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NURS 3366: EXAM 3 REVIEW: Cardiovascular, Pulmonary, Renal, Genitourinary
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NURS 3366: EXAM 3 REVIEW: Cardiovascular, Pulmonary, Renal, Genitourinary
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NURS 3366: EXAM 3 REVIEW: Cardiovascular, Pulmonary,Renal, Genitourinary
Right atrium tricuspid valve right ventricle pulmonic valve pulmonary artery
pulmonary arterioles pulmonary capillaries [gas exchange with alveoli occurs here] pulmonary
venules pulmonary veins left atrium mitral valve left ventricle aortic valve
aorta
part of this freshly oxygenated blood goes into coronary arteries, which
branch off the aorta just beyond the aortic valve.
part goes up to brain via carotids
rest goes to tissue beds of remainder of body
arterioles capillaries [gas exchange with tissue occurs here] venules veins inferior venacava
(from body) or superior vena cava (from head) right atrium
❖ PERIPHERAL VASCULAR SYSTEM
➢ Venous: vessels that carry deoxygenated blood from tissues to right side of heart
▪ Healthy veins: Facilitate good venous return & prevent backflow;
▪ Bad Veins: bad valves ⟶ backflow ⟶ venous congestion ⟶ peripheral tissue edema; stasis
& immobility ⟶ sluggish blood flow
▪ Chronic Venous Insufficiency (CVI): backflow (congestion) of blood into distal veins of legs &
feet
• Floppy valves ⟶ blood backflow ⟶ congestion & stasis of blood in legs & feet ⟶
increased hydrostatic pressure ⟶ engorged veins ⟶ pushes fluid into tissues ⟶ edema ⟶
S&S
• S&S: edema ⟶ swollen, tight, dry, discolored skin; venous stasis ulcers (tissue
breakdown from edema/poor cell fxn), thrombi, varicose veins (+ hydrostatic pressure ⟶
backflow pressure to surface veins)
• Risk factors: standing for too long, pregnancy, old people, genetics, immobility
• Tx: encourage mobility, hydration, elevate legs for venous return, blood thinners, look for
skin breaks, TED hose
▪ Deep Vein Thrombosis (DVT): clot on vein wall, usually deep vein in thigh/calf
• S&S: Thrombophlebitis, redness/pain/erythema/warmth (inflammatory signs), edema,
unilateral
• Risk factors: 1+ element of Virchow’s Triad
◆ Virchow’s Triad: injury to endothelium of vein (ex. surgery), stasis of blood flow (ex.
muscles not pumping/venous insuff), hypercoagulability (ex. Dehydration)
➢ Couch potato, casts, bed-ridden, pregnant, obese, diuretics/hormone therapy,
CVI
• Sequela of DVT ⟶ Pulmonary Embolus
▪ Pulmonary Embolism (PE):
• Thrombus breaks free & becomes venous emboli ⟶ goes to lungs ⟶ gets stuck in pulm
arterioles (PE) ⟶ blocks deoxy blood from getting to alveoli to get Oxy ⟶ SOB, chest
pain, ⟶ irritates arterial intima ⟶ inflammation ⟶ leakage of blood into lung tissue ⟶
hemoptysis
• S&S: chest pain, SOB, hemoptysis (blood in sputum), shock (from systemic release of
inflammatory mediators), death
• Tx: encourage mobility, hydration, elevate legs for venous return, blood thinners, look for
skin breaks, TED hose
▪ VTE (venous thromboembolism) = DVT + PE
➢ Arteries: vessels that carry oxygenated blood from heart to tissue beds all over body
▪ Healthy arteries: good vasomotor tone & patent lumen (flexible, compliant, patent, normal
resistance) ⟶ good perfusion ⟶ no ischemia
• Good Perfusion: delivery of O2 & nutrients to tissues
◆ cap refill <2 seconds, skin pink, warm, pulse normal, norm BP range (110/60 to
115/70), normal organ function (good urine output, good mentation, cardiac output)
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, ▪ Bad Arteries: Loss of vasomotor tone (too constricted/inflexible/brittle/too dilated/no
tone/slack) & altered/non-patent lumen (non-patent ⟶ blockage) ⟶ leads to lack of O2 to
distal tissues ⟶ ischemia
• Arterial insufficiency usually due to Atherosclerosis = SYSTEM WIDE!!
