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CC2 > Chapter 26 Clinical > Flashcards

Chapter 26 Clinical Flashcards

Vascular Peripheral Circulation - Disorders

1
Q

Pump failure means:

A

inefficient pump/ contractile force

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2
Q

HFrEF/ systolic HF

A

HF with left ventricular ejection fraction

Causes blood accumulation in lungs
Reduction in forward flow/ CO

= inadequate arterial flow to tissues

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3
Q

HFpEF, diastolic HF

A

HF with preserved left ventricular ejection fraction

Systemic venous congestion
Reduction in forward flow

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4
Q

Blood vessels must be:

A

intact, patent, and responsive

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5
Q

Arterial Occlusion/ Arteries become damaged or obstructed
(6 factors):

A

Atherosclerotic plaque
Thromboembolus
Chemical or mechanical trauma
Infections or inflammation
Vasospastic disorders
Congenital malformations

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6
Q

Arterial Occlusion (Sudden)

A

profound and irreversible tissue ischemia and tissue death

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7
Q

Arterial Occlusion (Gradual)

A

less risk for tissue death, able to form collateral circulation (opp. to adapt to gradual blood flow decrease)

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8
Q

Venous Occlusion, causes:

A

Thromboembolus, incompetent venous valves, reduced pumping action

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9
Q

Edema, formation:

A

dec. venous blood flow – inc. venous pressure – fluid out of capillaries into interstitial space

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10
Q

Edematous tissue is prone to:

A

breakdown, injury, infection
due to inadequate nutrition = cell death

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11
Q

Peripheral Vascular Disease, type and severity depend on:

A

type, stage, extent of disease process, progression speed

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12
Q

Peripheral Vascular Disease, prognosis:

A

Ischemia (most)

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13
Q

Peripheral Vascular Disease, similar symptoms:

A

pain, skin changes, diminished pulses, possible edema

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14
Q

Characteristics of Arterial Insufficiency

A

Pain: intermittent claudication to sharp, unrelenting, constant

Pulses: diminished, absent

Skin: dependent rubor, elevation pallor

Edema: dry, shiny skin; cool to cold temp; loss of hair (toes, dorsum), thickened and ridged nails

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15
Q

Characteristics of Venous Insufficiency

A

Pain: aching, throbbing, cramping

Pulses: present but difficult to palpate thru edema

Skin: pigmentation in gaiter area (medial and lateral malleolus), thick and tough skin, may be reddish-blue, often with dermatitis

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16
Q

Ulcers, Arterial Insufficiency:

A

Location: tip of toes, web spaces, heel, or other pressure points (if immobile)

Pain: very painful

Depth: deep, with joint space involved

Shape: circular

Ulcer base: pale to black, wet to dry gangrene

Leg edema: minimal unless leg kept in dependent position constantly to relieve pain

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17
Q

Ulcers, Venous Insufficiency:

A

Location: malleolus (medial, lateral) or anterior tibial area

Pain: minimal to very painful

Depth: superficial

Shape: irregular borders

Ulcer base: granulation tissue (beefy red to yellow fibrinous in chronic, long-term ulcer)

Leg edema: moderate to severe

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18
Q

Assessment (Health History)

A

ask pain and precipitating factors

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19
Q

Intermittent Claudication, definition:

A

Indicates peripheral arterial insufficiency (50 – 75% of lumen/ cross-section area obstructed)

muscular, cramp-type pain, discomfort, fatigue in extremities consistently reproduced with the same degree of activity or exercise and relieved by rest

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20
Q

Intermittent Claudication, nursing intervention:

A

monitor progression by documentation of amount of exercise or distance walked (blocks, feet, or meters) before onset of pain

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21
Q

Rest Pain, definition:

A

Persistent pain in anterior portion of foot (forefoot) even at rest, worse at night and may interfere with sleep

Indicates severe arterial insufficiency and a critical state of ischemia

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22
Q

Rest Pain, nursing intervention:

