10 minute topic vascular disease Flashcards
Vascular diseases
PVD (peripheral vascular disease) and PAD (peripheral arterial disease)
both have interference of normal blood flow
PAD (peripheral arterial disease)
results from atherosclerosis usually the lower extremities
Atherosclerosis
gradual thickening of the intima and media of the arteries, ultimately resulting in the progressive narrowing of the vessel lumen
Classifications of PAD
Inflow (distal aorta and iliac arteries)
Outflow – femoral, popliteal & tibial artery
subtypes of PAD
Buerger’s, subclavian steal, thoracic outlet syndrome, Raynaud’s, popliteal entrapment
PAD risk factors
HTN, hyperlipidemia, DM, Smoker, Obesity, sedentary lifestyle, familial predisposition, age
PAD s/sx
Burning pain during exercise (intermittent claudication) Pain while in bed < cap refill < distal pulse Loss of hair on calf Dry, scaly skin thick toenails muscle atrophy
PAD diagnostic tests
Arteriography
Exercise tolerance test
Plethysmography
PAD Arteriography
arterial injection of contrast medium, under fluoroscopy
PAD Arteriography nursing actions
(same as with cardiac cath) Observe for bleeding and hemorrhage. Palpate pedal pulses to identify possible post-procedure occlusions
PAD Exercise tolerance test
used to evaluate claudication during exercise
PAD Plethysmography
used to determine the variations of blood passing through an artery, thus identifying abnormal arterial flow in the affected limb
PAD nursing care
encourage exercise
avoid crossing legs
elevate the legs but not above the heart
promote vasodilation and reduce vasoconstriction
Medications for PAD
ASA, clopidogrel (Plavix) Pentoxifylline (Trental)
give with meals
need several weeks to take effect
Antiplatelets
Anti-platelet teaching
take with food
monitor for signs of bleeding
meds take weeks for effect
PAD surgical interventions
Percutaneous transluminal angioplasty
Arterial revascularization
Percutaneous transluminal angioplasty
balloon or stint them open
will be on anti-platelet therapy for 1-3 months
Arterial revascularization
used for severe claudication and/or limb pain at rest
bypass graft around occlusion
Arterial revascularization post procedure nursing actions
monitor BP, hypotension increases risk of clot or graft collapse
limit hip and knee bending
pain may be severe when reestablishing blood flow
Arterial revascularization PT teaching
avoid crossing legs
loose clothing
no smoking or cold due to vasoconstriction
foot care
Arterial revascularization complications
Graft occlusion
Compartment syndrome
Compartment syndrome
Tissue pressure within a confined body space can restrict blood flow and the resulting ischemia can lead to irreversible tissue damage
Examples of PVD’s
venous thromboembolism (VTE) venous insufficiency varicose veins
venous thromboembolism (VTE)
blood clot formed as a result of venous stasis, endothelial injury, or hypercoagulability (hypercoagulation)
Thrombophlebitis
thrombus that is associated with inflammation
Venous insufficiency
occurs secondary to incompetent valves in the deeper veins of the lower extremities
Varicose veins
enlarged, twisted and superficial veins
VTE risk factors
Hip surgery, total-knee replacement, open prostate surgery Heart failure Immobility Pregnancy Oral contraceptives
Venus insufficiency risk factors
Sitting or standing in one position over a long time
Obesity
Pregnancy
Thrombophlebitis
Varicose veins risk factors
A person over 30yrs with standing occupation Pregnancy Obesity Systemic diseases Family history
VTE s/sx
Can be asymptomatic Calf or groin pain – classic sign Tenderness – classic sign Sudden onset of swelling – classic sign assess for SOB & chest pain (feeling of impending doom)
Venus insufficiency s/sx
Pain
Stasis ulcers -typically found around ankles
Stasis dermatitis (brown discoloration around ankles that can extend up the calf relative to the level of insufficiency)
Edema
Varicose veins s/sx
Aching pain (dull)
Distended superficial veins (visible just below the skin)
Tortuous in nature
D-dimer diagnostic test
measures fibrin degradation products present in the blood produced from fibrinolysis.
indicates thrombus formation has possibly occurred
Venous duplex ultrasonography diagnostic test
uses high-frequency sound waves to provide picture of the blood flow through a blood vessel.
Impetus plesmography
determine the variations of blood passing through a vein, thus identifying abnormal venous flow in the affected limb
Venogram
if other tests are negative but they still suspect a DVT
they put a contrast medium material into the vein and use x-ray and fluoroscopy to see it
Trendelenburg test
used for varicose veins
If they fill proximally there are varicose veins
If they fill distally there are none (normal)
DVT & thromblophlebitis nursing care
encourage rest elevate extremity no massage warm compress compression or antiembolism stockings
Venous Insufficiency nursing care
Elevate legs several times a day for at least 15 to 30 min
Elevate feet at least 6 inches at night
Avoid crossing legs and constrictive clothing or stockings
TED hose – after the legs have been elevated and when swelling is at a minimum.
Therapeutic procedures for varicose veins
sclerotherapy
Vein Stripping
Endovenous Laser Treatment
Radiofrequency Energy application
sclerotherapy
chemical solution is injected into the varicose vein to produce localized inflammation which will, close the lumen of the vessel over time and it will collapse on itself
Vein Stripping
moval of large varicose veins that cannot be treated with less-invasive procedures
Vein Stripping post procedure
keep legs elevated
encourage ROM
need compression stockings
Radiofrequency Energy application
electrode will scar the dilated vein causing it to close down on itself
Endovenous Laser Treatment
heat from a laser is used to close the dilated vein.
Aneurysms
weakness in a section of a dilated artery that causes widening or ballooning in the wall of the blood vessel
Aneurysm forms
Saccular (only affecting one side of the artery)
Fusiform (involving the complete circumference of the artery)
abdominal aortic aneurysms
account for 75% of aneurysms
Aneurysm prevention
no smoking
decrease WT
healthy diet/exercise
control BP (#1)
Aneurysm risk factors
Atherosclerosis
Age (arterial stiffening occurs)
Aneurysm s/sx
none initially
Abdominal aortic aneurysm (AAA) s/sx
Abdominal pain pulsating abdominal mass (no not palpate) > BP Aortic dissections (likely fatal)
Thoracic aortic aneurysm s/sx
Coolness or cyanosis below
Severe back pain
Hoarseness, cough, shortness of breath, and difficulty swallowing
Decrease in urinary output
Aneurysm diagnosis
x-ray
CT and ultrasound to assess location and size
Percutaneous aneurysm repair
Insertion of endothelial stent grafts
typically used for aortic aneurysms, but can be used to repair a thoracic aortic aneurysm
Thoracic aortic repair
similar to open heart surgery
