ch 37 vascular disorders Flashcards
1
Q
what age, gender, and race is more likely to develop aneurysms
A
older age
men
whites
2
Q
risk factors aneurysms (6)
A
- smoking
- salmonella
- HIV
- syphilis
- atherosclerosis
- trauma
3
Q
complications of AAA
A
-dissection to massive hemorrhage
4
Q
S+S AAA (2)
A
- abdominal pulsation
- bruit
5
Q
who gets ultrasound screening regularly to check for aneurysms (2)
A
- smokers > 50 yo
- family h/o aneurysms
6
Q
Dx for aneurysms (4)
A
- ultrasound
- CT (emergency)
- MRI with contrast
- angiography
7
Q
treatment for small (<4 cm) aneurysm
A
ultrasounds q6months to monitor
8
Q
treatment for large (5.5 cm+) aneurysm
A
surgery
9
Q
what should you do preop for a bleeding aneurysm (2)
A
- IV fluids
- PRBCs
10
Q
postop care for AAA repair
A
- check blood flow to lower extremities
- check pulses regularly
- stool softeners
- splint with pillows
11
Q
S+S burst AAA
A
- tachycardia
- hypotension
- pale clammy skin
- decreased urine output
- altered LOC
- abdominal pain
- severe flank/back pain
- bruising on abdomen/back
12
Q
complications of AAA repair surgery
A
- endoleak
- recurring aneurysm
- renal artery occlusion
- graft thrombosis
- intraabdominal hypertension
- abdominal compartment syndrome
- infection
13
Q
risk factors PAD (6)
A
- smoking
- hyperlipidemia
- hypertension
- DM
- african american
- age >60 yo
14
Q
classic symptom PAD
A
-intermittent claudication
15
Q
S+S PAD (6)
A
- intermittent claudication
- paresthesia
- thin, shiny, taut skin
- loss of hair on lower legs
- pallor
- reactive hyperemia
16
Q
what is reactive hyperemia
A
elevated legs: paleness
standing: very red and warm legs
17
Q
what is intermittent claudication
A
cramping pains relieved with rest
18
Q
late S+S of PAD
A
pain at rest - nighttime ischemia
19
Q
complications of PAD (3)
A
- atrophy skin/muscles
- ulcerations
- necrosis (leads to amputation)
20
Q
Dx for PAD (3)
A
- ankle brachial index (ABI)
- bp upper extremities v lower extremities
- if abnormal: CT w angiography
21
Q
what pt is cilostazol contraindicated in
A
pt with HF
22
Q
Tx for PAD (6)
A
- stop smoking
- control HTN
- H1C <7%
- exercise - walking 30-60 mins/day
- nutrition: low fat
- alternative: B6, B12, gingko
23
Q
meds for Tx of PAD (4)
A
- antiplatelets (aspirin, clopidogrel, ticlodipine)
- ACE inhibitors (ramipril)
- pentoxifyline (for intermittent claudication)
- cilostazol (for intermittent claudication)
24
Q
what does pentoxifyline do
A
decreases blood viscosity
25
what does cilostazol do
increases exercise tolerance and bloodflow
26
surgery for PAD (2)
- balloon angioplasty
| - peripheral artery bypass
27
inflammatory, vaso-occlusive disorder that is characterized by decreased blood flow to upper extremities (and is NOT due to atherosclerosis)
thromboangitis obliterans (buergers disease)
28
highest risk factors for buergers disease (3)
- young men
- smoker
- <40 yo
29
S+S buergers disease (2)
- intermittent claudication
| - ischemic rest pain
30
Tx buergers disease (3)
- IV iloprost for acute use
- stop smoking
- amputations
31
what does iloprost do for pts with buergers disease
vasodilation
32
what is raynauds phenomenon
vasospasm response to extreme temps
33
what age and gender is raynauds phenomenon most common in
women between 15-40 yrs
34
treatment raynauds phenomenon
calcium channel blockers
35
what are three major risk factors for blood clotting (virchows triad)
- venous stasis (immobility)
- endothelial damage (DM, HTN, smoking)
- blood hypercoagulability (pregnancy)
36
how to prevent DVTs (6)
- lovenox or heparin
- early ambulation
- TED hose/SCDs
- avoid prolonged sitting/bedrest
- avoid crossing legs
- no smoking
37
S+S DVT (5)
- redness
- swelling
- warmth
- pain
- unilateral pain
38
what is important to remember when assessing pt with suspected DVT
-don't dorsiflex foot or palpate - clot could dislodge
39
S+S superficial thrombophlebitis (3)
-warmth
-swollen
-redness
(common with IVs)
40
Dx superficial thrombophlebitis (3)
- doppler ultrasound
- D-dimer
- venogram
41
Tx options superficial thrombophlebitis (6)
- heparin IV drip
- subq enoxaparin
- warfarin
- factor 10a inhibitors
- 6 months anticoagulants after 1st clot, lifelong after 2nd
- thrombolytics
42
what lab should you monitor q4-6 hrs for heparin
PTT
43
antidote for heparin
protamine sulfate
44
what is important to remember with IV drip admin of heparin
never piggy back, have to have 2nd pump
45
INR for warfarin
2-3
46
S+S varicose veins (2)
- visible tortuous veins
| - heavy aching with standing and walking
47
Tx varicose veins (only if symptomatic)
- laser surgeries
| - ablation
48
risk factors varicose veins (6)
- female
- smoking
- obesity
- old age
- history of VTE
- pregnancy
49
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
50
S+S chronic venous insufficiency (CVI) (4)
- chronic skin changes
- hardening of skin
- dark plaques
- venous stasis ulcers
51
Tx chronic venous insufficiency (4)
- compression dressings (Unna boot)
- hydrocolloid dressings
- antibiotics if infected wounds
- pentoxifylline
52
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
