Cyndi - Week 5 - Exam 3 Flashcards
what are the characteristics of arteries?
- oxygenated blood
- thick walls of elastic tissue and smooth muscle
- high pressure - does the pumping - harder to stop bleed
what are the characteristics of veins?
- blood return system
- deoxygenated blood
- large diameter, thin walls
- valves to prevent back flow
- low pressure system
what does is the endothelium and what does it do?
semi permeable barrier between the vessel lumen and the surrounding tissue
- fluid filtration
- hemostasis
- angiogenesis (creation of new vessel)
- neutrphils chemotaxis
- controls WBC in and out of blood sream
- produces nitric oxide - contraction of vessels
- chemicals that produce/breakdown clots
what are the two types of peripheral vessel disease?
arterial disease and venous disease
what is arterial disease? and what 3 ways is it caused by?
narrowing causes oxygen delivery problems
- atherosclerosis
- smoking
- diabetes
what are the characteristics of venous disease?
- valvular insufficiency
- venous stasis, blood pooling (blood clot risk, edema)
what is peripheral arterial disease? (PAD)
Progressive narrowing of the arteries of the neck,
abdomen, and extremities
what are the risk factors (modifiable) of PAD?
tobacco, diabetes, ↑ CRP, HTN, atherosclerosis, hyperlipidemia
best teaching for PAD?
stop smoooking
what are the contributory factors of PAD?
Family history, male gender, high triglycerides, aging,
homocysteine, hyperuricemia, obesity (↑ LDL/Tri), sedentary lifestyle, stress
what is atherosclerosis? how does it begin and progress?
Cholesterol and lipids in arteries
• Begins as soft deposits in artery wall
• Causes injury and inflammation of arterial endothelium
• Hardens with time into a plaque
atherosclerosis decreases vessel lumen size, this leads to what?
• Inflammation causes plaque instability, platelet
response (“fix + patch → scar → lumen smaller)
• Lesion develops
• Lesion ruptures – thrombus formed
• Thrombus travels and occludes an artery
what are the 6 P’s of PAD?
- Pain
- Pallor
- Pulselessness
- Paresthesia
- Paralysis
- Poikilothermia
what are the clinical manifestations of PAD?
- 6 P’s
- Neuropathy
- Cap refill prolonged
- Cooler skin
- Decreased or absent pulses
- Intermittent claudication
- Non‐healing ulcer
what is the classic symptom of PAD?
intermittent claudication
what are the characteristics of intermittent claudication?
- Ischemic pain due to exercise
- Resolves after 10 minutes rest
- Reproducible - occurs again
- 10% of patients with PAD have
what are the sxs of critical limb ischemia?
cold, no pulse, pain
what is the tx plan for someone with critical limb ischemia?
- Revascularization needs to occur STAT
- Surgery or stent
- Protect from trauma
- Reduce vasospasm
- Treat pain
- Prevent/control infection
- Calm and educate patient
what is important to teach the patient about protecting from trauma?
remove things you might trip on, check feet every day
what position would you want your patient with critical limb ischemia in?
supine - easy to get blood through veins - least resistance
what are the diagnostic tests for PAD?
- Doppler imaging
- Ankle‐brachial index (ABI)
- Angiogram bilateral legs – gold standard
- CT angiogram
- MRI/MRA
- Labs
what labs are needed for PAD?
CBC, Lipid profile, ESR, CRP
what are the potential complications of PAD?
- Bleeding, hematoma
- Thrombosis, embolization
- Amputation
what is the goal for PAD treatment?
to ensure adequate tissue perfusion
what are the parts of treatment for PAD?
- lifestyle changes
- medications
- patient education
what are the lifestyle changes needed for PAD?
smoking, diet, exercise
what are medications needed for PAD?
- Pain
- Reduce cholesterol, control BP and blood glucose
- Dilate peripheral arteries (Pletal)
- Antiplatelet meds to prevent clots (Trental)
what is the patient education for PAD?
- Monitor skin on extremities
- Modify risk factors (Quit smoking, Dietary changes, control diabetes, hypertension, Exercise – esp walking)
- Patient compliance (importance)
- When to seek emergency help (cold limb, SOB, clot)
what is an angiogram?
contrast injected into arteries using fluoroscopy to visualize blockages
what is an angioplasty?
Percutaneous transluminal balloon angioplasty
- balloon (blow up and pull through)
- stents (straw, opens up; can have antiplatelet impregnated in it)
- may use thrombolytics like TPA overnight in the ICU
- antiplatelet medication
what are the characteristics of a femoral-popilteal bypass?
• Native or synthetic graft • Monitor distal pulse • Improved activity tolerance • Antiplatelet medication ***should expect immediate perfusion and pulses
what are the risk factors for chronic venous insufficiency?
Sedentary lifestyle obesity pregnancy standing for long periods hypertension smoking trauma, family history VTE history phlebitis
what are the clinical manifestations of chronic venous insufficiency?
