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24 Cards in this Set

  • Front
  • Back
Peripheral artery disease (PVD or PAD):
etiology and risk factors
Primary risk factors
– Atherosclerosis
– Diabetes
– Smoking
Other risk factors
– Elevated lipid levels
– Phlebitis
– Surgery
– Autoimmune disease
Associated diseases
– Coronary artery disease (CAD), myocardial infaction
– Atrial fibrillation
– Carotid stenosis, stroke
– Renal failure
Etiology and risk factors (cont.)
 Lower limbs more susceptible to arterial occlusion
– Disease or embolism usually occur in bifurcations.
– Most common areas: aortoiliac bifurcation and femoral bifurcation
 Claudication symptoms more in men, at 60-70 years
 Increased incidence for women after menopause.
 Almost 50% with claudication have coronary artery disease.
Causes of acute occlusions
 Embolism
– Atrial fibrillation
– Atherosclerosis (atheroma)
– Tumor
 Thrombosis
– Obesity
– Sepsis
– Hypotension, low cardiac output
– Aneurysms, aortic dissection
– Bypass graft
– Atherosclerosis (atheroma)
 Trauma
 Vasospasm
 Edema
 Thrombosis risk
 Collaterals arterioles develop slowly in response to low oxygen levels.
 Vasodilation has a limited effect
 Anerobic metabolism causes lactic and pyruvic acid build up
 Lack of flow causes pain (intermittent claudication) when muscle is forced to work without adequate blood supply.
Clinical Manifestations

 Paresthesias **
 Intermittent claudication and rest pain
– Calves or buttocks
– Sharp cramp or burning sensation
– Does not occur with sitting or standing
** Arterial steal: arterioles in muscle steal from cutaneous and peripheral nerves, resulting in coldness and pins and needles sensation
Medical management
 Reduce risk
 Skin care
 Exercise
 Dietary changes
 Promote arterial flow
Reduce risk
 Stop smoking
 Skin care
– Good shoes that protect and allow air flow
– Avoid elastic support hose
– 6 inch shock blocks under the head of bed (reverse trendelenburg)
– Fleece boots, heels floated off the bed, heel protector, bed craddle
 Exercise
– Walk 30-45 minutes per day
– Stop at onset of pain
 Dietary changes
– Low fat (especially saturated), low cholesterol, low calorie
– High fiber
Promote arterial flow:
1. Pentoxifylline (Trental)
2. Cilostazol
3. ASA, Clopidogrel
1. - Reduces blood viscosity and increases RBC flexibility.
– Increases duration of exercise.

2. – Increases walking distance.
– Vasodilator, antiplatelet

3. reduce risk of embolism
Nursing management of the medical client
 Promote arterial flow and prevent vasoconstriction
– Keep warm, reduce stress, legs below heart level
– Avoid crossing legs or standing in one place for a long time.
– Lotion avoided between toes.
– Keep feet dry, cotton socks
– Shoes to protect.
– Elevate feet slightly if swell.
 Relieve pain
 Maintain skin integrity
 Promote activity tolerance
 Promote knowledge of disease process
Surgical management of peripheral arterial disease
 Endovascular interventions, in cath lab
– Angioplasty
– Atherectomy
– Stent placement
– Local anesthesia, quick recovery
Arterial bypass: Nursing management of the surgical client: preoperative care
 Pulses with doppler, marked
 Assess for other atherosclerosis problems such as with heart, brain, kidneys.
 Reverse malnutrition.
 Clean wounds.
 Resolve all infections, especially if synthetic graft (Gortex, PTFE) is used.
Arterial bypass: Postoperative care
 Adequate vascular volume
– Stable BP, good u/o, skin warm, intake = output, stable Hgb and Hct
 Supine position
 Pain meds for 48-72 hours
 ROM, ambulation
 Avoid tape on legs
 Assess pulses, neurological status of extremities
Arterial bypass: Complications
COmp synd - s/ : severe pain, tense swollen leg, pain with passive stretching, decreased sensation, rusty brown urine (myoglobinuria)
Acute arterial occlusion:
* 6P - clin manifestn's
- Trauma, embololism, thrombosis
Acute arterial occlusion: Management
 Surgical embolectomy
– Limited amount time to prevent permanent damage.
–Local anesthesia
 Anticoagulants
– To allow time to do embolectomy.
 Fibrinolytics
Distal necrosis of toes from arterial embolization.
Abdominal aortic aneurysm
Classification of aneurysms
Saccular: unilateral outpouching
Fusiform: bilateral outpouching
Dissecting: bilateral outpouching in which layers of vessel separate, creating a cavity
False: wall ruptures and a blood clot is retained in an outpouching of tissue or there is a connection between a vein and artery that does not close.
Medical management
 Antihypertensive medications are administered.
 Check size every 6 months.
 Surgery for 4-6 cm and larger.
 CAD and COPD history predisposes to atelectasis, CHF, MI.
 Prerenal failure from decreased blood flow from aneurysm, emboli, clamping during surgery, decreased cardiac output.
 Lower extremity or bowel emboli (colitis)
 Spinal cord ischemia
 Impotence
Postoperative care
 Intensive care
 Vital signs, urine output, hemodynamic pressures
 Ventilator
 Monitor tissue and organ damage from long aortic clamping time.
– Skin
– Bowel
– Spinal cord
– Kidneys
 Pain managed with PCA or epidural.
Aortic dissection: etiology and risk factors
 Longitudinal splitting (false lumen) of medial (muscular) layer of aorta by blood flow
 Occurs following a tear in the intima (inner lining).
 Blocks arterial branches
 Men, 50-70, hypertensive
 Marfan’s syndrome
Clinical manifestations
 Abrupt excruciating pain (most common)
– Ripping, knife-like tearing
– Radiate to back, abdomen, extremities, anterior chest
 Hypertension (common)
– pale skin, apprehensive, sweating, diminished pulses
 Other
– Unequal pulses, different BP’s in each arm
– Paraplegia or hemiplegia
– Oliguria, hematuria
– Mental status changes
– Chest pain, aortic regurg murmur
Aortic dissection: Complications
 Cardiac tamponade
– Pulsus paradoxus
– Muffled heart sounds
– Narrowed pulse pressure
 Ischemia to vital areas
– Spinal cord weakness or paralysis
– Oliguria
– Ileus
Aortic dissection: Management
 Lower BP
– Vasodilator infusion (nitroprusside)
– Beta blockers to reduce contractility
 Reduce pain
– Subsides when dissection stabilizes
 Blood transfusion
 Management of heart failure
Nursing care
 Reduce BP
– Semi-Fowlers
– Minimize unnecessary environment stress such as noise.
– Opioids for pain, tranquilizers if necessary
– Constant BP monitoring if antihypertensives used (arterial line)
– Monitor anxiety, v.s., paradoxical pulse, pulse pressure
 Observe for further tearing or rupture of aorta.