A

requires extremity to be lowered to a dependent position to improve perfusion to distal tissues

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23
Q

Assessment (Physical Assessment)

A

patient’s skin color and temperature, character or quality of peripheral pulses

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24
Q

Rubor, definition:

A

reddish-blue discoloration of the extremities

observed within 20s to 2 minutes in dependent position

suggests severe peripheral arterial damage where BVs cannot constrict and remain dilated

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25
Q

Cyanosis, definition:

A

bluish tint of the skin, amount of oxygenated hemoglobin is reduced (darker red in color)

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26
Q

Chronically-reduced nutrient supply

A

loss of hair, brittle nails, dry or scaling skin, atrophy, ulcerations (from cell and tissue death)

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27
Q

Edema, affected area:

A

bilateral or unilateral

28
Q

Gangrene occurs with:

A

prolonged, severe ischemia

represent tissue necrosis

29
Q

What are arterial ulcers?

A

blood is unable to flow into the lower extremities, like the legs and feet.

When skin and underlying tissue are deprived of oxygen, the tissue starts to die off and form an open wound.

30
Q

Venous ulcers

A

develop in areas where blood collects and pools, as swelling there interferes with the movement of oxygen and nutrients through tissues

31
Q

Vascular ulcers, negative impacts (5):

A

increased risk of infection, sepsis, gangrene, and pain and limited movement

32
Q

Absence of Pulse

A

indicates site of stenosis (narrowing or constriction) or occlusion is proximal to level

occlusive arterial disease

33
Q

Pulses, assessment:

A

compared bilaterally and simultaneously

compare both sides for symmetry in:
rate (60 – 100 bpm)
rhythm (regular, irregular)
quality (0 – 4+)
0 no palpable pulse
1+ faint pulse
2+ slightly diminished pulse
3+ normal pulse
4+ bounding pulse

34
Q

CW Doppler Ultrasound (continuous wave)

A

when pulses can’t be reliably palpated

can detect blood flow in advance arterial disease states, esp. if collateral circulation has developed

35
Q

ABI (Ankle-Brachial Index)

A

ratio of ankle SBP/ brachial SBP

objective indicator of arterial disease that allows examiner to quantify degree of stenosis

inc. stenosis/arterial narrowing = progressive decrease in SBP distal to involved sites

notify provider on absence of signal in areas previously detected

36
Q

Why do we avoid excessive pressure?

A

severely diseased arteries can collapse even with minimal pressure

37
Q

Obtaining ABI:

A

Client in supine position for 5 mins approx.

ABI: posterior tibial SBP/ brachial SBP, both left and right

ABI = 1.0 – 1.40 (no arterial insufficiency); ankle SBP of healthy person is same or slightly higher than brachial SBP

38
Q

Ankle, ABI:

A

approp. size cuff on client’s ankle above malleolus

check pulse of posterior tibial and dorsalis pedis on both legs

SBP obtained while listening to Doppler (doppler can’t measure DBP)

39
Q

Arm, ABI:

A

both evaluated bec. px may have asymptomatic stenosis in subclavian artery which causes BP on affected side to be 15 – 20 mmHg (or more) lower than systemic pressure

if abnormally low, do not use for assessment

40
Q

Indications for ABI/ perform baseline ABI on any patient:

A

With decreased pulses
Change in clinical status: sudden cold or painful limb
Above 65 years old
History of diabetes and/ or nicotine use
Underwent arterial intervention or surgery

41
Q

ABI, Instruct patient to:

A

Avoid nicotine/ products use
Drinking caffeinated beverages at least 2 hours prior
Expect some discomfort when cuffs are inflated

42
Q

Exercise Testing, use:

A

Used to determine how long a patient can walk, measure ankle SBP in response to walking (true vascular claudication)

43
Q

Exercise Testing, how:

A

Px’s brachial SBP obtained on each arm prior to treadmill walking, or modified to a set distance in a hallway

