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110 Cards in this Set
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- Back
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Peripheral Arterial Disease
Arterial Ulcers Buerger's Disease Raynaud's Disease Acute Arterial Occlusion are all what type of peripheral vascular diseases? |
Arterial Disorders
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Thrombophlebitis
Chronic venous insufficiency Venous ulcers Pulmonary emboli are all what type of peripheral vascular diseases? |
Venous Disoorders
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What are the 8 P's of Vascular Assessment?
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Pain
Pallor (color) Pulse Parasthesis Paralysis Puffiness Pinkies (cap. refill) Poikilothermia (Temp) |
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In the three P's, where will you assess pain?
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In the extremity.
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In the three P's what colors can the pallor be?
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Pale, bright red, bluish, brownish
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In the three P's, where will you take a pulse?
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Dorsalis Pedis and Posterior Tibial
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In the three P's, what do you do if you can't find a pulse?
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Get a dopler if you cannot find a pulse.
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In the three P's, what would indicate parasthesis?
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Do they have numbness or tingling in the affected area?
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In the three P's, what would indicate paralysis?
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Can they move the affected area?
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In the three P's, what would be a sign of puffiness?
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Edema or not.
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In the three P's, what would you look for in pinkies?
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Capillary refill - less than three seconds is normal.
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In the three P's, what would you look for in poikilothermia (temp)?
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Is the affected are cool, warm?
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If the affected area is cool in assessing poikilothermia (temp), what would you do next?
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Feel up the leg until you feel warmth. This is probably the spot where it is occluded.
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Predominently in males and in the legs, seen in the 6th to 8th decades, commoncirculatory problem which narrowed arteries reduce blood flow to your limbs, may be completely asymptomatic, symptoms usually occur when blockages are greater than or equal to 60%, caused by atherosclerosis or acute thrombus, if you have PAD you are at increased risk for CVA and MI?
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Definition of Peripheral Arterial Disease
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Arteries become narrowed and blood flow decreases in?
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Artherosclerosis
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What builds up collateral circulation?
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Exercise
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Intermittent claudication, leg numbness or weakness, cool lower extremities, sores on feet and legs that don't heal, hair loss of feet and legs, change in toenails, diminished or absent pedal or post tib pulses, rest pain, when les are elevated pale and cyanotic, deep red rubor when legs are dependent,
are symptoms of? |
PAD
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What is the most common symptom of PAD?
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Intermittent claudication
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Occurs when a muscle is not getting enough oxygen, then it is exercised?
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Intermittent claudication
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What kind of change in the toenails are we looking for as a symptom of PAD?
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Thick and ridged toenails.
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In PAD, this is described as pain worse than a toothache and excrutiating when they put their foot up. It usually starts in the big toe then spreads?
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Rest pain
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Smoking
Obesity Diabetes HTN Hyperlipidemia are what kind of risk factors related to PAD? |
Treatable or modifiable
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Increasing age
Family hx increased levels of CRP and homocysteine are what kind of risk factors related to PAD? |
Not modifiable
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Physical exam (8 P's)
Ankle brachial index (ABI) Ultrasound MRA Arteriogram Blood tests are what for PAD? |
Diagnosis and Tests
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What is the normal resting ankle-brachial index?
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1 or 1.1
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This means that your blood pressure at your ankle is the same or greater than the pressure at your arm, and suggest that you do not have significant narrowing or blokage of blood flow?
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A normal resting ankle-brachial index of 1 or 1.1.
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A resting ankle-brachial index of less than 1 is?
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Abnormal
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If the ABI is <0.95?
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Significant narrowing
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If the ABI is <0.8?
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Intermittent claudication with exercise.
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If the ABI is <0.4?
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Symptoms may occur when at rest.
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If the ABI is <0.25?
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Severe limb-threatening PAD.
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Pre Procedure - H&P and pt education, labs, IV and IVF
Intra Procedure - Conscious sedation Post Procedure - Line removal, lying flat, increase po fluids What procedure is this? |
Arteriogram (femoral)
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STOP SMOKING
Lifestyle modification to reduce risk factors Exercise to increase collateral circulation Medications, are what for PAD? |
Collaborative Treatment
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Medications used in Collaborative Treatment in PAD
Pletal, Trental? |
Medications used in Collaborative Treatment in PAD
Heorrheologic |
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Medications used in Collaborative Treatment in PAD
Statins? |
Medications used in Collaborative Treatment in PAD
Cholesterol Lowering Agents |
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Medications used in Collaborative Treatment in PAD
CA channel blockers, ACE inhibitors, Beta blockers? |
Medications used in Collaborative Treatment in PAD
Antihypertensives |
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Medications used in Collaborative Treatment in PAD
Plavix, ASA |
Medications used in Collaborative Treatment in PAD
Antiplatelets |
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Ineffective peripheral tissue perfusion
Chronic pain Activity Intolerance Riskk for impaired skin integrity are Nursing Diagnosis for? |
PAD
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Exercise for collateral circulation
Keep legs and feet dependent Keep legs and feet warm (no direct heat, wool socks, etc.) are intervention for what nursing diagnosis related to PAD? |
Interventions for the Nursing diagnosis of, Ineffective peripheral tissue perfusion.
