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CEN > Cardiovascular Emergencies > Flashcards

Cardiovascular Emergencies Flashcards

1. Explain concept related to the care of an ED patient experiencing a cardiovascular emergency. 2. Describe various patient presentations related to cardiovascular emergencies. 3. List interventions necessary for a patient presenting with a cardiovascular emergency.

1
Q

cardiac output

A

SV x HR

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2
Q

SNS r/t HR

A

increases HR d/t:

  • stress
  • anxiety
  • acute pain
  • release of catecholamines
  • hypotension
  • drugs w/ + chronotropic effects
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3
Q

PNS r/t HR

A

decreases HR d/t:

  • vagus nerve stimulation
  • cardiac conduction abnormalities
  • drugs with (-) chronotropic effects
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4
Q

heart rhythm r/t HR

A

some dysrhythmias can impair adequate filling of heart chambers or result in loss of atrial kick which contributes to 20-40% of ventricular filling in healthy adult

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5
Q

define stroke volume

A

amount of blood ejected from each ventricle per contraction

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6
Q

stroke volume overview

A

measured in ml/beat

amount ejected / ventricle is equal in healthy patient

positively influenced by preload and contractility

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7
Q

define contractility

A

strength of each myocardial contraction

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8
Q

contractility overview

A

significantly contributes to CO

affected by preload (Frank-Starling law), afterload, electrolyte status, myocardial oxygenation, amount of functional myocardium, and drugs with inotropic effects

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9
Q

define preload

A

volume of blood that results in pressure or stretch of the ventricles during diastole

affected by amount of venous return to heart

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10
Q

what increases preload?

A

peripheral venous constriction

alpha adrenergics (epi, norepi, dopamine)

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11
Q

what decreases preload?

A

decreased intravascular volume 2/2:

  • hemorrhage
  • diuresis
  • v/d
  • third spacing
  • redistribution of blood flow

also vasodilators

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12
Q

define afterload

A

resistance to ventricular emptying during systole

negatively influences stroke volume

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13
Q

what increases afterload?

A

vasoconstriction or mechanical obstruction of ventricular outflow such as:

  • aortic or pulmonic stenosis
  • HTN
  • hypothermia
  • compensatory shock mechanisms
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14
Q

what decreases afterload?

A
  • hyperthermia
  • distributive shock
  • vasodilators
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15
Q

increasing CO: adults vs children

A

adults: HR and SV
children: tachycardia (cannot increase SV)

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16
Q

define MAP

A

average pressure over entire cardiac cycle

(DBPx2 + SBP)/3

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17
Q

define pulse pressure

A

difference between systolic and diastolic BP

calculate via systemic or pulmonary pressure

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18
Q

low systemic pulse pressure

A

narrowing pulse pressure

decreased LV SV, blood loss, low stroke volume 2/2 shock or cardiac tamponade

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19
Q

high pulse pressure

A

widening pulse pressure

may be transient and normal effect of activity

caused by chronic or acute conditions

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20
Q

chronic causes of high pulse pressure

A

atherosclerosis

aortic regurg

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21
Q

acute causes of high pulse pressure

A 
aortic aneurysm
aortic dissection
PDA
endocarditis
anxiety
fever
pregnancy
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22
Q

Cushing Triad

A

indicative of increased intracranial pressure

widening pulse pressure or HTN
bradycardia
irregular breathing pattern

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23
Q

chronotropes

A 
affect HR (generation of electrical impulse)
at SA node
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24
Q

inotropes

A

affect contractility

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25
Q

dromotropes

A

affect automaticity (electrical impulse velocity) of heart at AV node

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26
Q

alpha beta receptors

A

Alpha 1 causes peripheral vascular Constriction

Beta2 causes bronchial smooth muscle Dilation

(AB,CD)

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27
Q

ACE inhibitors pharmacology

A

-angiotensin-converting enzyme, -pril
-affect RAAS by blocking angiotensin I to angiotensin II
-results in decreased BP (HTN) and afterload (CHF)
decreased preload and -afterload via vasodilation an diuresis

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28
Q

ACE inhibitors adverse effects

A

dry cough
angioedema, rash
renal impairment
category D in pregnancy

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29
Q

ARBs pharmacology

A
  • angiotensin receptor blockers, -sartan
  • inhibit angiotensin II receptors
  • results in vasodilation, decreased aldosterone levels, increasing excretion of Na and sparing of K+
  • for HTN and CHF
  • only oral
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30
Q

