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113 Cards in this Set
- Front
- Back
- 3rd side (hint)
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Capillaries
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made up of a single layer of endothelial cells.
Deliver oxygen and nutrients to tissues & remove metabolic waste |
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Veins
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Return deoxygenated blood to the heart
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Valves
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composed of endothelial leaflets.
Only allow blood to flow in one direction |
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Lymph Vessels
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small walled thin vessels resembling capillaries
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Function of lymph vessels
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accomodate collection of lymph fluid from peripheral tissue & Transports lymph fluid to venous system
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6 P's characteristic of Peripheral vascular disease
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1. Pain 5. Parasthesia
2. Pulselessness 6. paralysis 3. Poikilothermy 4.Pallor |
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Intermittant Claudication
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Pain associated with decreased perfusion. ( increases with activity and decreases with rest)
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Pain at rest
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Indicates severe arterial occlusion causing tissue ischemia
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Embolectomy
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removal of blood clot located in a large vessel
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Percutaneous Transluminal Angioplasty
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gains access to to arteries in lower extremities
relieves arterial sclerosis |
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Endarterectomy
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Incision into obstructed vessel, emboli and atherosclerotic plaque are stripped away
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Vein Ligation and stripping
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Treats varicose veins, greater or lesser saphenous systems or both are removed
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Sclerotherapy
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Manages varicose veins, cosmetic treatment of small prominent variscosities
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Signs and symptoms of arterial embolism
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severe acute pain that is aggrevated by movement and pressure. Gradual loss of sensory and motor function.
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Signs and symptoms of arterial embolism
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absent distal pulses. Pallor or mottling. a sharp line of color and temp demarcation
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Signs and symptoms of Peripheral Arterial Occlusive disorder
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develop gradually, Intermittant claudification ( classic sign)
aching, cramping, tiredness, weakness, tingling, numbness |
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Signs and symptoms of Peripheral Arterial Occlusive disorder
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Absence of peripheral pulses, shiny skin, scaly skin, muscle atrophy, thickened toenails,
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Thromboanginitis Obliterans
(Buerger Disease) Signs and symptoms |
Intermittant Claudification, rest pain, skin color and temp changes in affected area, cold sensitivity
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Thromboanginitis Obliterans
(Buerger Disease) Signs and symptoms |
abnormal sensation, ulceration, gangrene
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Thromboanginitis Obliterans
(Buergers disease) |
Inflammatory thrombotic disorder
Occurs only in smokers |
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Raynaud's Disease
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Intermittant constriction of arterioles. Primarily affects the hands. can affect toes and the tip of the nose
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Raynaud's Disease
Signs and Symptoms |
cold hands, numbness, tingling, pallor, finger involvement is not symetrical.
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Aneurysms
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Dilated segment of an artery caused by weakness & stretching of arterial wall. can be congenital or accquired
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Factors that affect blod flow
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Resistance - controlled by diameter of blood vessels
Viscosity - thickness of blood |
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Hemoconcentration
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increased viscosity, caused by increase in red blood cells or decrease in water
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Age related changes to vascular system
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hardening of vessel walls,Loss of elasticity,decrease in hemoglobin
aorta stiffens, lower heart rate, decrease in stroke volume |
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Edema Scale
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1 = 1/4 inch, 2 = 1/4 to 1/2 inches
3= 1/2 to 1 inch, 4 = more than 1 inch. If depression of thumb remains it is pitting edema |
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Hohman's sign
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Pt. flexes knee slightly then the foot is sharply dorsiflexed if pain positive if no pain negative
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Allen Test
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Pt. clenches hand tightly while nurse occludes radial pulse & ulnar arteries, pt. opens hands& nurse releases
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Allen Test (continued)
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pressure, if the ulnar artery is patent the palm will return to normal color
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Nursing Diagnoses for Vascular system disorders
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Pain, fear, Ineffective peripheral tissue perfusion, Impaired mobility,activity intolerance,
