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57 Cards in this Set
- Front
- Back
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Peripheral vascular disease (PVD) is talking about veins or arteries?
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arteries.. we we will call it PAD
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PAD affects which limbs most commonly?
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Legs
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PAD slow or aggressive?
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Slow progression
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Most common cause of PAD?
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atherolsclerosis- plaque buildup
chronic obstruction |
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What else can cause PAD?
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An acute arterial occlusion- embolus
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Depending on where embolus ends up, there are several names for the clot...
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Heart-infarction
Brain-stroke Leg-gangrene |
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How does PAD manifest?
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Intermittent claudication- leg pain that occurs with activity, pain relieved one they rest
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What does PAD feel like when pt tries to walk?
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Cramping burning pain forces pt to stop walking, usually in calves.
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Is tha pain above or below the occlusion?
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Below- severe pain
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What does the extremity affected by PAD feel like?
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Extremity is cool, pulseless, mottled (splotchy look).
May have gangrene |
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As PAD gets worse, what happens with the pain?
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It eventually will continue even when resting
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What do the sores on the toes from PAD look like?
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Sores are small, deep, even edges, punched out look- stage 4 of PVD
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Key features of Chronic Peripheral Arterial disease
Stage 1: asymptomatic |
No claudication, but decreased or absent pedal pulse
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Key features of Chronic Peripheral Arterial disease
Stage 2: claudication |
Pain with activity (sudden burning pain), relieved with rest
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Key features of Chronic Peripheral Arterial disease
Stage 3: rest pain (as disease progresses) |
Awakens pt at night, “numbness, burning”, relieved w/ dependent position
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Key features of Chronic Peripheral Arterial disease
Stage 4: necrosis/gangrene |
Ulcers, blackened tissue present
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Where is the best place to check for pedal pulses with PAD?
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posterior tibialis will be the best place to check
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** 6 Ps to assess for in PAD pts?
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Pain, Perfusion, Pallor, Pulselessness, Paralysis, Paresthesia, Polar (coolness)
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** Do we encourage exercise with PAD?
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Yes- encourage exercise to increase collateral circulation
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How do we tell PAD pts to exercise?
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Walk until the point of claudication, stop and rest, then walk again
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** What position should we have PAD pts avoid?
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avoid putting feet above the heart or crossing the legs. Avoid crossing legs or wearing restrictive clothing
If legs are swollen elevate feet because swelling prevents arterial flow |
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** What is the goal treatment for PAD?
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Vasodilation
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** How do we promote vasodilation in PAD pts?
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keep warm to vasodilate and increase circulation (compresses), (avoid stress, caffiene, smoking)
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Drugs for PAD pts?
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aspirin, clopidogrel (Plavix)
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Six P’s of Ischemia
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Pain, Pallor, Pulselessness, Paralysis, Paresthesia, Polar (coolness)
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Arteriography of lower extremeties
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Imaging to see exact amount of occulsion in vessel
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Arterial revascularization
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To increase arterial blood flow
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Surgical thrombectomy or embolectomy.
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MD inserts a catheter and retrieves the embolus.
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Complications after Surgical thrombectomy or embolectomy.
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new emboli, compartment syndrome(edema, pain, decreased cap refill, numbness, muscle tenseness)
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What is Revascularization of pt with INFLOW disease
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Inflow procedures bypass arterial occlusions above superficial femoral arteries.
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What is Revascularization of pt with OUTFLOW disease
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Outflow procedures bypass the arterial occlusion at or below the superficial femoral arteries.
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Post bypass care, what should the nurse observe for?
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Observe for pain which may be one of the first indicators of post op graft occlusion.
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What should the nurse monitor post bypass?
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To promote graft patency, monitor pts BP and notify surgeon if pressure increases or decreases beyond normal limits
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What device should the pt use post bypass?
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Incentive Spirometer- Coughing and deep breathing Q1-2Hrs
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Is the pt NPO post bypass surgery?
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Yes for at least 1 day
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What are th 2 complications that can occur post bypass?
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Graft Occlusion and Compartment syndrome
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Is graft occlusion an emergency?
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Yes!
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2 interventions for graft occlusion
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Emergency thrombectomy (which the surgeon can do bedside) is the most common treatment for graft occlusion
OR Local intra-arterial thrombolytic therapy with an agent such as tissue plasminogen (t-PA) or infusion of platelet inhibitor such as abciximab(ReoPro) may be used for acute graft occlusions. |
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Compartment syndrome
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occurs when tissue pressure within a confined body space becomes elevated and restricts blood flow. The resulting ischemia can lead to tissue damage and eventually tissue death.
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How to assess for Compartment syndrome
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Assess motor and sensory function of affected extremity, increasing pain, swelling, and tenseness. Report any of these symptoms to surgeon immediately.
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What is an Aneurysm?
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Permanent localized dilation of an artery, which enlarges the artery to at least 2 X its normal diameter.
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Where do aneurysms occur?
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They often occur where artery is not supported by muscle.
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Most common cause of aneurysms?
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Atherosclerosis
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Other Causes of aneurysms?
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Atherosclerosis- most common
Hypertension Hyperlipidemia Smoking Family history Connective tissue diseases Blunt trauma |
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What are the symptoms of an aneurysm?
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Asymptomatic usually
Cause symptoms of pressure |
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What does an aortic aneurysm feel like to the patient?
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Patient may report feeling heart beat in abdomen when laying down and feel a lump.
Abdominal pain- gnawing, unaffected by movement, lasting hours or days, repositioning does not help |
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Do we palpate if we suspect an aneurysm?
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NO! Do not push down on it, it can burst!
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What do we hear when we auscultate an aneurysm?
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May hear bruit, like ultrasound HR of a baby
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What happens if an aneurysm ruptures?
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life threatening because hemorrhagic shock occurs, quickly will die
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How do we diagnose aneurysms?
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View abdominal x-ray- eggshell appearance, CT and ultrasound.
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Nursing care for AAA (aortic abd aneurysm)
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Antihypertensives (to decrease BP and prevent rupture!)
Monitor size by CT Take meds as prescribed Do not lift more than 15-20 lbs 6-12 wks post op |
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What are aneurysm S/S that must be promptly reported?
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• Abdominal fullness or back pain
• Chest/back pain • SOB or difficulty swallowing or hoarseness |
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What are symptoms of AAA?
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Abdominal, flank, or back pain unaffected by movement and lasting for hrs. or days
Pulsating upper abdomen slightly left of the midline Bruit |
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What symptoms of ruptured AAA?
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• Hypotension
• ↓LOC • Diaphoresis • Oliguria (scant urine) • Loss of pulses distal to rupture • Dysrhythmias and severe pain with sudden onset in the back or lower abdomen, which may radiate to groin, buttocks, or legs. |
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What is Raynaud’s?
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patients often have an associated systemic connective tissue disease such as SLE (systemic Lupus Erythematosus). As a result of vasospasm, the superficial skin vessels are constricted and blanching of the extremities occurs, followed by cyanosis.
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What do the limbs look like with Raynaud’s?
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o When vasospasm is relieved the tissue becomes hyperemic. The patient’s extremities are cold and numb. Ulcers may also be present.
o Attacks are intermittent and can be aggravated by cold or stress. In severe cases, the attacks last longer and gangrene of digits can occur |
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Patient teaching for Raynaud's
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Minimize exposure to cold
Reduce caffeine (vasoconstriction) Reduce stress Smoking cessation Take meds (vasodilating agents) as prescribed |
