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NU 340 > Ch. 30 > Flashcards

Ch. 30 Flashcards

1
Q

venous insufficiency is a result of

A
  • prolonged venous hypertension
  • stretching veins
  • damaging valves

venous stasis dermatitis or ulcers, swelling, and cellulitis

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2
Q

causes of venous insufficiency

A
  • standing or sitting for long periods of time
  • obesity
  • thrombus formation
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3
Q

clinical manifestations of venous insufficiency

A
  • edema of both legs
  • stasis dermatitis
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4
Q

goal of management for venous insufficiency

A

decreases edema and increase venous return

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5
Q

nonsurgical management of venous insufficiency

A
  • management of edema-leg elevation, compression stockings
  • management of venous stasis ulcers
  • drug therapy
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6
Q

surgical management of venous insufficiency

A

not usually done because it is not successful

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7
Q

varicose veins

A

distended, protruding veins that appear darkened and tortuous
- common in adults over 30 whose occupation requires prolonged standing

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8
Q

conservation management of varicose veins: the 3 E’s

A

elastic stockings
elevation of extremities
exercise

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9
Q

conservation management of varicose veins

A
  • sclerotherapy
  • surgical removal/stripping of veins
  • endovenous ablation to heat the veins
  • 3 E’s: elastic stockings, elevation of extremities, exercise
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10
Q

desired blood pressure: people over 60

A

below 150/90

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11
Q

desired blood pressure: people younger than 60

A

below 140/90

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12
Q

according to the JNC 8 guidelines, patients with what BP level should be treated with drug therapy (for HTN)

A

people over 60: 150/90
people under 60: 140/90

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13
Q

malignant hypertension

A

aka HTN crisis
- severe type of elevated BP that rapidly progresses, Medical Emergency
- systolic: > 180
- diastolic: > 120

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14
Q

one of the most common health problems seen in primary care settings

A

hypertension

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15
Q

hypertension is classified as

A
  1. essential (primary) or
  2. secondary
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16
Q

essential (primary) HTN

A

no real cause; most common form
- not due to medical condition, due to risk factors: diet, sedentary, physical inactivity, smoking

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17
Q

secondary HTN

A

specific disease states or drugs can increase susceptibility to HTN
- end-stage renal disease (kidney d/o)
- cushings
- pregnancy

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18
Q

hypertension is called the

A

silent disease

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19
Q

hypertension damages __

A

the endothelium of blood vessels

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20
Q

mechanisms that influence/control blood pressure

A
  • the arterial baroreceptor system
  • regulation of bodily fluid volume
  • the renin-angiotensin-aldosterone system
  • vascular autoregulation
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21
Q

essential (primary) HTN: risk factors

A
  • Age greater than 60 years
  • Family history of hypertension*
  • Obesity
  • Physical inactivity
  • Excessive alcohol intake
  • Hyperlipidemia
  • African-American ethnicity
  • High intake of salt or caffeine
  • ↓Intake of K+, Ca+, or Mg+
  • Smoking
  • Stress
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22
Q

secondary HTN: risk factors/causes

A
  • Kidney disease
  • Primary aldosteronism
  • Pheochromocytoma
  • Cushing’s syndrome
  • Pregnancy
  • Medications
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23
Q

ABI indicative of PAD

A

ABI < 0.9

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24
Q

ABI formula

A

highest systolic pressure from leg
divided by
highest systolic pressure from brachia

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25
Q

how ABI is calculated

A

leg: R posterior tibial, dorsalis pedis and L posterior tibial, dorsalis pedis

brachia: R and L arm

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26
Q

health promotion and maintenance of HTN

A
  • weight reduction (through diet and exercise)
  • DASH diet: dietary approach to stop hypertension (veggies, fruits, proteins, micronutrients, limited Na)
  • reduce intake of dietary intake
  • increase physical activity
  • smoking cessation: nicotine causes vasoconstriction of blood vessels which increases BP
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27
Q

HTN diagnostic assessments

A

assess for secondary cause, risk and target organ damage
- urinalysis for protein, RBC (r/t kidney d/o, blood vessel constriction)
- Labs- BUN, creatinine
- chest x-ray (cardiomegaly: enlarged heart- mostly w people who have had HTN for a while)
- ECG shows degree of cardiac involvement

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28
Q

HTN patient problems (hint: think mngmnt and compliance)

A
  • need for health teaching due to the plan of care for HTN management
  • potential for decreased adherence due to side effects of drug therapy and necessary changes in lifestyle
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29
Q

