ch 37 vascular disorders Flashcards
what age, gender, and race is more likely to develop aneurysms
older age
men
whites
risk factors aneurysms (6)
- smoking
- salmonella
- HIV
- syphilis
- atherosclerosis
- trauma
complications of AAA
-dissection to massive hemorrhage
S+S AAA (2)
- abdominal pulsation
- bruit
who gets ultrasound screening regularly to check for aneurysms (2)
- smokers > 50 yo
- family h/o aneurysms
Dx for aneurysms (4)
- ultrasound
- CT (emergency)
- MRI with contrast
- angiography
treatment for small (<4 cm) aneurysm
ultrasounds q6months to monitor
treatment for large (5.5 cm+) aneurysm
surgery
what should you do preop for a bleeding aneurysm (2)
- IV fluids
- PRBCs
postop care for AAA repair
- check blood flow to lower extremities
- check pulses regularly
- stool softeners
- splint with pillows
S+S burst AAA
- tachycardia
- hypotension
- pale clammy skin
- decreased urine output
- altered LOC
- abdominal pain
- severe flank/back pain
- bruising on abdomen/back
complications of AAA repair surgery
- endoleak
- recurring aneurysm
- renal artery occlusion
- graft thrombosis
- intraabdominal hypertension
- abdominal compartment syndrome
- infection
risk factors PAD (6)
- smoking
- hyperlipidemia
- hypertension
- DM
- african american
- age >60 yo
classic symptom PAD
-intermittent claudication
S+S PAD (6)
- intermittent claudication
- paresthesia
- thin, shiny, taut skin
- loss of hair on lower legs
- pallor
- reactive hyperemia
what is reactive hyperemia
elevated legs: paleness
standing: very red and warm legs
what is intermittent claudication
cramping pains relieved with rest
late S+S of PAD
pain at rest - nighttime ischemia
complications of PAD (3)
- atrophy skin/muscles
- ulcerations
- necrosis (leads to amputation)
Dx for PAD (3)
- ankle brachial index (ABI)
- bp upper extremities v lower extremities
- if abnormal: CT w angiography
what pt is cilostazol contraindicated in
pt with HF
Tx for PAD (6)
- stop smoking
- control HTN
- H1C <7%
- exercise - walking 30-60 mins/day
- nutrition: low fat
- alternative: B6, B12, gingko
meds for Tx of PAD (4)
- antiplatelets (aspirin, clopidogrel, ticlodipine)
- ACE inhibitors (ramipril)
- pentoxifyline (for intermittent claudication)
- cilostazol (for intermittent claudication)
what does pentoxifyline do
decreases blood viscosity
what does cilostazol do
increases exercise tolerance and bloodflow
surgery for PAD (2)
- balloon angioplasty
- peripheral artery bypass
inflammatory, vaso-occlusive disorder that is characterized by decreased blood flow to upper extremities (and is NOT due to atherosclerosis)
thromboangitis obliterans (buergers disease)
highest risk factors for buergers disease (3)
- young men
- smoker
- <40 yo
S+S buergers disease (2)
- intermittent claudication
- ischemic rest pain
Tx buergers disease (3)
- IV iloprost for acute use
- stop smoking
- amputations
what does iloprost do for pts with buergers disease
vasodilation
what is raynauds phenomenon
vasospasm response to extreme temps
what age and gender is raynauds phenomenon most common in
women between 15-40 yrs
treatment raynauds phenomenon
calcium channel blockers
what are three major risk factors for blood clotting (virchows triad)
- venous stasis (immobility)
- endothelial damage (DM, HTN, smoking)
- blood hypercoagulability (pregnancy)
how to prevent DVTs (6)
- lovenox or heparin
- early ambulation
- TED hose/SCDs
- avoid prolonged sitting/bedrest
- avoid crossing legs
- no smoking
S+S DVT (5)
- redness
- swelling
- warmth
- pain
- unilateral pain
what is important to remember when assessing pt with suspected DVT
-don’t dorsiflex foot or palpate - clot could dislodge
S+S superficial thrombophlebitis (3)
-warmth
-swollen
-redness
(common with IVs)
Dx superficial thrombophlebitis (3)
- doppler ultrasound
- D-dimer
- venogram
Tx options superficial thrombophlebitis (6)
- heparin IV drip
- subq enoxaparin
- warfarin
- factor 10a inhibitors
- 6 months anticoagulants after 1st clot, lifelong after 2nd
- thrombolytics
what lab should you monitor q4-6 hrs for heparin
PTT
antidote for heparin
protamine sulfate
what is important to remember with IV drip admin of heparin
never piggy back, have to have 2nd pump
INR for warfarin
2-3
S+S varicose veins (2)
- visible tortuous veins
- heavy aching with standing and walking
Tx varicose veins (only if symptomatic)
- laser surgeries
- ablation
risk factors varicose veins (6)
- female
- smoking
- obesity
- old age
- history of VTE
- pregnancy
prevention of varicose veins (6)
- avoid sitting/standing for long periods of time
- healthy body weight
- avoid constrictive clothing
- walk daily
- elevate legs above heart
- compression socks
S+S chronic venous insufficiency (CVI) (4)
- chronic skin changes
- hardening of skin
- dark plaques
- venous stasis ulcers
Tx chronic venous insufficiency (4)
- compression dressings (Unna boot)
- hydrocolloid dressings
- antibiotics if infected wounds
- pentoxifylline
differences between PVD arterial (5) v venous (4) ulcers
ARTERIAL:
- intermittent claudication
- no/weak pulse
- round smooth sores
- black eschar
- sores on toes and feet
VENOUS:
- dull achy pain
- lower leg edema
- yellow slough, drainage
- sores on ankles
