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58 Cards in this Set
- Front
- Back
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We do not give what vaccines to CA pts?
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Live vaccines-immunosurpressed
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Involves progressive narrowing and degeneration of arteries of neck, abdomen, and extremities
Atherosclerosis is the leading cause of majority of cases Typically appears at ages 60s to 80s Largely undiagnosed Describes what vascular disorder? |
Peripheral artery disease
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What puts a pt at risk for developing peripheral artery disease?
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Hyperlipidemia
HTN Diabetes Cigarrette smoking |
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What is the classic symptom of PERIPHERAL ARTERY DISEASE????
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INTERMITTENT CLAUDATION- Ischemic muscle ache or pain that is felt by a constant level of exersise, relieved by rest within 10 minutes, and is reproducable
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Pts with peripheral artery disease develop what, being:
Shooting or burning pain in extremity Present near ulcerated areas Produces loss of pressure and deep pain sensations Injuries often go unnoticed by patient? |
Paresthesia
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What are some s and s of peripheral artery disease?
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Thin, cool, shiny, and taut skin
Loss of hair on the lower legs Diminished or absent pedal, popliteal, or femoral pulses Pallor Reactive hyperemia (increased blood flow after ischemia) |
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How would someone with peripheral artery disease describe the pain? What makes it worse? What time of day is it worst?
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Occurs in the forefoot or toes and is aggravated by limb elevation
Occurs from insufficient blood flow Occurs more often at night |
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Atrophy of the skin and underlying muscles
Delayed wound healing Wound infection Tissue necrosis Gangrene and amputation Arterial ulcers Are all complications of what disease? |
Peripheral artery disease
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A doppler, angiography or MRA would help diagnose ?
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Peripheral artery disease
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What is the most effective exercise for pts with claudication?
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Walking 30 - 60 min a day, stop and rest for pain
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How does ginkogo biloba help with intermittent claudication?
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Helps increase walking distance
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What therapy helps lower homocystenine levels?
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Vitamin 6, folate, vitamin b12 (cobalmin)
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Pts with perierpheral artery disease should have less than what mg cholesterol per day, and decrese what?
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less than 200 per day, decrease saturated fat, use soy products instead of animal protien
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Peripheral artery disease-
keep checking strength of? Change what hourly? Dont raise? Dont put direct heat on? |
Strength of pulses
Change postitions hourly Dont raise feet above heart level No direct heat on feet |
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Percutaneous transluminal balloon angioplasty
A peripheral arterial bypass operation with autogenous vein or synthetic graft material to bypass blood around the lesion Endarterectomy Patch graft angioplasty Amputation Are all possible treatments for pts with? |
Peripheral artery disease
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After surgery, we monitor vitals?
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4x every 15 minutes
4x every 30 minutes every 1-4 hours after |
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Outpouching or dilation of weakened area in an artery most common in the aorta and arteries at the base of brain.
Classified by region (thoracic/abdominal) Or as dissecting (really shouldn’t be called aneurysm) splitting of the arterial wall (most often in thoracic area) -seen mainly in Marfan’s syndrome and older people Focus on Aorta (why constant stress on vessel walls) Occurs more frequently in men Found more in the abdominal area below level of renal arteries Growth is unpredictable 50% of all aneurysms greater than 6cm will rupture within one year Major risk is arthrosclerosis Ruptures most often fatal Describes an? |
Aortic anneyrism
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Main have pain in back, neck, substernal area when lying supine
May have dyphagia and dyspnea, stridor or cough when pressing on esophagus or largngeal nerve This annyurrysm could be where and what could the first sign be? |
Thoracic
first sign could be rupture |
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“heartbeat” in abdomen when lying down
Pulsating abdominal mass Abdominal or lumbar pain Claudication Cool or cyanotic extremities Systolic bruit may be heard What annyursm could this be? |
Abdominal annuy-aortic
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Sudden/severe/persistent “ripping” pain in anterior chest
Pain may extend to shoulder or abdomen Pallor and sweating Tachycardia May have elevated BP and you may get different reading in the other arm Syncope Paralysis of lower extremities Are sXs of what? |
Dissecting aortic annuysumm
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Main nursing care for pt with annyurism?
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Maintain BP at normal level
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Inflammatory disease of the small and medium sized veins and arteries accompanied by thrombi and spasms.
Most common in leg or foot but may effect upper and lower extremities Cause is unknown What disease is this? |
Buergers disease (Thromboangitis obligerans)
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Starting with inflammation, what happens in Buergers disease and who is at risk?
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Inflammation---microthrombi---vasospasm---obstructs blood flow
YOUNG MEN WHO SMOKE |
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If pt has these signs and symptoms, he could have what?
Bluish cast to toe or finger “coldness” in affected limb Nerve inflammation → severe pain Blocked blood vessels → claudication as seen in PAD with accompanying symptoms Ischemic ulcers and gangrene are common complications |
Buergurs disease
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Localized, intermittent episodes of vasoconstriction of small arteries of the hands and less commonly the feet causing color and temperature changes
Vasospastic disorder of unknown origin Primarily affects young women Usually begins in tips of the fingers causing pallor, numbness, and sensation to the cold Attacks triggered by exposure to the cold, emotional stress, caffeine ingestion, and tobacco use What disease could this be? |
Reynauds disease
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Triphasic color change after attack is triggered
Pallor Cyanosis Rubor Pain Skin thickening and nails become brittle These are the cinical manefestations of what disease? |
Reynauds disease
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Keep hands warm (where gloves in cool environments)
Avoid stressful situations Dissection of nerve fibers that allows vasoconstriction to relieve symptoms Analgesics for pain Vasodilators Calcium channel blockers for vasospams This is the nursing care for what disease? |
Reynauds disease
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What is virchows triad?
