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95 Cards in this Set
- Front
- Back
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anastomosis |
junction of two vessels |
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aneurysm |
a localized sac or dilation of an artery formed at a weak point in the vessel wall |
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angioplasty |
an invasive procedure that uses a balloontipped catheter to dilate a stenotic area of a blood vessel |
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ankle-brachial index (ABI) |
ratio of the ankle systolic pressure to the brachial systolic pressure; an objective measurement of arterial disease that provides quantification of the degree of stenosis |
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arteriosclerosis |
diffuse process whereby the muscle fibers and the endothelial lining of the walls of small arteries and arterioles thicken |
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atherosclerosis |
inflammatory process involving the accumulation of lipids, calcium, blood components, carbohydrates, and fibrous tissue on the intimal layer of a large or medium-sized artery |
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bruit |
sound produced by turbulent blood flow through an irregular, tortuous, stenotic, or dilated vessel |
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dissection |
separation of the weakened elastic and fibromuscular elements in the medial layer of an artery |
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duplex ultrasonograhy |
combines B-mode grayscale imaging of tissue, organs, and blood vessels with capabilities of estimating velocity changes by the use of a pulsed Doppler |
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intermittent claudication |
pain, discomfort, or fatigue caused by the inability of the arterial system to provide adequate blood flow to the tissues in the face of increased demands for nutrients and oxygen during exercise |
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ischemia |
deficient blood supply |
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rest pain |
persistent pain in the foot or digits when the patient is resting, indicating a severe degree of arterial insufficiency |
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rubor |
reddish-blue discoloration of the extremities; indicative of severe peripheral arterial damage in vessels that remain dilated and unable to constrict |
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strenosis |
narrowing or constriction of a vessel |
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thickens |
Aging produces changes in the walls of the blood vessels that affect the transport of oxygen and nutrients to the tissues. The intima ____________ as a result of cellular proliferation and fibrosis.
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Elastin |
____________ fibers of the media become calcified, thin, and fragmented, and collagen accumulates in the intima and the media. These changes cause the vessels to stiffen, which results in increased peripheral resistance, impaired blood flow
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increased
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__________ left ventricular workload causes hypertrophy, ischemia and failure of the left ventricle, and thrombosis and hemorrhage in microvessels in the brain and kidney. |
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peripheral arterial insufficiency
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A muscular, cramp-type pain, discomfort, or fatigue in the extremities consistently reproduced with the same degree of exercise or activity and relieved by rest is experienced by patients with ________________ ______________ ___________ . |
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intermittent claudication |
peripheral arterial insufficiency is referred to as ____________. |
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muscle metabolites and lactic acid
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As the tissues are forced to complete the energy cycle without adequate nutrients and oxygen, _________________ and ___________ are produced. |
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forefoot(i.e., the anterior portion of the foot)
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Persistent pain in the _____________ when the patient is resting indicates a severe degree of arterial insufficiency and a critical state of ischemia.
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Rest pain |
____________ pain frequently requires that the extremity be lowered to a dependent position to improve perfusion to the distal tissues.
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Arterial insufficiency general characteristics |
Intermittent claudication to sharp, unrelenting, constant pain Diminished or absent pulse Skin: Dependent rubor—elevation pallor of foot; dry, shiny skin; cool-tocold temperature; loss of hair over toes and dorsum of foot; nails thickened and ridged |
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Venous insufficiency general characteristics |
Aching, cramping pain Pulses present, but may be difficult to palpate through edema Pigmentation in gaiter area (area of medial and lateral malleolus), skin thickened and tough, may be reddish blue, frequently with associated dermatitis |
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Arterial ulcer locations |
Tip of toes, toe webs, heel or other pressure areas if confined to bed |
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Arterial ulcer characteristics |
Very painful Deep, often involving joint space Circular Ulcer base: Pale to black and dry gangrene Leg edema: Minimal unless extremity kept in dependent position constantly to relieve pain |
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Venous ulcer locations |
Medial malleolus, lateral malleolus, or anterior tibial area |
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Venous ulcer characteristics
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Minimal pain if superficial or may be very painful Superficial depth Irregular border Ulcer base: Granulation tissue—beefy red to yellow fibrinous in chronic long- term ulcer Moderate to severe edema |
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Cyanosis |
a bluish tint of the skin, is manifested when the amount of oxygenated hemoglobin contained in the blood is reduced
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Rubor
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____________ suggests severe peripheral arterial damage in which vessels that cannot constrict remain dilated. Even with -___________, the extremity begins to turn pale with elevation.