Treadmill at 1.5 mph with a 12% incline for a max of 5 mins, or walks with gradual rise in speed and incline to the point of claudication

44
Q

Exercise Testing, nursing interventions:

A

no running, but walking on a slight incline
cycling – eval client’s ability to walk

45
Q

Exercise Testing, results:

A

Normal response: little to no drop in ankle SBP

True vascular claudication: ankle SBP drops

46
Q

Unable to complete exercise test if:

A

significant arterial insufficiency
severe cardiac, pulmonary, or orthopedic problems
physical disability

47
Q

Duplex Ultrasound, use:

A

standard for diagnosing lower extremity venous thrombosis

determine the level and extent venous disease, and chronicity

48
Q

Duplex Ultrasound, nursing interventions:

A

noninvasive and usually requires no patient preparation

abdominal vascular duplex ultrasound – NPO status for at least 6 hrs prior

49
Q

CT Scan, abdomen:

A

useful in assessing characteristics and monitoring changes within the aorta
(such as an increasing aortic diameter indicating aneurysmal formation)

50
Q

Angiography, for:

A

confirm the diagnosis of occlusive arterial disease

locate a vascular obstruction or an aneurysm and collateral circulation

51
Q

Aneurysm

A

abnormal dilation of a blood vessel

52
Q

Radiopaque contrast agent with Iodine: Allergic reaction manifestations

A

dyspnea, nausea & vomiting, sweating, tachycardia, numbness of extremities

53
Q

Radiopaque contrast agent with Iodine: Allergic reaction treatment

A

administer epinephrine, antihistamines, corticosteroids

54
Q

Arterial Disorders, cause:

A

Chronic progressive pathologic changes to the arterial vasculature (atherosclerotic changes)

Acute loss of blood flow to tissues (aneurysm rupture)

55
Q

Arteriosclerosis

A

Most common disease of arteries, thickened walls of arteries or arterioles

56
Q

Atherosclerosis

A

Generalized arterial disease: when present in extremities, also present elsewhere in body

Atheromas or plaques

57
Q

Atheromas/ Plaques

A

accumulation of lipids, calcium, blood components, carbohydrates, and fibrous tissue on the intimal layer of the artery

58
Q

Atherosclerosis, direct:

A

o stenosis (narrowing) of the lumen
o obstruction by thrombosis
o aneurysm
o ulceration
o rupture

59
Q

Atherosclerosis, indirect:

A

o malnutrition
o subsequent fibrosis of the organs that the sclerotic arteries supply with blood

60
Q

What is ischemic necrosis?

A

death of cells due to deficient blood flow

61
Q

What happens when there is severe and permanent reduction of nutrient supply?

A

Ischemic necrosis and replacement by fibrous tissues (which require much less blood flow)

62
Q

Atherosclerotic Lesions, Fatty Streaks:

A

 yellow and smooth
 protrude slightly into the lumen of the artery
 composed of lipids and elongated smooth muscle cells
 have been found in the arteries of people of all ages, including infants
 Do not usually cause clinical symptoms, prognosis to formation of plaques unclear

63
Q

Atherosclerotic Lesions, Fibrous Plaques:

A

 white to white-yellow
 protrude to various degrees into the arterial lumen, sometimes completely obstructing it
 composed of smooth muscle cells, collagen fibers, plasma components, and lipids
 found predominantly in the abdominal aorta and the coronary, popliteal, and internal carotid arteries
 believed to be progressive lesions

64
Q

Risk Factors for Atherosclerosis (Modifiable)

A

use of nicotine products (dec. BF to extremities, inc. clot formation, CO lowers O2, lowers HDL)

diabetes (2-4x) - earlier onset, faster progression

HTN

Hyperlipidemia, diet

Stress

Sedentary lifestyle

elevated serum CRP = inc. vascular damage

Hyperhomocyteinemia

65
Q

Risk Factors for Atherosclerosis (Non -Modifiable)

A

increasing age

family history/ genetics

CC2 (2 decks)

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