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The 3 factors that can contribute to a pt forming a clot
1. stasis 2. trauma 3. hypercoagability |
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Formation of a thrombus (clot) in association with inflammation of the vein
Classified as superficial or deep Caused by Virchow’s triad (need to 2 out of three for thrombus to occur -Stasis of blood flow -Damage to the inner lining of vein -Hypercoagubility of blood This descibes? |
Thrombopheblitis
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These all put a pt at risk for developing what?
Obesity Post-Surgery CHF A-Fib Immobility MI Pregnancy IV therapy Hypercoagulable states Polycythemia Dehydration malnutrition |
Throbophlebitis
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How does thrombophlebitis happen?
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RBCs, WBCs, and platelets adhere to form a thrombus (usually near valve cusps
As thrombus enlarges it can partially or totally occlude lumen Thrombus can also break loose/detach (emboli) and enter the venous circulation |
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Palpable cordlike vein
Surrounding area warm, red, and tender Edema Arms (mostly like caused by IVs) Legs (most likely a result of varicose veins These are signs of what type of thromboplebitis? |
Superficial thrombophlebitis
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Edema (location depends on what vein is occluded)
Pain Warm skin Homan’s sign (pain on dorsiflexion of foot) Are signs of what type of thrombophlebitis? |
Deep thrombophlebitis
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Pain relief
Elevate affected extremity Measure circumference of affected extremity Monitor peripheral pulses Prevent skin ulceration (over bed cradle) No restrictive clothing Bedrest (to prevent pulmonary embolism) Don not massage affected extremity Are all important when taking care of a pt with? |
Thromboplebitis
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Pink tinged sputum
Tachypnea Tachycardia SOB Chest pain Apprehension (feeling of impending doom) Are all signs of what complication from thromboplebitis? |
Pulmonary embolism
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If suspected pulmonary embolism, what drugs should you administer?
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Anticoagulants
Thrombolytics if within 72 hours Heparin in hospital Lovenox shots until warfarin therapeutic Warfarin (2-4 months) |
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What are 3 important things to teach pts on Warfarin therapy?
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Wear a helmet
Avoid extreme sports Maintain consistency with eating foods rich in vitamin K (green leafy veggies) |
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Inadequate venous return over long periods of time that causes pathologic changes as a result of ischemia in the vasculature, skin, and supporting tissues.
Defines? |
venous insufficiency
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In venous insufficiency, prolonged venous HTN or thrombus causes what causes what?
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stretched veins/damaged vein valves and causes poor venous return
**Standing or sitting ppl for long periods of time are at risk to develop** and pregnancy and obese ppl |
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Edema of lower legs may extend to knees
Discoloration of skin (thick brown skin around ankles and feet) Venous stasis ulcers All are manifestations of? |
Venous insufficiencies
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What insufficiency is there edema present?
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Venous insufficiency
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What insufficincy is where nails are thick and brittle?
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arterial
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What insufficiency is relieved when elevated the affected extremity?
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Venous insufficiency-drains extremity of blood
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Pulses are decreased and absent in pts with?
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Arterial insufficiency
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What temperature is the extremity with venous insufficiency?
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Warm
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An extremitiy with aterial insufficiency is what temp?
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Cool
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Venous insufficeincy's ulcers are (wet or dry)?
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Moist
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Dry ulcers are found on what insufficiency's extremity?
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Arterial
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Elevate venous insufficient legs how often?
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At least 20 minutes a day 4 times a day
***KEEP ABOVE HEART WHEN IN BED** |
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When should venous insuff pt wear the compression stockings?
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Wear day and evening, take off at night
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Mitral valve prolapse causes what on auscultation?
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murmur
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If pt comes in ER with chest pain what do you do?
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ED with chest pain, it gives you a list of what to do first, 1. ensure airway 2. admin 02 3. obtain 12 ecg lead 4. insert 2 ivs 5. get pain score 6. medicate for pain MS or Nitro (SL) etc.
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When is it ok to give clot busting drugs to pt with stroke?
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Within 3 hours when symptoms start of MI.
Within 4-6 hours for pt with heart attack. Otherwise you can be opening up vessels that are already dead |
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What is BNP and what can it tell us about the heart?
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Brain naturetic peptide- normally there is a small amt in the blood. It is made by the heart. IF BNP is high, it can tell us heart is working harder ***HEART FAILURE** If lowers after HF treatment, shows us treatment is working.
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3 things that can affect blood cultures!??
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Aspirin, tylenol, antibiotics
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Thrombophlebitis is mainly in?
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Veins- can cause so much edema it can effect pulses from arteries, but checking peripheral pulses would not be main focus
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A way to help fix raynauds disease could be?
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Dissect the pathways that do the vasoconstriction that causes the unwanted symptoms of the disease
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What is a bruit?
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The unusual sound blood makes when it runs past an obstruction
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