Arterial Disorders

Question 1

arteries are

Answer 1

high pressure systems that carry oxygenated blood away from the heart

Question 2

veins are

Answer 2

low pressure systems containing valves that carry deoxygenated blood back to the heart

Question 3

causes of PAD

Answer 3

-atherosclerosis
-tobacco use
-DM
-hyperlipidemia
-increase CRP
-uncontrolled HTN
-genetic link

Question 4

intermittent claudication

Answer 4

pain w/ walking d/t arteriole perfusion being so poor, when the pt walks and the skeletal muscle pump squeezes the blood to the heart, it occludes the tiny bit of arterial perfusion that the person has
location of pain correlates to site of occlusion

Question 5

arterial ulcers

Answer 5

-distal digits & bony prominences
-deep lesions
-punched out
-little or no exudate

Question 6

lack of arterial perfusion leads to

Answer 6

hair loss, dry/scaly/dusky/pale or mottled skin, thickened toenails, cool to touch, dec cap refill, dec pedal pulses, dependent rubor and muscle atrophy

Question 7

how to dx PAD

Answer 7

doppler ultrasound or ABI

Question 8

ankle - brachial index

Answer 8

performed by using hand held doppler blood pressure on all 4 extremities

right ABI = highest pressure in right foot / highest pressure taken on either arm

Question 9

ABI ranges

Answer 9

normal: 0.9-1.3
ABI <0.9 = occlusive arterial disease
ABI 0.4-0.9 = often associated w/ claudication
ABI <0.4 = non healing ulceration, ischemic rest pain

Question 10

medications for PAD

Answer 10

-statins
-antihypertensives
-anti plates (ASA, plavix)
-cilostazol

Question 11

cilostazol

Answer 11

first line drug therapy for intermittent claudication if exercise/smoking cessation not effective
inhibits platelet aggregation & increases vasodilation

Question 12

PAD collaborative care + teaching

Answer 12

-walk to the point of pain then stop & rest and then resume again until the point of pain (walking exercises) inc collateral circulation
-proper foot care (nurses never cut toenails)
-procedures: angioplasty/stenting, intervention radiology catheter based procedures, bypass surgery or amputation

Question 13

intervention radiology catheter based procedures

Answer 13

-alternative to open surgery
-cath lab
-catheter is inserted via femoral artery for: percutanerous transluminal angioplasty (PTA) OR stents OR atherectomy OR cryoplasty (PTA + cold therapy)

Question 14

post op surgery care

Answer 14

-frequent PVS assessment
-notify HCP if: dramatic inc in pain level, loss of pulses distal to site, extremity pallor/cyanosis
-knee flexed position should be avoided
-early ambulation is important
-meticulous foot care

Question 15

aortic aneurysm

Answer 15

permanent, localized, out pouching of vessel walls

Question 16

aortic aneursym CM

Answer 16

-often asym
-frequently found during routine physical exams
-pulsatile mass in periumbilical area
-bruit present
-back pain

Question 17

most serious complication of aneurysms

Answer 17

rupture

Question 18

goals of aneurysms care

Answer 18

-early detection (fam hx is a major risk factor)
-prevent rupture

Question 19

care if aneurysms is <4cm

Answer 19

-watchful waiting
-dec risk factors
-annual monitoring of size

Question 20

care if aneurysms is >4cm

Answer 20

surgical therapy

Question 21

open aneurysm repair (OAR)

Answer 21

large abdominal incision -> clamp artery around aneurysms -> sew synthetic graft

Question 22

endovascular aneurysm repair

Answer 22

-less invasive, catheter inserted through femoral vein and surgery is performed inside the vessel
-post op will just have dressing over groin

Question 23

aneurysms post op management

Answer 23

-ICU
-monitor: graft patency (keep BP in adequate range), CV status, infection, GI (risk for ileus), peripheral perfusion, and renal perfusion

Question 24

raynaud’s

Answer 24

episodic vasospastic (autoimmune) disorder of small cutaneous arteries, most often in fingers & toes
can be isolated or w/ other disease like SLE or RA

Question 25

dx of raynaud’s

Answer 25

based on symptoms x2 years

Question 26

raynaud’s characteristics

Answer 26

-vasospams induced color changes
-extreme sensitivity to cold, emotional upset, tobacco & caffeine
-lasts minutes to hours
-cold/numb followed by throbbing, aching tingling and swelling

Question 27

primary nursing focus for raynaud’s

Answer 27

teaching
-wear layered clothes & gloves when handling cold items
-avoid temperatures extremes
-immerse hands in warm water to dec spasms
-avoid caffeine, alcohol, & stressors

Question 28

drug therapy for raynaud’s

Answer 28

CCB (if severe to dec spasms)