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Pharmacologic (analgesia as ordered)
Nonpharmacologic (stress reduction techniques, alternative therapy) are intervention for what nursing diagnosis related to PAD? |
Interventions for the Nursing diagnosis of Chronic Pain.
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Pace ativities
Gradual increase in duration and intensity of exercise Rest with dependent extremities if claudication develops, are intervention for what nursing diagnosis related to PAD? |
Interventions for the Nursing diagnosis of Activity Intolerance.
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Assess feet and legs daily
Keep legs and feet clean and dry bad cradle and float heels, are intervention for what nursing diagnosis related to PAD? |
Interventions for the Nursing diagnosis of Risk for impaired skin integrity.
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Done for progressive severe symptoms, tissue ischemia, symptoms affecting quality of life, or gangrenous and pregangrenous wounds?
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Revascularization
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Angioplasty and Stent placement
Artherectomy Endarderectomy Surgery Bypass Surgery (Femoral-femoral bypass, femoral-popliteal bypass, femoral-tibial bypass, axillo-femoral bypass) Amputation (last resort, BKA - below knee amputation, AKA - above knee amputation) are part of? |
Revascularization
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Check ACT if < 150 may pull line if no closure device used
Keep affected leg straight and HOB flat for 2-6 hours as ordered Monitor femoral site for bleeding or heatoma Assess pedal puls, VS and sit q15min x4, then q30min x4, then q1h x4 Educate patient on what to do if bleeding occurs Provide plavix as ordered and educate patient, are what part of Stent Procedure? |
Post Stent Procedure
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What should you educate the patient to do if bleeding occurs after a stent procedure?
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Apply pressure and get help.
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If the patient needs to cough or sneeze after a stent procedure, what should they do?
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Apply pressure at the site.
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What does the effectiveness of an endarderectomy depend on?
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Particular area of blockage
Extent of arterial blockage |
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What two types of bypass grafting surgery are used in PAD?
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Aortal bypass grafting surgery and Femoral bypass grafting surgery
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Keep SBP <160
Neurovascular checks q1h for 1st 4h then q2h (use 8 P's) Assess dressing for drainage with NV checks TCDB q1WA and IS q2WA Early ambulation, OOB for all meals, IVF and give meds as ordered, stict I/O's, pain control, are postoperative care for? |
Endarderectomy, Femoral Popliteal Bypass, and Bypass Grafting Surgeries
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Distal to area of diminished blood supply, wound margins are even, can be deep or superficial, wound beds may be pale and have dry necrotic eschar and exposed tendons, usually don't drain much, surrounding tissues shine - light- hairless, usually very painful - pain reduced by dependent positiona dn worsened with elevation?
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Arterial ulcers
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Also known as Thromboangitis obliterans (TAO)
Rare d/o characterized by inflammation and spasms of small and medium arteris and veins Leads to blockages of arms and legs causing clots to form and ischemia of limbs Occurs in males <40 who smoke, may have gentic link? |
Beurger's Disease
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Episodic vasospactic disorder of small cutaneous arteries usually in fingers/toes
Occurs in young women - freq. associated with collagen disease Precipitated by exposure to cold, emotional upset, smoking and caffeine, Characterized by white, blue, red color changes Treatment not required-self limiting? |
Raynaud's Disease
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Develops quickly and abruptly, caused by thrombus, embolism, or trauma
More common in patients with Afib, MI, Prosthetic valves, Cardiomyopathy, Infective endocarditis Thrombus lodges at sites of bifurcation and atherosclerotic blockage Blood flow diminished or absent distal to thrombus Symptoms depend on size and location of thrombus? |
Acute Arterial Blockage
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Embolus
Thrombosis Trauma? |
Type of acute arterial blockage
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Severity depends on if there is collateral flow, absent distal pulses, sever pain in extremity, pale, cyanotic, or mottled extremity, may have line of demarcation, cold or cool to touch extremity, parasthesia or paralysis of extremity, must restore flow to prevent tissue death?
