Care of Patients with Atherosclerosis, PAD, or Aneurysms Flashcards
definition of arteriosclerosis
thickening, or hardening, of the arterial wall that is often associated with aging.
definition of atherosclerosis
typer of arteriosclerosis; involves the formation of plaque within the arterial wall. leading risk factor for cardiovascular disease.
partial or complete block of blood flow
risk factors for atherosclerosis (non modifiable and modifiable)
low HDL-C, high LDL-C, increased triglycerides, genetic predisposition, DM, obesity, sedentary lifestyle, smoking, stress, African American or hispanic ethnicity, older adults
lab assessments for atherosclerosis
elevated lipids- cholesterol and triglycerides
total serum cholesterol- should be below 200
LDL cholesterol- increase levels indicate increased risk, should be less than 130
HDL cholesterol- increased levels, lower your risk of CAD, should be less than 50
interventions for atherosclerosis
lifestyle modifications such as smoking, weight management, exercise and nutrition,
drug therapy: statin or other lipid lowering agents.
common examples of statins
lovastatin
atorvastatin
simvastatin
rosuvastatin
pravastatin
statins
reduce cholesterol synthesis in the liver and increase clearance of LDL from the blood
contraindicated in active liver disease or during pregnancy
discontinued if the patient experiences muscle cramping or elevates liver enzyme levels
avoid grapefruit and grapefruit juice
peripheral artery disease
chronic condition occurring with partial or total arterial occlusion. decreased perfusion to lower extremities. atherosclerosis is the most common cause
clinical manifestations for PAD
intermittent claudication: cramping, burning, muscule discomfort or pain occurs during activity, stops after rest
rest pain: numbness or burning sensation located in the toes, and is usually relieved by placing the extremeity in a dependent position (below heart)
loss of hair on the lower calf, ankle, and foot
dry, scaly, dusky, pale or mottled skin
thickened toenails
with severe disease: cold, cyanotic, darkened extremity, posterior tibial pulse is most sensitive and specific indicator of arterial function: note signs of ulcer formation
imaging assessment for PAD
Magnetic resonance angiography MRA can assess blood flow in the peripheral arteries.
interventions for PAD
exercise, positioning (avoid crossing legs, don’t wear restrictive clothes, elevate legs/feet) promote vasodilation (avoid cold exposure, avoid direct heat, avoid emotional stress, caffeine, and nicotine) drug therapy (hemorheologic or anti-platelet agents), control BP, invasive nonsurgical procedure and surgical management.
acute peripheral arterial occlusion
occlusions may be sudden and dramatic. caused by embolus or thrombus. more common in lower extremities. most patients with an embolic occlusions have had a recent acute MI and or atrial fibrillation.
acute peripheral arterial occlusion manifestations
cool or cold, pulseless, and mottled affected extremity
Six P’s of Ischemia: pain, pallor, pulselessness, paresthesia, paralysis, poikilothermy
acute peripheral arterial occlusion interventions
prompt treatment is essential to avoid permanent damage or loss of an extremity. anticoagulant therapy. surgical- embolectomy or thrombectomy.
aneurysms etiology
permanent localized dilation of an artery, which enlarges the artery to at least two times its normal diameter.
aneurysm types
abdominal aortic aneurysm: account for most aneurysms, commonly asymptomatic, and frequently rupture
thoracic aortic aneurysms
clinical manifestations of AAA
abdominal, flank, or back pain that is usually steady, with a gnawing quality, is unaffected by movement, and may last for hours or days; prominent pulsation in upper abdomen (do not palpate)
Ruptures of aneurysms
most frequent complication and is life threatening because abrupt and massive hemorrhagic shock results.
pain described as tearing, ripping, and stabbing and located in the chest, back, and abdomen; symptoms of hypovolemic shock; nausea, vomiting
aneurysms etiology
atherosclerosis, HTN, hyperlipidemia, smoking
imaging for aneurysms
CT scan with contrast is the standard tool for assessing the size and location. Size of aneurysms and presence of symptoms determine patient management.
non surgical management for aneurysms
monitor growth and maintain BP at a normal level to decrease the risk for rupture
Mr. Jones is prescribed
atorvastatin (Lipitor) by the health
care provider. The nurse instructs
him to watch for and report which
side effect?
* A. Nausea and vomiting
* B. Cough
* C. Headaches
* D. Muscle pain
D
Which of the following clients are
at risk for PAD? (Select all that
apply)
* A. Client with hypertension
* B. Client with Diabetes
* C. Client who smokes cigarettes
* D. Client with anemia
* E. Client who is very thin
ABC
The nurse is instructing a client
with PAD about ways to promote
vasodilation. What information
does the nurse include? (Select all
that apply)
* A. Maintain a warm environment at home
* B. Wear socks or insulated shoes at all times
* C. Apply direct heat to the limb by using a
heating pad
* D. Prevent cold exposure of the affected
limb
* E. Completely abstain from smoking or
chewing tobacco
ABDE
While assessing a client with AAA,
the nurse notes a pulsation in the
upper abdomen slightly to the left
of midline between the xiphoid
process and the umbilicus. What
does the nurse do next?
* A. Measure the mass with a ruler
* B. Palpate the mass for tenderness
* C. Percuss the mass to determine
borders
* D. Auscultate for a bruit over the mass
D
Ms. Brown is admitted to the
hospital. Which test would the
physician order to confirm an
accurate diagnosis as well as to
determine the size and location of
the AAA?
* A. CT scan with contrast
* B. Electrocardiogram
* C. Magnetic resonance imaging
* D. Thoracentesis
A
