Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
98 Cards in this Set
- Front
- Back
|
The arterial system is part of the |
circulatory system |
|
|
Goal of the circulatory system |
to get blood oxygen and nutrients to the tissues |
|
|
Arteries, arterioles and capillaries are parts of the |
circulatory system parts |
|
|
Arteries have how may layers? |
3 from in to out intima media adventicia |
|
|
Intima layer |
next to blood- smooth when born and gets rougher when you age this is part of the reason older people get clots |
|
|
media layer |
middle layer related to stretching ability of arteriole system you lose elastin as you age and your blood vessels get stiffer |
|
|
Adventicia layer |
has strength because it has collagen |
|
|
Capillaries |
facilitate nutrient delivery to the tissues |
|
|
Arteriosclerosis |
hardening of the arteries, they get thicker , lose elasticity and calcify |
|
|
Atherosclerosis |
a form of arteriosclerosis which results in plaque formation Results from- genetics, thrombosis, platelet activation issues, inflammation, altered cellular metabolism |
|
|
Arterial Occlusive Disease |
90% involves lower extremities |
|
|
Assessment of the patient of arterial occlusive disease- Risk factors |
smoking HTN Lipids Diabetes Obesity Positive family history |
|
|
Physical findings of arterial occlusive disease |
dim or absent pulses color change hear a bruit or feel a thrill (the palpable form) pain at rest- they do better when moving parasthesias- tingling feeling in legs Tissue necrosis intermittent claudication |
|
|
Pain at rest with patient with arterial occlusive disease means |
very advanced disease |
|
|
Diagnostic tests for arterial occlusive disease |
dopplar ultrasound stress testing CT MRI Arteriography ankle-brachial Index Transcutaneous Oximetry Renal function tests |
|
|
Ateriography |
like angio but with arteries of legs ed |
|
|
Ankle-Brachial Index ABI- |
this test is done but measuring blood pressure at the ankle and in the arm while a person is at rest. Measurements are usually repeated at both sites after 5 minutes of walking on a treadmill |
|
|
Transcutaneous Oximetry |
measures the amount of oxygen that reaches the skin through blood circulation. Physicians primarily use it to assess the severity of artery disease in the legs or much less commonly in the arms or hands |
|
|
Renal function tests |
kidneys have a lot to do with blood pressure |
|
|
Managagement- what can nurses do for people with arterial occlusive disease? |
encourage weight loss Exercise Take pills on time promote vasodilation- walk the patient even if it hurts stop smoking avoid constrictive clothing discourage periods of sitting and standing for long periods of time don't cross legs get good shoes good foot care Give beta blockers, pain meds, aspirin/plavix, calcium channel blockers Look at legs every day |
|
|
Medical/surgical management with patient with Arterial occlusive disease |
Balloon angioplasty with stunting arterial bypass endarterectomy Embolectomy- take out the clot Amputation surgical repair of trauma |
|
|
Nursing diagnosis with patient with arterial occlusive disease |
decreased tissue perfusion pain impaired skin integrity risk for injury activity intolerance wound care- don't use tape |
|
|
Arterial thrombus |
blood clot form more frequently when people have inflammation polycythemia dehydration arterial trauma |
|
|
polycythemia |
more blood cells, these people are more likely to form clots |
|
|
Arterial embolism |
foreign object air bacteria fat cancer cells thromboemboli leads to occlusion of blood flow |
|
|
Thomboemboli |
usually originate from left side of the heart CHF AFIB endocarditis synthetic valves |
|
|
Buergers disease |
recurrent inflammation and spasm of the small arteries and veins in the upper and lower extremities causing small and midsize clots to form usually associated with smoking 80 percent are male pain at rest ischemic alterations in skin |
|
|
Treatment for Buergers |
corticosteroids anticoagulants amputation |
|
|
Signs and symptoms of Burgers disease |
pain at rest ischemic alterations in skin- ulcer 80% male associated with smoking |
|
|
Raynauds |
blue white and red disease- vasospasm of arteries usually in finger |
|
|
Signs and symptoms of Raynauds |
cold can trigger as can stress people wear warm gloves in summertime digits turn blue white and red mostly women |
|
|
Treatment for raynauds |
wear gloves stay warm avoid injury calcium channel blockers nitro ( last resort) |
|
|
Disorders of the AORTA |
Aneurysms thoracic aortic aneurysms abdominal aortic aneurysms |
|
|
Aneurysm |
dilation of the aorta or other blood vessel commonly arteries |
|
|
Causes of aneurysm |
atherosclerosis smoking trauma congenital men>50 HTN |
