Chapter 41: Vascular Disorders Flashcards
two risk factors for thromboangiitis obliterans (Buerger’s disease)
men younger than 45 years
long history of tobacco and/or marijuana use
(without other CVD risk factors)
treatment for peripheral artery disease involves _____________ modification, ______ therapy, __________ therapy, ______________ therapy, and sometimes __________.
risk factor, drug, exercise, nutrition, surgery
surgery that involves opening the artery and removing the obstructing plaque
endarterectomy
peripheral artery disease or venous disease: ulcer drainage moderate to large amount
peripheral venous disease
three examples of complimentary alternative medicines used for peripheral artery disease
DHEA omega 3 fatty acids
black cohosh
garlic supplements
peripheral artery disease or venous disease: ankle-brachial index >0.90
peripheral venous disease
severe, life-threatening complication of acute ascending aorta dissection that occurs when blood escapes from dissection into pericardial sac
cardiac tamponade
in diagnosing aneurysms, ___________ may reveal abnormal widening of the thoracic aorta, and ________________ may show calcification within the aortic wall
chest X-ray, abdominal X-ray
Manifestations of peripheral artery disease: pallor develops when the leg is ____________
elevated
peripheral artery disease or venous disease: dermatitis often occurs
peripheral venous disease
Aortic surgery patients with a history of CVD should receive a drug from this class
beta blocker
disorder that involves the formation of a thrombus with vein inflammation
venous thrombosis
type of aneurysm that is typically asymptomatic or mimic pain associated with abdominal or back disorders; a pulsatile mass in periumbilical area slightly to the left of the midline may be present on physical assessment
abdominal aortic aneurysm (AAA)
in diagnosing aneurysms, _______________ gives helpful information by using contrast imaging to map the entire aortic system
angiography
peripheral artery disease or venous disease: hair may be present or absent
peripheral venous disease
condition characterized by chronic ischemic rest pain lasting more than 2 weeks, nonhealing arterial leg ulcers, or gangrene of the leg from PAD
critical limb ischemia (CLI)
potentially lethal complication in emergency repair of AAA is development of this impaired organ perfusion caused by IAH and resulting multisystem organ failure
abdominal compartment syndrome
episodic vasospastic disorder of small cutaneous arteries, most often involving the fingers and toes
Raynaud’s phenomenon
results from the creation of a false lumen between the intima and the media of arterial wall
aortic dissection
type of aneurysm that is circumferential and relatively uniform in shape
fusiform aneurysm
Manifestations of peripheral artery disease: ______ pain can occur with progression and worsening of disease
rest
seepage of blood back into the old aneurysm
endoleak
Aortic aneurysm surgery: Adequate _____ is important to maintain graft patency. Give __________ and _________________ to maintain blood flow.
blood pressure (BP), IV fluids, blood components
Educating patients with critical limb ischemia involves ____________, ____________, and _________________ the feet to prevent skin cracking and infection, keeping the affected foot ________ and ______, wearing ______, ________, and ___________ footwear, and avoiding ____ and _____ extremes
inspecting, cleansing, lubricating, clean, dry, soft, roomy, protective, hot, cold
non-atherosclerotic, segmental, recurrent inflammatory disorder of the small and medium arteries and veins of the arms and legs
thromboangiitis obliterans (Buerger’s disease)
five risk factors of peripheral artery disease (PAD)
age over 60
hypertension
hyperlipidemia
smoking
diabetes
peripheral artery disease or venous disease: capillary refill <3 seconds
peripheral venous disease
In diagnosing aortic dissection, this may show a widening of the mediastinum and pleural effusion
chest X-ray
peripheral artery disease or venous disease: edema is absent unless leg is constantly in dependent position
peripheral artery disease
peripheral artery disease or venous disease: ulcer tissue: yellow slough or dark red, “ruddy” granulation
peripheral venous disease
may occur in isolation but could occur with thyroid, scleroderma, SLE, environmental factors (vibratory or cold machinery, exposure to heavy metals)
Raynaud’s phenomenon
peripheral artery disease or venous disease: ulcer often painful
peripheral venous disease
formation of a thrombus in a superficial vein
superficial vein thrombosis
in diagnosing aneurysms, a(n) ________ may rule out an MI
ECG
conservative management for patient with critical limb ischemia involves protecting the extremity from ___________, decreasing ______________, preventing and controlling ____________, and improving ___________
trauma, ischemic pain, infection, perfusion
peripheral artery disease or venous disease: loss of hair on legs, feet, toes
peripheral artery disease
type of aneurysm that is a disruption of all arterial wall layers with bleeding that is contained by surrounding anatomic structures
false aneurysm or pseudoaneurysm