HTN interventions: Lifestyle modifications

A
  • Sodium restriction (2g Na diet)
  • Weight reduction
  • DASH diet (if overweight or obese)
  • Moderation of alcohol intake (1-2/day if need it)
  • Smoking cessation (cut back at least)
  • Exercise (decrease weight and reduce vasoconstriction)
  • Relaxation techniques (to help with stress)
  • Caffeine avoidance (if applicable)
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30
Q

HTN interventions: drug therapy

A

First Line Options
- Diuretics: HCTZ, furosemide
- Calcium channel blockers:
Dihydropyridines: Amlodipine
Non-Dihydropyridines: Diltiazem/Verapamil
- ACE inhibitors: Lisinopril
- Angiotensin II receptor antagonists: Valsartan, Losartan

Secondary Options (may be paired with 1st line)
- Beta-blockers: Metoprolol
- Central alpha agonists: Clonidine

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31
Q

diuretic water slide

A

thiazide, loop, and potassium-sparing
- work on kidneys; increase UO to decrease BP
- take in morning (enuresis)
- stay hydrated- don’t want to become dehydrated
- check BP before and after med
- monitor electrolytes daily: potassium (hypokalemia) (spironolactone- hyperkalemia)
- daily weights
- I&Os are equal (daily)

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32
Q

calcium channel blockers: action

A

blocks calcium access to cells
- decrease contractility
- decreased conductivity of the heart

therefore reducing demand for O2

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33
Q

side effects of calcium channel blockers

A
  • decreased BP
  • bradycardia
  • may precipitate A-V block
  • HA
  • abdominal discomfort (constipation, nausea)
  • peripheral edema
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34
Q

angiotensin II receptor blockers (ARBs): action

A

decrease blood pressure
- treat HTN and heart failure
- taken PO

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35
Q

angiotensin II receptor blockers (ARBs): drugs

A

usually end in “-sartan”
- candesartin
- valsartin
- irbestartan
- losartan

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36
Q

ACE inhibitors: name ends in

A

ends in “pril”
- lisinopril
- enalapril
- benzapril
- captopril

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37
Q

ACE inhibitors: action

A

decreases peripheral vascular resistance WITHOUT
- increased cardiac output
- increased cardiac rate
- increased cardiac contractility

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38
Q

ACE inhibitors: side effects

A
  • dizziness
  • orthostatic hypotension
  • GI distress
  • nonproductive cough***
  • HA
  • electrolytes: hyperkalemia
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39
Q

B-blockers ends in

A

“olol”
- metoprolol
- atenolol
- propranolol

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40
Q

B-blockers: action

A

blocks beta receptors in the heart causing:
- decreased heart rate
- decreased force of contraction
- decreased rate of AV conduction

**check BP and HR before giving med

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41
Q

B-blockers: side effects

A
  • bradycardia
  • GI disturbance
  • CHF
  • decreased BP
  • depression
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42
Q

drug-nutrient interactions with calcium channel blockers (CCBs)

A

The grapefruit conundrum- Calcium channel blockers
- interferes with absorption causing higher drug level results

  • GI complaints (constipation, nausea)
  • Headache
  • Flushing
  • Bradycardia or reflex tachycardia
  • Skin rash
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43
Q

principles of nutrition therapy for HTN patients

A
  • Weight management: Lose weight and maintain appropriate weight for height
  • Sodium control (2 g/day maximum)
  • Other minerals: calcium, potassium, magnesium
  • DASH diet: Lower blood pressure through diet alone
  • Additional lifestyle factors: smoking, alcohol, caffeine, exercise
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44
Q

self-management education

A
  • Teach medication compliance, usually for the rest of life
  • Discuss goals of therapy, potential side effects, and how to identify potential problems
  • Assist patient to understand therapeutic regimen
  • Discuss consequence of noncompliance: organ failure: kidney failure (dialysis), heart: MI, brain: CVA
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45
Q

emergency care for HTN crisis (interventions)

A
  • Place pt in semi-fowler’s
  • Administer O2
  • Administer IV nitroprusside: dilates blood vessels and reduces BP
  • Monitor BP q5-15 mins: want BP to come down gradually over a few hours (need to go to ICU for this degree of monitoring/care*)
  • Observe for neurologic or cardiovascular complications (LOC; s/ CVA: weakness, speech, facial drooping; MI)
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46
Q

HTN crisis s/sx

A
  • Extremely high BP
  • Dizziness
  • Blurred vision
  • Disoriented
  • Severe HA
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47
Q

