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92 Cards in this Set

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Artery-Peripheral Arterial Disease (PAD)
is associated with these
Aneurysms
Raynauds
Buerger's
Veins- Peripheral Vascular disease
PVD is associtated with these
Venous Thrombosis
DVT
Superficial Thrombosis
Varicose Veins
Chronic Venous insufficiency
Venous leg ulcer
PE
Leading cause of PAD?
Atheroscleosis is the leading cause of the majority of cases
This process involves progressive narrowing and degeneration of arteries of the neck, abdomen, & extremities.
Peripheral Artery Disease
PAD may affect what vesicles of circulation?
Aortoiliac Artery
Femoral Artery
Popliteal Artery
Tibial Artery
Peroneal Artery
This disease appears typically at ages 60-80's
Is largely undiagnosed
Peripheral Artery Disease
What are 4 common risk factors associated with PAD
1) Cigarette smoking
2) hyperlipidemia
3)Hypertension
4) Diabetes Mellitus
Intermittent Claudication is a classic symptom of PAD; it is described as what?
Ischmeic muscle ache or pain that is precipitated by a constant level of exercise.
Resolves in 10 minutes or less with rest.
Reproducible
Paresthesia is described how?
Shooting or burning pain in extremity
Present near ulcerated areas
Produces loss of pressure & deep pain sensations
Injuries often go unnoticed by the patient
What are some factors to look for in association with PAD?
Thin, shiny, taut skin.
Loss of hair on lower legs
Diminished or absent pedal, popliteal, or femoral pulses
Pallor
Reactive hyperemia
Pentoxifylline (Trental) is prescribed for Intermittent Claudication what does it do?
Increase Erythrocyte flexibility

Decrease Blood viscosity
Cilostazol (Pletal) is prescribed for Intermittent Claudication what does it do?
Increase Vasodilation
Increase Walking distance
What is described as poor circulation & blockage of blood in the leg arteries produces an aching tired, and sometimes burning pain in the legs. This pain is brought on by exercise and relieved by rest.
Intermittent Claudication
With relation to Signs/Symptoms of acute arterial ischemia (an emergency) what are the six P's?
Pain
Pallor
Pulse less
Paresthesia
Paralysis
Poikilothermia (most often temp is; Cool!)
What are 4 musts when caring for a leg with critical leg ischemia?
Protect from trauma
Reduce vasospasm
Prevent/control infection
Maximize arterial profusion
What are four possible Nursing diagnoses for clients with PAD?
1) Ineffective tissue perfusion (peripheral)
2) Impaired skin integrity
3) Activity intolerance
4) Ineffective therapeutic regimen management
What are 4 overall goals for a patient with PVD/PAD?
1) Adequate tissue perfusion
2) Relief of pain
3) Increased exercise tolerance
4) Intact, healthy skin on extremities
During the acute intervention in regards to PAD/PVD following surgery, what things must the nurse monitor?
Skin color/temp
Capillary refill
peripheral pulses distal to operative site
Senstation/movement of extremity
Continued circulatory assessment
Turn/position frequently
Avoid knee-flexed positions except during exercise
Nursing implementations for PAD/PVD patient in regards to Ambulatory & home care would be?
Management of risk factors
Importance of meticulous footcare
Importance of gradual physical activity
Daily inspection of the feet
Shoes lightly laced
Comfortable shoes w/ rounded toes & soft insoles
With respect to the PAD/PVD patient what is evaluated with regards to skin integrity?
Experience intact skin, free of infection on lower extremities.

(maintain adequate tissue perfusion & ID activities that promote circulation)
Outpouching or dilation of an arterial wall, commonly involving the aorta is called?
Aneurysm
Aneurysm found in abdomen, thoracic aorta, and 3rd is ?
Popliteal
The cause of aneurysms is ?
Atherosclerosis
There are 2 disorders not caused by atherosclerosis, what are they?
1) Raynaud's Phenomenon

2) Buerger's Disease (thromboangitis obliterens)
What disorder effects young women 15-40 in their fingers/toes. Has an unknown etiology. Has decreased perfusion due to arteriole vasospasm, white, blue, then rubor?
Raynaud's Phenomenon
What disorder has an unknown etiology. Is an inflammatory disorder of medium sized arteries, veins, nerves of UE/LE. Is associated with intermittent claudication, resting pain & can develop ulceration?
Buerger's Disease
This disorder is associated with feeling coldness, then numbing, then aching pain, tingling & swelling.

