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145 Cards in this Set
- Front
- Back
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3 layers of the a vessel
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intima
media adventitia |
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layer that allows constriction and dilation of a vessel
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media
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single layer of endothelial cells, responds to chemicals to change diameter
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capillaries
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____join together to form venules
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capillaries
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________ picks up excess tissue fluid and returns it via venous system
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lymph system
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does have valves to ensure onew way flow ; aka pumpless system
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lymph. system
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composed of water and dissolved proteins
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lymph
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how many liters are lagged behind for reabsorbing ?
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3 liters
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chronic disease of the arterial system
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arteriosclerosis
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char. by abnormal thickening and hardening of vessel walls
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arteriosclerosis
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Describe pathology of arteriosclerosis
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a) tunica intima stiffens and thickens
b) size of arterial lumen decreases |
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is a form of arteriosclerosis caused by deposits of intra-arterial fat and fibrin that harden over time
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atherosclerosis
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caused by lesions from endothelial injury, smoking, HTN, diabetes, dyslipidemia, autimmune disease, infections
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atherosclerosis
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leading contributor to coronary artery and cerebral disease
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atherosclerosis
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pathogenesis of atherosclerosis
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a) inflammation of endothelial cells
b) cytokine release c) Growth factors release d) Macrophages adhere to injured endothelium |
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is the process of oxidation among low density proteins
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atherogenesis
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risk factors that promote LDL oxidation
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smoking and diabetes
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s/s atherosclerosis
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inadequate tissue perfusion
ischemia tissue death (due to arterial occlusion) development collateral circulation |
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s/s of arterial occlusion
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pain
intermittent claudication muscular hypoxia metabolite accumulation |
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c/c due to arterial occlusion
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tightening of calves
burning sensation during walking claudication- usually refers to cramping pains in the legs (usually the calf muscles, but may be in the thigh muscles) caused by poor circulation of the blood in the arteries to the leg muscles during exercise. True claudication is relieved with rest from exercise |
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other s/s of arterial occlusion
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dependent rubor
white pallor of extremity when elevated pain at rest coldness in extremities weak or absent pulse (stenosis) hypertophied toenails loss of hair tissue atrophy shiny skin ulcerations gangrene |
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more s/s of arterial occlusion
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arterial steal
bruits |
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occurs as arterioles of the muscles are maximally dilated because of hypoxia and paresthesias
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arterial steal - stealing from cutaneous and peripheral nerve vessels (pins and needles)
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sound produced by turbulent blood flow
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bruit
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what disorders may produce a bruit?
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stenotic vessels
dilated segments (aneurysms) |
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arterial occlusion sites:
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aortoiliac bifurcation
R or L femoral occlusion popliteal/tibial occlusion calf claudication |
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is a type of ultrasound that uses sound waves to measure the flow of blood through a blood vessel. Waveforms of the blood flow are shown on the ultrasound screen.
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Doppler flow study
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non invasive dx studies for atherosclerosis
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Doppler flow study
MRI ankle-brachial index (ABI) |
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ABI that indicates presence of PVD
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90% or less
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0.9 to 0.7 ABI
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mild claudication
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0.7 to 0.4 ABI
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moderate to severe claudication
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0.4 to 0.3 ABI
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severe claudication
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< 0.3 ABI
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ischemia w/ impending loss of tissue
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A detailed picture of areas inside the body. The pictures are created by a computer linked to an x-ray machine that scans the body in a spiral path. Also called helical computed tomography.
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spiral CT
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study that reveals lumen of blood vessels and runoffs. contrast media is used; specific locations are visualized (i.e. aneurysms, collateral circ)
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arteriography
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ways to reduce risk factors and promote arterial flow
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smoking cessation
weight reduction exercise dec. blood lipid level promote arterial flow (ie. Trental) |
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types of endovascular interventions
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angioscopy
laser mechanical atherectomy thrombolytic therapy stents |
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commonly used in coronary vessels to stretch the arteries
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PTA - percutaneous transluminal angioplasty
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is done to salvage limbs; a form of revascularization; done after performing an arteriography
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arterial bypass
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the use of pts own saphenous vein to promote blood flow to L/E
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femoral artery bypass graft
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incision is made into artery and the plaque is removed, artery is sutured back; usually done at carotid artery
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Endarterectomy
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post of Nsg care following arterial surgery
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Bed rest w/ leg flat
monitor distal pulses monitor skin color and PMS maintain u/o greater than 30cc/hr assess mental status assess for hematoma no leg crossing extremity dependent positioning monitor edema daily ASA |
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post op complications following arterial surgery
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pseudo aneurysm
hematoma infection compartment syndrome |
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develops from swelling around the fascial compartment of the leg
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compartment sndrome
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s/s of compartment syndrome
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a) pain out of proportion to surgery
b) tense swollen leg c) pain with muscle stretching d) rusty urine (myoglobin release) |
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types of amputation
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open (guillotine)
closed (flap) |
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amputation : post op care
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a) dressing on stump
b) cast applied or rigid dressing c) first 24 hours: raise stump on pillow d) after 24 hours: keep stump flat in bed |
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things to know regarding amputations
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a) stumps tend to shrink with healing
b) phantom limb sensations c) rehab involves prosthesis fitting 2-3 wks after sutures are removed |
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is a localized dilation (50% increase in size) of an artery
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AAA
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risk factors for AAA
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men over age 50
hereditary HTN |
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most common cause of AAA
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atherosclerosis
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location of aneurysm
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venous or arterial
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is when the dilation occurs in the layers of the vessel wall
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true aneurysm