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Occlusive arterial disease
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_______________ impairs blood flow and can reduce or obliterate palpable pulsations in the extremities.
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Arterial disorders
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________________ cause ischemia and tissue necrosis.These disorders may occur because of chronically progressive pathologic changes to the arterial vasculature (e.g., atherosclerotic changes) or due to an acute loss of blood flow to tissues (e.g., aneurysm rupture). |
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Arteriosclerosis
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_________________ (hardening of the arteries) is the most common disease of the arteries. It is a diffuse process whereby the muscle fibers and the endothelial lining of the walls of small arteries and arterioles become thickened.
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Atherosclerosis |
____________ involves a different process, affecting the intima of large and medium-sized arteries. These changes consist of the accumulation of lipids, calcium, blood components, carbohydrates, and fibrous tissue on the intimal layer of the artery.
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atheromas
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accumulation of lipids, calcium, blood components, carbohydrates, and fibrous tissue on the intimal layer of the artery are referred to as ________ or plaques. |
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direct
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The most common _________ results of atherosclerosis in arteries include narrowing (stenosis) of the lumen, obstruction by thrombosis, aneurysm, ulceration, and rupture.
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indirect
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_______________ results of atherosclerosis in arteries include malnutrition and the subsequent fibrosis of the organs that the sclerotic arteries supply with blood |
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reaction-to-injury
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According to ______________ theory, vascular endothelial cell injury results from prolonged hemodynamic forces, such as shearing stresses and turbulent flow, irradiation, chemical exposure, or chronic hyperlipidemia.
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fatty streaks and fibrous plaque |
two types of atherosclerotic lesions |
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Fatty streaks
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___________ are yellow and smooth, protrude slightly into the lumen of the artery, and are composed of lipids and elongated smooth muscle cells. These lesions have been found in the arteries of people of all age groups, including infants. It is not clear whether ___________ predispose a person to the formation of fibrous plaques or whether they are reversible. They do not usually cause clinical symptoms.
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Fibrous plaques
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______________ are composed of smooth muscle cells, collagen fibers, plasma components, and lipids. They are white to white-yellow and protrude in various degrees into the arterial lumen, sometimes completely obstructing it. These plaques are found predominantly in the abdominal aorta and the coronary, popliteal, and internal carotid arteries, and they are believed to be progressive lesions
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collateral circulation
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Gradual narrowing of the arterial lumen stimulates the development of _______________, which arises from preexisting vessels that enlarge to reroute blood flow around a hemodynamically significant stenosis or occlusion.
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Collateral flow
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___________ allows continued perfusion to the tissues, but it is often inadequate to meet increased metabolic demand, and ischemia results.
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peripheral arterial disease (PAD) |
The National Heart, Lung, and Blood Institute’s observational study of genetic determinants of ____________________ found that it is positively correlated low lifetime physical activity.
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Nicotine
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___________ in tobacco decreases blood flow to the extremities and increases heart rate and blood pressure by stimulating the sympathetic nervous system, causing vasoconstriction.
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Carbon monoxide
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_____________ , a toxin produced by burning tobacco, combines more readily with hemoglobin than oxygen, depriving the tissues of oxygen.
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C-reactive protein (CRP)
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______________ is a sensitive marker of cardiovascular inflammation, both systemically and locally. Slight increases in serum _________________ levels are associated with an increased risk of damage in the vasculature
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Increases serum CRP levels |
including increasing age, female gender, hypertension, hypercholesterolemia, obesity, elevated blood glucose levels, smoking, or a positive family history of cardiovascular disease
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Atherosclerosis MODIFIABLE risk factors |
• Nicotine use (i.e., tobacco smoking or chewing) • Diet (contributing to hyperlipidemia) • Hypertension • Diabetes (speeds the atherosclerotic process by thickening the basement membranes of both large and small vessels) • Hyperlipidemia • Stress • Sedentary lifestyle • Elevated C-reactive protein • Hyperhomocysteinemia |
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Atherosclerosis Nonmodifiable Risk Factors |
• Increasing age • Female gender • Familial predisposition/genetics |
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Hyperhomocysteinemia
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_____________ has been positively correlated with the risk of peripheral, cerebrovascular, and coronary artery disease as well as venous thromboembolism (VTE). |
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Homocysteine
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__________________ is a protein that promotes coagulation by increasing factor V and factor XI activity while depressing protein C activation and increasing the binding of lipoprotein (a) in fibrin.
