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Med Surg 1 > 31 > Flashcards

31 Flashcards

1
Q

____ carry blood away from the heart

A

arteries a = away

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2
Q

____ carry blood towards the heart

A

veins

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3
Q

when metabolic requirements increase, blood vessels ____ to increase the from of O2 and nutrients to the tissues

A

dilate

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4
Q

when metabolic needs decreases, vessels ____ and blodo flow to the tissues decrease

A

constrict

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5
Q

____ which is deficient blood supply to a body parts occurs when the blood vessels fail to dilate in response to the need for increased blood flow

A

ischemia

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6
Q

as blood passes through tissue capillaries ___ is removed and ___ is added

A

O2 and CO2

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7
Q

___ ___ is caused by a pressure difference that exists b/w the arterial and venous systems

A

blood flow

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8
Q

t/f: arterial pressure is greater than venous pressure?

A

true

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9
Q

flow rate = pressure difference / resistance

A

flow rate = pressure difference / resistance

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10
Q

____ is sound produced by turbulent blood flor through an irregular, tortuous,stenotic, or dilated vessel

A

bruit

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11
Q

fluid exchange across the capillary wall is _____. it forms the interstitial fluid

A

continuous

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12
Q

_____ ___ is a driving pressure that is generated bu the blood pressure

A

hydrostatic force

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13
Q

____ ____ is the pulling force created by plasma proteins

A

osmotic pressure

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14
Q

what is the most imporatnt factor that determines resistance in the vascular system?

A

vessel radius

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15
Q

t/f: peripheral vascular resistance is the opposition to blood flow provided by the blood vessels

A

true

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16
Q

peripheral vascular resistance is proportional to what?

A

viscosity or thickness of blood length and diameter of vessel

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17
Q

a large increase in ____ may increased blood viscosity and reduce capillary blood flow

A

hematocrit

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18
Q

what is the most important factor in regulating the caliber and therefore blood flow of peripheral blood vessels?

A

sympathetic nervous system

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19
Q

t/f: all vessels are innervated by SNS except capillary and precapillary sphincters

A

true

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20
Q

stimulation of SNS causes ____ and the neurotransmitter responsible is ___

A

vasoconstriction, NE

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21
Q

_____ released from adrenalmedulla, Acts like NE in constricting peripheral blood vessels inmost tissue beds

A

epinephrine

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22
Q

epinephrine may also cause _____ in skeletal muscle, heart, and brain

A

vasodilation

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23
Q

renin + angiotensinogen > angiotension I >ACE > angiotension II

A

renin + angiotensinogen > angiotension I >ACE > angiotension II

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24
Q

all peripheral vascular diseases are characterized by _____ _____ ___ through peripheral vessels

A

reduced blood flow

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25
Q

inadequate peripheral blood flow occurs when?

A

when the hearts pumping action becomes inefficient

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26
Q

L sided HF > blood in lungs > reduced CO > inadequate arterial blood flow to tissues

A

L sided HF > blood in lungs > reduced CO > inadequate arterial blood flow to tissues

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27
Q

R sided HF > systemic venous congestion > reduced forward flow

A

R sided HF > systemic venous congestion > reduced forward flow

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28
Q

sudden arterial occlusion result in ____ ____ and ____ ___

A

tissue ischemia and tissue death

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29
Q

edamotous tissue cant receieve adequate nutrition from blood and are more susceptible to _____, _____, and _____

A

breakdown, injury, and infection

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30
Q

obstructed lymphatic vessels results in ____

A

edema

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31
Q

common symptoms of peripheral vascular disease

A

pain skin changes diminished pulse possible edema

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32
Q

health history of vascular disease

A

pain assess amount of exercise / walking

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33
Q

intermittent claudication is causes by the inability of the ____ ____ to provide adequate blood flow to the tissues during increased demands for nutrients and O2 during exercise

A

arterial system

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34
Q

persistent pain in the _____ when pt is resting indicates severe arterial insufficiency and critcial state of ischemia

A

forefoot (anterior portion)

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35
Q

___ ___ is is worse at night and may interfere w/ sleep.

A

rest pain

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36
Q

rest pain requires the extremity to be _______ to a dependent position to improve perfusion to the distal tissues

