Cardiac - Unit 2 - Care of Patients with Vascular Problems Flashcards
Assessment - Arterial vs. Venous Problems
Arterial - smooth, shiny, loss of hair, thick nails, loss of sensation, pale, cyanotic, cool.
Venous - brown pigment around ankles, edematous, warm.
Assessment of Peripheral Pulses - Arterial vs. Venous
Arterial - decreased or absent pedal pulses, ABI or = to 1
Venous = Normal pulses & ABI
Assessment of pain - Arterial vs. Venous
Arterial = intermittent claudication, rest pain, loss of movement.
Venous = achy
What are some diagnostics for arterial or venous problems?
Doppler Ultrasound, Arteriogram or Venogram
Arteriosclerosis - def
thickening or hardening of arterial wall often associated with aging.
Atherosclerosis - def
type of arteriosclerosis involving formation of plaque within the arterial wall.
What are some lab assessments for atherosclerosis?
Lipid levels, HDL, LDL, homocysteine (high levels means you can be vulnerable to plaque buildup)
What are some medical treatments for atherosclerosis?
Evaluate labs and life style changes, nutrition therapy, durg therapy (statins, fibrates [gemfibrozil - decrease triglycerides], cholesterol absorption inhibitors [ezetimibe], bile acid sequestrants, niacin)
What are some surgical interventions for arterial problems?
PTA, endarterectomy, bypass graft, thrombectomy, embolectomy, amputation
What are some surgical interventions for venous problems?
Vein ligation (they tie veins together to prevent pooling of blood), thrombectomy, debridement (removing dead tissue)
What is angioplasty?
PTA (Percutaneous Transluminal Angioplasty with stent) - they go in and open up the blockage and stent it.
What’s an endarterectomy?
They go in and basically strip the inside of the artery…
Pre-op procedure - assessments?
Vitals & Pulses
Post-op procedure - assessments?
Peripheral pulses, fluid status, coagulation status, pain, exercise & motion.
What are some complications for arterial procedures?
Graft occlusion, compartment syndrome, acute arterial occlusion and ulcer formation.
What are some complications for venous procedures?
Ulcer formation, pulmonary embolism.
What are ulcers like for arterial problems?
Painful, tops of toes/heels/feet - grayish appearance, gangrene, mottled, dry, etc.
What are ulcers like for venous patients?
Lightly to non-painful, bottom third of leg, uneven edges, ruddy, superficial/wet
How do we position extremities for these patients (tell both)?
Arterial - gravity flow.
Venous - elevate the extremity.
Thrombus - def
Formation of a blood clot within the vascular system.
Embolus - def
clot or foreign substance traveling within the vascular system.
Embolus originating in left side of heart may travel to the brain. T/F?
TRUE
What are the signs and symptoms of sudden arterial occlusion? (6 P’s)
Pain - sudden & severe Pallor - appearance is pale then white, cold and blotched - finally mottled & cyanotic. Pulselessness - Paresthesia - (pens & needles) Paralysis - Polar or poikilothermia (temp varies)
What is buerger’s disease?
Where you want Bravas all the time…
Just kidding - it’s an imflammatory & spasmotic occlusive vascular disease that happens more in Jewish men that are over the age of 40. A history of smoking is the biggest cause!
What are symptoms of buerger’s disease?
Pain (intermittent claudication), paresthesia, weak pulses, ulcerations, gangrene
What is the treatment for buerger’s disease?
Vasodilation, pain relief, stop smoking, buerger/allen exercises (improve circulation), dependant positioning, amputation
What is Raynaud’s disease?
Bilateral intermittent cold induced digital ischemia - it usually affects fingers and can progress to necrosis and loss of tissue and it usually happens in females and is affected by smoking.
What is Raynaud’s Phenomenon?
Raynaud’s secondary to another disease such as Lupus, Scleroderma, Rheumatoid Arthritis
What are symptom’s of Raynaud’s?
Bilateral, intermittent pallor, cyanosis, rubor (white, then blue, then red)
Numbness, tingling, burning.
What are the treatment options for Raynaud’s?
Calcium channel blockers, nitro, resperine, biofeedback, protection from cold, no smoking, if severe = regional sympathectomy (cutting of a sympathetic nerve)
What can also induce Raynaud’s?
Coffee & Chocolate
What are arterial aneurysms? The two types?
Abnormal dilation of an artery caused by deformity of its wall.
True = involves all three layers.
False = hematoma outside arterial wall.
Predisposing factors include family history, atherosclerosis, syphilus, HTN
What are some symptoms of an AAA?
Can be asymptomatic, but also can include pulsating abdominal mass w/ bruit, pain in back, abdomen or flank, blood stools, scrotal bruising, embolus, or sudden intense back pain/shock with a rupture!
What are symptoms of a thoracic aortic aneurysm?
Back pain, SOB, hoarseness, difficult swallowing, mass may be visible above suprasternal notch, sudden excruciating back or chest pain (rupture)
What are some diagnostic tests for a TAA or an AAA?
CT Scan, MRI, Ultrasound, CXR
What are some post-op nursing care things for thoracic and abdominal aneurysm’s?
TAA - monitor PAP pressure, chest tubes, assess LOC, assess upper extremity CSM.
AAA - assess renal function, assess abdomen, assess spinal cord function and if there’s graft occlusion.
What is marfan’s?
Genetic abnormality of connective tissue usually found in tall slender men with long extremities - can cause valve prolapse and treatment depends on symptoms.
What is a VTE?
Venous Thromboembolism.
What are some assessment findings with VTE?
Calf or groin pain or tenderness and sudden onset of unilateral leg swelling
What are some treatment options for VTE?
anticoagulation therapy, bedrest, compression stockings, surgical management
What are varicose veins?
Abnormally dilated, engorged, tortuous and superficial veins - symptoms include achy legs, itching, muscle cramps, local redness and tenderness
What is schleroptherapy?
Used for small varicose veins - they insert a catheter, heat it up, the vein collapses and is then removed and BAM, you’re golden!