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Intermittent claudication
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________________ is a symptom of generalized atherosclerosis and may be a marker of occult coronary artery disease.
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70 mg/dL |
LDL levels less than _____________ mg/dL are recommended for patients with a history of diabetes, cigarette smoking, atherosclerosis, or hypertension
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200 total cholesterol 150 triglyceride |
Secondary goals include achieving total cholesterol levels less than _________ mg/dL and triglyceride levels less than_____________ mg/dL.
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3-hydroxy-3-methylglutaryl coenzyme A (HMGCoA) reductase inhibitors (statins)
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Medications classified as_________________, including but not limited to atorvastatin (Lipitor), lovastatin (Mevacor), pravastatin (Pravachol), simvastatin (Zocor), fluvastatin (Lescol), and rosuvastatin (Crestor), are currently first-line treatment because they reduce the incidence of major cardiovascular events
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Hypertension
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_______________ , which may accelerate the rate at which atherosclerotic lesions form in high-pressure vessels, can lead to a cerebrovascular accident (CVA or stroke), ischemic renal disease, severe PAD, or coronary artery disease.
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atherosclerosis
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The management of ____________ involves modification of risk factors, a controlled exercise program to improve circulation and its functioning capacity, medication therapy, and interventional or surgical graft procedures.
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inflow surgical procedures
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Vascular surgical procedures are divided into two groups:__________________ , which improve blood supply from the aorta into the femoral artery. This procedures are described with diseases of the aorta.
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outflow surgical procedures
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Vascular surgical procedures are divided into two groups: ____________________ , which provide blood supply to vessels below the femoral artery. This procedures are described with peripheral arterial occlusive disease. |
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angioplasty
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If an isolated lesion or lesions are identified during the arteriogram,____________, also called percutaneous transluminal angioplasty (PTA), may be performed.
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PTA (percutaneous transluminal angioplasty)
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Complications from___________ include hematoma formation, embolus, dissection (separation of the intima) of the vessel, acute arterial occlusion, and bleeding
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stent or stent graft
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Complications associated with ____________ use include distal embolization, intimal damage (dissection), and dislodgment.
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advantage
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The ____________ of angioplasty, stents, and stent grafts is the decreased length of hospital stay required for the treatment; many of the procedures are performed on an outpatient basis.
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Arterial
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_______________blood supply to a body part can be enhanced by positioning the part below the level of the heart. For the lower extremities, this is accomplished by elevating the head of the patient’s bed or by having the patient use a reclining chair or sit with the feet resting on the floor.
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PAD; venous insufficiency
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For patients with_____________ , blood flow to the lower extremities needs to be enhanced; therefore, the nurse encourages keeping the lower extremities in a neutral or dependent position. In contrast, for patients with ______________, blood return to the heart needs to be enhanced, so the lower extremities are elevated.
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isometric
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The nurse can assist the patient with walking or other moderate or graded _____________ exercises that may be prescribed to promote blood flow and encourage the development of collateral circulation.
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collateral circulation
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The nurse instructs the patient to walk to the point of pain, rest until the pain subsides, and then resume walking so that endurance can be increased as ____________ develops.
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Pain
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_________ can serve as a guide in determining the appropriate amount of exercise. The onset of ________ indicates that the tissues are not receiving adequate oxygen, signaling the patient to rest before continuing activity.
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peripheral vascular disease
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Not all patients with ____________ should exercise. Before recommending any exercise program, the patient’s primary provider should be consulted. Conditions that worsen with exercise include leg ulcers, cellulitis, gangrene, or acute thrombotic occlusions.
