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45 Cards in this Set
- Front
- Back
Circulatory system-
What is it's function, what is the vessel structure, and explain the lymph system |
Function is transportation. It delivers nutrients and oxygen and perfuses the organs
The vessel structure: tunica adventia supports the vessel Tunica media constricts and relaxes Tunica intima is smooth and slippery The lymph system picks up 1/10th of fluid and plasma proteins and empties into vascular system in chest cavity |
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Explain Arteries, veins and capillaries
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Arteries-Thick walled, high pressure system. They deliver oxygen and nutrients. They also sense info.
Veins are thin walled and have a low pressure system. Veins pick up waste products and valves prevent back-flow (Clots can be around valves) Capillaries are single thickness vessels. They connect arteriole and venules, they provide the actual exchange of nutrients, oxygen and waste products. |
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Give an example of a Chronic arterial disease/disorder
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Peripheral Atherosclerosis
The primary sites of involvement are the femoral (groin) and peripheral sites (behind the knee) |
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What is atherosclerosis
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It is a form of arteriosclerosis in which deposits of fat and fibrin obstruct and harden the arteries-it impairs blood supply to the peripheral tissues and leads to peripheral vascular disease PVD.
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Factors that lead to chronic arterial disease
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Factors that cannot be modified- heredity, sex/gender, race increases in African Americans, increase in age
Factors that can be modified: cigarette smoking -nicotine causes vasoconstriction and platelet aggregation. -Carbon monoxide causes: decreased oxygen transport and damage to the inner lining Hypertension Diabetes-control of BS effect rate of progression Cholesterol Contributing factors obesity lack of exercise stress |
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Manifestations of chronic arterial disease
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S/S are direct result of inability to deliver blood, nutrients, and oxygen to the tissues.
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Subjective assessment for chronic arterial dsease
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Subjective Data:
Intermittent claudication -muscle pain below point of occlusion -caused by tissue hypoxia and lactic acid accumulation -described as gnawing, burning, cramp-like -may be relieved by rest or dependency |
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Objective data for chronic arterial disease
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Weak/absent pulses. -Mark where you found the pulse with an X.
Bruit-hum or swish Thickened, yellowish, discolored nails, temp variation- cooler below occluson and warmer above occlusion due to increased collateral flow elevational pallor Dependent rubor -occurs after prolonged hypoxia may see muscle atrophy-late sign of long term disease delayed capillary refill time numbness and tingling absence of sweating may cause impotence in males if occlusion is high necrosis and ulcer formation -usually on feet or toes -well defined edges -non bleeding -deep pale base with necrotic tissue -painful Ankle arm pressure index -leg pressure/brachial pressure -below 1 indicates arterial disease -pressure normally higher in feet and legs assess claudication distance Take leg/ankle pressure BP and divide it by arm pressure. Leg: 140/80...Arm 120/80...140/120>1 |
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Nursing diagnoses for those who have chronic arterial disease
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Impaired tissue perfusion
High risk for injury Activity intolerance Knowledge deficit |
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Treatment of chronic arterial disorders
risk factor modification |
-Risk factor modification
*Emphasis on exercise and smoking cessation Clean feet, emphasize exercise until pain then stop and rest until pain stops, then start exercising again |
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Treatment of chronic arterial disorders
meds |
Meds
-Vasodilators-use is controversial Rheologic agents -Pentoxifylline (trental) increases RBC flexibility, decrease platelet aggregation, decreases blood viscosity thus increasing peripheral circulation --may cause GI upset --may take several weeks to note improvement ASA and antiplatelet aggregation agents -Decrease antiplatelet aggregation -NDx: potential risk for injury: hemorrhage |
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Treatment of chronic arterial disorders
Percutaneus Transluminal angioplasty-explain |
Balloon tip through occlusion
Inflated balloon presses plaque against vessel wall thus improving blood flow Complications: -occlusion of artery through spasm, clot or collapse rupture of artery |
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Treatment of chronic arterial disorders
Name and explain the -ectomys that are done |
Emboletomy-removal of blood clot
Endarterectomy-strip plaque on artery lining Sympathectomy-disruption of sympathetic innervation of vessel (that would cause vasoconstriction) rarely performed today |
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Treatment of chronic arterial disorders
Arterial bypass-explain |
Arterial bypass
*Nursing care: -pain control -assess color and temp distal to graft -assess sensation and movement in limb -assess peripheral pulses -monitor for edema -monitor for infection, hemorrhage -monitor vital signs -avoid pt crossing legs -keep pressure off of extremity - avoid sharp flexion of graft site - encourage activiy as tolerated |
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Treatment of chronic arterial disorders
Amputation-explain |
Amputation
-last resort save as much of limb as possible usually for severe necrosis or infection Ndx: Impaired mobility, Alteration in body image |
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acute arterial occlusion name some diseaes and describe
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Acute arterial occlusion is a group of diseases that result in occlusion of the branches of aorta and arteries. Atherosclerosis (AS) is the most common cause
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Etiology of acute arterial occlusion
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Underlying chronic arterial disease
Arterial invasive procedure Post operative vascular patient Atrial fibrillation Diabetes Aneurysm Trauma with lacerated, compressed or severed vessels |
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Manifestations and nursing diagnosis for acute arterial occlusion
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1. Sudden onset of pain coldness, numbness.
