI  What kills patients from MI is the dysrhythmias of the heart muscle which is usually Vfib  Vernicles are just wiggling, not pumping  Your patient is dying  New CPR protocol is to get the AED faster and quicker than before because you need to shock them asp out of Vfib Nitroglycerin - Treats Stable and unstable - Nitrogen nitrates dilates smooth muscle – Vasodilator - Sublingual, eye drops, patch on arm, paste that can go on the arm Prinzmental’s – - We do not treat with nitroglycerin - Treat with CCB (calcium channel blocker) If we know someone who has angina and we know that angina is most commonly precipitated by what? - (activity)exertion - If they are about to exert themselves what do we teach? o Take a dose of nitroglycerin prior to any heavy activity o Nurse needs to be careful with this because blood pressure can drop - What will you teach the patient to watch for? o Wait a few moments before getting back up o Sit down, lay down o If pain is not relieved, then take another one - What if your patient takes nitroglycerin and gets a headache? o Document the finding, expected side effect ACS – Acute Coronary Syndrome ACLS- advanced cardiac life support We are all certified in BLS – basic life support Work in ER or cardiac floor you need ACLS - ACLS helps teach how to care for acute coronary syndrome ACS is angina, mostly unstable angina, as it progresses to MI Chest pain followed through all the way definitive care for whatever is causing lack of blood flow - That is CAD Plaque is ruptured and platelets are sticking, which causes red blood cells to start to stick - When red blood cells stick then a clot is formed - A clot is not cool in the coronary artery If we have a clot in the coronary artery then there is going to happen to the myocardium? - Tissue without blood dies MI is infraction tissue - dead tissue - Person who has a true heart attack then they have dead heart muscle tissue o Ischemic heart muscle (dead heart muscle) - Sometime we can get it back o Rarely we can get it all back You’re a nurse working and a patient presents to you with CP, what are you going to do? - What are you going to assess? - Assessment pain – PQRST - Get vitals - EKG (ECG) basic tenant of ACS care o Electricity through the heart o If you go sick dead heart, then the electricity is going to flow differently Know everything else you got to do with ACS… (not in order) - B – beta blocker o decrease blood pressure and slow heart rate o heart is not going to work as hard - M – morphine o Reduces pain and relaxes smooth muscle (vasodilates) - O – oxygen o BNC - N – nitroglycerin o Give first for pain because it reduces pain and it acts by being a vasodilator - A – aspirin o 325mg – chew because absorption happens first in the oral cavities Drug given that has to be given orally for absorption to occur – Vitamin B - Nitroglycerin o Takes about 2 minutes to work o If that pill is swallowed it will be deactivated and not work at all - Isosorbide dinitrate that is specially made long term made by absorbing in the gut Assess EKG then get the nitroglycerin or some other type of drug Orthostatic hypotension can happen with nitroglycerin What type of oxygen will we use? - BNC – least invasive to most invasive - The point is to give oxygen to the heart muscle If the patient has COPD and has CP what will we do? - Give oxygen!! - Hope that we will not decrease the respiratory drive EKG will give us a clue where we don’t have enough blood - Some means we have ischemia - Some means we have myocardial infraction - Some mean we have an unhappy heart or patient is a faker - It will tell us the area of the heart that is affected After we get the results of EKG the nurse will prepare patient to… - Cheat x-ray - Important Lab - Cardiac enzymes pg 749 o Cardiac – specific troponin  May have a point of care test  If it is positive, then something has happened in the last 6 hours or so  cTnT – cardiac-specific troponin T  cTnI – cardiac-specific troponin I o CK-MB  Creatine kinase Myocardia Bands o Myoglobin  Protein released from any muscle So lab positive troponin, EKG positive and CP present – make sure to do these things To restore blood flow to the heart - MD worked on patient and options for treatment are o cardiologist o interventional cardiologist o cardio thorastic surgeon o interventional radiologist Stent – - look at blood flow around the heart called coronary angiography (heart cath) o Through femoral artery and inject dye o You are just looking o Make sure they are not allergic to they dye How big is the femoral artery? About as big as your thumb To access the femoral artery for an angiography puts the patient at risk for bleeding - This is called PCI which we will learn more about in complex Pg 746 has a picture of angiography A- Dye in artery (it is really close to being closed) B- After stent and artery is much better Thrombolytic therapy may be started when there is not a cath place around and they need start some sort of intervention a. Which breaks down blood clots b. Clot coronary artery (we want to break this down) c. Don’t give something when they may be at an increased chance of bleeding i. Head bleed, bleeding disorder, recent GI bleed d. Can bleed out of IV sites and catheters e. WATCH FOR BLEEDING Heparin – prevents clots from further forming - Does not break down clots There is never a normal time for bleeding Even when a patient is on Thrombolytic therapy or heparin or warfarin, there is an increased chance in bleeding, it is not normal for them to bleed - Do not just document the finding if your patient is bleeding Mess if you do a heart cath if you start that with someone who has been on thrombolytic therapy, so there is a wait time, but not always - Can give things to reverse thrombolytic therapy What to do with a ACS patient - Ave 1 – cath lab (ideal - live in the city) - Ave 2 – thrombolytic therapy rd - 3 Ave – angiography (look at the vessels) o PCI is putting a stent in o Stent Fig 34-6 o If multiple vessels are affected, then might do open heart surgery  CABG (coronary artery bypass graft)  Harvest blood vessels from legs, or chest and go in distal to where the blockage is to restore blood flow to the heart  First one was done here in Memphis at Baptist East  Defective option: stent fails then go to CABG  Not the invasive crack open the chest surgery, can be done with minimal invasive technique Nurse will expect what EKG change after cardiac intervention has occurred? - EKG will return to baseline - Oxygen gets back to the tissue and will not short circuit the EKG Troponin will be increased - Release of protein from a ticked