if acute arterial ischemia is present, immediate intervention is needed to avoid these three things
ischemia, necrosis, gangrene
represents the spectrum from deep vein thrombosis to pulmonary embolism
venous thromboembolism (VTE)
type of aneurysm in which the wall of the artery forms the aneurysm with at least 1 vessel layer still intact
true aneurysm
peripheral artery disease or venous disease: skin color bronze-brown pigmentation
peripheral venous disease
these two diagnostic tests show the location and extent of peripheral artery disease (PAD)
angiography
magnetic resonance angiography
in diagnosing aneurysms, a ______ or ________ can diagnose and assess the location and severity of aneurysms
CT, MRI
potentially lethal complication in emergency repair of AAA is development of this reduction of blood flow to the viscera
intraabdominal hypertension (IAH)
six manifestations of acute arterial ischemia
pain, pallor, pulselessness, paresthesia, paralysis, poikilothermia
peripheral artery disease or venous disease: ulcer located near medial malleolus
peripheral venous disease
this type of aneurysm surgical repair involves a large abdominal incision through which the surgeon cuts into the diseased aortic segment, removes any thrombus or plaque, sutures a synthetic graft to the aorta proximal and distal to the aneurysm, and sutures the native aortic wall around the graft to act as a protective cover
open aneurysm repair (OAR)
peripheral artery disease or venous disease: decreased or absent peripheral pulses
peripheral arterial disease
these are expandable metallic devices that are placed in the artery after balloon angioplasty
stents
this type of aortic dissection affects the ascending aorta and arch
Type A
peripheral artery disease or venous disease: dermatitis rarely occurs
peripheral artery disease
peripheral artery disease or venous disease: ankle-brachial index ≤0.90
peripheral artery disease
type of aneurysm that is asymptomatic or manifests as deep, diffuse chest pain that may extend to the interscapular area
thoracic aortic aneurysm (TAA)
combination of percutaneous transluminal angioplasty (PTA) and cold therapy
cryoplasty
peripheral artery disease or venous disease: ulcer margin irregularly shaped
peripheral venous disease
peripheral artery disease or venous disease: ulcer tissue: black eschar or pale pink granulation
peripheral artery disease
health promotion for PAD and aneurysms involves
reducing CVD risk factors (controlling BP, ceasing tobacco use, maintaining normal body weight and serum lipids)
peripheral artery disease or venous disease: intermittent claudication or rest pain in foot
peripheral artery disease
peripheral artery disease or venous disease: capillary refill >3 seconds
peripheral artery disease
In diagnosing aortic dissection, this rules out cardiac ischemia
ECG
PAD: long-term ____________ therapy is used after surgery with one of these two drugs
antiplatelet, aspirin, clopidrogel
type of aneurysm that is pouchlike with a narrow neck connecting the bulge to one side of the arterial wall
saccular aneurysm
involves thickening of artery walls, resulting in a progressive narrowing of the arteries of the upper and lower extremities
peripheral artery disease (PAD)
classic symptom of lower extremity peripheral artery disease (PAD)
intermittent claudication
peripheral artery disease or venous disease: skin temperature cool, temperature gradient down the leg
peripheral artery disease
in diagnosing aneurysms, _____________ is useful for aneurysm screening and to monitor aneurysm size
ultrasound
Aortic aneurysm surgery: reason to keep continuous ECG monitoring
myocardial ischemia/infarction or dysrhythmias may occur
treatment not indicated for PAD and why
anticoagulant therapy; no benefit and increased risk for bleeding
peripheral artery disease or venous disease: dull ache or heaviness in calf or thigh
peripheral venous disease
this type of surgery is used to treat acute type A aortic dissections
open aneurysm repair (is a surgical emergency)
most frequent cause of acute arterial occlusion
embolization of a thrombus from the heart
peripheral artery disease or venous disease: ulcer drainage minimal
peripheral artery disease
Aortic aneurysm surgery: to prevent infection, give ___________________ as prescribed
broad-spectrum antibiotic
acute inflammation of the walls of small, cannulated veins
phlebitis
peripheral artery disease or venous disease: lower leg edema present
peripheral venous disease
peripheral artery disease or venous disease: pruritus rarely occurs
peripheral artery disease
These three tests are equally reliable for diagnosing aortic dissection
MRI
3D CT scanning
transesophageal echocardiography (TEE)
peripheral artery disease or venous disease: normal or thickened nails
peripheral venous disease
peripheral artery disease or venous disease: pruritus often occurs
peripheral venous disease
Manifestations of peripheral artery disease: _________________ develops when the limb is in a dependent position, also known as ________________
reactive hyperemia, dependent rubor
Aortic aneurysm surgery: Assess bowel sounds every ___________
4 hours
Aortic surgery patients have a __________ preparation and _______ cleansing with a(n) _______________ agent the day before surgery.