▪ Blood Pressure: Desired is 110/60 to 115/70 (avg 110/70)
• Systolic: heart is contracting & ejecting blood out to arteries (systole)
• Diastolic: heart is between systoles, ―resting‖ (diastole)
• BP to arterial tone: walls are rigid & have no give = higher BP; relaxed walls, = lower BP
• BP to volume of blood: more volume = higher BP; smaller volume = lower BP
▪ Risk factors: family history, age, diet (LDL), obesity, alcohol consumption (toxic byproducts),
DM2 (too many glucose, lipodystrophy/increased LDL’s), smoking (toxic byproducts, nicotine
vasoconstrictor increases BP & HR)
▪ Arteriosclerosis: stiffened artery walls (sclerose: to harden)
• HTN/Aging/diabetes/hyperlipidemia/smoking ⟶ Intima (inner lining) of arterial walls
become damaged ⟶ collagen fibers enter walls and stiffen them ⟶ decreased elasticity &
compliance ⟶ altered vasomotor tone (abnormal tone & resistance) ⟶ arterial
insufficiency ⟶ ischemia
▪ Atherosclerosis: fatty deposits
• Fatty deposits (collagen/LDL) enter injured arterial wall ⟶ inflammatory & coagulatory
process triggered ⟶ plaque formation (fat/clots/collagen) ⟶ reduces lumen patency ⟶
compromised perfusion & reduced blood flow to distal tissues ⟶ ischemia
• Mostly from extra LDL cholesterol in the blood (Arterio & athero sclerosis often happen
together)
◆ LDL: high in cholesterol ⟶ plaques
◆ HDL: high in protein, liver breaks down & gets rid of LDL’s. HDL >40, ratio of chole to
HDL <4
• S&S: narrowing/hardening blocks flow to tissues ⟶ bad perfusion ⟶ ischemia
◆ Ischemic pain – increased w/ exertion (high O2 demand) & decreased w/ rest; pain
distal to plaque/narrowing
◆ Periphery: Diminished/absent pulse, delayed cap refill, pale/cool/blue skin, delayed
healing from no O2 ⟶ ischemic skin ulcer
◆ Less cardiac output (hypoxic cardiomyocytes ⟶ decreased contractibility), altered
mentation (no O2 to brain ⟶ stroke), low urine output
▪ Peripheral Arterial Disease (PAD): peripheral arterial problems outside the heart (usually legs)
& S&S/problems of ischemia due to narrowed arteries
• Leg S&S: Intermittent claudication ―limping‖ from ischemic pain in the legs (worse w/
exercise), ischemia ⟶ cool/pale feet, diminished pulse, delayed cap refill, no hair on legs,
shiny legs (O2 for follicles), ischemic skin ulcers (no O2 makes skin fragile & traumatizes
easily), 5 P’s
▪ Arterial Thrombi & Emboli: clots where flow is sluggish, in narrow vessels/injuries
• Ex: Narrowing/injury/athero in femoral artery ⟶ thrombus forms ⟶ ischemia to distal
tissues ⟶ S&S of 5P’s/pallor/pain/pulse/paresthesia/paralysis (Note: If embolus forms it
would travel down to the arteries & arterioles of the feet)
• Ex: Atrial Fibrillation ⟶ quivering of Atria so pockets of blood in atria don’t flow properly ⟶
platelets/fibrin collect ⟶ thrombus on atrial wall ⟶ L. Atrium clot would become embolus &
go to brain/arteries or R. Atrium clot would go to lungs
▪ Hypertension: consistent elevation of BP >140/90; common death in Americans b/c affects all
organs
• Primary HTN: essential/idiopathic HTN. VS. Secondary HTN: caused by some other dz
(adrenal tumor or renal problems/failure from hanging on to Na & H20)
• Risk Factors: same as atherosclerosis, high sodium intake ⟶ water retention ⟶ high
pressure
• Patho: atherosclerosis, overdrive of Sympathetic Nervous System (SNS), overdrive of
RAAS
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