- Discolored skin, eczema, ulcers
- Edema
- Pain
how is chronic venous insufficiency diagnosed?
venous duplex ultrasound
what is the tx for chronic venous insufficiency?
- Compression stockings (edema)
- Elevate to aid blood flow back to the heart
- Debridement (ulcers) (infection)
- Varicose vein ligation/stripping
what are the potential complications of chronic venous insufficiency?
- Venous stasis ulcer – poor healing
- Osteomyelitis
- Amputation
what is venous thromboembolism (VTE/DVT)?
Thrombus with an inflammatory component
• Sudden or chronic limited mobility of lower extremity
• Virchow’s triad (stasis of blood flow, endothelial injury, hypercoagulability)
what are the sxs of DVT/VTE?
Unilateral localized swelling, heat, pain, redness
how is DVT/VTE diagnosed?
venous duplex ultrasound, D‐dimer lab test
how are DVT/VTE prevented?
- Anticoagulants
- Early ambulation, range of motion
- Sequential Compression Devices, elastic compression stockings
- Pt and family education
what are the complications of DVT/VTE?
Pulmonary Embolism
• Causes sharp thoracic pain, dyspnea
• Poor systemic oxygenation
• Elevated D‐dimer, suggestive VQ or CT scan chest
what is the treatment for VTE?
- Bedrest
- Heparin drip or Lovenox or heparin subQ bridge
- Coumadin or other long term blood thinner oral
what are the surgical tx for VTE?
- InferiorVena Cava (IVC) filter placement
• Interventional radiology
• Short term – usually 3 months
• Surgery can be done for PE, but very invasive - VenousThrombectomy ‐ removal of clot in a vein
what is the patient education for VTE?
- Early ambulation
- Anticoagulants
- Leg squeezers
- Pt education – when to seek help
what is an aortic aneurysm?
A weakening in an artery wall that causes bulging or dilation
• Susceptible to rupture
• Disrupted wall can cause turbulent blood flow within the artery
what does the severity of an aortic aneurysm depend on?
location, type, size, rapidity of change
what are the causes of aortic aneursyms?
congenital, degenerative (atherosclerosis), mechanical
what are the risk factors of aortic aneursyms?
male, smokers, obesity, age, HTN, CAD, genetic
what is the process of an aortic aneursym?
- blood vessel has high blood pressure → blood vessel dilates → blood vessel bursts q
where are the aortic aneurysm locations?
- thoracic (ascending, arch, descending)
- abdominal
what are the types of aneurysms?
True - saccular - fusiform False - pseudoaneurysm Dissection
what are the clinical manifestations of aortic aneursym?
• Frequently a silent condition
• Pain if pressure put on surrounding area; may have intermittent
generalized discomfort
• Indications of reduced blood flow distally
• May have bruit in abdomen
what are the diagnostic studies for aortic aneurysm?
- X‐rays
- ECG—rule out MI
- Echocardiography
- Ultrasonography
- CT scan – chest and abdomen
- MRI
- Angiography
what are the sxs to monitor for a ruptured aneurysm?
• S/S hemorrhage or shock:
Sudden onset of tachycardia, hypotension, pain,
level of consciousness, diaphoresis, dyspnea, weakness
what happens if there is a rupture into thoracic or abdominal cavity?
- Massive hemorrhage
* Most do not survive long enough for hospital
what happens if there is a rupture into the retroperitoneal space?
- Bleeding may be tamponaded
- Severe pain
- May/may not have back/flank ecchymosis (Grey‐Turner’s sign)
how can we prevent aneursym rupture?
Risk factor modification to prevent aneurysm rupture
• No heavy lifting
• Meds for hypertension
• Follow up testing every 6 mo – 1 year to measure
• Surgery recommended for 5.5 cm size or greater
• Educate on signs and symptoms of complications
• Monitor pulses distal to aneurysm
what are the surgical tx for aneurysms?
Open surgery
• Insert synthetic graft
• Suture native aortic wall
Endovascular (percutaneous) repair • Percutaneous • Bilateral femoral artery access for stent insertion • Insert stent • Easier recovery Same mortality for both
***If ruptured AA ‐ 90% mortality rate
what is an aortic dissection?
Tear in intimal lining allows blood to “track” between intima and media layers of arterial wall
how do aortic dissections occur?
- As heart contracts, each systolic pulsation ↑ pressure on damaged area
- Further ↑ dissection
- May occlude major branches of aorta
what are the clinical manifestations of aortic dissection?
- Pain characterized as sudden, severe pain in chest or back
- Described as “sharp” and “worst ever”
- May mimic that of MI
what are the diagnostic tests for aortic dissection?
Same - • X‐rays • ECG—rule out MI • Echocardiography • Ultrasonography • CT scan – chest and abdomen • MRI • Angiography
what is the tx for aortic dissection?
surgery or stent
what are the complications of aortic dissection?
- Cardiac tamponade
- Aortic rupture
- Occlusion of major blood vessels
- Hemorrhage, exsanguination