ARBs adverse effects

A 
hypotension
dizziness
HA
hyperK
rarely dry cough
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31
Q

calcium channel blockers

A

-dipine

negative inotropic, chronotropic, dromotropic effects

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32
Q

beta blockers

A
  • lol
  • negative inotropic, chronotropic, dromotropic effects
  • beta receptors
  • cardioselective (B1) or non cardioselective (lungs) (B2)
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33
Q

CP risk factors

A 
CAD
angina
MI
stents
pacemaker
age, sex, genes
weight, diet, smoking, exercise, stress
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34
Q

sx of MI

A

vary by vessel

  • pain in chest, jaw, neck, left arm, epigastrum, scapular
  • N/V
  • hemodynamic instability (hypotension, sx decreased CO or shock, sob, dysrhythmias, anxiety, impending doom)
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35
Q

assessing MI

A 
OPQRST
onset
provoke, precipitate, palliate
quality
radiate, region
severity, sx
timing
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36
Q

atypical MI presentations

A

women, elderly

  • sob, palpitations
  • fatigue, syncope
  • n/v
  • diaphoresis
  • pain/discomfort
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37
Q

assessing MI

A 
labs
rads (CXR, echo, doppler, stress, catheterization)
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38
Q

phosphodiesterase inhibitors in MI

A

i.e. sildenafil, etc.

can lead to profoundly decreased CO with inferior wall infarct or nitroglycerins

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39
Q

indications of pacemaker

A

refractory bradycardia
heart block
idioventricular dysrhythmias

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40
Q

transvenous pacing

A

catheter electrode threaded into the right atrium or ventricle via the subclavian, internal jugular, brachial, or femoral vein

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41
Q

transcutaneous pacing

A

pad on mid-thoracic back and front of chest at lead V3

fixed or demand, 60-80 bmp, 60-80 mA, increasing 5-10 mA until capture

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42
Q

electrical component of pacing

A

pacer spike precedes each:

QRS complex (ventricular pacing)
P wave (atrial pacing)
both (atrioventricular pacing)
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43
Q

mechanical component of pacing

A

palpable pulse that correlates to each paced beat

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44
Q

lack of capture on pacemaker

A

acidosis
hypoxemia
wires not connected
wet/diaphoretic skin/electrodes

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45
Q

define cardioversion

A

synchronized defibrillation

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46
Q

cardioversion overview

A

with spontaneous circulation, usually hemodynamically unstable

V.tach with pulse
SVT
refractory a.fib/flutter

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47
Q

cardioversion procedure

A

sync
marker above R waves
hold defib button until shock delivered
rest sync mode for every delivery

12 lead before, during, after

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48
Q

why defibrillate?

A

lack of spontaneous circulation

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49
Q

most types of defibrillators

A

biphasic

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50
Q

joules for adult defibrillation

A

biphasic 120-200

monophasic 200-300

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51
Q

joules for ped defibrillation

A

2/kg then 4/kg

max of 10/kg

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52
Q

define dysrhythmias

A

abnormal cardiac electrical activity resulting in aberrant rhythms

asymptomatic or sx r/t altered CO

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53
Q

types of dysrhythmias

A 
bradycardia
tachycardia
supraventricular arrhythmias
ventricular arrhythmias
heart block
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54
Q

define bradycardia

A

impaired/delayed electrical impulse

SA node or CNS activation of heart is affected

adults below 60 bpm
peds is age specific

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55
Q

causes of bradycardia

A 
CAD
aging
respiratory (peds)
cardiac defects
drugs
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56
Q

sx bradycardia

A 
hypotension
ams
shock
cp
acute HF
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57
Q

interventions for stable bradycardia

A

correct cause
atropine, IV crystalloids

if asymptomatic, observation

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58
Q

interventions for unstable bradycardia

A

correct cause
dopamine, epi infusion
transcutaneous pacing

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59
Q

define tachycardia

A

adults > 100 bpm (unstable > 150)

peds age specific

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60
Q

causes of tachycardia

A 
acute pain, fever, activity
CAD
cardiac defects
electrolytes
excessive drug use/OD
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61
Q

