Nurs 605: Peripheral Vascular

Front 1

common signs and symptoms of peripheral vascular disease?

Back 1

EPICN - In extermeties, Edema, Pain, Intermittent claudication, Color change in cold weather, Numbness

Front 2

intermittent claudication can be caused by atherosclerosis. What is another disease that can cause ischemia with exertion, BUT is reduced by leaning forward, (instead of just resting)

Back 2

spinal stenosis, leaning forward stretches spinal cord out reducing pain, and is relieved less by rest.

Front 3

hair loss is an indication of what?

Back 3

loss of arterial perfusion, gangrene with dry or brown/black ulcers may ensue

Front 4

fatigue, aching, pain, or numbness in the buttocks or hips suggest ischemia stemming from what artery?

Back 4

aortoilliac

Front 5

erectile dysfunction suggests ischemia stemming from what artery?

Back 5

iliacpudendal

Front 6

fatigue, aching, pain, or numbness in the thigh suggests ischemia stemming from what artery?

Back 6

common femoral or aortoiliac

Front 7

fatigue, aching, pain, or numbness in the upper calf suggests ischemia stemming from what artery?

Back 7

superficial femoral

Front 8

fatigue, aching, pain, or numbness in the lower calf suggests ischemia stemming from what artery?

Back 8

popliteal

Front 9

fatigue, aching, pain, or numbness in the foot suggests ischemia stemming from what artery?

Back 9

tibial or peroneal

Front 10

abdominal pain after meals and subsequent "food fear" and weight loss indicate

Back 10

intestinal ischemia of the celiac or superior or inferior mesenteric arteries

Front 11

what are the risk factors for Lower Extremity Peripheral Arterial Disease (LEPAD)

Back 11

-50 (with smoking, diabetes, dyslipidemia, hypertension, or hyprhomocysteinemia) | 50-70- smoking or diabetes | 70+ just cause | pulse abnormal | exertion pain | known disease of arteries

Front 12

What are the risk factors for Renal Artery Disease?

Back 12

-30 and hypertensive | 55+ with SEVERE hypertension | accelerated hypertension | worsening renal function | small kidney | unexplained pulmonary edema

Front 13

what are the risk factors for Abdominal Aortic Aneurysm?

Back 13

excess infrarenal aortic diameter (over 3.0 cm) | smoking | 65+ | family hist. | arterial disease | hypertension | high Cholesterol

Front 14

IRONY

Back 14

an unexpected outcome, or the use of a word that is the opposite of its literal meaning

It's ironic that he tripped on a crutch and broke his leg.

Front 15

lymphadema in the arm or hand may follow what surgery?

Back 15

axillary node dissection and radiation therapy

Front 16

prominent veins in an edematous arm suggest what?

Back 16

venous obstruction

Front 17

what is Raynaud's disease?

Back 17

wrist pulses normal, but more distal arteries are induce sharply demarcated pallor in the fingers

Front 18

what is a description for a widely dilated artery?

Back 18

aneurysmal

Front 19

bounding carotid, radial, and femoral pulses are seen in aortic ___.

Back 19

insufficiency, (lack of elasticity produces an abnormally powerful pulse in regions downstream)

Front 20

asymmetric diminished pulses are seen in arterial ____ from atherosclerosis or embolism.

Back 20

occlusion

Front 21

Lymphadenopathy refers to what? What are two classifications of this that should be distinguished in an exam?

Back 21

lymphadenopathy is simply swollen lymph nodes, independent of tenderness. The physician should distinguish between a local or general version of this, by either finding a local lesion near the swelling, or by identifying large nodes in 2 other nonadjacent nodes.

Front 22

occasionally you must search more ___ to find what would be the dorsalis pedis artery.

Back 22

laterally, it may be congenitally absent in some people.

Front 23

diabetes mellitus patients are often missing what pulse?

Back 23

dorsalis pedis arterial pulse

Front 24

A missing pulse mixed with pain and tingling, cold and paleness, is known as what and requires what?

Back 24

sudden arterial occlusion, (ie. embolism or thrombosis), and reuiqres emergency treatment. (keep in mind that if collateral circulation is good, only numbness and coolness may result).

Front 25

edema causes swelling that may do what?

Back 25

obscure veins, tendons, and bony prominences

Front 26

besides edema, what else can cause different circumferences in the legs?

Back 26

muscular atrophy

Front 27

a painful pale swollen leg together with tenderness in the groin over the femoral vein suggests deep _____ thrombosis.