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Manifestations of acute arterial blockage
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Usually apparent by the signs and symptoms
8 P's of vascular assessment Arteriogram is used to determine the size, location of occlusion, and for? |
Diagnosis of Acute Arterial Blockage
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Anticoagulant therapy with IV Heparin
Immediate Embolectomy (if no done within 4-6h can have renal failure, compartment syndrome, or ARDS Thromboendarterectomy with grafting Intra-arterial infusion of thrombolytic agent (-r-tPA, streptokinase, or urokinase - bleeding complications - monitor labs) Oral anticoagulation, Treatment for? |
Acute arterial blockage
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Also called venous thrombus
Most common disorder of the veins Formation of a clot in association with inflammation of the vein Superficial or deep? |
Thrombophlebitis
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Venous Stasis
Increased coagulability of blood Vessel damage this is called? |
Virchow's Triad
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Vessel Trauma leads to platelets going to injured site and clot forms with platelets and fibrin this leads to RBC trapped in fibrin network and clot grows and leads to inflammatory response triggered causing pain, redness and swelling at the area of the thrombus. Pieces my break loose and travel through circulation (emboli). Fibroblasts invade thrombus which scars the vein and destroys valves (valve damage is permanent)?
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Pathophysiology of acute arterial blockage
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Dysfunctional valves
Inactive muscles (obesity, CHF, no regular exercise, immobility, preganancy, recent post-partum, atrial fibrillation, orthopedic injuries? |
Venous stasis
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Hematologic disorders
Cancers Systemic Infections Estrogen based oral contraceptives Hormone replacement Smoking? |
Hypercoagulability states
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Damaged endothelium has decreased fibrinolytic properties predisposing development of thrombus (Presence of IV cath longer than 48 hours, IV therapy with high dose antibiotics, K+, chemotherapy or hypertonic solutions, contaminated IV equipment?
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Endothelium Damage
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Primarily caused by IV and IVF
Palpable firm subcutaneous cordlike vein Surrounding area tender, reddened and warm Mild temp elevation Treatment (warm moist compress, antinflammatories)? |
Superficial Thrombophlebitis
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Usually asymptomatic, usually in calfs, dull aching pain with ambulation, unilateral leg edema, warm, reddened skin, calf tenderness, +Homan's sign (unreliable), lower extremity edema/cyanosis, upper extremity neck, back, face edema, and cyanosis?
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Deep Vein Thrombosis
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Pulmonary emboli
Chronic venous insufficiency (valvular destruction, retrograde flow of blood, venous stasis, arterial circulation impaired)? |
Complications of DVT
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Coagulation studies
Non-invasive venous studies (venous doppler, duplex scanning, plethysmography-done with sono) Invasive (venogram-causing DVT, Lung scan-VQ scan, Pulmonary arteriogram-gold standard of PE) |
Diagnostic tests for DVT
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Elevation
Warm moist heat Compression stockings Mild oral analgesics Anticoagulation therapy, are what type of treatments for DVT? |
Conservative
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Venous thrombectomy
Vena cava filter (Greenfield) - if the pt can't tolerate oral coag. med's, are what type of treatments for DVT? |
Surgical
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Drugs that inhibit certain clotting factors (prevent clot formation, prevent extension of a preformed clot, does not dissolve clot)
All anticoagulants work in the clotting cascade but do so at different points, these are in reference to? |
Anticoagulant therapy
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Turns off 3 main activating factors (activated II, X, IX)
Turns off the coagulation pathway and prevents clots from forming Monitor for Heparin induced thrombocytopenia Check PTT q6h until stable while on heparin gtt Protamine is the antidote? |
Heparin
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Works similar to heparin
More specific for activated factor X than for activated II Much more predictable anticoagulation response Frequent lab monitoring is not required Lovenox (given SC once daily) |
Low Melecular Weight Heparins
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Inhibits clotting factors II, VII, IX, X
Rely heavily on vitamin K for synthesis Interferes with the proper production of vitamin K End result is dysfuntional slotting and prevention of clot formation Teach patients to eat consistent amount of green leafy vegetables daily Vitamin K is antidote Must have blood drawn to monitor levels? |
Coumadin
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Bleeding
Risk increases with increased dosage Increased in pts taking ASA, plavix, or other drugs that impair platelet function Teach pts that bleeding should not occur and to notify the MD and get levels checked if bleeding gums, very heavy menstrual flow, etc. Discontinue therapy Reversal agents? |
Anticoagulation Side Effects
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ASA
Dipyridamole Plavix and Ticlid Trental Aggrenox? |
Antiplatelet Agents
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Home care -
ted hose (on in morning before legs dependent, off hs) stop smoking, exercise (daily walks and leg exercises) avoid constrictive clothing, garters, girdles avoid contraceptives Coumadin therapy get PT levels monitored as ordered notify MD of bleeding diet (consistent greens)? |
Discharge teaching for DVT prevention
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Most commonly caused by DVT
Other causes are trauma, varicose veins, or unknown etiology Develops due to incompetent valves? |
Chronic Venous Insufficiency
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Lower leg edema, worse with standing, leg pain and itching that increases with standing, brown, brawny pimentation of LE and foot, stasis dermatitis (causes the itching), thick hard fibrous SC tissues (lipodermasclerosis), normal pulses, ulcerations (superificial, uneven edges, over medial and anterior ankle)?