sx tachycardia

A 
anxiety, diaphoresis
palpitations, chest discomfort
sob
dizziness, syncope
hypotension, shock
loss of VS
MS change
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62
Q

interventions for stable tachycardia

A

correct cause

amiodarone IVPB

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63
Q

interventions for unstable tachycardia

A

cardioversion w/ sedation

regular, narrow complex: 50-100 joules, biphasic

irregular, narrow complex: 120-200 joules, biphasic

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64
Q

interventions for pulseless tachycardia

A

defib and CPR
epi q 3-5 min
amiodarone VI

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65
Q

interventions for tachycardia in general

A

cardiac work up, EP consult
cath, surgery
labs
AICD/pacemaker

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66
Q

where do supraventricular dysrhythmias originate?

A

atria

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67
Q

types of supraventricular dysrhythmias

A
  • premature atrial contractions (PACs)
  • paroxysmal supraventricular tachycardia (PSVT)
  • Wolff-Parkinson-White
  • AV node re-entry tachy
  • a.fib
  • a.flutter
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68
Q

Wolff-Parkinson-White syndrome

A

fast HR d/t extra/abnormal pathway between atria and ventricles

impulse travels via normal and extra route, causing impulse to travel rapidly

presence of delta wave

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69
Q

AV node re-entry tachycardia

A

more than one pathway through AV node

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70
Q

a.fib

A

common irregular pattern

many impulses in atria with complete travel thru AV node w/o coordinated electrical activity

fibrillating/quivering atria

RVR: > 100 bpm

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71
Q

a.flutter

A

1+ rapid circuits in atrium that result in organized, reg rhythm

sawtooth waves
AV conduction fixed or variable

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72
Q

causes of supraventricular tachycardias

A 
conduction abnormalities
CAD
cardiac defects
aging
excessive drug use
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73
Q

sx supraventricular tachycardias

A 
100-150 bpm
any bp
sob, dypsnea
palpitations, chest tightness
MS change
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74
Q

interventions for stable supraventricular tachycardia

A

vagal maneuvers

pharm cardioversion as appropriate

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75
Q

interventions for unstable supraventricular tachycardia

A

synchronized cardioversion

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76
Q

interventions for supraventricular tachycardia with HR > 150 bpm

A

cardioversion at 50-200 joules (biphasic)

amiodarone IVPB

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77
Q

define PVCs

A

originate in ventricles

failure of SA node or overriding of ventricle-generated impulses

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78
Q

PVC overview

A

“skipped’ HB sensation

usually benign but may be caused by specific condition and produce specific sx

may be bigeminal or trigeminal

3+ PVCs = tachycardia

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79
Q

ventricular tachycardia

A

w/ or w/o pulse

torsades

  • polymorphic VT
  • rhythm twists
  • QRS variable amplitude
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80
Q

v.fib

A

quivering ventricles

no coordination for filling or ejecting of blood in chambers

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81
Q

causes of PVCs

A 
blunt trauma
underlying conditions (prolonged QT)
heart disease
hypoxic myocardium
electrolytes
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82
Q

sx PVCs

A 
HR 150-300
palpitations, chest discomfort
syncope
dyspnea
hypotension
loss of VS
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83
Q

interventions of PVCs with pulse

A

cardioversion (VT)

magnesium (torsades)

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84
Q

interventions for PVCs w/o pulse

A

defib, CPR, epi

correct cause

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85
Q

1st heart block

A

usually benign

prolonged PR interval

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86
Q

2nd degree heart block, type I

A

aka Wenckebach (most common)

gradual increase in PR interval until dropped QRS

87
Q

2nd degree heart block, type II

A

consistently long PR interval until dropped QRS

88
Q

3rd degree heart block

A

no electrical coordination between atrium and ventricles

P-wave intervals consistent
QRS intervals consistent

89
Q

causes of heart block

A

aging
CAD
drug OD

90
Q

interventions for heartblock

A

atropine for low grade (ineffective for high grade or heart transplant)

transcutaneous pacing for high degree, or heart transplant

identify cause (H and Ts)

