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24 Cards in this Set
- Front
- Back
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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 |
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Etiology and risk factors (cont.)
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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. |
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Causes of acute occlusions
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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 |
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Pathophysiology
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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. |
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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 |
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Medical management
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Reduce risk
Skin care Exercise Dietary changes Promote arterial flow |
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Reduce risk
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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 |
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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 |
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Nursing management of the medical client
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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 |
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Surgical management of peripheral arterial disease
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Endovascular interventions, in cath lab
– Angioplasty – Atherectomy – Stent placement – Local anesthesia, quick recovery |
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Arterial bypass: Nursing management of the surgical client: preoperative care
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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. |
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Arterial bypass: Postoperative care
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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 |
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Arterial bypass: Complications
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Hemorrhage
clotting Infxn COmp synd - s/ : severe pain, tense swollen leg, pain with passive stretching, decreased sensation, rusty brown urine (myoglobinuria) |
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Acute arterial occlusion:
* 6P - clin manifestn's |
- Trauma, embololism, thrombosis
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Acute arterial occlusion: Management
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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. |
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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. |
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Medical management
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Antihypertensive medications are administered.
Check size every 6 months. Surgery for 4-6 cm and larger. |
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Complications
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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 |
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Postoperative care
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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. |
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Aortic dissection: etiology and risk factors
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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 |
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Clinical manifestations
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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 |
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Aortic dissection: Complications
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Cardiac tamponade
– Pulsus paradoxus – Muffled heart sounds – Narrowed pulse pressure Ischemia to vital areas – Spinal cord weakness or paralysis – Oliguria – Ileus |
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Aortic dissection: Management
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Lower BP
– Vasodilator infusion (nitroprusside) – Beta blockers to reduce contractility Reduce pain – Subsides when dissection stabilizes Blood transfusion Management of heart failure |
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Nursing care
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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. |