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Nursing Diagnoses for Vascular system disorders
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Impaired skin integrity, disturbed body image, Ineffective self-health management
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Therapeutic measures for vascular disorders
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Exercise, Stress management, Pain management, antiembolism stockings, Intermittant Pneumatic compression
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Therapeutic measures for vascular disorders
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Positioning, Thermotherapy, protection of affected extremity
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Buerger - Allen Exercises
Purpose |
Allow gravity to fill and empty the blood in vessels
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Buerger - Allen Exercises
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Lie flat on back and raise legs above the level of heart for 2 minutes or until they become pale. Lower legs & flex and
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Buerger - Allen Exercises
(continued) |
extend feet for 3 min. then keep legs flat for 5 min. do this whole process 6x. do 3 or 4 times daily
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Nursing diagnoses for vascular post op patients
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risk for infection, decreased cardiac output
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Pt. teaching for varicose veins
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Exercise, avoid prolonged standing & sitting, Don't cross legs, avoid restrictive clothing, elevate extremities when possible
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Pt. teaching for varicose veins
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Lose weight, use OTC analgesics and frequent position changes to control pain, wear antiembolism hose if ordered by doctor.
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Risk factors for developing Thrombi
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Bed rest, surgery with general aneshesia for people over 40, Leg trauma with immobilization or traction,
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Risk factors for developing Thrombi (continued)
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Previous venous insufficiency, Obesity, oral contraceptive use, malignancy
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Virchow's Triad - 3 factors contributing to venous thrombus formation
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1. Stasis of the blood
2. damage to the vessel walls 3. hypercoagulability 2 of 3 must be present for thrombi to form |
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Patient teaching for venous thrombosis
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protect legs from pressure and trauma, elevate legs while sitting, do not rub or massage affected areas, gradually increase activity
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Patient teaching for venous thrombosis
(continued) |
slow down or stop if you have pain during activity, avoid prolonged standing, don't cross your legs, Notify Dr. if you have chest pain
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Patient teaching for venous thrombosis
(continued) |
Notify Dr. if you have shortness of breath
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Medications used for Arterial embolism
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IV anticoagulant therapy
& Thrombolytic agents |
Can't be used if: active internal bleeding, CVA, recent major surgery, uncontrolled hypertension, & pregnant
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Surgery to treat Arterial embolism
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embelectomy
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:)
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Nursing Interventions for Arterial embolism are aimed at...?
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Improving circulation and preventing further damage to affected tissues
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Test used confrim diagnosis of Peripheral Arterial Occlusive disease
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duplex imaging and if surgery is contemplated angiography
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Medical Treatment for Peripheral arterial occlusive disease.
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Lifestyle changes: quit smoking, exercise, weight management
Treating underlying diseases..Hypertension, |
Hyperlipidemia, and diabetes
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Meds to treat peripheral arterial occlusive disease
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Platelet aggregation inhibitors-plavix. Ace Inhibitors- Ramipril
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Meds under investigation to treat peripheral arterial occlusive disease
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recombinant growth factor and immune modulator agents
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Surgery for peripheral arterial occlusive disease
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Stenting, endartectomy with and without graft, and percutaneous transluminal angioplasty to enlarge lumen of the vessel
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Drugs used to treat Thromboangitis Obliterans
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ASA, prostaglandin iloprost, calcium channel blockers, antibiotics, anticoagulants
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Ulcers may be treated with vascular endothelial growth factor
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Drugs used to treat Raynaud's disease
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calcium channel blockers, transdermal nitroglycerin, endothelial receptor antagonist, & IV prostaglandin agents
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Surgery to treat Raynaud's disease
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Sympathectomy may be used to treat severe cases, and interupt the sympathetic nervous system
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Surgery to treat varicose veins
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1.Sclerotherapy
2. Ligation and stripping |
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heparin antidote
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protamine sulfate