- can be in the form of a) saccular b) fusiform (bulging on all sides) c) dissecting (separated walls) |
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clinical manifestations of AA
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asymptomatic (smaller ones)
pulsating abd mass w/ or w/o pain back pain mottled LE color dyspnea ; cough loss of voice/hoarseness |
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s/s of ruptured AAA
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severe abd pain, back and flank pain
pulsating abd mass or rigid abd signs of shock syncope ecchymosis in flank and perianal area n/v w/ hypotension decreased RBD and increased WBC |
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surgical intervention AAA
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resection
bypass graft |
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Dx of AAA
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U/s, CT, MRI, Transesophageal-Echocardiography
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5 Ps of arterial embolism
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pain
pallor pulselessness paresthesia paralysis |
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Nsg Dx; post op AAA
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Risk for fluid vol deficit
impaired gas exchange altered tissue perfusion pain bowel ischemia |
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post of care AAA
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2-3 days in ICU
monitor EKG strict I/O Pain control, antibiotics monitor BP PMS extremities check for mottled skin report calf and leg pain keep incision clean IS w/ TCB q2-3hrs |
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elevated BP on a AAA pt indicates:
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stress on graft suture line
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cool pale and mottled skin on a post op AAA pt indicate
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an obstructed graft
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pain and tenderness in calf or leg indicate:
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thrombophlebitis from clot formation
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post op back pain on AAA patients indicates:
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tearing of the graft
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discharge guidelines for post op AAA
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`wound care
activity restrictions: no lifting > 5 lbs avoid driving check complications i.e. clots/grafts |
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an intermittent arterial peripheral vascular disorder char. by marked vasoconstriction of extremities when exposed to cold or emotional stress
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Raynaud's Disease
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s/s of Raynaud's
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pallor or cyanosis of fingers
gangrene of tips of fingers |
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intermittent attacks of pallor followed by cyanosis, then redness of digits, then a return to normal. Initiated by exposure to cold or stress
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Raynaud's phenomenon
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treatment for Raynaud's
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avoid stress
wear gloves avoid cigarettes avoid injury to fingers and toes |
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are abnormally dilated tortous veins; occur more on L/E
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variocose veins
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caused by incompetent valves in the saphenous veins
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variocose veins
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affect 1 in 5 persons in world; more on women
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varicose veins
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causes of varicose veins
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prolonged standing
heavy lifting obesity thrombophlebitis pregnancy trauma abd/pelvic tumors chr.liver disease |
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assessment of varicose veins
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PE
c/o leg problems brawny edema palpation of dilated, bulbous or corkscrew vessels long term stasis leading to stasis ulcers |
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non-pitting edema that is orange peel looking char. by thickening / hardening of the skin , infiltrated with plasma proteins
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Brawny edema
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Dx tests for varicose veins
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doppler U/S
MRI |
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Nsg Dx for varicose veins
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altered tissue perfusion
pain r/t cramping, heaviness and achiness altered body image r/t ghastly looking veins |
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Tx for varicose veins
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sclerotherapy
vein ligation or stripping |
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hypertonic saline injected to vein and applied w/ compression bandage
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sclerotherapy
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nst interventions to varicose veins post-oop
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apply elastic support stockings
avoid standing for long periods avoid crossing legs exercise walking observe skin avoid heavy lifting wait 24-48 hours before showering inform client re ecchymosis and scarring; will fade 3-4 months; procedure may need to be repeated |
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assessment of DVT
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Homan's sign
swelling of extremity erythema feeling of heaviness Hx of abd/pelvic surgery, obesity, BC pills, bedridden clients |
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prevention of DVT
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elastic stockings
A pumps SQ heparin/lovenox exercise |
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complications of DVT
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Brawny edema
PE valvular destruction |
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management of DVT
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antocoag.therapy
thrombolytic therrapy |
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contraindication to anticoag.Rx
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GI bleed
trauma recent surgery liver disease recent CVA post partum |
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pain when foot is dorsiflexed
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positive Homan's sign
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used to prevet extension of clot; need to monitor INR and platelet count
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IV heparin or coumadin therapy
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As an enzyme, it catalyzes the conversion of plasminogen to plasmin, the major enzyme responsible for clot breakdown
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TPA - tissue plasminogen activator
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nursing mgt of DVT post op
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bed rest
foot elevated elastic stockings analgesic patient education |
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cramp type pain in the extremities, relieved by rest and is caused by inadequate arterial perfusion
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intermittent claudication
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persistent pain in the forefoot when the patient is resting indicating severe ischemia
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rest pain
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a reddish-blue color of the extremities observed after the extremity is placed in the dependent position; suggests peripheral arterial damage in which vessels remain dilated
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Rubor
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ratio of the SBP in the ankle to the SBP in the arm; allows quantification of the degree of stenosis
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ABI - ankle brachial index
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ABi of healthy person
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1.0
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means hardening of the arteries
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arteriosclerosis
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most common direct results of atherosclerosis
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stenosis
obstruction by thombosis aneurysm ulceration rupture |
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Atherosclerotic lesions: 2
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fatty streaks - lipids and smooth muscle cells
fibrous plaques - smooth muscle cells, collagen fibers, plasma components |
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a sensitive marker of cardiovascular inflammation
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CRP - c-reactive protein
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risk factor for atherosclerosis; increases homocysteine proteins depressing cRP levels and increasing factor V and factor XI activity; increasing the binding of liproprotein (a) in fibrin
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hyperhomocysteinemia
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complications of PTA
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hematoma formation
embolus dissection bleeding |
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complications with stent or stent-graft use
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distal embolization
intimal damage (dissection) dislodgment |
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nsg interventions to improve peripheral arterical circulation
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position the part below level of heart
assist with walking and exercise |
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conditions that might worsen with exercise
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leg ulcers
cellulitis gangrene acutre thrombotic occlusions |
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the goal for pts with PAD
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arterial dilation
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nsg intervention to promote vasodilation
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warmth applications
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why is walking encouraged?
