Arterial and Venous Issues

Question 1

PAD

Answer 1

Leading Cause= Atherosclerosis
Tobacco Use
DM
Hyperlipidemia
Elevated CRP
Uncontrolled HTN
FMHx

Question 2

Characteristics of PAD

Answer 2

Decreased/Absent peripheral pulses

Cap Refill > 3 sec

ABI less than 0.90

Edema is not present unless the leg is in dependent position

Lack of muscle and hair on legs, feet, and toes

Ulcers on tips of toes, foot, or lateral malleolus

Rounded, smooth ulcers that look “punched out”

Minimal Drainage

Black eschar/pale pink granulation

Pain with intermittent claudication
that is constant tooth-ache feeling

Ulcer may or may not be painful

Nails thickened and brittle

Skin = Dependent rubor, pallor when elevated in color and is shiny, thin, and taut

Cool temp gradient down the leg

Dermatitis and Pruritis rarely occurs

Question 3

ABI

Answer 3

Normal = 0.9-1.3
Lower the ABI, the more severe the PAD is
< 0.9 = Occlusive arterial disease
0.4-0.9 = claudication
<0.4 = non-healing ulceratinons; ischemic rest pain

Question 4

Nursing Interventions

Answer 4

Risk factor modification

Statins
Antihypertensives
Antiplatelets (ASA, Plavix)
cilostazol (Pletal) - intermittent claudication (inhibits aggregation & increases vasodilation)

Walking exercises
Proper foot care
Angioplasty/stent
Intervention Radiology Cath Procedures
Bypass
Amputation

Question 5

Intervention Radiology Cath-Based Procedures

Answer 5

Femoral artery to re-establish blood flow in the cath lab

Question 6

Surgery Post-op. Nursing Care

Answer 6

PVS assessment frequently

Notify HCP- dramatic increase in pain level, loss of pulses distal to site, extremity pallor/cyanosis, change in PVS status

Knee-flexed position avoided (impedes flow)

Early ambulation
Meticulous foot care

Question 7

Abdominal Aortic Aneurysm (AAA)

Answer 7

Descending Aorta out-pouching of the vessel wall related to high high-pressure

Question 8

AAA Clinical Manifestations

Answer 8

Asymptomatic (found during routine physical exams)
Pulsatile Mass in periumbilical area
Bruit (+)
Back Pain??

Question 9

AAA Complication

Answer 9

RUPTURE - Hemorrhage

Question 10

AAA Collaborative Care

Answer 10

Early Detection (FMHx)

GOAL = Prevent Rupture

Small (< 4 cm) = monitor, lower risk factor, decrease BP, Annual monitoring of size

Sx therapy
Rupture= high mortality
Elective Prefer

Question 11

Open Aneurysm Repair (OAR)

Answer 11

Clamp the artery and sew with a synthetic graft
Large Abd. Incision

Question 12

Endovascular Aneurysm Repair (EVAR)

Answer 12

Like a heart cath
Inside the less invasive vessel

Question 13

AAA Nursing Management Post-Op

Answer 13

ICU due to increased monitoring required

Monitor graft patency (adequate BP), CV status, (risk for MI), Infection, GI status (risk for ileus), peripheral perfusion distally, and renal perfusion (UOP per hr)

Discharge teaching

Question 14

Raynaud’s Phenomenon

Answer 14

Epidosic vasospastic (autoimmune) of small cutaneous arteries causing color changes (especially in fingers and toes)

Extreme sensitivity to cold, emotional upset, tobacco, & caffeine

Cold/numb followed by throbbing, aching, tingling, swelling

Question 15

Raynaud’s Phenomenon Dx

Answer 15

Symptoms for 2 years

Question 16

Raynaud’s Phenomenon Nursing Management

Answer 16

Patient Teaching
Wear layered clothing - gloves when handling cold items
Avoid temperature extremes
Immerse hands in warm water (decreases spasms)
Avoid caffeine, alcohol, and stressors (aka triggers)
CCB

Question 17

Chronic Venous Insufficiency

Answer 17

Leathery brown appearance with thickened, hardened, indurated sin that is warm (no temp gradient)

Dermatitis and pruritus occurs frequently

Edema

Eczema w/itching & scratching often present

Ulcer above medial malleolus, quite painful/worse when in dependent position (irregularity shaped with moderate to large drainage amount)

Yellow slough or dark red, “ruddy” granulation

Normal/thickened nails

Increased risk of infection if not treated

Question 18

CVI Collaborative Care

Answer 18

Compression worn dailey
Avoid sitting/standing for long periods (impedes venous return)
Elevate legs above level of heart (promote venous return)
Daily walking program
Teach proper foot & leg care
High calorie, high protein diet (skin healing)

Question 19

Compression Therapy

Answer 19

Static = graded compression from distal to proximal (measure by vascular) ie TED hoses

Dynamic/Intermittent (intermittent pneumatic Compression pumps/sleeves)

Question 20

Venous Thromboembolism
Risk Factors

Answer 20

VENOUS STASIS= advanced age, prolonged bedresdt, HF, fractures leg/hip, long trip w/o adequate exercise, obesity, pregnancy, varicose veins

ENDOTHELIAL DAMAGE = caustic/hypertonic IV drugs, Fx pelvis,hip/leg, IV drug abuse, Trauma

HYPERCOAGULABILITY = Dehydration/malnutrition, high altitudes, oral contraceptives, pregnancy, cancer, tobacco

Question 21

VTE Clinical Manifestations

Answer 21

Unilateral leg edema
Pain
Tenderness w/ palpitation
Dilated superficial veins
Sense of fullness in thigh/calf
Paresthesia
Warm skin & erythema, temp > 100.4 = inflammation
PEs = Most serious complication

Question 22

VTE Nursing Care

Answer 22

Early and Aggressive Mobilization/
tq2
Flex/extended feet/hips/knees q2-4 hours while awake (mimic skeletal muscle pump)
Anticoagulant therapy
Relevant patient teaching to minimize risks
Inferior vena cava interruption filters

Question 23

Vena Cava Filter

Answer 23

Stainless Steel filter to prevent PE where clots trapped inside filter as blood travels up