bowel, skin, antimicrobial
peripheral artery disease or venous disease: skin temperature warm, no temperature gradient
peripheral venous disease
manifestations include hypotension, narrowed pulse pressure, distended neck veins, muffled heart sounds, and pulsus paradoxus
cardiac tamponade
After surgical or radiologic intervention for PAD, check the operative extremity every ________ and later every _______. Assess these six things
15 minutes, 1 hour
color, temperature, capillary refill, peripheral pulses, sensation, movement
this type of surgery is a treatment option for acute and chronic type B aortic dissections with complications
endovascular aortic repair (EVAR)
(alternative is thoracic EVAR or TEVAR)
peripheral artery disease or venous disease: varicose veins may be visible
peripheral venous disease
removal of obstructing plaque
atherectomy
PAD: Postoperative ankle brachial index (ABI) measurements place the patient at risk for this
graft thrombosis
most common complication of AAA repair
endoleak
characterized by vasospasm-induced color changes from white to blue to red
Raynaud’s phenomenon
peripheral artery disease or venous disease: skin color dependent rubor, elevation pallor
peripheral artery disease
peripheral artery disease or venous disease: skin texture thick, hardened, and indurated
peripheral venous disease
The initial goals of therapy for acute aortic dissection without complications are _____ and _____ control and ________ management
HR, BP, pain
involves a thrombus in a deep vein (most often iliac and/or femoral)
deep vein thrombosis (DVT)
peripheral artery disease or venous disease: ulcer located on tips of toes, foot, or lateral malleolus
peripheral artery disease
peripheral artery disease or venous disease: thickened, brittle nails
peripheral artery disease
phlebitis usually resolves quickly after this intervention
IV catheter removal
optimal therapy for patient with critical limb ischemia
revascularization via bypass surgery using autologous vein
this type of aortic dissection, when without complications, can be treated conservatively
Type B
peripheral artery disease or venous disease: skin texture thin, shiny, taut
peripheral artery disease
six modifiable risk factors for aortic aneurysms
hypertension, CAD, tobacco use, high cholesterol, previous stroke, obesity
this type of aortic dissection begins in the descending aorta
Type B
in treating aortic dissection, this drug is titrated to a target HR under 60 bpm or SBP between 100-110
IV beta blocker
peripheral artery disease or venous disease: ulcer may or may not be painful
peripheral artery disease
conservative medical therapy is used to treat aneurysms of this size (risk factor modification)
<5.4 cm
Aortic aneurysm surgery: When the descending aorta is involved perform a _______________ assessment
neurovascular
three nonmodifiable risk factors for aortic aneurysms
age, male gender, family history
peripheral artery disease or venous disease: ulcer margin rounded, smooth, looks “punched out”
peripheral artery disease
how the ankle-brachial index is calculated
(ankle SBP/brachial SBP)
peripheral artery disease or venous disease: peripheral pulses present, may be hard to palpate with edema
peripheral venous disease
Aortic aneurysm surgery: Avoid heavy lifting for _________
6 weeks
surgical repair is used to treat aneurysms of this size
> 5.4 cm
in diagnosing aneurysms, _____________________ assesses the function of the aortic valve
echocardiography
those with small aneurysms of ________ cm should have monitoring of aneurysm size using ultrasound or CT every _______ months
4.0-5.4; 6-12 months
three key factors that cause venous thrombosis
Virchow triad: venous stasis, damage of endothelium, hypercoagulability
Aortic aneurysm surgery: When the ascending aorta and aortic arch are involved, perform a ____________ assessment
neurologic (LOC, pupil size and responsiveness to light, facial symmetry, tongue position, speech, upper extremity movement, quality of hand grasps)
this type of aneurysm surgical repair is a minimally invasive procedure that involves the placement of a sutureless aortic graft into the abdominal aorta inside the aneurysm via the femoral artery
endovascular graft procedure (EVAR)