|
|
Thoracic aortic aneurysms (aortic arch)
|
if breaks usually results in immediate death Pain is higher up, neck, upper back, may affect vocal cords pressure on the trachea, esophagus, laryngeal ,nerve or superior vena cava. Dyspnea. stridor, or brassy cough if pressing on trachea. Hoarseness and dysphagia if pressing on esophagus or laryngeal nerve edema of face and neck distended neck veins |
|
|
Abdominal Aortic aneurysms ( renal and iliac arteries)
|
90% of aortic aneurysms pulsating abdominal mass bruit common low back pain if it breaks at home 98% of people die IF it breaks in the ER survival rate goes to 95% If in the operating room survival up to 90% ` |
|
|
Normal aorta
|
|
|
|
Small AAA |
|
|
|
Intermediate AAA |
|
|
|
Large AAA
|
|
|
|
They usually wont do surgery on a patient with an aneurysm unless the area is greater than |
5cm and growing |
|
|
Types of aneurysms |
fusiform or circumferential berry dissecting |
|
|
Saccular aneurysm |
pouches on one side |
|
|
Fusiform or circumferential |
around the entire vessel |
|
|
Berry aneurysm |
|
|
|
Dissecting aneurysm |
tearing (patient actually feels tearing) when tear in tunica and media allow blood to invade or dissect the laters of the vessel, blood is usually contained in adventitia, forming a saccular or longitudinal aneurysm` |
|
|
how to diagnose aneurysm
|
MRI Chest Xray CT TEE |
|
|
Medical management is limited in
|
effectiveness If we can keep BP down this is helpful <100 |
|
|
Surgical Management of aneurysm
|
If they have to stop blood flow to lower part of body the kidneys are at great risk for being damaged. Clotting is also a major problem so you may lose your pulses with clotting THe back is also innervated and blood supplied by aorta, if you lose blood supply to your back you may become paralyzed. |
|
|
Nursing Care for patients with aneurysms
|
Graft leakage bowel Ischemia spinal cord ischemia- look at CWMS and motor Impaired renal function-decrease urine output. |
|
|
Nursing diagnosis for patients with aneurysms |
risk for decreased cardiac output impaired skin integrity |
|
|
Discharge teaching with aneurysms |
Heparin then oral anticoagulation therapy after discharge Surgical repair: endovascular stent Grafts- metal sheath covered with polyester fabric or a woven polyester tube Synthetic fabric Graft |
|
|
Veins |
thin walled low pressure valves to help get blood back to the heart stimulation of the sympathetic nervous system makes them constrict Calf muscles play an important role in compressing deep veins with every step |
|
|
what are the primary causes of disorders of the venous circulation? |
occlusive disorders and ineffective venous blood flow |
|
|
what are some disorders of venous circulation? |
Thrombophlebitis Superficial thrombophlebitis Deep vein thrombosis chronic venous insufficiency varicose veins |
|
|
Thrombophlebitis |
blood clot inflammation superficial veins Deep veins- about 80-90% of blood flow back to the heart, these are serious |
|
|
Superficial thrombophlebitis risk factors |
IV is primary risk factor in conjuncture with vericos veins DVT's and some cancers |
|
|
Manifestations of superficial thrombophlebitis |
pain and tenderness at the site erythema if bad enough you will see a red track along the vein |
|
|
Treatment and nursing care of superficial thrombophlebitis |
warm moist compress for 15 minutes 2-3 daily Heat elevation anti-inflammatory drugs assess for cellulitis (skin infections caused by bacteria) |
|
|
Assessment for cellulitis |
antibiotics blood cultures WBC's ESR |
|
|
Risk factors for DVT |
IMMOBILITY surgery- can interfere with blood circulation Cancers- increase coagulation Hormone therapy- birth control pregnancy and delivery trauma coagulation disorders |
|
|
Manifestations of DVT |
pain tenderness warmth swelling/edema color changes humans sign absence of symptoms- some people don't have symptoms |
|
|
DVT diagnostic tests |
ultrasound MRI VENOGRAM |
|
|
Venogram |
a special dye (contrast material) is put into your veins so they can be seen clearly on an x-ray picture. Looks at the condition of your veins and the calves in your veins |
|
|
DVT management/assessment |
History- complaints of leg pain duration and characteristics physical exam- inspect affected extremity for redness, edema, palpate for tenderness, warmth, cordlike structures, body temp Prevention intervention- Heparin drip- doesn't dissolve clots just prevents them from getting bigger Education |
|
|
Complication of DVT |
Pulmonary embolisms- most come from DVT |
|
|
Symptoms of PE |
SOB Chest pain tachycardia tachypnea anxiety--lots of it |
|
|
Diagnosis of PE |
ultrasounds plethysmography MRI Spiral CT Venogram VQ scan |
|
|
VQ scan |