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Coumadin antidote
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Vitamin K
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Heparin side effects
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Thrombocytopenia, bleeding, hemorrhage, nausea, vomiting, irritation at injection site
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Coumadin side effects
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Bruising, hemorrhage, nausea and anorexia
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Lovenox; side effects
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Thrombocytopenia, anemia, edema, nausea, fever, confusion, cardiac toxicity, and bruising
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Lovenox; nursing interventions
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Give SubQ only, do not aspirate, rotate sites, Leave a bubble in the syringe when administering, give at same time each day
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Teach pt. to report bleeding, use a soft toothbrush, and electric razor, do not take ASA
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Coumadin nursing interventions
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Check PT/INR before each dose, monitor for bleeding, do not take with ASA
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heparin nursing interventions
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Check aPTT before each dose. Goal is 1.5 -2.0 times normal (60-80 seconds) Monitor for bleeding, avoid trauma
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Aspirin side effects
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GI irritation, tinnitus, pruitis, headache, and bleeding
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Aspirin nursing interventions
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Assess patient for bruising and bleeding, give with food or milk if GI irritation occurs
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Cilostazol actions
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Inhibits platelet aggregation used to treat intermittent claudication
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Cilostazol side effects
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Cardiac dysrhythmias, headache, dizziness, & diarrhea
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Cilostazol nursing interventions
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Monitor patient for bleeding and signs of heart failure, blood work must be done during therapy, may take up to 12 wks. for effect
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glycoprotein llb/llla receptor antagonistagent - abciximab
(ReoPro) Actions |
Short term use to prevent ischemia with acute coronary syndromes and to prevent
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reocclusion after certain angioplasty and atherectomy procedures. usually given with lovenox
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glycoprotein llb/llla receptor antagonistagent - abciximab
(ReoPro) side effects |
Risk of major bleeding
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glycoprotein llb/llla receptor antagonistagent - abciximab
(ReoPro) Nursing interventions |
Immediately report GI, urinary or puncture site bleeding, Infusion should be stopped if major bleeding occurs, route is IV
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Plavix action
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Inhibits platelet aggregation
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Plavix Side effects
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GI disturbances, rash and TTP
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Plavix Nursing Interventions
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teach patient importance of having regular blood test and reporting any bleeding, bruising, or rash, and taking with food will reduce
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GI symptoms
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Calcium Channel Blockers actions
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dilates peripheral and coronary arteries used to treat hypertension, angina pectoris and cardiac dysrhythmias
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Calcium channel blockers examples
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Procardia, norvasc, cardizem
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Calcium Channel blocker side effects
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drowsiness, dizziness, cardiac dysrhythmias, CHF, MI, Hypotension, and polyuria
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Calcium Channel blocker nursing interventions
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Monitor BP and pulse, check for edema, tell patient to limit caffeine, avoid alcohol and swallow extended release tablets
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and capsules whol, teach patient how to manage orthostatic hypotension
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Alpha-Adrenergic Blockers
examples |
minipress, hytrin
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Alpha-Adrenergic Blockers actions
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decreases vascular resistance and lowers BP, treats hypertension, Raynaud's disease, urinary symptoms
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associated with Benign hypertrophic prostate
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Alpha-Adrenergic Blockers
Side effects |
dizziness, headache, drowsiness, nausea, orthostatic hypotension, edema, and palpitations
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Alpha-Adrenergic Blockers
Nursing interventions |
teach patient to manage orthostatic hypotension, and to take safety precautionsif dizzy, teach patient to monitor weight
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daily, Patient should take the first dose or an increased dose at bedtime, Monitor BP and pulse
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Hemorrheologic Agent
example |
Trental
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Hemorrheologic Agent action
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decreases blood viscosity, fibrinogenand platelet aggregation, increases flexibility
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of RBCs to allow passage through small vessels, used to treat intermittent claudication
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Hemorrheologic Agent side effects
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dyspepsia, epistaxis, dizziness, nausea, vomiting, angina, tachycardia, cardiac dysrhythmias, leukopenia,