Is treated with CCB's.
Raynaud's Phenomenon
This disorder typically affects Middle/Far eastern young males ages 25-49. Has familial tendency/history. Client's must absolutely quit smoking.
Buerger's Disease
Patients with this disorder need to be taught to protect from cold, avoid caffeine & smoking.
Raynaud's Phenomenon
These 3 important factors are called Virchow's triad to development of venous thrombosis, what are they?
Venous statis (valves not woring, inactive muscles)
Endothelium damage (trauma, IV therapy, caustic medications)
Hypercoagulation of blood (many hematology disorders, women on HRT or BCP's who smoke, overweight, > 35, family history)
What is the most common disorder of veins?
Venous thrombosis (thrombus w/ inflammation of the vein)
Where does a DVT usually occur & in what type of patients?

(DVT is most serious as it can lead to PE)
Usually occurs in iliac or femoral artery, in approximately 5% of all surgical patients.
This type of venous thrombosis occurs in 65% of all patients w/ IV's. They are palpable firm, subcutaneous, cord-like vein. Area around it appears warm, red, tender & swollen.
Superficial Thrombophelebitis
Superficial Thrombophelebitis in upper extremities is caused by what?
IV's
Superficial Thrombophelebitis in lower extremities is due to trauma to what veins?
Varicose
With Superficial thrombophelebitis how is the extremity to be positioned?
Elevated
With Superficial thrombophelebitis do you use hot or cold moist treatments?
Hot
With finding Superficial thrombophelebitis how soon should the IV cath be removed?
Immediately
With Superficial thrombophelebitis what is generally given for discomfort?
ASA, NSAID, & Tylenol
With Superficial thrombophelebitis are anticoagulants and/or compression stockings used?
Yes, to lower extremities after acute thrombophlebitis has passed
True or False
May have no symptoms or symptoms of unilateral leg edema, pain in leg, warm skin, erythema, temp >100.4 F ?
True
True or False

Homan's sign is reliable to r/o DVT's?
False
What are the 2 most serious consequences in regards to DVT's?
PE & Chronic venous insufficiency
OF all treatments its the easiest & cheapest to prevent DVT
Early ambulation
In DVT Treatment the patient should be OOB for all meals & ambulate how many times per day minimum?
three times
With DVT treatment the use of TED hose, intermittent external compression hose is contraindicated when?
When patient has active DVT
With DVT treatment/prevention in the hospital: bedrest, _______ limb, and meds, and _______ compresses.
A) Elevate