when inhaled radioactive gas gets inhaled they see where it goes, then they give you radiation in your veins to see if venous dye goes to the same places, if there is a mismatch then blood flow is being blocked |
|
|
Treatment of DVT |
Early mobility TEDS SCDs SQ Heparin |
|
|
Surgical treatment of DVT |
vena cava filter(greenfield filter) IBCs- inferior vena cava filters Clots catch in the top of net and blood flows around them |
|
|
Chronic Venous Insufficiency (CVI) |
a disorder of inadequate venous return over a prolonged period. Deep vein thrombosis is the most frequent cause of chronic venous insufficiency |
|
|
Causes of CVI |
DVT Varicose veins Trauma |
|
|
Pathophysiology of Chronic Venous Insufficiency |
occlusion valve damage impaired flow or venous stasis breakdown of RBC's- brown skin They don't heal well |
|
|
Nursing Diagnosis for CVI |
ineffective tissue perfusion Pain Risk for injury- be careful these people don't get hurt impaired physical mobility Impaired skin integrity risk for infection disturbed body image ineffective health maintenance |
|
|
Collaborative care for CVI |
History and physical exam- inspect the patient Symptom relief- legs up special ointments Promote circulation- keep legs warm Promote healing Prevention of tissue damage- may need surgical debridement |
|
|
Who is at risk for varicose veins |
heredity women over 35 more than men older adults pregnancy occupations that require long periods of standing weight race- white at higher risk than most others |
|
|
manifestations of Varicose veins |
leg heaviness aching itchiness tiredness warmth skin changes |
|
|
Varicose Veins |
valve incompetence/ tortuous veins |
|
|
Complications of varicose veins |
CVI stasis ulcers |
|
|
Treatment for varicose veins |
compression stockings leg elevation mobility- calf constriction helps a lot sclerotherapy surgery Vein stripping |
|
|
Schlerotherapy |
inject sclerosing agent that obliterates the veins that re-routs the blood to other veins |
|
|
Post op care for varicose vein |
pressure bandages elevate legs gradual increase in elevation avoid sitting or standing for a long time |
|
|
Nursing diagnosis for varicose vein patients |
pain r/t ineffective tissue perfusion impaired skin integrity risk for peripheral neuromuscular dysfunction |
|
|
Disorders of the lymphatic system |
network in body for lymph, nodes where germs accumulate and are attacked by bodies defense system, filters plasma and plasma proteins out of the capillaries from the interstitial tissue and back into the blood stream, smooth muscle and one way valves. Skeletal muscles help to push lymph around the body |
|
|
Lymphadenopathy |
swelling of the lymph nodes occurs when you are sick result of localized infection like strep Generalized lymphadenopathy is associated with maliganacy |
|
|
Lymphanginitis |
like the phlebitis but in lymph vessel Red streak heat pain swelling fever chills |
|
|
Lymphedema |
extremity edema due to accumulation of lymph |
|
|
Primary Lymphedema |
rare and related to under development or lack of development of lymph system |
|
|
Secondary lymphedema |
related to damage, obstruction or removal of lymph vessels. Frequently this is related with surgical removal of breast tissue |
|
|
Pathophysiology of lymphedema |
obstruction of lymph drainage presents fluid and protein molecules from interstitial tissues from returning to the circulation. The protein molecule increase the osmotic pressure in interstitial tissues, drawing in additional fluid that causes edema in the soft tissues. Edema begins distally and progress up the limb. |
|
|
Diagnostic tests for lymphedema |
MRI CT Scan |
|
|
Treatments for lymphedema |
meticulous skin and foot care to prevent infection in the affected extremity. Wear shoes exercise leg elevation diuretic therapy Low Na diet No IV or BP on obstructed extremity |
|
|
Nursing Diagnosis for disorders of lymphatic system |
impaired tissue integrity r/t lymphatic flow excess fluid volume r/t malformation of lymph vessel Disturbed body image r/t disproportionate size of extremity secondary to lymphedema |
|
|
Arterial Leg Ulcers |
location- toes heel foot Appearance- deep- pale skin- pallor- elevation rumor- dangling temp- cool Edema- absent or mild Pain- severe Gangrene may occur Pulse- decreased or absent |
|
|
Venous Leg Ulcers |
Location- medical leg/ankle appearance: pink Skin: brown discoloration stasis dermatitis synoptic on dangling temp- warm edema- present to extreme Pain- mild aching gangrene- does not occur Pulse- present |
|
|
Management of arterial leg ulcers |
revascularization (surgery PTCA) cellulitis- oral IV antibiotics Protective dressing- vascular boots, lambs wool, bed cradle, bedrest Dressing Medications- Trental asa coumadin |