91
Q

H and Ts in cardiac dysrhythmias

A 
hypovolemia
hypoxia
hydrogen ion (acidosis0
hyper/hypokalemia
hyper/hypoglycemia
hypothermia
toxins
tamponade
tension pneumo
thrombosis (coronary, pulm)
trauma
92
Q

define sudden cardiac arrest

A

failure of cardiac electrical system

NOT and MI

93
Q

risk factors for sudden cardiac arrest

A 
CAD, MI
syncopal episodes
exertional cp, dyspnea, syncope
HF, hx MI
EF < 40%
modifiable CAD risk factors
94
Q

interventions for sudden cardiac arrest

A

defib, cpr

implanted defib for future

95
Q

causes of cardiopulmonary arrest

A

trauma
chronic, acute illness
sudden cardiac arrest

96
Q

bls interventions

A 
recognize
activate response
high quality CPR
rescue breaths
rapid defib
97
Q

interventions for cardiopulmonary arrest

A 
CPR
airway
breathing
defib
meds
98
Q

compressions in cardiopulmonary arrest

A

most important to have effective, continuous compressions for cardiac perfusion and CO

100-120 bpm
adequate depth and recoil
minimize interruptions

99
Q

airway in cardiopulmonary arrest

A

advanced airway can delay cpr or defib

use bls maneuvers to ensure airway patency

100
Q

breathing in cardiopulmonary arrest

A 
rise and fall of chest
bag-mask unless ineffective
prevent hyperventilation
30:2
ventilate q 5-6 sec with advanced airway
101
Q

hyperventilation in cardiopulmonary arrest

A

prevent!

increases intrathoracic pressure which decreases venous return to heart

102
Q

defib in cardiopulmonary arrest

A

early defib has better outcomes
CPR while charging
resume immediately after shock
no pulse checks w/o organized rhythm

103
Q

meds in cardiopulmonary arrest

A

circulate with CPR
epi q3-5 min
amiodarone or lidocaine

104
Q

benefits of family presence during cardiopulmonary arrest

A

more likely to understand
grieving process
medical hx
reduce fear/anxiety/isolation

105
Q

concerns for family presence during cardiopulmonary arrest

A

interference
misinterpret efforts, litigation
traumatic
grief response may be violent

106
Q

procedure for family presence during cardiopulmonary arrest

A

one staff member to remain with family and explain procedure in clear, simple terms

allow for interaction with patient if possible

107
Q

trauma considerations for cardiopulmonary arrest

A

poor survival rates (0-3.7%), especially with hypovolemia

108
Q

thoracotamy in trauma cardiopulmonary arrest

A

high mortality rate

maybe for penetrating injury with quick transport and objective signs of life upon arrival

also for massive intrathoracic hemorrhage, tamponade, internal cardiac massage

109
Q

causes of pediatric cardipulmonary arrest

A

usually resp failure or shock

apparent life threatening event

SIDS

110
Q

pediatric apparent life threatening event

A

ALTE
cause of cardiopulm arrest

color change, marked change in muscle tone, choking, gagging

111
Q

SIDS

A

cause of cardiopulm arrest
unknown cause
accidental suffocation
<1 year, most 2-3 mo

112
Q

interventions for pediatric cardiopulm arrest

A

high quality BLS
PALS
family presence

113
Q

causes of maternal cardiac arrest

A

BEAU-CHOPS

bleeding/DIC
embolism
anesthesia
uterine atony
cardiac disease
HTN/preeclampsia
Others: H/Ts
placentae abruptio/previa
sepsis
114
Q

interventions for maternal cardiopulm arrest

A
  • ACLS
  • higher chest compressions
  • displace uterus to left to prevent vena cava syndrome
  • PIV above diaphragm
  • remove fetal monitoring device prior to defib
  • remove cause
  • emergency C section if no ROSC within 4 min
115
Q

PCI in cardiopulm arrest

A

early PCI is gold standard
thrombolytics if no PCI
transfer to PCI hospital

116
Q

therapeutic hypothermia in cardiopulm arrest

A

only therapy shown to improve neuro recovery after ROSC with persisting neuro deficits

initiate immediately after ROSC when pt comatose

117
Q

procedure for therapeutic hypothermia

A 
32-34 C for 12-24 hrs
continuous core temp
control shivering
sedation, analgesia, neurmusc block
baseline electrolytes
hourly glucose
IUC with temp monitor
118
Q

consistent findings in at least two contiguous EKG leads indicates what?