A

lowered

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37
Q

____ ____ may accompany reduced blood flow through the superficial femoral or popliteal artery

A

calf pain

38
Q

pain in the ___ or ____ may result from reduced blood flow in the abdominal aorta or common iliac or hypogastric arteries

A

hip or butt

39
Q

during a physical assessment for diagnosis of arterial disorders the pts ___ ___ and ___ must be thoroughly assessed

A

skin color, temp pulses

40
Q

adequate blood flow > warm, rosy color extremities

A

adequate blood flow > warm, rosy color extremities

41
Q

inadequate blood flow > cool, pale extremities

A

inadequate blood flow > cool, pale extremities

42
Q

a reddish-blue discoloration of extremities known as _____ may be observed w/in 20 sec-2min after the extremity is placed in the dependent position

A

rubor

43
Q

rubur suggest severe peripheral arterial damage in which vessels that can not constrict remain _____

A

dilated

44
Q

abscence of a pulse may indicate that the site of ______ (narrowing or constriction) is proximal to that location

A

stenosis

45
Q

pulses should be palpated bilaterally and simultaneously, comparing both sides for symmetry in ____, ____, and ______

A

rate, rhythm, quality

46
Q

what is the first sign of peripheral arterial disease in the elderly?

A

gangrene

47
Q

outcomes of arterial insufficiency

A

reduced mobility and activity loss of independence

48
Q

what is used to hear the blood flow in the vessels when pulses can not be palpated

A

a doppler

49
Q

how is a doppler used

A

supine to evaluate lower extremities > HOB elevated 20-30 degrees > legs externally rotated > gel applied > tip of doppler positioned 45-60 degree angle over loaction to identify blood flow

50
Q

____ ____ ___ is the ratio of systolic BP in the ankle to the systolic BP in the arm

A

ankle brachial index (ABI)

51
Q

______ testing is used to determine how long a pt can walk and to measure ankle systolic blood pressure in response to walking

A

exercise

52
Q

___ _____ involves B mode grey scale imaging of tissue organs and blood vessels w/ a pulsed doppler to help determine the level and extent of venous disease

A

duplex ultrasonography

53
Q

____ is abnormal dilation of a blood vessel

A

aneurysm

54
Q

______ “hardening of the arteries” is a diffuse process where he muscle fibers and endothelial lining of walls of small arteries and arterioles become thickened

A

arteriosclerosis

55
Q

_____ is inflammatory process involving accumulation of lipids/ calcium/ blood componenets/ carbs/ fibrous tissue/ on the intimal layer of a large or medium artery

A

artherosclerosis

56
Q

arterial blood supply to a body part can be enhanced by positioning the part ____ the level of the heart

A

below

57
Q

how can a pt position the lower extremities below the heart?

A

elevate HOB using a reclining chair sit with feet resting on floor

58
Q

how can the nurse help improve peripheral arterial insufficiency to lower extremities?

A

assist pt with walking isometric exercise promote vasodilation apply warmth to promote arterial flow instruct pt to avoid cold adequate clothing warm bath or drink hot water bottle or heating pad on abdomen

59
Q

should pts apply hot water bottles or heating pads to the lower extremities during peripheral arterial insufficiency?

A

NO, its safer to apply hot water bottle or heating pad to abdomen and this can cause reflex vasodilation in the extremities USE HEAT W? CAUTION

60
Q

how should a pt with peripheral arterial insufficiency of lower extremities be instructed to walk?

A

walk to the point of pain > rest till pain subsides > then resume walking so endurance can be increased as collateral circulation develops

61
Q

what should pts with peripherial arterial insufficiency avoid which cause vasoconstriction?

