Adult 1_ raynauds, PAD, venous thromboembolism - Sheet1 Flashcards
What is Raynaud’s phenomenon?
Episodic vasospasming of small arteries, usually in the hands, due to cold temperatures, vibrating machinery, stress, caffeine, alcohol, smoking, or an underlying disease.
What triggers Raynaud’s phenomenon?
Cold temperatures, vibrating machinery, stress, caffeine, alcohol, smoking, or an underlying disease.
What are the primary assessment findings for Raynaud’s phenomenon?
Blue/red/white color changes in fingers, pallor (due to decreased perfusion), cyanosis, numbness, throbbing, tingling, and swelling.
Why do fingers change color in Raynaud’s phenomenon?
Due to vasospasms causing decreased blood flow (pallor), lack of oxygen (cyanosis), and then reperfusion (redness).
What skin and nail changes may occur after frequent, prolonged Raynaud attacks?
Skin may become thickened, and nails may become brittle.
What are potential complications of Raynaud phenomenon?
Punctate lesions of the fingertips and superficial gangrenous ulcers.
What nursing interventions can help manage Raynaud’s phenomenon?
Avoid temperature extremes, wear protective clothing in the cold, and cease smoking and caffeine consumption.
Why should patients with Raynaud phenomenon have routine follow-ups?
To monitor for the development of connective tissue or autoimmune diseases.
What requires prompt intervention in patients with Raynaud phenomenon?
Digital ulceration or critical ischemia.
What are the treatment options for Raynaud-related digital ulcers or critical ischemia?
Prostacyclin infusion therapy (e.g., iloprost), antibiotics, analgesics, and surgical debridement of necrotic tissue.
When is sympathectomy considered for Raynaud phenomenon?
In severe cases refractory to medical treatment when digit survival is threatened.
How long must symptoms persist for a diagnosis of Raynaud phenomenon?
At least 2 years.
What type of medications are prescribed for Raynaud’s phenomenon?
Calcium channel blockers and topical nitroglycerin ointment.
How do calcium channel blockers help Raynaud’s phenomenon?
They relax the smooth muscles of the arterioles, improving blood flow.
How does topical nitroglycerin ointment help?
It acts as a vasodilator, increasing blood flow to affected areas.
What medication interaction should be avoided with nitroglycerin ointment?
Erectile dysfunction (ED) medications, due to the risk of severe hypotension.
What two medications may lessen the severity of Raynaud phenomenon?
Botulinum toxin A and statins.
What is Peripheral Artery Disease (PAD)?
Narrowing and stiffening of arteries reducing blood flow to the lower extremities.
What are the primary signs and symptoms of PAD?
Intermittent claudication, burning, tightness, soreness, paresthesia with nerve injury, taut and shiny skin, decreased/absent pedal pulses, pallor when elevated, hair loss on lower extremities, poorly healing ulcers.
What is the 5 P’s neurovascular assessment for PAD?
Pain, pallor, paresthesia, pulse, paralysis.
What are the medical treatments for PAD?
- Percutaneous transluminal atherectomy: Removal of fatty blockage from artery.
- Percutaneous transluminal balloon angioplasty (with/without stent): Holds narrowed artery open.
- Peripheral artery bypass: Grafts to reroute blood flow.
- Amputation: If necrosis is extensive.
What nursing interventions help manage PAD?
- Use Doppler to assess pedal pulses.
- Encourage smoking and alcohol cessation.
- Educate on foot care and proper foot inspections.
- Teach a low-fat diet.
- Manage diabetes and glucose levels.
- Conduct frequent skin/neurovascular assessments.
- Educate on gradual exercise increase.
- Teach reportable symptoms of sensation changes.
- NO COMPRESSION SOCKS
- Venous deficiencies only
What are complications from the medical treatments for PAD?
bleeding, hematoma, compartment syndrome
What diagnostic tests are used for PAD?
- Doppler ultrasound with duplex imaging: Evaluates blood flow.
- Ankle-brachial index (ABI): Screens for artery stiffness.
What medications are commonly prescribed for PAD?
ACE inhibitors and antiplatelet agents.
What is Virchow’s Triad?
Three factors contributing to thrombus formation: venous stasis, endothelial damage, and hypercoagulability.
What are the primary signs and symptoms of VTE?
Unilateral leg edema, pain, tenderness with palpation, decreased/absent pedal pulses, tightness, paresthesias, warm skin, redness, low-grade fever.
What is the 5 P’s neurovascular assessment for VTE?
Pain, pallor, paresthesia, pulse, paralysis.
What are the medical treatments for VTE?
- Catheter-directed thrombolysis: A catheter delivers medication to dissolve the clot.
- Thrombectomy: Surgical removal of the clot through a venous incision.
- Vena cava interruption devices: Filters clots without disrupting blood flow.
What nursing interventions help manage VTE?
- Use an electric shaver instead of razors.
- Use a soft toothbrush.
- Be cautious with dental work.
- Encourage early mobilization to prevent clot formation.
- Use sequential compression devices (SCDs) and compression stockings.
- Perform frequent skin/neurovascular assessments.
What is a major complication of VTE?
Pulmonary embolism (PE): Symptoms include feeling of impending doom, shortness of breath, cyanosis, restlessness, low SpO₂, dyspnea, inflammation, and venous damage.
What are common risk factors for VTE?
Sedentary lifestyle, family history, comorbidities, oral contraceptive use.
What diagnostic tests are used for VTE?
- Duplex ultrasound: Visualizes the clot.
- D-dimer test: Checks for clotting cascade proteins.
- INP >4 indicates increase risk of bleeding
What medications are commonly prescribed for VTE?
Anticoagulants to prevent new clot development, clot spread, and embolization.
-Heparine IV instead of warfarin for quicker effects
- Vitamin K antagonists
- Thrombin inhibitors
- Factor Xa inhibitors
Active treatment for at least 3–6 months
-RISK FOR BLEEDING