A

ischemia, injury, or infarct

119
Q

opposite changes from contiguous EKG leads that may be found in reciprocal leads indicates what?

A

confirm interpretation

120
Q

EKG alteration for ischemia

A

tall or inverted T waves

ST depression

121
Q

EKG alteration for heart injury

A

elevated ST with reciprocal changes

T-wave may invert in some leads

122
Q

EKG alteration for infarction (acute)

A

ST elevation

T-wave may be inerted

123
Q

EKG alteration for infarction (old)

A

abnormal Q wave

normalized baseline

124
Q

indications for Right Sided EKG

A

acute MI of R ventricle or posterior wall

adult and geriatric

125
Q

ACS

A

s/sx of MI

caused by imbalance of myocardial oxygen supply and demand

126
Q

four stages of MI

A

stable angina
unstable angina
NSTEMI
STEMI

127
Q

stable angina overview

A

cp with exertion, short duration

relieved by rest or meds

128
Q

unstable angina overview

A

cp with no exertion/at rest, lasts longer than stable

indicates unstable atherosclerotic plaque, may lead to acute MI

129
Q

NSTEMI overview

A

MI with ischemic cp

rupture of unstable plaque that resulting in intermittent coronary occlusion

130
Q

STEMI overview

A

MI with complete obstruction of 1+ coronary arteries with thrombosis

131
Q

anterior left ventricle infarct

A

sx LV failure

crackles, S3, resp distress d/t pulm edema

132
Q

right ventricle infarct

A

sx RV failure

hypotension, increased CVP, jugular venous distention, no crackles

133
Q

pain, EKG, trop in stable angina

A

relieved by rest or nitro

transient ST depression

normal

134
Q

pain, EKG, trop in unstable angina

A

> 20 min, unrelieved by rest, nitro

transient ST depression
T wave inversion

normal

135
Q

pain, EKG, trop in NSTEMI

A

continuous cp

ST segment depression
T wave abnormal

elevated

136
Q

pain, EKG, trop in STEMI

A

pain worse than angina

ST elevation > 2mm in V1-3 and > 1 mm in other leads

elevated

137
Q

trop and CK-MB trends during infarct

A

trop:
3-12 hours
peak 10-24 hrs

CK-MB:
4-12 hrs
peak 10-24 hrs

138
Q

moNA

A

morphine
oxygen
nitro
aspirin

139
Q

morphine during ACS

A

decrease pain, anxiety

for persistent cardiac pain unrelieved by nitro

140
Q

oxygen during ACS

A

if SpO2 below 94% or severe resp sx or shock

141
Q

initial nitro during ACS

A

sublingual

  • reduce myocardial oxygen demand
  • coronary artery dilation
  • improve collateral blood flow to ischemic myocardial tissue
  • dilate peripheral vasculature
  • reduce preload
142
Q

additional nitro during ACS

A

transdermal or IV if necessary

143
Q

contraindications for nitro during ACS

A

hypotension
bradycardia
phosphodiesterase inhibitors
inferior wall infarcts

144
Q

aspirin during ACS

A

greatest benefit if taken asap

160-324 mg

few contraindications
class D pregnancy
145
Q

stemi interventions

A

early reperfusion

PCI gold standard (less than 90 min)

fibrinolytic therapy if PCI unavailable

146
Q

pharm interventions post-infarct

A

beta blockers (for all ACS)

ACE inhibitors or ARBs to reduce infarct size and improve ventricular remodeling

147
Q

define heart failure

A

inadequate CO and oxygen delivery to tissues

LV EF < 40%

148
Q

types of HF

A

systolic: inability to pump effectively
diastolic: inability to fill adequately

149
Q

sx R side HF

A 
peripheral edema
JVD
ascites
hepatomegaly
increased CVP
150
Q

sx L side HF

A 
SOB
dyspnea
crackles
S3
pulm edema
151
Q

interventions for HF

A 
ABCs
cardiac monitor
oxygen > 90%
BiPap
IV
fluids with caution
loop diuretics, vasodilators