off heart Table 34-14 Acute Coronary Syndrome - Subjective data Monitoring – maintain a continuous ECG monitoring while patient is in ED and during and after transport and entire hospital stay - Need EKG and heart rate at all times CABG or stent + CP (angia) = serious condition Table 34-20 – FITT guidelines - Cardiac rehab – especially after CABG must go through this - To restore as much normal activity and function in the patient as possible o We don’t want to place stress on the heart as it continues to heal o Exercise increases BP which makes the heart work harder o Start low and slow o Start 5 min walking and ultimate goal of 30 minutes walking - Stop any activity when any cheat pain occurs o Stop completely for the day - Passive to active range of motion - Increase their resistance - If they have pain or short of breath, then stop activity What about sex? – pg761 - Sex is equivalent to a brisk walk (book) - Best response? o Resume sexual activity at a pace in which you are comfortable o If you get CP and SOB out of the norm then stop Do not take Nitroglycerin (vasodilate) and Viagra (vasodilate) together = dead patient - Teach patient not to take these drugs with nitroglycerin because is causes severe hypotension - Viagra also treats pulmonary arterial hypertension o Pt has isolated pulmonary arterial hypertension where the coronary artery has to build arteriosclerosis and it is causing an increase pressure in lung perfusion o Dilates specifically central vessels and pulmonary artery Vascular Disorders Ch 38 There is arterial and venous - Which is worse? o Arterial – PAD  Beyond aorta  Things that affect distal circulation What does someone get Peripheral Disease? - Risk Factors of CAD and hypertension: o Smoking, excessive alcohol, diabetes unmanaged, family history Arterial disease 2 things happen in the pathology 1. Arteriosclerosis – hardening 2. Atherosclerosis – plaque buildup a. Most common site is bifurcation i. Bifurcation – aorta splits in the pelvis into two arteries called the common iliacs. Common iliacs go down and bifurcate 1. One goes femeroral ii. Splits where stuff likes to stick is the buildup of plaque When know what happens when an artery hardens and plaque builds up - Same thing in PAD In the legs the nurse needs to watch for is pain with walking activity to the point that we have to stop walking, but it gets better if we have to sit down and rest for 10 or 15 minutes - Intermittent claudication Table 38-1* Venous vs Peripheral Test to figure out how much blood flow is going of extremities 6P - Pain - Pallor - Paresthesia - Pulslessness - Poikilothermic – different temp from other extremity - Paralysis If a patient comes in with this then they could have and arterial blood flow problem How do we know if it is truly arterial- disease of the arteries? - ABI (ankle-brachial index) – test that is preformed to determine if a patient has arterial disease - Ultrasounds or angiography tests Hallmark: pain when blood needs oxygen but cannot get it We have someone who has plaque or thickened arteries blood flow is not going to flow like it needs to - Want to do everything we can to promote blood flow o All the way down to the cellular level (RBCs) - PAD we may put them on medication o Antiplatelet – aspirin  Probably 325mg dose everyday - If they may have had a stroke or something, we would put them on something stronger  Such as Plavix pg 836 - Trental and Pletal help vasodilate, increase circulation How do we naturally increase blood flow – move (exercise - walk) - Increasing distal blood flow Does a warm or cold distal artery carry blood better? - Warm Why do fingers hurt in the cold? - Vasoconstricts so it hurts - Tissues are becoming ischemic, they want more If patient does not have good blood flow what position do you want them in? - Dependent position so the blood can get to that area Warm bath? - Foot soak and massage Pt has PAD and you walk in patients room and they are in severe pain in the right leg? - Look and assess for distal pulse, but not a petal pulse o There is an arterial clot - MEDICAL EMERGENCY (foot is dying) o Don’t leave the patient o Call the provider of some sort, try to warm the extremity, or increase blood flow How to teach patient to keep good blood flow to the feet - Keep them warm - Move them - Don’t injure them - Keep foot safe – loose tennis shoes o Not tight because it is going to rub a whole in the foot or cut off circulation o May need surgery WWKYP bypass - bleeding How does the nurse know if arterial bypass surgery has been effective? - Patient’s pulse strength, capillary refill, color, temp return to normal Nurse caring for a patient that just had a fem bypass you walk in the room patient extremity that just had the bypass is white as a sheet. What do you do? - Call someone Walk in patient room and their knees are up under the chair and they are knees are flexed in a real tight angle, what are you going to do? - Immediately straight out the leg, if you cramp an artery, it won’t do what it needs to do Buerger's disease - Arterial disease process - Occurs in young men o Usually under 30 or 40 - Risk factor? o Smoking cigarettes Young male + smoking cigarettes + dead fingers and toes is caused by Buerger’s Disease - Number one way to prevent this is not to smoke Raynaud’s Phenomenon - More commonly in women - Autoimmune - Fingers turn different colors (red, white and blue) - Stress precipitates a Raynaud attack, or exposure to cold o Things that cause vasoconstriction Venous side DVT- deep vein thrombosis - Risk o Sitting for long periods of time o Large person - DVT will kill you, superficial thrombosis will not How do we know a patient has a DVT - Patient says their calf hurts - Obese - Airplane for the last 18 hours and clot before On assessment - Calf is appearance and circumference is larger than the other - Redness and tenderness in one calf or leg Are we worried about pulses with DVT? - Nope. (it’s a vein not an artery) How do we treat it? - Heparin drip o Risk for bleeding o Monitor PTT o Antidote – protamine sulfate - Lovenox subQ - Warfarin o Antidote – vitamin K Why on warfarin and heparin? - While bridging them over - Prevent clot Could become a pulmonary embolism OR an ischemic stroke Chronic venous disease dark discoloration of the legs caused by chronic edema, develop venous ulcers - Take forever to heal, not as bad as arterial disease Venous disease – elevate extremities Last thing – varicose veins are superficial veins that hold a lot of blood Risk: developing a clot, causing edema, causing poor circulation - Get them elevated, get them out, wear TED hose


