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33 Cards in this Set
- Front
- Back
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Signs of Arterial Dysfunction |
- Skin temp is cool, gradient through leg
- Skin color is dependent rubor and elevated pallor
- Cap refill greater than 3 seconds
- Sensation is numbed, tingling/burning sensation
- Pain includes claudication, tingling/stinging
- Weakness and atrophy in the muscles
- Edema is absent
- Ulcers are often on toes, dry, white in color |
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Signs of Venous Dysfunction |
- Skin temp is warm, no temp gradient
- Color is brown/brauwny/red
- Cap refill is normal <3 seconds
- Peripheral pulses are present, but likely difficult to pinpoint due to edema
- Sensation is unchanged
- Pain is a dull ache/heavy
- Some weakness
- Edema in lower legs (present)
- Ulcers are wet/red/draining |
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Common Nursing Diagnosis for Arterial Alterations |
- Ineffective peripheral tissue perfusion
- Imbalanced nutrition: more than body requirements
- Ineffective health maintenance
- Activity Intolerance |
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Risk factors for PAD/CAD/CHD |
male gender, obesity, diabetes, nicotine use, hyperlipidemia, low activity/sedentary, age, hypertension |
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Clinical Manifestations of PAD |
Intermittent Claudication (cramping, numbness, fatigue of muscle). The same amount of exercise will cause the pain ea. time.
Observations seen in arterial insufficiency (shiny skin/hairless/pallor/cool/dry ulcers, >3 sec cap refill)
Eventually claudication becomes pain at rest |
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Diagnosis of Peripheral Arterial Disease (Ankle - Brachial Index) |
An ABI is normally greater than or equal to 1. A lower ABI ratio indicates reduced blood flow to lower extremities. An ABI is calculated by the ankle systolic BP by the higher of the ankle systolics.
Doppler studies
Angiography
MRI
CT
Stress Testing (treadmill test) |
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Collaborative Care: Peripheral Arterial Disease |
Lifestyle Changes: Weight Loss/Diet changes including DASH diet (low lipid/low sugar/low salt)
Nicotine Cessation
Exercise: Create hypoxia in the tissues which stimulates growth of arterioles (collaterol circulation) |
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Important Patient Teaching: Peripheral Arterial Disease |
Foot Care: tepid water, check bottom of feet regularly, always wear shoes and socks, sensation in foot tends to be decreased
Avoid Restricting Blood Flow: no crossing legs, no restrictive clothing, no compression stockings
Nutrition: protein, vitamins, micro vitamins (have healing in mind)
Care with heat: lack of arterial flow means slow heat diffusion. |
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Pharmacology in Peripheral Arterial Disease (what to avoid/whats normal) |
In general - Antihypertensives/vasodilators
Avoid Beta Blockers
Pentoxyifylline (trental) - Makes RBC more flexible
Clopidogrel (Plavix) - Decreases clotting and risk for clots
ASA- Decrease risk of clots/anti inflammatory
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Surgery & Angioplasty - Peripheral Arterial Disease |
Important that the patient understands they still have the disease after surgery, palliative not a cure.
After Surgery -- Watching for bleeding. Arteries are high pressure and the patient will bleed out qu9ickly. Increased HR w/o change in BP is a sign of compensated shock.
Check pulse (peripheral pulses), bp, site for redness and swelling. Unusual bruising, signs of hemorrhage. Peripheral pulse and cap refill should be checked to determine blood flow. |
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Acute Arterial Occlusion - Definition and Clinical Manifestation |
- Sudden blockage of artery. Emergency, needs to be dealt with immediately.