Back 27

iliofemoral. (except in the calf) pg. 488

Front 28

local swelling, redness, warmth, and a subcutaneous cord suggest a ____ thrombophlebitis.

Back 28

superficial

Front 29

brownish discoloration or ulcers just above the malleolus suggest what?

Back 29

chronic venous insufficiency

Front 30

While arterial occlusive disease is much less common in the arms than in the legs, absent or diminished pulses at the wrist are found in acute embolic occlusion and in what disease?

Back 30

Brueger's disease (thromboangiitis obliterans) - an inflammatory and obliterative disease of the blood vessels of the extremities, primarily the lower extremities, occurring chiefly in young men and leading to ischemia of the tissues and gangrene

Front 31

arterial occlusion involves what coloration, or lack of coloration, in the feet after the feet are lowered?

Back 31

persisting rubor. This replaces the quick refill that would be normal, and may take up to a minute to appear. This is NOT a good test for VENOUS insufficiency.

Front 32

what is the trendelburg test?

Back 32

closing the saphenous vein after having the leg drain of venous blood. Then having patient stand up and noting the first sign 1) whether venous blood quickly comes back to saphenous vein (indicating communicating branches have failed venous valves. And then releasing the great saphenous vein and noting 2) whether filling of lower extremities happens quickly, indicated failed venous valves in the saphenous.

Front 33

Injury to ___ ___ cells can provoke thrombus formation, atheromas, and the vascular lesions of hypertension

Back 33

vascular endothelial

Front 34

An ____ begins in the intima as lipid-filled foam cells, then fatty streaks

Back 34

atheroma

Front 35

What is the ankle-brachial formula and index?

Back 35

ABI = ankle systolic BP/brachial systolic BP = say 110/120 or a fraction close to 1. LOW values indicate Peripheral Arterial Disease (PAD). 0.90 is low of normal. 0.60 to 0.90 is mild PAD, moderate is 0.60 to 0.40, and severe is 0.40 and below.

Front 36

What is the cause: Edema is soft, with pitting on pressure, and occasionally bilateral. Look for brawny changes and skin thickening, especially near the ankle. Ulceration, brownish pigmentation, and edema in the feet are common.

Back 36

chronic venous insufficiency

Front 37

What is the cause: Edema is soft in the early stages, then becomes indurated, hard, and nonpitting. Skin is markedly thickened; ulceration is rare. There is no pigmentation. Edema is found in the feet and toes, often bilaterally.

Back 37

Lymphedema. develops when lymph channels are obstructed by tumor, fibrosis, or inflammation, and in cases of axillary node dissection and radiation.

Front 38

Chronic ARTERIAL OR VENOUS Insufficiency?: Pain - Intermittent claudication, progressing to pain at rest

Back 38

chronic ARTERIAL Insufficiency

Front 39

Chronic ARTERIAL OR VENOUS Insufficiency?: Mechanism - Tissue Ischemia

Back 39

chronic ARTERIAL Insufficiency

Front 40

Chronic ARTERIAL OR VENOUS Insufficiency?: Pulses - Decreased or Absent

Back 40

chronic ARTERIAL Insufficiency

Front 41

Chronic ARTERIAL OR VENOUS Insufficiency?: Color - Pale - especially on elevation, dusky red on dependency

Back 41

chronic ARTERIAL Insufficiency

Front 42

Chronic ARTERIAL OR VENOUS Insufficiency?: Temp - Cool

Back 42

chronic ARTERIAL Insufficiency

Front 43

Chronic ARTERIAL OR VENOUS Insufficiency?: Edema - Absent or mild; may develop as the patient tries to relieve rest pain by lowering the leg

Back 43

chronic ARTERIAL Insufficiency

Front 44

Chronic ARTERIAL OR VENOUS Insufficiency?: Skin changes - Trophic changes: thin, shiny, atrophic skin; loss of hair over the foot and toes; nails thickened and ridged

Back 44

chronic ARTERIAL Insufficiency

Front 45

Chronic ARTERIAL OR VENOUS Insufficiency?: Ulcers - If present, involves toes or points of trauma on feet

Back 45

chronic ARTERIAL Insufficiency

Front 46

Chronic ARTERIAL OR VENOUS Insufficiency?: Gangrene may develop

Back 46

chronic ARTERIAL Insufficiency

Front 47

Chronic ARTERIAL OR VENOUS Insufficiency?: Often painful

Back 47

chronic VENOUS Insufficiency

Front 48

Chronic ARTERIAL OR VENOUS Insufficiency?: Mechanism - ____ hypertension

Back 48

chronic VENOUS Insufficiency

Front 49

Chronic ARTERIAL OR VENOUS Insufficiency?: Pulses - Normal, though may be difficult to feel through edema

Back 49

chronic VENOUS Insufficiency

Front 50

Chronic ARTERIAL OR VENOUS Insufficiency?: Color - Normal, or cyanotic on dependency. Petechiae and then brown pigmentation appear with chronicity.