HTN outcomes

A
  • Verbalize understanding of the plan of care, including drug therapy and any necessary lifestyle changes
  • Report adverse drug effects, such as coughing, dizziness, or sexual dysfunction, to the primary health care provider immediately
  • Consistently adhere to the plan of care, including regular follow-up with the primary health care provider
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48
Q

peripheral vascular disease

A
  • Disorders that alter the natural flow of blood through the arteries and veins of the peripheral circulation
  • Divided into PAD and PVD
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49
Q

PAD is the result of

A

systemic atherosclerosis

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50
Q

PVD risk factors

A
  • Advancing age
  • obesity
  • HTN
  • DM
  • +smoker
  • hyperlipidemia
  • African American
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51
Q

PAD

A

Disorders that alter the natural flow of blood through the arteries and veins of the peripheral circulation
- PVD implies arterial disease

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52
Q

PVD: physical assessment

A

Intermittent claudication
Pain that occurs even while at rest; numbness and burning
Inflow disease
- Discomfort in lower back, buttocks, thighs
Outflow disease
- Burning or cramping in calves, ankles, feet, toes

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53
Q

six P’s of arterial insufficiency

A
  • Pain
  • Pallor
  • Pulselessness (use doppler if can’t feel to confirm no pulse)
  • Paresthesia
  • Paralysis: cant feel feet or legs
  • Poikilothermia (coolness of extremities), numbness, tingling
54
Q

PAD physical assessment (integumentary findings)

A

Hair loss and dry, scaly, pale or mottled skin and thickened toenails

55
Q

severe arterial disease physical assessment

A

extremity is cold and gray-blue or darkened; pallor may occur with extremity elevation; dependent rubor; and/or muscle atrophy

56
Q

PVD dx assessment

A

Imaging assessment
- Arteriography: contrast dye used to see blood vessels; most invasive- iodine allergy risk
Other diagnostic tests:
- Ankle-brachial index (ABI)** (blood pressure in arms/legs, <0.9=PAD)
- Exercise tolerance testing: treadmill and heart monitor- how far before claudication
- Plethysmography: graph of BP readings

57
Q

PVD non-surg interventions

A

Exercise (walking as tolerated)
Positioning (controversial)
Promoting vasodilation
Drug therapy (Antiplatelet agents-ASA, Clopidogrel)
Control HTN

58
Q

PVD surg interventions

A

Arterial revascularization

59
Q

PVD: invasive non-surgical

A

Percutaneous transluminal angioplasty (stents)
Laser-assisted angioplasty (smaller occlusions)
Atherectomy

60
Q

clopidogrel (plavix)

A

antiplatelet medication
- prevents PVD/PAD
- watch skin and URI as s/e
- caution with HTN, renal/hepatic problems, hx of bleeding

61
Q

PVD surgical management

A

aortoiliac and aortofemoral bypass surgery

62
Q

aortoiliac and aortofemoral bypass: procedure

A

a midline incision into the abdominal cavity is required, with an additional incision in each groin

63
Q

Postoperative care after aortoiliac and aortofemoral bypass

A

Deep breathing every 1 to 2 hour
Monitor for graft occlusion (emergency)
Treatment of graft occlusion
Monitor for compartment syndrome
Assess for infection
Assess GI function

64
Q

PAD discharge teaching

A

Keep feet clean and dry (check between toes)
Always wear shoes and make sure fit right
Keep toenails clean and filed (Podiatrist)
Apply lubricating lotion to feet if dry
Prevent exposure to extreme heat or cold
Avoid constricting garments
See Podiatrist or HCP if problem develops
Avoid extended pressure on feet or ankles

65
Q

acute peripheral arterial occlusion

A

Embolus—the most common cause of occlusions, although local thrombus may be the cause

  • sudden and dramatic
  • more common in lower extremities
66
Q

acute peripheral arterial occlusion: assessment

A

six P’s
pain, pallor, pulselessness, paresthesia, paralysis, poikilothermia (coolness)

67
Q

acute peripheral arterial occlusion drug therapy

A

anticoagulant drug therapy with unfractioned heparin (UFH) is first intervention to prevent further clot formation

68
Q

acute peripheral arterial occlusion surgical therapy

A

Thrombectomy or embolectomy: removes occlusion (clott)
arteriotomy: surgical opening of artery to retrieve embolus

