Ch 26 Flashcards
What is the primary problem associated with arterial insufficiency?
Reduced oxygen delivery (ischemia)
Arterial insufficiency leads to pain and tissue damage due to lack of oxygen-rich blood.
What type of pain is associated with arterial insufficiency?
Claudication (activity-induced, relieved at rest)
This pain occurs because muscles demand more oxygen during activity than the compromised arteries can supply.
How does venous insufficiency affect pain perception?
Aching, heaviness, worse with prolonged standing
Pain is minimal due to blood pooling rather than ischemia.
What are the skin characteristics of arterial insufficiency?
Cool, pale, shiny, no hair
These characteristics arise from reduced blood flow leading to tissue starvation.
What skin characteristics are associated with venous insufficiency?
Warm, thickened, brown discoloration
This occurs due to chronic pressure and leakage of blood components into surrounding tissues.
Where do arterial ulcers typically form?
Tips of toes, heels, or pressure points
These areas are farthest from the heart and have the lowest blood supply.
Describe the appearance of arterial ulcers.
Deep, pale, and painful
The lack of oxygenated blood results in deep ulcers that are extremely painful due to ischemia.
Where are venous ulcers commonly located?
Medial malleolus (inner ankle)
These ulcers occur in areas of blood pooling and swelling.
What is the typical appearance of venous ulcers?
Shallow, granulating, irregular edges
They are healing but delayed due to chronic swelling and inflammation.
How are pulses affected in arterial insufficiency?
Diminished or absent
Blocked or narrowed arteries reduce blood flow to peripheral areas.
What is the status of pulses in venous insufficiency?
Present
Venous insufficiency does not affect the arterial blood flow.
What causes the pain associated with arterial insufficiency?
Ischemia due to arterial blockage or narrowing
Pain occurs during activity when muscles demand more oxygen than is available.
What leads to skin thickening and discoloration in venous insufficiency?
Chronic pressure and leakage of blood components
This results in brown discoloration from hemosiderin and edema from fluid leakage.
What physiological role do arteries serve in the circulatory system?
Deliver oxygen-rich blood to tissues
Problems with arterial flow lead to ischemia, causing pain and tissue damage.
What physiological role do veins serve in the circulatory system?
Return deoxygenated blood to the heart
Problems with venous flow cause pooling and associated symptoms.
A client is receiving enoxaparin and warfarin therapy for a venous thromboembolism (VTE). Which laboratory value indicates that anticoagulation is adequate and enoxaparin can be discontinued?
Prothrombin time (PT) is 0.5 times normal.
Oral anticoagulants such as warfarin are monitored by PT or the INR. Because the full anticoagulant effect of warfarin is delayed for 3 to 5 days, it is usually administered concurrently with heparin until desired anticoagulation has been achieved (i.e., when the PT is 1.5 to 2 times normal or the INR is 2.0 to 3.0)
A client is receiving enoxaparin and warfarin therapy for a venous thromboembolism (VTE). Which laboratory value indicates that anticoagulation is adequate and enoxaparin can be discontinued?
Prothrombin time (PT) is 0.5 times normal.
Oral anticoagulants such as warfarin are monitored by PT or the INR. Because the full anticoagulant effect of warfarin is delayed for 3 to 5 days, it is usually administered concurrently with heparin until desired anticoagulation has been achieved (i.e., when the PT is 1.5 to 2 times normal or the INR is 2.0 to 3.0)
A client with no known history of peripheral vascular disease comes to the emergency department reporting of sudden onset of lower leg pain. Inspection and palpation reveal absent pulses; paresthesia; and a mottled, cyanotic, cold, and cadaverous left calf. While the health care provider determines the appropriate therapy, the nurse should:
Elevate the affected leg as high as possible.
Or
Keep the affected leg level or slightly dependent.
Keep the affected leg level or slightly dependent.
A client is diagnosed with a large thoracic aneurysm. Which findings will the nurse expect when assessing this client? Select all that apply:
Stridor
Hoarse voice
Brassy cough
Reduced radial pulses
Aphonia
Stridor, hoarse voice, brassy cough, a phobia.
The thoracic area is the most common site for a dissecting aneurysm. Symptoms vary and depend on how rapid the aneurysm dilates and how the pulsating mass affects surrounding structures. Symptoms of this type of aneurysm include stridor caused by pressure of the aneurysm against the trachea. Other symptoms include a hoarse voice, a brassy cough, and aphonia (or loss of voice) caused by pressure on the laryngeal nerve. A thoracic aneurysm does not affect pulses in the arms.
Pentoxifylline (Trental) is a medication used for what vascular condition?
Trental and Pletal are the only medications specifically indicated for the treatment of claudication.
While receiving heparin to treat a pulmonary embolus, a client passes bright red urine. What should the nurse do first?
Prepare to administer protamine sulfate.
Explanation:
Frank hematuria indicates excessive anticoagulation and bleeding — and heparin overdose. The nurse should discontinue the heparin infusion immediately and prepare to administer protamine sulfate, the antidote for heparin. Decreasing the heparin infusion rate wouldn’t prevent further bleeding. Although the nurse should continue to monitor PTT, this action should occur later. An I.V. infusion of D5W may be administered, but only after protamine has been given.