Back 50

chronic VENOUS Insufficiency

Front 51

Chronic ARTERIAL OR VENOUS Insufficiency?: Temp - Normal

Back 51

chronic VENOUS Insufficiency

Front 52

Chronic ARTERIAL OR VENOUS Insufficiency?: Edema - present, often markedly

Back 52

chronic VENOUS Insufficiency

Front 53

Chronic ARTERIAL OR VENOUS Insufficiency?: Skin changes - Often brown pigmentation around the ankle, stasis dermatitis, and possible thickening of the skin and narrowing of the leg as scarring develops

Back 53

chronic VENOUS Insufficiency

Front 54

Chronic ARTERIAL OR VENOUS Insufficiency?: Ulcers - If present, develops at sides of ankle, especially medially

Back 54

chronic VENOUS Insufficiency

Front 55

Chronic ARTERIAL OR VENOUS Insufficiency?: Gangrene does NOT develop

Back 55

chronic VENOUS Insufficiency

Front 56

What is the process for acute cellulitis?

Back 56

Acute bacterial infection of the skin and subcutaneous tissues

Front 57

What is the process for acute lymphangitis?

Back 57

Acute bacterial infection (usually streptococcal) spreading up the lymphatic channels from a portal of entry such as an injured area or an ulcer

Front 58

What is the process for Arterial Disorders > Acute Arterial Occlusion?

Back 58

Embolism or thrombosis, possibly superimposed on arteriosclerosis obliterans

Front 59

What is the process for Arterial Disorders > Atherosclerosis (obliterans) > Intermittent claudication pain?

Back 59

Episodic muscular ischemia induced by exercise, due to atherosclerosis of large or medium-sized arteries

Front 60

What is the process for Arterial Disorders > Atherosclerosis (obliterans) > pain at rest?

Back 60

Ischemia even at rest

Front 61

What is the process for Arterial Disorders > Raynaud's Disease?

Back 61

Raynaud's disease: Episodic spasm of the small arteries and arterioles; no vascular occlusion

Front 62

What is the process for Arterial Disorders > Raynaud's Phenomenon?

Back 62

Raynaud's phenomenon: Syndrome secondary to other conditions such as collagen vascular disease, arterial occlusion, trauma, drugs

Front 63

What is the process for Compartment syndrome?

Back 63

Pressure builds from trauma or bleeding into one of the four major muscle compartments between the knee and ankle. Each compartment is enclosed by fascia and thus cannot expand to accommodate increasing pressure.

Front 64

What is the process for Erythema Nodosu?

Back 64

Raised tender bilateral subcutaneous lesions seen in systemic conditions such as pregnancy, sarcoidosis, tuberculosis, streptococcal infections, inflammatory bowel disease

Front 65

What is the process for Thromboangiitis Obliterans (Buerger's disease)?

Back 65

Inflammatory and thrombotic occlusions of small arteries and also of veins, occurring in smokers

Front 66

What is the process for Venous Disorders > Chronic Venous Insufficiency (deep)?

Back 66

Chronic venous engorgement secondary to venous occlusion or incompetency of venous valves

Front 67

What is the process for Venous Disorders > Deep Venous Thrombosis (DVT)?

Back 67

Clot formation in a deep vein

Front 68

What is the process for Venous Disorders > Superficial Thrombophlebitis?

Back 68

Clot formation and acute inflammation in a superficial vein

Front 69

What are some associated symptoms of Acute Cellulitis?

Back 69

A local area of diffuse swelling, redness, and tenderness with enlarged, tender lymph nodes and fever; no palpable cord

Front 70

What are some associated symptoms of Erythema Nodosum?

Back 70

Lesions recur in crops; often malaise, joint pains, and fever

Front 71

What are some characterizations of Acute Lymphangitis?

Back 71

An arm or a leg, lasting days or longer, red streaks on the skin with tenderness, enlarged TENDER lymph nodes, and FEVER

Front 72

What are some characterizations of compartment syndrome?

