Unit Iii-Peripheral Vascular Disease

Front 1

PVD definition

Back 1

-Any abnormal condition that affects the blood vessels outside the heart and lymphatic vessels. Results in decreased blood flow through peripheral blood vessels. Can involve arteries, veins, or both

Front 2

Ischemia from arteries

Back 2

-caused by diseased arteries, or inadequate oxygen to tissues

Front 3

Necrosis is?

Back 3

-from loss of blood and oxygen supply...tissue death.

Front 4

Damaged arteries can be caused by

Back 4

-atherosclerotic plaque
-thrombus
-embolus
-damage from chemical/mechanical trauma
-infection
-vasospastic disorders
-congenital malformations

Front 5

Normal venous pressure is _____ than arterial pressure, and?

Back 5

higher
-its also lower in the right atrium than in the feet

Front 6

Damaged veins can be caused by?

Back 6

-thrombus
-non-ambulatory
-incompetent valves
-decreased pumping action of surrounding muscle

Front 7

What does damaged veins cause?

Back 7

-increased venous pressure
-edema
-venous ulcers

Front 8

If the pressure in peripheral veins are greater than the pressure in tissues, where does the fluid go?

Back 8

-blood vessels leak causing veous ulcers/dark spots.

Front 9

Venous diseases can do what?

Back 9

-lead to pooloing of blood in extremities, resulting in edema
-ulceration and thrombus may result from venous disorders
-venous diseases include DVT's, vericose veins, and venous stasis ulcers

Front 10

Geriatric considerations for PVD

Back 10

-arteries become thicker
-vessels stiffen, increasing peripheral vascular resistance and increasing work load of the left ventricle

Front 11

Assessment of PVD

Back 11

-risk factors
-skin/color temp changes
-pain
-necrosis and ulceration
-muscle atrophy
-exercise tolerance
-pulses-weak/absent
-cap refill

Front 12

Nursing Diagnosis for someone with PVD?

Back 12

-Ineffective tissue perfusion, peripheral, r/t compromised circulation
-pain r/t impaired ability of peripheral vessels to supply tissues with O2
-risk for impaired skin integrity r/t compromised circulation
-knowledge, deficient, regarding self-care

Front 13

Interventions for PVD

Back 13

-place extremity below level of heart for arterial circulatory problems, up for venous.
-no ROM
-no message of legs

Front 14

Things that might prevent compression and things that might promote vasodilation

Back 14

-arterial dilation promotes blood flow
-sclerosed or damaged
-warmth promotes arterial flow and cold causes vasoconstriction
-nicotine causes vasospasms
-emotional upset causes vasoconstriction
-avoid constricting clothing
-no crossing legs
-vasodilator medications
-adrenergic blockers

Front 15

maintain tissue integrity planning

Back 15

-prevent foot injury and blisters
-use neutral soaps and body lotions to prevent skin drying
-stockings clean/dry
-soak fingernails/toenails before trimming
-trim nails straight across, may need podiatrist
-dont cut corns and calluses
-blister, infections, ingrown toenails
-same steps as DM
-good nutrition

Front 16

Diagnostic studies for PVD

Back 16

-doppler
-CW-continous wave doppler study, which allows for calculation of the ABI
-ABI-ankle-brachail index-ration of ankle systolic bP to arm systolic blood pressure
-duplex ultrasonography
-CT
-angiography with dye

Front 17

duplex ultrasonography

Back 17

-imaging of tissues, veins arteries. Allows changes in velocity to be estimated

Front 18

Ankle brachail index ration

Back 18

ABI-ankle-brachail index-ration of ankle systolic bP to arm systolic blood pressure

Front 19

Continous wave doppler

Back 19

CW-continous wave doppler study, which allows for calculation of the ABI

Front 20

Arteriosclerosis

Back 20

-Thickening, loss of elasticity, calcification of arterial walls
-results in decreased blood supply

Front 21

Artherosclerosis

Back 21

-a fatty streak which builds to a fatty plaque
-yellowish plaques of cholesterol, lipids, and cellular debris in inner layers of large and medium-sized arteries.
-results in decreased blood flow
-creates risk for thrombosis

Front 22

What are some risk factors that lead to arteriosclerosis?