+ inotropes if cardiogenic shock

152
Q

define aortic dissection

A

tear in intimal layer of aorta that exposes medial layer to forces of blood pressure

results in dissection of two layers of arterial wall

153
Q

risk factors for aortic dissection

A 
HTN
atherosclerosis
60 + years
cardiovascular surgery
connective tissue disease
cocaine
trauma
154
Q

sx aortic dissection in general

A

sudden pain to chest, back, flank, shoulders

tearing, ripping, sharp, stabbing

not relieved by analgesia

20 mmHg BP difference

155
Q

sx ascending aortic dissection

A

MS change

sx stroke, MI, cardiac tamponade, aortic valve insufficiency

156
Q

sx descending aortic dissection

A

renal failure
paraplegia
loss of distal pulses

157
Q

interventions for aortic dissection

A

ABCs
O2
two large bore IVs
SBP > 100-120

IV nitroprusside, nitroglycerin, beta blockers

analgesics prn
surgical repair

158
Q

define hypertensive urgency

A

substantial elevation in bp that should be treated w.in 24 hours

159
Q

define hypertensive emergency/crisis

A

SBP > 180
DBP > 120
evidence of end organ damage

160
Q

sx hypertensive emergency/ crisis

A 
AMS
cp, dizziness
epistaxis, HA
HF
hematura, oliguria
S3, S4
SZs, visual disturbance
161
Q

interventions for hypertensive emergency/crisis

A 
O2
IV
continuous BP (art line)
nitro/nitroprusside IV
labetalol if other meds contradinicated

ICU

162
Q

define endocarditis

A

inflammation of endocardium, including valves

163
Q

sx endocarditis

A

sx infection
pleuritic cp
abd or back pain

signs of embolization

  • stroke like sx
  • hemoptysis
  • conjunctival petechiae
164
Q

complications of endocarditis

A 
MI
pericarditis
cardiac arrhythmias
valvular insufficiency
CHF
stroke
arthritis
aneurysm
abscesses
165
Q

define pericarditis

A

acute or chronic inflammation of pericardial sac

166
Q

causes of pericarditis

A 
virus, bacterial infection
acute MI
aortic dissection
cancer, radiation
renal failure
mediastinal injury
connective tissue disorder
167
Q

sx pericarditis

A

sudden onset cp worse with inspiration, activity, supine and relieved by leaning forward

pericardial friction rub
tachycardia
sx infection

168
Q

EKG changes in pericarditis

A

-ST elevation
-absent reciprocal changes
tall, peaked T waves in all leads except aVR, V2
-PR segment depression in lead II

169
Q

pharm management of pericarditis

A

anti-inflammatory meds
corticosteroids if refractory to tx

if with HF:

  • high dose NSAIDs
  • colchicine
  • abx/antifungals
  • corticosteroids or diuretics
170
Q

define blunt cardiac injury

A

blunt force to chest that may result in damage to myocardium, coronary arteries, or other heart structures

171
Q

causes of blunt cardiac injury

A

MVCs with thorax on steering wheel

falls, crush injuries, violence, sports

172
Q

mechanism of injury for blunt cardiac injury

A

rapid deceleration
shearing forces
compression

173
Q

areas of injury during blunt cardiac trauma

A

RV and RA
coronary arteries
pericardium
thoracic aorta

174
Q

sx blunt cardiac trauma

A

varies, maybe asymptomatic
cp
dysrhythmias and ectopy

sx of:

  • cardiac tamponade
  • great vessel rupture
  • shock
  • thorax, thoracic spine fx
  • pulse changes
  • cardiac failure
175
Q

define pericardial tamponade

A

potentially life threatening condition in which pericardial sac, which normally holds 20-50ml fluid, accumulates additional fluid, resulting in pericardial or cardiac effusion

increase pressure compresses heart and affects ability to pump

176
Q

precipitating factors for pericardial tamponade

A 
dissecting aortic aneurysm
end stage lung CA and other CA
MI
cardiac surgery
pericarditis
trauma
177
Q

complications of pericardial tamponade

A

pulm edema
shock
rapidly fatal w/o tx

178
Q

sx pericardial tamponade

A

beck triad
kussmaul sign
obstructive shock

179
Q

Beck triad

A

3 D’s
distant (muffled) heart sounds
distended jugular veins (JVD)
decreased BP

180
Q

Kussmaul sign

A

paradoxical increase in JVD and jugular venous pressure on inspiration

181
Q

interventions for pericardial tamponade

A

pericardiocentesis or pericardial window

fluids with caution (consider vasopressors)

advanced airway with caution

182
Q

define peripheral vascular disease

A

slow and progressive circulation disorder that may affect arteries, veins, or lymphatic system