B) Warm
With DVT treatment/prevention for what duration do elastic compression hose need to be worn?
3 to 6 months
What ROM movement are done to the feet & ankles Q2-4h with DVT treatment/prevention?
Dorsi-flex the feet & Rotate the ankles
True or False
Anticoagulants dissolve clots?
False, body eats up it’s own clots
True or False
You cangive oral anticoagulants at same time as IV heparin? Why or why not?
True, due to the Half-life
Coumarin derivatives: what are 2 other names?
Coumadin & Warifarin
Coumarin derivatives: measured how, given how? antidote?
half-life 1 to 2 days, Coumadin takes 48 to 72 hours to start working, & several more days before max effect achieved. Vitamin K is the antidote
What does LMWH stand for?
Low-molecular weight heparin
What do you look at each of these for with Nursing interventions?
Urine:____________
Stools:___________
Mental status:_____
Nose/Gums:_______
Skin:_____________
Urine:Blood
Stools:Blood
Mental status:Changes
Nose/Gums:Bleeding
Skin: Bruising
What are important lab values in regards to Venous thrombosis?
PT / PTT / INR / H&H / platelets
What diet is recommended to teach the patient to intake regarding Venous thrombosis?
Well balanced (dark green leafy veggies, CA & Vit E play active roles in clotting mechanism)
Regarding Venous thrombosis what are 5 possible risk factors to modify?
Cigarettes, Hormones, Sedentary lifestyle, Birth control pills, & Obesity
What S/S must you educate your patient about regarding Venous thrombosis?
PE (dyspnea, tachpnea, pleuritic chest pain)
Regarding Venous thrombosis what positioning factors will you educate your patient on?
To change frequently, no sit/stand long periods, no crossing legs
Vitamin K plays what role in anticoagulation therapy?
It is the antidote to Coumadin
What foods contain Vitamin K?
Broccoli, spinach, kale, greens (Green leafy veggies!)
What medications interfere with anticoagulants?
ASA
Nsaid
Dilantin
Barbituates
Vitamin E
Alcohol
What is the most common symptom of varicose veins?
Ache/pain after standing for a long time
True or False
Varicose veins are usually treated.
False
The etiology for this disorder is unknown except for occupations, pregnancy, & congenital weakness.
Varicose veins
What surgical procedures are used on varicose veins?
sclerotherapy, ligation, lasers
How is Heparin given?
IM & IV
How is Heparin measured?
Units
What is the antidote to Heparin?
Protamine sulfate (1mg of Protamine will neutralize 100 units of heparin
To avoid complications with varicose veins what are three measures that can be used?
Control weight, wear compression devices, elevate feet above heart.
Previous episodes of DVT can lead to ________ leg ulcers.
Venous
With chronic venous insufficiency (CVI) & leg ulcers; they are considered to be costly, painful, debilitating, but are they life threatening disorders?
No, not life threatening
In the presence of CVI / leg ulcers how may the ankle appear?
Brown & leathery (this is due to red blood cells breaking down & leading from capillaries & venules into tissue = edema)
If CVI and leg ulcers are left untreated what 2 things may result?
Infection & cellulitis
What is defined as the symptom of itching, an uncomfortable sensation leading to the urge to scratch?
pruritis
What is defined as a common result of venous insufficiency of the legs beginning with ankle edema and progressing to tan pigmentation, patchy erythema, petechiae, and induration
stasis dermatitis
CVI & leg ulcers are common in what group?
The elderly
Vein incompetence, deep vein obstruction, AV fistula's, congenital venous malformation are causes of what disorder?
Chronic venous insufficiency
Treating venous leg ulcers what is essential?
compression
With venous leg ulcers what type of dressing is recommended?
Moist dressing
Are antibiotics given for venous leg ulcers?
No
What should a diet include in regards to venous leg ulcers?
Protein, vitamin a, vitamin c, & zinc
With client teaching regarding venous leg ulcers what five things should be included?
Activity, how to apply compression devices, limb positioning, good skin care, & to prevent trauma.
What are these treatments commonly used for radiant heat bandage, skin graft, autograft, & bioengineered skin?
Venous leg ulcers
True or False
PE's are most common complication in the hospital?
True
These move from sudden standing, change in blood flow, & Valsalva maneuver
PE's
Anxiety, unexplained dyspnea, tachypnea, tachycardia, cough, pleuritic chest pain, hemoptysis, crackles, fever, Pulmonic heart sounds become louder, pulse becomes rapid & weak, low B/P and change in mental status are signs and symptoms of what?
PE
Lethal clots come from where?
femoral & iliac veins
What are four locations clots may come from?
Deep veins of the legs, right side of the heart (especially r/t atrial fib), upper extremities (although rare), & pelvic veins (can occur after surgery or childbirth)
During an assessment of a 63-year-old patient at the clinic, the patient says, “I have always taken an evening walk, but lately my leg cramps and hurts after just a few minutes of walking. The pain goes away after I stop walking, though.” The nurse should
A. Ask about any skin color changes that occur in response to cold.
B. Check for the presence of tortuous veins bilaterally on the legs.
C. Assess for unilateral swelling, redness, and tenderness of either leg.
D. Attempt to palpate the dorsalis pedis and posterial tibial pulses.
The nurse performing an assessment with a patient who has chronic peripheral arterial disease (PAD) of the legs would expect to find
A. Swollen, dry, scaly ankles.
B. A positive Homans’ sign.
C. Prolonged capillary refill.
D. A draining ulcer on the heel.