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promotes blood flow and development of collateral circulation
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good nutrition to promote circulation
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vitamins A and C
protein zinc |
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how to promote tissue integrity
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Proper footwear
proper foot care fingernails trimmed assistance to pts w/ impaired vision proper nutrition |
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hallmark symptom is intermittent claudication
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Peripheral Arterial Occlusive Disease
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assessment of PAD
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cool extremities
skin and nail changes ulcerations gangrene muscle atrophy Bruits abnormal or absent pulse color of extremity |
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medications for PAD treatment
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Pentoxifylline (Trental)
cilostazol (Pletal) |
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a phosphodiesterase III inhibtor that is a vasodilator and thwarts platelet aggregation
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cILOSTAZOL (pLETAL)
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Antiplatelet agents
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ASA
clopidrogrel (Plavix) |
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surgical management of PAD
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vascular grafting
endarterectomy |
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most common veins used for grafts
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saphenous
cephalic |
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sythetic grafts
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Dacron
expanded polytetrafluoroethylene (ePTFE, such as Gor-Tex or Impra cryopreserved saphenous and umbilical veins |
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complication of a graft
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infection
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nsg managmement post-op to maintain circulation
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pulses
doppler assessment color and temp cap refill sensory and motor function ABI every 8 hrs for the first 24 hours monitor every hour for the first 8 hours and then every 2 hours for 24 hours |
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is char. by reverse flow in the vertebral and basilarartery to provide blood flow to the arm
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subclavian steal syndrome
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s/s of subclavian steal syndrome
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vertigo
ataxia syncope bilateral vision changes |
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autoimmune disease that results in occlusion of distal vessels
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Buerger's Disease
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indicated for Buerger's disease
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vasodilators
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an inflammation of the aorta
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aortitis
-Takayasu's -syphilitic aortitis |
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correct urinary output post op
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at least 30mL/hr
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a localized sac or dilation formed at a weak point in the wall of the artery
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aneurysm
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2 types of common aneurysms
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saccular
fusiform |
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small aneurysms as a result of infection
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mycotic aneurysms
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most common dissecting aneurysm
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Thoracic Aortic aneurysm
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indications of a rupturing AAA
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intense back pain
falling BP decreased Hct |
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nsg management post op - endovascular repaire
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supine for 6 hours
elevate HOB Vs and doppler assessment assess for bleeding, pulsation, swelling, pain and hematoma skin assessment temperature s/s of postimplantation syndrome |
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a tear in the intima or the media
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aotric dissection
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six Ps of acute arterial embolism
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pain
pallor pulselessness paresthesia poikilothermia paralysis |
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procedure that involves extraction of a thrombus by a catheter
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EMBOLECTOMY
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CONTRa indications to thrombolytic therapy
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active internal bleeding
CVA recent major surgery uncontrolled HTN pregnancy |
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most common side effect of thrombolytic therapy
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bleeding
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Virchow's triad
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venous stasis
vessel wall injury altered blood coagulation |
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inflammation of the vein walls
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thrombophlebitis
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prevention of venous thrombosis in surgical patients
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administration of low-molecular weight heparin
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subcutaneous LMWHs
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Lovenox (enoxaparin)
Dalteparin (Fragmin) |
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selectively inhibits faxtor Xa
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Fondaparinux (Arixtra)
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a Vitamin K antagonist used for extended therapy
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Warfarin (Coumadin)
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Coumadin therapy effect happens in _____ days
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3 to 5
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risks of protamine sulfate injection
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bradycardia
hypotension |
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reversal of Warfarin
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administration of Vit K
frozen plasma prothrombin concentrate |
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a sudden decrease of platelet count by 30% from baseline level
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HIT - heparin induced thrombocytopenia
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