Arterial Diseases (Exam 2) Flashcards by Isaiah Smith

Arterial Disorders

PAD

Aneurysms

Raynauds

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Difference between arteries and veins

Arteries are high pressure carrying blood away from the heart. The blood is oxygenated. Where peripherals pulses come from

Veins carry blood back to the heart. The blood is deoxygenated. Veins have valves that helps enhance blood flow to through the heart

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Who gets Peripheral Arterial Disease?

Atherosclerosis

Tobacco use

Hyperlipidemia

Increase CRP

HTN

Family history

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Intermittent Claudication

Symptom of PAD

Location of pain correlates with location of occulusion

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Arterial Ulcers

Often distal digits and bony prominences

Deep lesions

Punched out

No exudate

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Lack of arterial perfusion leads to

Hair loss

Dry scaly dusky pale skin

Thickened toenails

Cool to touch

Decrease cap refill

Decreased pedal pulses

Dependent rubor

Muscle atrophy

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PAD: Diagnostic Test

Doppler ultrasound

Ankle brachial index

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Doppler ultrasound

Can determine degree of blood flow

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Ankle-brachial index

Screening tool

Hand held doppler on all 4 extremities

for example Right Leg ABI =

Highest pressure in the RIGHT foot divided by highest pressure in BOTH arms

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Know how to calculate patient ABI

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ABI numbers

Normal = 0.9-1.3

Occlusive arterial disease = <0.9

PAD with claudication = 0.9-0.4

Non healing ulcers PAD = <0.4

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Medications for PAD

Statins

Antihypertensives

Antiplatelets

cilostazol (drug for intermittent claudication)

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cilostazol

First line drug therapy for intermittent claudication if exercise/smoking cessation not effective

(inhibits platelet aggregation and increases vasodilation)

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What is the first line drug therapy for intermittent claudication?

cilostazol

Inhibits platelet aggregation

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PAD: Collaborative Care (Teaching)

Walking exercises (walk till pain - stop rest - walk till pain)

Proper foot care (patient cannot feel feet)

Angioplasty / stenting

Catheter based procedures

Bypass (cabg)

Amputation

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Interventional radiology catheter based procedures

Similar to angiography / Specialized catheter inserted via femoral artery:

-Percutaneous transluminal angioplasty (balloon)

-Stents

-Atherectomy (removal of plaque)

-Cryoplasty (PTA + cold therapy)

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Percutaneous Transluminal Angioplasty

Balloon therapy of the atherosclerosis

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Atherectomy

Removal of plaque

Cryoplasty

PTA + Cold therapy

Types of PAD bypass surgerys

What they are called is determined by location of blockage

-Aorto bifemoral

-Axillobifemoral

-Fem-fem

-Iliofemoral

-Fem-pop

PAD Post-op Surgery Nursing Care

Frequent PVS assessment

Knee flexed position should be avoided

Early ambulation

Meticulous foot care

Notify HCP post op PAD surgery if

Dramatic increase in level of pain

Loss of pulses distal to site (doppler prn)

Extremity pallor of cyanosis

Change in other PVS status

What should be avoid followed PAD surgery?

Knee flex position. Impeded arterial flow

T/F: Early Ambulation is important follow PAD surgery?

True

Abdominal Aortic Aneurysm

Tripple Permanent localized outpouching of vessel wall

Aortic Aneurysm: Clinical Manifestations

Often asymptomatic Back pain Frequently found during routine exams Pulsatile mass in periumbilical area Bruit present

Most serious complication of aneurysm

Rupture

AA: Collaborative Care

Early detection (familial) Prevent rupture

What is considered a small aneurysm?

<4mm

Collaborative Care: Small Aneurysms

Watchful waiting: -Decrease Risk factors (CV) -Decrease BP -Annual monitoring of size

Surgery of AA if

AA grows larger Elective If rupture the mortality is high

Open aneurysm repair (OAR)

Open surgery that involves large abdominal incision Clamp artery Sew synthetic graft

Endovascular Aneurysm Repair

Preformed inside vessel Less invasive Similar outcome to OAR

AA: Nursing Management Post - Op

ICU after surgery Monitor graft patency (maintain adequate BP) CV status (risk of MI) Infection Peripheral perfusion Renal perfusion

Raynaud's Phenomenon

episodic vasospastic (autoimmune) disorder of small cutaneous arteries, most often in fingers and toes may occur in isolation or with other disease (SLE , RA)

What other disease might raynaud's occur with?

SLE (lupus) RA (Rheumatoid Arthritis)

Raynaud's Diagnosed based on

2 years of symptoms

Raynaud's characterized by

vasospasm induced color changes

Raynaud's is precipitated by

Sensitivity to cold Emotional upset Tobacco Caffeine

How long does raynaud's last?

Minutes to hours

Raynaud's Cold/Numb is followed by

Throbbing Aching Tingling Swelling

Raynauds: Nursing Management

Wear layered clothing; gloves when handling cold item Avoids temperature extremes Immerse hands in warm water to decrease spasm Avoid caffeine, alcohol, and stressors

Raynauds: Drug Therapy

Calcium-channel blockers