Buy Material

Are you sure you want to buy this material for

25 Karma

Buy Material

BOOM! Enjoy Your Free Notes!

We've added these Notes to your profile, click here to view them now.


You're already Subscribed!

Looks like you've already subscribed to StudySoup, you won't need to purchase another subscription to get this material. To access this material simply click 'View Full Document'

Why people love StudySoup

Jim McGreen Ohio University

"Knowing I can count on the Elite Notetaker in my class allows me to focus on what the professor is saying instead of just scribbling notes the whole time and falling behind."

Kyle Maynard Purdue

"When you're taking detailed notes and trying to help everyone else out in the class, it really helps you learn and understand the I made $280 on my first study guide!"

Jim McGreen Ohio University

"Knowing I can count on the Elite Notetaker in my class allows me to focus on what the professor is saying instead of just scribbling notes the whole time and falling behind."

Parker Thompson 500 Startups

"It's a great way for students to improve their educational experience and it seemed like a product that everybody wants, so all the people participating are winning."

Become an Elite Notetaker and start selling your notes online!

Refund Policy


All subscriptions to StudySoup are paid in full at the time of subscribing. To change your credit card information or to cancel your subscription, go to "Edit Settings". All credit card information will be available there. If you should decide to cancel your subscription, it will continue to be valid until the next payment period, as all payments for the current period were made in advance. For special circumstances, please email


StudySoup has more than 1 million course-specific study resources to help students study smarter. If you’re having trouble finding what you’re looking for, our customer support team can help you find what you need! Feel free to contact them here:

Recurring Subscriptions: If you have canceled your recurring subscription on the day of renewal and have not downloaded any documents, you may request a refund by submitting an email to

Satisfaction Guarantee: If you’re not satisfied with your subscription, you can contact us for further help. Contact must be made within 3 business days of your subscription purchase and your refund request will be subject for review.

Please Note: Refunds can never be provided more than 30 days after the initial purchase date regardless of your activity on the site.