69
Q

acute peripheral arterial occlusion nursing care

A
  • Monitor for compartment syndrome
  • prompt treatment
  • monitor for spasms, swelling of skeletal muscles (compartment syndrome)
70
Q

acute peripheral arterial occlusion interventions

A
  • Prompt treatment is important to prevent permanent damage or loss of extremity
  • Thrombectomy or embolectomy
  • Monitor for compartment syndrome
71
Q

aneurysm

A

a permanent localized dilation of an artery, enlarging the artery to twice its normal diameter
- worried about it rupturing

71
Q

aneurysms of central arteries

A

Fusiform aneurysm (affects entire circumference)
Saccular aneurysm (out-pouching of part of wall)
Dissecting aneurysm (aortic dissection)
- Blood accumulates in the wall of artery

72
Q

Abdominal aortic aneurysm

A

aneurysm in an abdominal artery
- common

73
Q

Thoracic aortic aneurysm

A

aneurysm in a thoracic artery
- not as common as abdominal

74
Q

arterial aneurysms

A

aneurysm in the artery

75
Q

Aneurysms of Central Arteries
are sometimes (hint: sx)

A
  • sometimes asymptomatic
76
Q

TAA: thoracic aortic aneurysm (assessment: s/sx)

A
  • Back pain
  • Shortness of breath
  • Difficulty swallowing
  • Not often detected by physical assessment
  • May have a mass above the suprasternal notch
77
Q

AAA: abdominal aortic aneurysm (assessment)

A
  • Gnawing pain with abdominal, flank, or back pain
  • Pulsation in upper abdomen
  • Detectable = at least 5 cm in diameter
  • Rupture symptoms = severe sudden pain in back, low abdomen; radiates to groin, buttocks, legs
    - Critical illness – at risk for hypovolemic shock caused by hemorrhage
78
Q

aneurysms dx assessment

A
  • Abdominal or lateral XR of spine shows AAA with “eggshell” appearance.
  • *CT: gold standard for assessing size and location of abdominal or thoracic aneurysm. (best test for dx and monitoring)
  • Thoracic aneurysm can be diagnosed by CXR.
  • Aortic arteriography used in patients prior to repair of thoracic aneurysm.
  • Ultrasonography used to diagnose, locate, and measure size of aneurysm.
79
Q

aneurysms nonsurgical management

A
  • Monitor the growth of the aneurysm (w/ CT scans)
  • Maintain BP at a normal level to decrease the risk of rupture
  • Treat HTN with anti-hypertensive drugs
  • Frequent CT scans for small or asymptomatic aneurysms
80
Q

aneurysms patient teaching

A

importance of keeping every appointment
going for scheduled tests
clinical manifestations that need to be reported promptly

81
Q

endovascular stent grafts

A

*Procedure of choice for almost all AAA repairs
- Decreased morbidity and mortality and shorter length of stay compared to surgical resection
- Graft placed percutaneously: small insertion going into femoral vein threaded into the abdominal or arterial aorta
- Closely monitor for complications

82
Q

endovascular stent grafts complications

A
  • Conversion to open surgical repair
  • Bleeding
  • Rupture
  • Peripheral embolization
  • Misplacement of graft
  • Endoleak: need this repaired in OR
  • Infection
82
Q

signs of graft occlusion or rupture

A
  • Changes in (peripheral) pulses
  • Cool to cold extremities below the graft
  • White or blue extremities or flanks
  • Severe pain
  • Abdominal distention
  • Decreased urine output
83
Q

Thoracic Aortic Aneurysm Repair pre-op care

A

same as abdominal

84
Q

Thoracic Aortic Aneurysm Repair operative procedure

A

same as abdominal
- endovascular stent graft

85
Q

Thoracic Aortic Aneurysm Repair post-op care assessments

A
  • Vital signs
  • Complications
  • Sensation and motion in extremities: distal pulses, color, temp
86
Q

Thoracic Aortic Aneurysm Repair post-op complications

A

Hemorrhage
Ischemic colitis
Cerebral or spinal cord ischemia
Respiratory distress: RR, pulse ox
Infection
Cardiac dysrhythmias: irreg heartbeat

87
Q

d/c instructions post aneurysm repair

A
  • activity restrictions: cant drive for a few weeks, limit stair climbing (1-2x/day limit) for a few weeks, no heavy lifting (<15 lb) for a few weeks
  • wound care: infection, bleeding, inspect redness, swelling, edema- call HCP
  • pain management: acetaminophen (don’t use NSAIDs/ibuprofen bc increases bleeding)
88
Q

aortic dissection

A

sudden tear in the aortic intima, opening the way for blood to enter the aortic wall

