Arterial and Venous Issues Flashcards
PAD
Leading Cause= Atherosclerosis
Tobacco Use
DM
Hyperlipidemia
Elevated CRP
Uncontrolled HTN
FMHx
Characteristics of PAD
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
ABI
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
Nursing Interventions
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
Intervention Radiology Cath-Based Procedures
Femoral artery to re-establish blood flow in the cath lab
Surgery Post-op. Nursing Care
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
Abdominal Aortic Aneurysm (AAA)
Descending Aorta out-pouching of the vessel wall related to high high-pressure
AAA Clinical Manifestations
Asymptomatic (found during routine physical exams)
Pulsatile Mass in periumbilical area
Bruit (+)
Back Pain??
AAA Complication
RUPTURE - Hemorrhage
AAA Collaborative Care
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
Open Aneurysm Repair (OAR)
Clamp the artery and sew with a synthetic graft
Large Abd. Incision
Endovascular Aneurysm Repair (EVAR)
Like a heart cath
Inside the less invasive vessel
AAA Nursing Management Post-Op
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
Raynaud’s Phenomenon
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
Raynaud’s Phenomenon Dx
Symptoms for 2 years
Raynaud’s Phenomenon Nursing Management
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
Chronic Venous Insufficiency
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
CVI Collaborative Care
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)
Compression Therapy
Static = graded compression from distal to proximal (measure by vascular) ie TED hoses
Dynamic/Intermittent (intermittent pneumatic Compression pumps/sleeves)
Venous Thromboembolism
Risk Factors
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
VTE Clinical Manifestations
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
VTE Nursing Care
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
Vena Cava Filter
Stainless Steel filter to prevent PE where clots trapped inside filter as blood travels up