A

tobacco emotional upset tight clothes and shoes crossing legs >15min at a time

62
Q

Pt teaching for peripheral arterial insufficiency

A

wear sturdy fitting shoes to prevent injury neutral soaps and lotions to prevent drying dont apply lotion between toes pat feet dry dont scratch or rub cut nails even shoe inserts to prevent calluses

63
Q

modifiable risk for atherosclerosis and PVD

A

C reactive protein Hyperhomcysteinemia nicotine diet hypertension diabetes obesity stress sedentary lifestyle

64
Q

nonmodifiable rick factors for atherosclerosis and PVD

A

age gender familial predisposition genetics

65
Q

____ ____ arise most commonly from thrombi that develop in the chambers of the heart. the thrombi become detached and carried away from the left side of the heart into the arterial system where they obstruct the artery

A

arterial emboli

66
Q

_____ phenomenon is a form of intermittent arteriolar vasoconstriction that result in coldness, pain and pallor of fingertips or toes

A

Raynauds phenomenon primary or idiopathic (raynauds disease) secondary raynauds (raynauds syndrome)

67
Q

what triggers Raynauds disease/syndrome?

A

emotional factors or unusual sensitivity to cold

68
Q

clinical manifestations of Raynauds phenomenon

A

pallor and sudden vasoconstriction bluish skin b/c of pooling deoxygenated blood during vasospasm red color when oxygenated blood is returned to digits after vasospasm numbness tingling burning

69
Q

nursing management for Raynauds phenomenon

A

stress management avoid cold wear layers warm up vehicles where sweaters in AC rooms avoid nicotine

70
Q

purpose and action of anticoagulants

A

delays clotting time of blood, prevent the formation of a thrombus in post op pts, forestall extension of thrombus after its formed. prevents thrombus from growing and fragmenting

71
Q

nursing management for anticoagulants

A

report any bleeding monitor aPTT, PT, INR, ACT, HG, Hct, platelet count, fibrinogen level

72
Q

nursing management for DVT

A

elevate affected extrimity graduated compression stockings warm moist packs for extremity walk once anticoagulant therapy given dorsiflexion of foot

73
Q

what is the routine for graduated compression stocking and DVT is the pt can ambulate?

A

remove the stocking at night and apply again in the morning before the legs are lowered from the bed

74
Q

____ __ Is a wrap that provides constant and consistent compression of the venous system. it includes zinc oxide, glycerin, gelatin and the foot should stay dorsiflexed at a 90 degree angel

A

Unna boot

75
Q

____ is a non elastic compression leg wrap that mimics the effect of muscle while the pt is walking that is usually worn during the day

A

CircAid

76
Q

_____ ____ compression devices can be used with graduated compression stocking to prevent DVT and an electric controller is supplied. knew/thigh hish sleeve are provided that fill and apply pressure to the ankle/calf/thigh

A

intermittent pneumatic compression devices

77
Q

should pt on bed rest have their feey and lower legs elevated periodicall above the level of the heart?

A

YES, this allows superficial and tibial veins to empty rapidly and remail collapsed and active/pasive leg exercises should be performed

78
Q

____ ____ results from obstruction of the venous valves in the legs or reflux of blood through the valves

A

venous insufficiency

79
Q

the development of ___ ___ occurs from inadequate exchange of O2 and other nutrients in the tissue

A

leg ulcer

80
Q

_____ ulcers are small circular deep ulceration on the tips of the toes or in the wweb spaces b/w the toes. they often occur in the medial side of the hallux or lateral fifth toe

A

arterial

81
Q

should a gangrenous arterial ulcer be debrided?

A

no b/c it is dry and it is better to manage the gangrene than an open wound that wont heal b/c of insufficient circulation

82
Q

chronic ___ insufficiency is characterized by activity which is pain caused by activity and relieved after rest

A

chronic arterial insufficiency

83
Q

chronic ___ insufficieny is characterized by paid described as aching or heavy.

A

chronic venous insufficiency

84
Q

____ ulcers occur in the medial or lateral malleolus and are typically large superficial and high exudative

A

venous

85
Q

what is the typical diet for pt w/ leg ulcers

A

high protein high vitamin C and A iron zinc low cholesterol and salt

86
Q

diagnosis for leg ulcers

A

impaired skin integrity impaired physical mobility imbalanced nutrition

87
Q

___ is infection and swelling of skin tissues

A

cellulitus

88
Q

___ is inflammation/infection of the lymphatic channels

A

lymphangitis

89
Q

____ is inflammation.infection of the lymph nodes

A

lymphadenitis

90
Q

____ is tissue swelling related to obstruction of lymphatic flow

A

lymphedema

Med Surg 1 (5 decks)

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