2ndary affects on organs

183
Q

primary cause of peripheral vascular disease

A

atherosclerosis

184
Q

types of peripheral vascular disease

A

artrial
venous
lymphatic

185
Q

define atherosclerosis

A

“hardening” of arteries that results from plaque accumulation on arterial wall

186
Q

atherosclerosis overview

A

arterial wall becomes narrow and stiff

leg muscles work harder to get oxygenated blood since they are most distal and most commonly affected

187
Q

define peripheral artery disease

A

narrowing or hardening of arteries outside of heart in which blood flow is compromised d/t compromised vessels

188
Q

complications of peripheral artery disease

A

organs supplied by these arteries damaged d/t decreased blood flow, oxygenation, nutrients

189
Q

sx peripheral artery disease

A 
might be asymptomatic
weakness/numbness
sores w/ delayed healing
shiny skin
decreased pedal pulses
hair loss
intermittent claudication
190
Q

define peripheral venous disease

A

chronic venous insufficiency where one or more veins do not adequately return blood flow from lower extremities to heart d/t damaged venous valves

191
Q

complications and sx of peripheral venous disease

A 
PE
dilated veins, varicose veins
edema
leg pain
skin fibrosis, venous ulcers
venous claudication
cellulitis, hair loss, redness, bruising
delayed wound healing
192
Q

define DVT

A

thromboembolic disease where blood clots develop in deep peripheral veins

193
Q

risk factors for DVT

A 
injuries to LE veins
slow blood flow 2/2 decreased mobility
increased estrogen
chronic conditions
genetics, age
obesity
194
Q

complications and sx of DVT

A 
venous stasis ulcers
delayed healing
clot traveling, PE
skin color changes
edema
195
Q

define thrombophlebitis

A

blood clot in superficial or deep vein that is inflamed, usually in legs

196
Q

risk factors for thrombophlebitis

A

varicose veins
recent surgery or trauma
prolonged inactivity

197
Q

complications of thrombophlebitis

A

limb ischemia
PE
varicose veins

198
Q

sx thrombophlebitis

A

edema
erythema
persistent pain, heaviness

199
Q

define lymphedema

A

most common peripheral lymphatic disease

edema 2/2 blockage to normal drinage pattern of lymph nodes

200
Q

causes of lymphedema

A 
surgery
CA
radiation
lymph node infection
inherited conditions
201
Q

sx lymphedema

A

asymmetry of affected extremity
progressive, painless swelling
leg heaviness

202
Q

define thromboembolic disease

A

blood clots that travel through blood stream and lodge in end organs, causing significant damage

203
Q

thromboembolic disease overview

A

typically in legs, but also arms

DVT type of thromboembolic disease

204
Q

improve/worsen pain in PVD

A

arterial:
-constant, worse with movement

venous:
-w. standing, better with elevation, rest

205
Q

quality of pain in PVD

A

arterial: burning
venous: aching, throbbing

206
Q

region of pain in PVD

A

arterial: distal to occlusion
venous: local to occlusion

207
Q

severity of pain in PVD

A

arterial: excruciating
venous: aching, throbbing

208
Q

timing of pain in PVD

A

arterial: as occlusion develops, not easily relieved
venous: pain evolves

209
Q

objective findings of PVD

A

arterial: cold extremity, decreased pulses progressing to paralysis
venous: extremity swelling with deep muscle tenderness, darkened skin, fever

210
Q

interventions for PVD

A

arterial: elevate HOB, not extremity
venous: elevate extremity

211
Q

activitity for PVD

A

arterial: encourage activity
venous: absolute bed rest

212
Q

complications of PVD

A

arterial: emboli, CAD, MI, stroke, ulcers, gangrene, limb ischemia
venous: emboli, PE, stroke

213
Q

tx of PVD

A

arterial: thrombolytics, embolectomy, balloon catheter extraction or bypass graft, surgery for ischemia
venous: anticoags or thrombolytics, vena cava filter, compression socks

CEN (12 decks)

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