- Manifests as pain, pallor, paresthesia, muscle weakness, poikilothermia, unilateral edema (and symptoms) |
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Raynaud's Disease - Definition |
Intermittent spasm of small arteries and arterioles, induces change in colors |
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Raynaud's Disease - Risk Factors |
usually women 16 - 40, exposure to cold, emotional stress, vibration usually triggers it, exposure to heavy metals |
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Raynaud's Disease - Clinical Manifestations |
Color changes in response to vasospasm (fingers, toes, tips of the nose) (white-red-blue)
Hyperemic response painful as well as vasospasms |
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Raynaud's Disease- Management and Tx |
Avoid precipitating causes
Wear loose warm clothes and gloves
Avoid smoking (vasconstriction)
Avoid temperature extremes
Vasodilators (beta blockers are usually avoided) |
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Buerger's Disease - Definition and risk factors |
Inflammation and occlusion of small arteries/arterioles
Risk Factors: male gender, 16 - 40 y/o, association with tobacco use
Clinical Manifestations: Claudication in distal areas, decreases pulses, arterial type ulcers |
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Buerger's Disease - Treatment and Management |
Stop smoking/Nicotine use
Avoid Injury/good skin care
Avoid Cold
Vasodilators/pentoxifylline
Beurger-Allen exercises
Surgery |
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Arterial Aneurysms - Definition and Risk Factors |
Localized dilation of an artery (thoracic/Abdominal/Aortic)
Risk Factors: hypertension, trauma, age, family hx, male gender, CAD, increased cholesterol, PAD, tobacco use, obesity
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Arterial Aneurysms - Clinical Manifestations |
Thoracic: Frequently asymptomatic. Pt may come in with chest pain, SOB, difficult swallowing, hoarse voice
Abdominal: May be able to feel pulsatile mass, may hear brewy. Back or lumbar pain.
Dissecting: Emergency!!! Intense pain described as a tearing type pain. Intima is literally being shaved away from artery. |
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Arterial Aneurysms - Treatment and Management |
If asymptomatic and small (<5cm) may monitor
Primary Tx revolves around treating hypertension. Increased BP increases risk of rupture, dissection and increase in size.
Surgical resection: before dissection occurs |
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AAA Open Repair: Risks |
Open repair may lead to acute renal failure. Monitor I & O, BUN and Creatinine
Abdominal surgeries are likely to refuse to cough and deep breath -- painful.
Monitor for bleeding/site/redness |
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Venous Alterations - Etiology/Risk Factors |
Valves and muscles fail to keep blood moving forward
Risk Factors: obesity, sedentary, lifestyle, pregnancy
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Venous Alterations - Manifestations |
Edema, increased pressure, blood begins to pool in capillary bed, leaking through skin (brown color). Wet ulcers on boney prominences. Hair. |
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Venous Alterations/Insufficiency - Collaborative & Nursing Care |
Improve venous return: support stockings, walk around, don't cross legs.
Put pt on bed rest and elevate feet.
** #1 medical concern with venous insufficency is DVT ** |
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What is the primary medical concern regarding venous alterations/insufficiency? |
The #1 concern regarding venous insufficiency is DVT |
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Venous Thrombosis - Risk factors and pathophysiology |
Risk Factors: Injury to vein wall (damage of endothelium), blood stasis, hypercoagubility (cancer), increased blood thickness (diuretics)
Bed Rest even a few hours is a huge risk for DCT. Laying flat causes diuresis. |
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Venous Thrombosis (DVT) - Goals/Tx |
Goal is never to treat DVT, but to prevent.
Prevention: walk around, cough and deep breath, hydration, SCD/compression stocking
Treatment: Bedrest, warmth, anticoagulant therapy (heparin & coumadin). |
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Anticoagulants: Heparin |
Lengthens clotting time, prevent thrombus from forming/growing.
Can cause bleeding or heparin induced thrombincytopenia.
LMW heparin is safe for outpatient use and does not require regular testing. |
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Anticoagulants: Warfarin (Coumadin) |
Inhibits synthesis of vitamin K dependent clotting factors.
Can cause bleeding, cramps, nausea, and fever. Nursing should monitor thrombin levels.
Teaching: Be consistent with diet. Dose will be adjusted according to diet and individual person.l Notify HCP before adding any new Rx. Soft bristle tooth brush, electric razor. |
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Deep Vein Thrombosis: Discharge Teaching |
Need frequent INR testing. Prevention of future DVT, legs elevated, activity, compression stocking |
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Physiology of Hypertension |
BP = CO x HR
HR x SV = CO
Normal Bp 120/80
Prehypertensive 140/90
Hypertension 160/100 |
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Types of hypertension |
Primary - Idiopathic
Secondary - Has specific cause
White coat hypertension Isolated Systolic Hypertension
Hypertensive Crisis - Really high (<210/120) |
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Hypertension - Clinical Manifestations |
Frequently None --
Effects are mainly on the vascular system of major organs: Brain, Eyes (retinal hemorrhage), heart (MI, HF), PAD, kidneys (acute and chronic renal failure) |