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Manifestations of Chronic Venous Insufficiency
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Elevate legs while resting and during sleep
Avoid prolonged sitting or standing Do not cross your legs Avoid tight contrictive clothgarters and girdles Wear TED hose, SCD's, AVI's, keep skin clean, soft, and dry Walk frequently to prevent venous stasis? |
Nursing Care and Treatment of Chronic Venous Insufficiency
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Gauze with calamine lotion, glycerin, and zinc oxide
Hardens and place Ace wrap over (left on 1-2 wks) |
Unna boot, treatment for CVI
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Unna Boot
Dressing changes as ordered for venous ulcers (boric acid, saline wet to dry, topical steroid, antifungal cream, antibiotic cream) Surgery as last resort for chronic non healing wounds? |
Treatments for CVI
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Caused by lack of blood flow, pallor on elevation, rubor on dependency, no edema, rest pain, intermittent claudiacation, cool skin, decreased or absent pulse, severe pain if acute, ulcers pale bed, ulcers on toes, feet, shins, even wound edges?
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Manifestations of arterial disorders
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Caused by incompetent valves or DVT. brown, brawny discoloration, cyanosis on dependency, significant edema, aching pain, stasis dermatitis, normal skin temperature, normal pulse, ulcers pink bed, superficial ulcers, ulcers on ankles, uneven wound edges?
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Manifestations of venous disorders
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Blood flow obstruction in the pulmonary vascular system by an embolus?
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Definition of Pulmonary Embolism
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Most arise from deep vein thrombi
May dislodge spontaneously or by mechanical force Medical emergency? |
Pulmonary Embolism
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Thrombi in circulation
Obstructing pulmonary arteries Inflammation Constrict bronchi Hemorrhage, infarction, or infiltrates Increased workload on heart leads to right sided heart failure? |
Pathophysiology of Pulmonary Embolism
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Depends on size of the emboli and size and number of blood vessels occluded (usually happen abruptly over minutes, dyspnea and tachypnea, tachycardia, cough, chest pain or pleuritic pain, anxiety and impending doom, low grade temp, crackles, hemoptysis, confusion, delirium, or decreaased LOC, syncope, cyanosis?
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Pulmonary Embolism symptoms
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D-Dimer
CT chest with contrast, V/Q lung scan Venous studies ABG Pulmonary angiography EKG to r/o cardiac? |
Diagnostics in PE
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Anticoagulation with heparin bolus and gtt
Start coumadin concurrently as it takes about 4 days to be therapeutic Monitor for anticoagulation complications Maintain resp status Prevention is key (early and frequent ambulation, leg exercises, SCD's, TED hose, AVI boots, no pillows under knees? |
Treatment for PE
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Trauma
Congenital abnormalities Peripheral vascular disease (Major cause) Diabetes Mellitus Reconstructive Improve quality of life, are references to? |
Amputations
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AKA - above knee amputation
BKA - below knee amputation these are the class of? |
amputations
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Open
Closed are ________ of amputations. |
Types
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ROM exercises: pre-op and post-op
Elevate first 24 hours Proper body alignment, BKA stump in extended position Monitor stump/incision Compression dressing to fit prosthesis Pain management No weight bearing for two weeks? |
Post op management for amputations
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Hemorrhage
Infection Delayed Healing Phantom Pain Contractures are complications of? |
Amputations
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Pain
Disturbed body image Impaired physical mobility Ineffective tissue perfusion Grieving are nursing diagnosis for? |
Amputations
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INR is used to evaluate this med?
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Coumadin
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Seen in amputees?
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Phantom pain
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Vessel damage?
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Thrombophlebitis
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Superficial wound?
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Venous Ulcer
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Inferior Vena Cava Interruption?
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Greenfield filter
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Piece of clot?
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Emboli
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Diagnostic test?
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Arteriogram
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Pale bed?
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Arterial Ulcer
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Hypercoagulability?
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Smoking
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Brownish discoloration?
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Hemoriterosis
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Treatment for CVI?
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Compression
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Used in the diagnosis of DVT/PE?
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D-Dimer
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Factor X assay used to evaluate this med?
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Heparin
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Immobility?
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Stasis
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