89
Q

aortic dissection assessment findings

A

Pain described as tearing, ripping, and stabbing
Diaphoresis, N/V, and feeling faint
BP usually WNL
↓ or absence of peripheral pulses
Aortic regurgitation
Altered LOC
Paraparesis (lower extremity weakness)
Stroke

90
Q

aortic dissections dx labs

A

CXR, CT, MRI or aortic angiography
TEE at bedside for patients that can’t be moved

91
Q

aortic dissection emergency care goals

A

Elimination of pain
Reduction of blood pressure (IV Nipride)
Decrease in the velocity of left ventricular ejection

92
Q

aortic dissection surgical treatment

A

proximal dissection; typically requires cardiopulmonary bypass (CPB)
- surgeon removed the intimal tear and sutures edges of the dissected aorta
- synthetic graft used usually

93
Q

aortic dissection nonsurg treatment

A
  • BP maintenance: CCAs calcium channel agonsists, BBs beta blockers
  • large bore IV catheters infusing 0.9% NaCl and give medication
  • pain control and IV BB: to decrease HR and BP
  • nitroprusside or nicardipine hydrochloride may be used if pain control IV BB doesnt work
94
Q

Aneurysms of the Peripheral Arteries

A
  • femoral
  • popliteal
95
Q

Aneurysms of the Peripheral Arteries sx

A

limb ischemia
diminished or absent pulses
cool to cold skin
pain

96
Q

Aneurysms of the Peripheral Arteries: you should not do what

A
  • DO NOT PALPATE TO PREVENT RUPTURE
97
Q

Aneurysms of the Peripheral Arteries post-op care

A

monitor for pain
ischemia

98
Q

raynaud’s phenomenon

A

Caused by vasospasm of arterioles and arteries of upper and lower extremities

99
Q

raynaud’s phenomenon drug therapy

A

Calcium channel blockers

100
Q

raynaud’s phenomenon interventions

A

Restrict cold exposure
Avoid vasoconstrictors
Avoid Caffeine
Stop smoking
Reinforce patient education
Lumbar sympathectomy

*lifestyle changes and drug therapy (CCB)

101
Q

venous disorders sx

A
  • will feel pedal pulses
  • warm
  • legs
  • blood is getting down but can’t get back up
102
Q

VTE

A

Thrombus—a blood clot
Virchow’s triad
Thrombophlebitis
Pulmonary embolism
Phlebitis (vein inflammation)

103
Q

risk assessment for VTE

A

Assesses risk and not to diagnose
Points for each risk factor
Consider Virchow’s Triad
- Blood flow stasis: long plane/car ride/immobility
- Endothelial injury: higher risk
- Hypercoaguability: cancer, thrombophilia, blood clotting d/o

104
Q

interventions to prevent VTE: outpatient

A

Avoid oral contraceptives
Drink adequate fluids to avoid dehydration
Exercise legs during long periods of BR or sitting

105
Q

interventions to prevent VTE: inpatient

A

Patient education
Leg exercises
Early ambulation
Adequate hydration
Graduated compression stockings
Anticoagulants for high risk

106
Q

assessment for VTE

A

*Calf or groin tenderness or pain
*Sudden onset of unilateral swelling of the leg
*NO Homans’ sign
*Induration
*Localized edema
*Venous duplex ultrasonography
MRI
D-dimer: may be elevated

107
Q

Nonsurgical Management VTE

A
  • Rest – no risk of PE with ambulation (dont want clot to dislodge/move)
  • Drug therapy includes:
  • Unfractionated IV heparin therapy
  • Low–molecular weight heparin (anoxaparin)
  • Warfarin therapy
  • Direct Oral Anticoagulants (DOAC) (apixaban: eliquis)
  • Thrombolytic therapy
  • Do not message extremity to avoid dislodgement (to brain causing stroke)
108
Q

