31 Flashcards
____ carry blood away from the heart
arteries a = away
____ carry blood towards the heart
veins
when metabolic requirements increase, blood vessels ____ to increase the from of O2 and nutrients to the tissues
dilate
when metabolic needs decreases, vessels ____ and blodo flow to the tissues decrease
constrict
____ 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
ischemia
as blood passes through tissue capillaries ___ is removed and ___ is added
O2 and CO2
___ ___ is caused by a pressure difference that exists b/w the arterial and venous systems
blood flow
t/f: arterial pressure is greater than venous pressure?
true
flow rate = pressure difference / resistance
flow rate = pressure difference / resistance
____ is sound produced by turbulent blood flor through an irregular, tortuous,stenotic, or dilated vessel
bruit
fluid exchange across the capillary wall is _____. it forms the interstitial fluid
continuous
_____ ___ is a driving pressure that is generated bu the blood pressure
hydrostatic force
____ ____ is the pulling force created by plasma proteins
osmotic pressure
what is the most imporatnt factor that determines resistance in the vascular system?
vessel radius
t/f: peripheral vascular resistance is the opposition to blood flow provided by the blood vessels
true
peripheral vascular resistance is proportional to what?
viscosity or thickness of blood length and diameter of vessel
a large increase in ____ may increased blood viscosity and reduce capillary blood flow
hematocrit
what is the most important factor in regulating the caliber and therefore blood flow of peripheral blood vessels?
sympathetic nervous system
t/f: all vessels are innervated by SNS except capillary and precapillary sphincters
true
stimulation of SNS causes ____ and the neurotransmitter responsible is ___
vasoconstriction, NE
_____ released from adrenalmedulla, Acts like NE in constricting peripheral blood vessels inmost tissue beds
epinephrine
epinephrine may also cause _____ in skeletal muscle, heart, and brain
vasodilation
renin + angiotensinogen > angiotension I >ACE > angiotension II
renin + angiotensinogen > angiotension I >ACE > angiotension II
all peripheral vascular diseases are characterized by _____ _____ ___ through peripheral vessels
reduced blood flow
inadequate peripheral blood flow occurs when?
when the hearts pumping action becomes inefficient
L sided HF > blood in lungs > reduced CO > inadequate arterial blood flow to tissues
L sided HF > blood in lungs > reduced CO > inadequate arterial blood flow to tissues
R sided HF > systemic venous congestion > reduced forward flow
R sided HF > systemic venous congestion > reduced forward flow
sudden arterial occlusion result in ____ ____ and ____ ___
tissue ischemia and tissue death
edamotous tissue cant receieve adequate nutrition from blood and are more susceptible to _____, _____, and _____
breakdown, injury, and infection
obstructed lymphatic vessels results in ____
edema
common symptoms of peripheral vascular disease
pain skin changes diminished pulse possible edema
health history of vascular disease
pain assess amount of exercise / walking
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
arterial system
persistent pain in the _____ when pt is resting indicates severe arterial insufficiency and critcial state of ischemia
forefoot (anterior portion)
___ ___ is is worse at night and may interfere w/ sleep.
rest pain
rest pain requires the extremity to be _______ to a dependent position to improve perfusion to the distal tissues
lowered
____ ____ may accompany reduced blood flow through the superficial femoral or popliteal artery
calf pain
pain in the ___ or ____ may result from reduced blood flow in the abdominal aorta or common iliac or hypogastric arteries
hip or butt
during a physical assessment for diagnosis of arterial disorders the pts ___ ___ and ___ must be thoroughly assessed
skin color, temp pulses
adequate blood flow > warm, rosy color extremities
adequate blood flow > warm, rosy color extremities
inadequate blood flow > cool, pale extremities
inadequate blood flow > cool, pale extremities
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
rubor
rubur suggest severe peripheral arterial damage in which vessels that can not constrict remain _____
dilated
abscence of a pulse may indicate that the site of ______ (narrowing or constriction) is proximal to that location
stenosis
pulses should be palpated bilaterally and simultaneously, comparing both sides for symmetry in ____, ____, and ______
rate, rhythm, quality
what is the first sign of peripheral arterial disease in the elderly?