2. Muscle weakness 3. Decreased or absent pulses 4. Skin is cool to touch Ndx Impaired tissue perfusion High risk for injury Activity intolerance |
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Treatment of Acute arterial occlusion
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Emergency
Skeletal muscle may survive 6-8 hours PTA Arterial Bypass |
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Treatment-Meds
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Fibrinolytics
-Dissolve clot -IV or arterial -monitor for infiltration and bleeding -followed up with heparin or coumadin Heparin -During acute period IV or SQ - Monitor PTT ( 1 1/2 to 2 1/2 X control) - Over 100 hold dose notify MD - Antagonist: Protamine sulfate - Does not dissolve clots, does not interfere with clot formation Coumadin -Started 3-5 day overlap with heparin -usually taken once daily (oral) - MOnitor PT (1 1/2 to 2 1/2 X control) -antagonist Vitamin K |
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What is thrombophlebitis and deep vein thrombosis
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Thrombus formation with inflammation of veins.
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Risk factors for Deep vein thrombosis
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Previous History
Pregnancy Polycythemia (over abundance of RBCs) Obesity Immobility Varicosities |
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Manifestations for Deep vein thrombosis
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Pain-localized, deep, aching, throbbing, increases with walking
Positive Homan's sign, pain in popliteal area with forceful dorsiflexion Swelling vein reddened and warm other Sx of inflammation |
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Pathophysiology of Deep Vein thrombosis
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thrombus form at bifurcations and veins
Newly formed venous thrombus have tails that may detach (emboli) 24-48 hours later will lyse or adhere to vessel wall **Virchow's triad: Hypercoagulabilty, stasis, and endothelial damage. |
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Diagnostic tests for Deep vein thrombosis
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Ultrasonography: duplex ultrasound
Ascending contrast venography (Gold standard for diagnosis DVT) |
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Treatment for Deep Vein thrombosis (prevention)
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Prevention
-Early ambulation and leg exercises Support hose avoid position that promotes stasis |
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Treatment for acute deep vein thrombosis
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Bedrest (4-10 days)
ROM to unaffected extremity elevate extremity (avoid acute hip flexion) Moist heat foot cradle (not used for a long time) anticoagulation measure calf Do not rub or massage heparin therapy |
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Pulmonary Embolism: Definition and Etiology
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Definition: Blood clot or other embolic material that has lodged in the lung circulation
Etiology -Venous stasis -prolonged immobilization -prolonged sitting/traveling -varicose veins -thrombophlebitis Hypercoagulability -injury -surgery (esp vascular 7 orthopedic) -tumor -Increased platelet count Miscellaneous -Advanced age -obesity -pregnancy -oral contraceptives -previous hx -Virchow's Triad -Smoking -A-fib |
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Manifestations of Pulmonary embolism
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Chest pain, usually sudden onset, pleuritic (well located, does not radiate)
-dyspnea -tachypnea -sx of shock -cough -hemoptysis (blood in sputum) -lungs: wheezing, frx rub, crackles |
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diagnostic tests for pulmonary embolism
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Chest Xray
EKG ABGs perfusion lung scan pulmonary angiography-gold standard for detecting pulmonary embolism |
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Pathophysiology for Pulmonary Embolism
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Partial or complete obstruction of PA
Alveolar dead space Loss of surfactant-atelectasis Chemicals released causing vaso and bronchoconstriction which cause shunting increased PA pressures Increased rt ventricle work and failure |
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Treatment of Pulmonary Emolism
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Prevention
Oxygen IV heparin EKG Thrombolytic therapy Possible surgery vena cava umbrella filter |
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Hypertensive crisis definition
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rapid onset
Systolic pressure > 220-240 mm Hg diastolic pressure >120-130 mm Hg |
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Clinical manifestations of Hypertensive crisis
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dyspnea, angina, tachycardia, ocular fatigue (eyes tired), occipital headaches, drowsiness
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Etiology of hypertensive crisis
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Younger people
African Americans Pregnant women Underlying collagen and or renal disease |
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Management of Hypertensive crisis
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ICU
IV antihypertensive reduce MAP 25%--excessive reduction can compromise cerebral perfusion Danger: intracranial bleeding, MI, CHF |
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Aneurysms-describe
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Abnormal localized vessel dilation caused by a weakness of arterial wall. May allow stasis of blood and thrombus formation
Most commonly located in aorta (greatest pressure) |
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Manifestations of aneurysms
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Most are asymptomatic
Some patients have vague abdominal discomfort described as throbbing. Pulsating sensation in abdomen when lying could occur,and if complaining of back pain, suspect rupture |
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Types of Aneurysms
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False-Actually a pulsating hematoma
true-cause is unknown Degenerative process Atherosclerosis thinning of elastin layers fusiform: entire circumference of vessel Sacular-part of vessel Dissecting: bleeding/hematoma |
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Diagnostic tests for aneurysms
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Chest X-ray may show calcification.
Angiography: insert dye provides clearer picture Sonography: sound waves-show blood flow and outlines aneurysm-before angiography or CT CT scan |
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Etiology for aneurysm
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Uncontrolled hypertension most common cause
Involves hemorrhage into vessel wall Acute life-threatening condition |
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Dissecting aneurysm
-manifestations |
Location dependent
Excruciating pain in chest or back Ripping or tearing Thigh systolic BP less than brachial BP Early BP may be increased then drops rapidly may palpate pulsatile mass Auscultate systolic bruit Sx of hemorrhage (tachycardia, pallor, diaphoresis) |
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Treatment for aneurysm
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Control BP
Surgical intervention Elective surgery 5% mortality Ruptured and then OR 50-75% mortality |
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Nursing care for an aneurysm
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Monitor for sx of bleeding
Monitor for sx of infection Monitor for sx of arterial occlusion assess pedal pulses with VS Antiembolism stockings Extend and dorsiflex feet monitor cardiac status Monitor urine output |
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Nursing diagnoses for an aneurysm
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High risk for injury
Pain Ineffective breathing pattern Bowel elimination |