Anticoagulants

A

used for prophylaxis and treatment of thromboembolic disorders like DVT, PE

  • heparin
  • warfarin
109
Q

heparin

A
  • Potentiates the inhibitory effect of antithrombin on factor Xa and thrombin
  • *IV or SQ route
  • ***Monitor aPTT (parameters based off hospital policies)
  • Therapeutic level 1.5 -2.5 times control (50-70/ 0.3-0.7 control)
  • Monitor for bleeding
  • Protamine sulfate
110
Q

warfarin

A
  • Interferes with vitamin K-dependent clotting factors (II, VII, IX, and X)
  • *PO
  • ***Monitor INR (parameters based off hospital policies)
  • Therapeutic level 2-4.5 times control (2-3/0.8-1.1 control)
  • Monitor for bleeding
  • Vitamin K
  • takes 3-4 days to work, take heparin and warfarin until INR is therapeutic
111
Q

low molecular weight heparin: Enoxaparin

A

Low molecular weight
Orthopedic surgeries
dVt prophylaxis, immobility, stints, cardiac surgeries - indicators
lEave bubble in syringe
Never by IM, only SQ- give within 2 hours of preop abdominal surgery and 12 hours at knee surgery
nO rubbing after admin, no aspiration, no mixing with other drugs
X out for pork allergies, heparin allergies, PUD, leukemia

“love an ox” by initiating bleeding protocols, having protamine sulfate on hand for antidote and monitoring coag studies

112
Q

Nursing Interventions for Patients Receiving Anticoagulants

A

Check dosage of drug
Monitor VS
Vitamin K or protamine sulfate on hand
Monitor aPTT for IV heparin; INR for warfarin
No monitoring for DOAC
Apply prolonged pressure over venipuncture and injection sites
Apply pressure, no massage, when giving SQ heparin

113
Q

Teaching for Patients Taking Anticoagulants

A

Stop smoking
Stop BCPs
Use electric razor
Soft toothbrush
Precautions to avoid injury (no hammers/ saws)
Report signs/symptoms of bleeding to HCP
Take prescribed dosage of drug at ordered time
Do not stop taking drug unless instructed by HCP
Avoid foods/drugs that can interfere with warfarin: no leafy greens, broccoli, brussels sprouts, liver, ASA, tylenol, laxatives/antacids, ABT
Keep appointments for blood draws

114
Q

surgical management of VTE

A
  • Thrombectomy: removes blood clotts in an artery or vein to restore blood flow through the blood vessel
  • Inferior vena caval interruption (IVC filter)
  • postop monitoring: for bleeding at incision site (groin), skin color, temperature, peripheral pulses, sx of infections
115
Q

stage 1 HTN according to JNC-8

A

SBP: 140-159
DBP: 90-99

*at least two elevated readings in both arms on separate occasions to dx

116
Q

stage 2 HTN according to JNC-8

A

SBP: > 160
DBP: > 100

*at least two elevated readings in both arms on separate occasions to dx

117
Q

HTN assessment

A
  • history: family hx, PMH, current/past diagnoses
  • physical assessment: often asymptomatic, blurry vision, dizziness, hA
  • psychological assessment: stressed? job? marital life? sick family member?
  • dx assessment: readings from taking BP, debate primary v secondary
118
Q

potassium-rich foods for patients taking diuretics

A
  • bananas
  • citrus (orange, cantaloupe, orange juice)
  • leafy greens
119
Q

diuretics side effects

A
  • decrease K
  • decrease Na
  • decrease Cl
  • decrease BP
  • decrease I&Os
  • decrease weight
  • hyperglycemia
  • dehydration
120
Q

what causes a HTN crisis?

A

usually med noncompliance
- abrupt discontinuance of HTN medications

121
Q

arteriosclerosis

A

hardening/thickening of the arterial wall
- arteries thicken, no flexible/no elasticity
- associated with aging

122
Q

atherosclerosis

A

result of fatty plaque build up
- type of arteriosclerosis
- formation of plaque within the arterial wall
- leading cause of CVD

123
Q

inflow obstructions

A

blockage iliac and up
- discomfort in lower back, buttocks, thighs

124
Q

outflow obstructions

A

blockage femoral and down
- burning or cramping in calves, ankles, feet, toes

125
Q

PAD physical assessment: stage 1

A
  • no claudication
  • may hear bruit
  • pedal pulses decreased or absent
126
Q

PAD physical assessment: stage 2

A
  • intermittent claudication with exercise
127
Q

PAD physical assessment: stage 3

A
  • rest pain, awakens at night
  • numbness and burning
  • pain in toes, arch, heel
  • pain relieved by placing extremity in dependent position
128
Q

PAD physical assessment: stage 4

A
  • ulcers and blacked tissue occur on toes, forefoot, and heel (necrosis)
  • gangrenous odor
129
Q

Preoperative care before aortoiliac and aortofemoral bypass

A
  • document VS and peripheral pulses
  • IV antibiotic before surgery
130
Q

padua prediction score

A

assessment tool to assess for VTE, not to diagnose

  • points for each risk factor
  • score >4 means VTE more likely

NU 340 (26 decks)

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