gangrene
outcomes of arterial insufficiency
reduced mobility and activity loss of independence
what is used to hear the blood flow in the vessels when pulses can not be palpated
a doppler
how is a doppler used
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
____ ____ ___ is the ratio of systolic BP in the ankle to the systolic BP in the arm
ankle brachial index (ABI)
______ testing is used to determine how long a pt can walk and to measure ankle systolic blood pressure in response to walking
exercise
___ _____ 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
duplex ultrasonography
____ is abnormal dilation of a blood vessel
aneurysm
______ “hardening of the arteries” is a diffuse process where he muscle fibers and endothelial lining of walls of small arteries and arterioles become thickened
arteriosclerosis
_____ is inflammatory process involving accumulation of lipids/ calcium/ blood componenets/ carbs/ fibrous tissue/ on the intimal layer of a large or medium artery
artherosclerosis
arterial blood supply to a body part can be enhanced by positioning the part ____ the level of the heart
below
how can a pt position the lower extremities below the heart?
elevate HOB using a reclining chair sit with feet resting on floor
how can the nurse help improve peripheral arterial insufficiency to lower extremities?
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
should pts apply hot water bottles or heating pads to the lower extremities during peripheral arterial insufficiency?
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
how should a pt with peripheral arterial insufficiency of lower extremities be instructed to walk?
walk to the point of pain > rest till pain subsides > then resume walking so endurance can be increased as collateral circulation develops
what should pts with peripherial arterial insufficiency avoid which cause vasoconstriction?
tobacco emotional upset tight clothes and shoes crossing legs >15min at a time
Pt teaching for peripheral arterial insufficiency
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
modifiable risk for atherosclerosis and PVD
C reactive protein Hyperhomcysteinemia nicotine diet hypertension diabetes obesity stress sedentary lifestyle
nonmodifiable rick factors for atherosclerosis and PVD
age gender familial predisposition genetics
____ ____ 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
arterial emboli
_____ phenomenon is a form of intermittent arteriolar vasoconstriction that result in coldness, pain and pallor of fingertips or toes
Raynauds phenomenon primary or idiopathic (raynauds disease) secondary raynauds (raynauds syndrome)
what triggers Raynauds disease/syndrome?
emotional factors or unusual sensitivity to cold
clinical manifestations of Raynauds phenomenon
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
nursing management for Raynauds phenomenon
stress management avoid cold wear layers warm up vehicles where sweaters in AC rooms avoid nicotine
purpose and action of anticoagulants
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
nursing management for anticoagulants
report any bleeding monitor aPTT, PT, INR, ACT, HG, Hct, platelet count, fibrinogen level
nursing management for DVT
elevate affected extrimity graduated compression stockings warm moist packs for extremity walk once anticoagulant therapy given dorsiflexion of foot
what is the routine for graduated compression stocking and DVT is the pt can ambulate?
remove the stocking at night and apply again in the morning before the legs are lowered from the bed
____ __ 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
Unna boot
____ 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
CircAid
_____ ____ 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
intermittent pneumatic compression devices
should pt on bed rest have their feey and lower legs elevated periodicall above the level of the heart?
YES, this allows superficial and tibial veins to empty rapidly and remail collapsed and active/pasive leg exercises should be performed
____ ____ results from obstruction of the venous valves in the legs or reflux of blood through the valves
venous insufficiency
the development of ___ ___ occurs from inadequate exchange of O2 and other nutrients in the tissue
leg ulcer
_____ 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
arterial
should a gangrenous arterial ulcer be debrided?
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
chronic ___ insufficiency is characterized by activity which is pain caused by activity and relieved after rest
chronic arterial insufficiency
chronic ___ insufficieny is characterized by paid described as aching or heavy.
chronic venous insufficiency
____ ulcers occur in the medial or lateral malleolus and are typically large superficial and high exudative
venous
what is the typical diet for pt w/ leg ulcers
high protein high vitamin C and A iron zinc low cholesterol and salt
diagnosis for leg ulcers
impaired skin integrity impaired physical mobility imbalanced nutrition
___ is infection and swelling of skin tissues
cellulitus
___ is inflammation/infection of the lymphatic channels
lymphangitis
____ is inflammation.infection of the lymph nodes
lymphadenitis
____ is tissue swelling related to obstruction of lymphatic flow
lymphedema