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headache, tremors, and rash
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Hemorrheologic Agent patient teaching
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Assess patient's vital signs, administer drug with meals to decrease GI upset, take safety precautions if patient is dizzy
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tell patients to report rapid or irregular pulse. explain how to manage epistaxis if it occurs, Monitor WBC count
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angiotensin-converting enzyme inhibitors (ACE inhibitors)
Actions, |
prevent peripheral vasoconstriction by blocking conversion of angiotensin 1 to angiotensin 2
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Used to treat hypertension, heart failure, ramipril used to treat Peripheral arterial occlusive disease
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angiotensin-converting enzyme inhibitors (ACE inhibitors)
Side effects |
nausea vomiting and diarrhea, persistent dry cough, hypotension, hyperkalemia, tachycardia, headache, dizziness
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fatigue,insomnia,hypoglycemic reaction in patients with diabetes, bruising, bleeding, petechiae, diminished taste
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angiotensin-converting enzyme inhibitors (ACE inhibitors)
Nursing Interventions |
Monitor V.S, Monitor protein, albumin, BUN, creatinine, WBC count, and potassium levels. Monitor for hypoglycemia
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In patients with diabetes. teach patient: not to stop taking med because rebound hypertension can occur. do not take OTC meds
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angiotensin-converting enzyme inhibitors (ACE inhibitors)
Nursing Interventions (continued) |
Teach client how to take his/her BP. Notify Dr. if dizziness occurs and persists. Taste of food may be diminished the 1st month of
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therapy. report signs and symptoms of angioedema Dr. immediately
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Poikilothermy
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decreased temperature at an ischemic site
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Parasthesia
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Abnormal sensation such as numbness, tingling, pins and needles or crawling sensation
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Bruit
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Murmur detected by auscillation
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peripheral pulses upper extremities
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brachial, ulnar, and radial
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Peripheral pulses lower extremities
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femoral, popliteal, dorsalis pedis,and posterior tibial
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Signs of vascular disease or aneurysm
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hairlessness on lower extremities,peripheral edema, discoloration of dependent areas,temperature changes in
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compromised area, ulcerations on lower extremities, limb pain, thick brittle toenails, temperture variation over invovled area.
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Signs of vascular disease or aneurysm
(continued) |
muscle atrophy, localized redness and induration in affected extremity, chest pain, dyspnea, hoarseness, swelling of head,
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Swelling of arms or both, back or abdominal pain
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Assessment for peripheral vascular disease should include:
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history of present illness, past medical history, family history, review of systems, functional assessment,
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Physical Exam should include
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General survey- posture, gait, presence of pain in affected extremities, edema of face, arms or legs. Cardiovascular - symetric
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peripheral pulses, capillary refill time, Homan's sign. Integument- temp of affected extremity, rubor in both lower extremities
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Physical Exam should include
(continued) |
statis dermatitis or ulcers
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Calor
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heat
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Dolor
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pain
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rubor
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redness
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tumor
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Swelling
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Four classic signs of inflammation
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Calor, dolor, rubor, tumor
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Potential complications of sclerotherapy
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Pulmonary embolism, thrombosis, Injection site necrosis, vasospasm, hemolysis, and allergic reactions
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How are unaboots used in treatment of ulcerations?
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Unna boots are medicated dressings used to allow a patient to be ambulatory while protecting the ulcer in a sterile environment
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Signs and symptoms of lymphangitis
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enlargement of lymph nodes along the lymphatic channel, tenderness in the lymph nodes,a red streak from the wound
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along the lymphatic path, plus symptoms of generalized infection elevated temp, chills,
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How is lymphangitis diagnosed
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according to signs and symptoms supported by wound cultures and Lymphangiography
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Stasis dermatitis
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Brown pigmentation sites with flaky, skin over edematous areas of the ankles
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