Back 72

Tight, bursting pain in calf muscles, usually in the anterior tibial compartment, sometimes with overlying dusky red skin. TIMING: Several hours if acute (pressure must be relieved to overt necrosis). During exercise if chronic. AGGRAVATORS: Acute: anabolic steroids; surgical complication; crush injury. Chronic: occurs with exercise. Relief: Acute: surgical incision to relieve pressure. Chronic: avoiding exercise; ice elevation. Tingling, burning sensations in calf; muscles may feel tight, full, numbness, paralysis if unrelieved

Front 73

What are the associated manifestations in the Arterial Disorder > Atherosclerosis > with Intermittent Claudication?

Back 73

Local fatigue, numbness, diminished pulses, often signs of arterial insufficiency (see p. 498)

Front 74

What are the associated manifestations in the Arterial Disorder > Atherosclerosis > withOUT Intermittent Claudication?

Back 74

Numbness, tingling, trophic signs and color changes of arterial insufficiency (see p. 498)

Front 75

Where is the pain, what is the timing, Aggravators and Relievers, in the Arterial Disorder > Atherosclerosis > with Intermittent Claudication?

Back 75

Where: Usually calf muscles, but also may be in the buttock, hip, thigh, or foot, depending on the level of obstruction. Timing: Fairly brief; pain usually forces the patient to rest. Aggravator: Exercise such as walking. Reliever: Rest usually stops the pain in 1-3 min.

Front 76

Where is the pain, what is the timing, Aggravators and Relievers, in the Arterial Disorder > Atherosclerosis > withOUT Intermittent Claudication?

Back 76

Distal pain, in the toes or forefoot. Persistent, worse at night sometimes. Aggravated by elevated feet, relieved with legs dependent - lowered.

Front 77

Where is the pain, what is the timing, Aggravators and Relievers, in the Thromboangiitis Obliterans (buerger's disease) > with Intermittent Claudication in arch of foot?

Back 77

Intermittent claudication, particularly in the arch of the foot. Fairly brief but recurrent. Exercise aggravates, and rest relieves. Distal coldness, sweating, numbness, and cyanosis; ulceration and gangrene at the tips of fingers or toes; migratory thrombophlebitis. Permanent cessation of smoking helps both kinds of pain (but patients seldom stop)

Front 78

Where is the pain, what is the timing, Aggravators and Relievers, in the Thromboangiitis Obliterans (buerger's disease) > with pain even at rest?

Back 78

Rest pain in the fingers or toes. Chronic, persistent, may be worse at night. Permanent cessation of smoking helps both kinds of pain (but patients seldom stop).

Front 79

Where is the pain, what is the timing, Aggravators, Relivers, and what are some associated symptoms, in the Arterial Disorder > Raynaud's Disease and Phenomenon?

Back 79

Distal portions of one or more fingers. Pain is usually not prominent unless fingertip ulcers develop. Numbness and tingling are common. Relatively brief (minutes) but recurrent. Exposure to cold, emotional upset. Relief in warmth. Color changes in the distal fingers: severe pallor (essential for the diagnosis) followed by cyanosis and then redness

Front 80

Where is the pain, what is the timing, Aggravators, Relivers, and what are some associated symptoms, in the Venous Disorder > Chronic Venous Insufficiency (deep)?

Back 80

Diffuse aching of the leg(s). Timing is Chronic, increasing as the day wears on. Standing aggravates. Elevation brings relief. Chronic edema, pigmentation, possibly ulceration (see p. 498)

Front 81

Where is the pain, what is the timing, Aggravators, Relivers, and what are some associated symptoms, in the Venous Disorder > Deep Venous Thrombosis (DVT)?

Back 81

Tight, bursting pain, if present, usually in the calf; may be painless. Timing: Often hard to determine because of lack of symptoms. Aggravated by walking, and relieved by not walking. Elevation speeds relief. Possible swelling of the foot and calf, local calf tenderness. Prior history of DVT

Front 82

Where is the pain, what is the timing, and what are some associated symptoms, in the Arterial Disorder > Acute Arterial Occlusion?

Back 82

Distal pain, usually involving the foot and leg. Sudden onset; associated symptoms may occur without pain. Coldness, numbness, weakness, absent distal pulses

Front 83

Where is the pain, what is the timing, and what are some associated symptoms, in the Venous Disorder > Superficial Thrombophlebitis?

Back 83

Pain in a local area along the course of a superficial vein, most often in the saphenous system. Timing:An acute episode lasting days or longer. Local redness, swelling, tenderness, a palpable cord, possibly fever