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Arterial dilation
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___________ promotes increased blood flow to the extremities and is therefore a goal for patients with PAD.
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abdomen
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Patients are instructed to test the temperature of bath water and to avoid using hot water bottles and heating pads on the extremities. It is safer to apply a hot water bottle or a heating pad to the___________ ; this can cause reflex vasodilation in the extremities.
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vasospastic disorders
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In patients with_______________ (e.g., Raynaud’s disease), heat may be applied directly to ischemic extremities using a warmed or electric blanket; however, the temperature of the heat source must not exceed body temperature. Even at low temperatures, trauma to the tissues can occur in ischemic extremities.
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metabolic rate
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Excess heat may increase the __________ of the extremities and increase the need for oxygen beyond that provided by the reduced arterial flow through the diseased artery. Heat must be used with great caution!
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Nursing intervention for Increased arterial blood supply to extremities
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Lower the extremities below the level of the heart (if condition is arterial in nature).
Encourage moderate amount of walking or graded extremity exercises if no contraindications exist. |
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Nursing intervention for decreased venous congestion |
Elevate extremities above heart level (if condition is venous in nature).
Discourage standing still or sitting for prolonged periods. Encourage walking. |
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Nursing intervention: Promotion of vasodilation and prevention of vascular compression
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1. Maintain warm temperature and avoid chilling.
2. Discourage use of tobacco products. 3. Counsel in ways to avoid emotional upsets; stress management. 4. Encourage avoidance of constrictive clothing and accessories. 5. Encourage avoidance of crossing the legs. 6. Administer vasodilator medications and adrenergic blocking agents as prescribed, with appropriate nursing considerations. |
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Vitamin C |
Vitamin __________ is essential for collagen synthesis and capillary development.
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Vitamin A |
Vitamin ______ enhances epithelialization and collagen formation.
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Zinc
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_________ is necessary for the synthesis of granulation tissue and re-epithelialization, and it also has anti-inflammatory effects
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gangrene
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In older adults, symptoms of PAD may be more pronounced than in younger people. In older patients who are inactive, ________may be the first sign of disease
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Normal PAD result from ankle brachial index (ABI) |
0.9 - 1.0 |
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Mild to moderate PAD |
0.4 - 0.9 |
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Severe PAD |
0.00 - 0.4 |
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Venous insufficiency |
Signs of chronic __________ are edema and altered skin pigmentation |
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rest pain
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When the arterial insufficiency becomes severe, the patient has ______. This pain is associated with critical ischemia of the distal extremity and is described as persistent, aching, or boring; it may be so excruciating that it is unrelieved by opioids and can be disabling.
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Ischemic rest pain
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_____________is usually worse at night and often wakes the patient. Elevating the extremity or placing it in a horizontal position increases the pain, whereas placing the extremity in a dependent position reduces the pain.
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PAD.
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Examination of the peripheral pulses is an important part of assessing arterial occlusive disease. Unequal pulses between extremities or the absence of a normally palpable pulse is a sign of ________.
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Pentoxifylline (Trental) and cilostazol (Pletal)
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____________ and ___________are approved by the U.S. Food and Drug Administration (FDA) for the treatment of symptomatic claudication.
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Pentoxifylline
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____________ increases erythrocyte flexibility, lowers blood fibrinogen concentrations, and inhibits neutrophil adhesion and activation.
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Cilostazol
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________, a phosphodiesterase III inhibitor, is a vasodilator that inhibits platelet aggregation. This agent is contraindicated in patients with a history of congestive heart failure or an ejection fraction less than 40%
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Statins
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_________ improve endothelial function in patients with PAD; however, there is conflicting research regarding whether or not _________ decrease claudication symptoms in patients or improve pain-free walking time in patients with PAD
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aspirin or clopidogrel (Plavix)
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Antiplatelet agents such as _________ or _________ prevent the formation of thromboemboli, which can lead to myocardial infarction and stroke.
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palliative therapy
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For patients whose overall health is so compromised that they cannot tolerate an extensive vascular surgical procedure, it is sometimes necessary to provide the __________ of primary amputation rather than arterial bypass.
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endarterectomy
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If __________ is performed, an incision is made into the artery and the atheromatous obstruction is removed
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