Back 22

-high cholesterol
-obesity
-smoking
-poor nutrition
-genetics
-age
-physical inactivity
-male

Front 23

Pathophysicology of arteriosclerosis?

Back 23

-changes are generalized and may involve large and small arteries or arterioles
-lipid deposit on the intima of the arteries
-calcification, thrombosis, and fibrosis contribute to development of plaques which occlude blood flow
-***Eventually vessles lose elasticity and blood flow decreases
-severity of s/s depend on severity of disease

Front 24

Commonly affected areas from arteriosclerosis

Back 24

-heart
-brain
-kidneys
-extremities

Front 25

Signs and Symptoms of arteriosclerosis?

Back 25

-not usually present until artery narrowed by 60% or more
-pain or changed appearance or sensation in foot or leg
-intermittent claudication
-resting causes pain to subside

Front 26

Intermittent claudication

Back 26

-pain in lower extremities that is relieved by rest.

Front 27

Management of arteriosclerosis

Back 27

-modify risk factors
-medication
-surgical graft procedures

Front 28

Peripheral arterial occlusive disease

Back 28

-blanket term for a form of arteriosclerosis involving occlusion of arteries, most commonly in the lower extremities; may be acute or chronic

Front 29

Possible causes of peripheral arterial occlusive disease

Back 29

-trauma
-thrombosis
-embolism
-arterosclerosis
-inflammation,
-thrombosis
-embolism

Front 30

Clinical signs/symptoms of peripheral arterial occlusive disease

Back 30

-100% blockage=acute arterial occlusion
-5 classic P's (pain, pallor, pulselessness, paresthesia, paralysis)

Front 31

What is a chronic arterial occlusion

Back 31

-intermittent claudication
-resting pain
-changes in skin and nails, dryness, scaling, thinning of skin, decreased/absent hair, brittle and thickened nails
-bruits

Front 32

Management of chronic arterial occlusion

Back 32

-general care measures used for pts with peripheral arterial disease
-surgical (grafting, endarterectomy)

Front 33

endarterectomy

Back 33

-incision made into artery, obstruction removed, artery sutured closed

Front 34

Postoperative nursing care for someone with chronic arterial occlusion

Back 34

-maintain adequate circulation through the arterial repair
-check pulses and compare
-Notify MD immediatly if decreased or loss of pulses
-monitor color/temp
-I&O
-can elevate leg to decrease edema
-avoid crossing legs

Front 35

Buerger's Disease (thromboangiitis obliterans)

Back 35

-inflammation in both arteris and veins, resulting in destruction of small and medium vessels.
-Usually affects lower ext. but can also be seen in upper ext. vessels. More common in arteries

Front 36

What causes Buerger's Disease

Back 36

-unknow, may be realated to autoimmune disorder
-affects male cigarette smokers between ages 20-40, small incidence in females

Front 37

Signs and symptoms of Buerger's disease

Back 37

-pain-cramps in feed (esp. arches) or legs after exercise which are relieved by rest (intermittent claudication)
-Rest pain-burning/sensitivity to cold
-pulses decreased or absent
-redness/cyanosis appears as disease progresses
-may progress to ulceration

Front 38

Prognosis of Buerger's disease

Back 38

-if gangrene is present, will usually require below the knee amputation or AKA

Front 39

Arterial thrombosis and arterial embolism

Back 39

-arterial embolism is a sudden arterial occlusion caused by emboli, which results in acute ischemia or affected body parts
-***emboli may be made of gas, solid material (blood clot), liquid, or fat
-most stem from thrombus formation in heart chambers
-arteriosclerotic conditions may predispose patients to emboli formation

Front 40

What is Angioplasty?

Back 40

-PTA: percutaneous transluminal angioplasty
-widens the internal diameter (lumen) of the artery by "smashing" the plaque against the vessel walls
-stents are placed to decrease the risk of reocclusion

Front 41

What are some potential complications of PTA

Back 41

-hematoma
-embolus
-dissection of the artery
-bleeding