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Nursing Semester 3 > Cyndi - Week 5 - Exam 3 > Flashcards

Cyndi - Week 5 - Exam 3 Flashcards

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1
Q

what are the characteristics of arteries?

A
  • oxygenated blood
  • thick walls of elastic tissue and smooth muscle
  • high pressure - does the pumping - harder to stop bleed
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2
Q

what are the characteristics of veins?

A
  • blood return system
  • deoxygenated blood
  • large diameter, thin walls
  • valves to prevent back flow
  • low pressure system
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3
Q

what does is the endothelium and what does it do?

A

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
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4
Q

what are the two types of peripheral vessel disease?

A

arterial disease and venous disease

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5
Q

what is arterial disease? and what 3 ways is it caused by?

A

narrowing causes oxygen delivery problems

  • atherosclerosis
  • smoking
  • diabetes
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6
Q

what are the characteristics of venous disease?

A
  • valvular insufficiency

- venous stasis, blood pooling (blood clot risk, edema)

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7
Q

what is peripheral arterial disease? (PAD)

A

Progressive narrowing of the arteries of the neck,

abdomen, and extremities

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8
Q

what are the risk factors (modifiable) of PAD?

A

tobacco, diabetes, ↑ CRP, HTN, atherosclerosis, hyperlipidemia

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9
Q

best teaching for PAD?

A

stop smoooking

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10
Q

what are the contributory factors of PAD?

A

Family history, male gender, high triglycerides, aging,

homocysteine, hyperuricemia, obesity (↑ LDL/Tri), sedentary lifestyle, stress

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11
Q

what is atherosclerosis? how does it begin and progress?

A

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

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12
Q

atherosclerosis decreases vessel lumen size, this leads to what?

A

• Inflammation causes plaque instability, platelet
response (“fix + patch → scar → lumen smaller)
• Lesion develops
• Lesion ruptures – thrombus formed
• Thrombus travels and occludes an artery

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13
Q

what are the 6 P’s of PAD?

A
  • Pain
  • Pallor
  • Pulselessness
  • Paresthesia
  • Paralysis
  • Poikilothermia
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14
Q

what are the clinical manifestations of PAD?

A
  • 6 P’s
  • Neuropathy
  • Cap refill prolonged
  • Cooler skin
  • Decreased or absent pulses
  • Intermittent claudication
  • Non‐healing ulcer
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15
Q

what is the classic symptom of PAD?

A

intermittent claudication

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16
Q

what are the characteristics of intermittent claudication?

A
  • Ischemic pain due to exercise
  • Resolves after 10 minutes rest
  • Reproducible - occurs again
  • 10% of patients with PAD have
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17
Q

what are the sxs of critical limb ischemia?

A

cold, no pulse, pain

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18
Q

what is the tx plan for someone with critical limb ischemia?

A
  • Revascularization needs to occur STAT
  • Surgery or stent
  • Protect from trauma
  • Reduce vasospasm
  • Treat pain
  • Prevent/control infection
  • Calm and educate patient
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19
Q

what is important to teach the patient about protecting from trauma?

A

remove things you might trip on, check feet every day

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20
Q

what position would you want your patient with critical limb ischemia in?

A

supine - easy to get blood through veins - least resistance

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21
Q

what are the diagnostic tests for PAD?

A
  • Doppler imaging
  • Ankle‐brachial index (ABI)
  • Angiogram bilateral legs – gold standard
  • CT angiogram
  • MRI/MRA
  • Labs
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22
Q

what labs are needed for PAD?

A

CBC, Lipid profile, ESR, CRP

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23
Q

what are the potential complications of PAD?

A
  • Bleeding, hematoma
  • Thrombosis, embolization
  • Amputation
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24
Q

what is the goal for PAD treatment?

A

to ensure adequate tissue perfusion

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25
Q

what are the parts of treatment for PAD?

A
  • lifestyle changes
  • medications
  • patient education
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26
Q

what are the lifestyle changes needed for PAD?

A

smoking, diet, exercise

27
Q

what are medications needed for PAD?

A
  • Pain
  • Reduce cholesterol, control BP and blood glucose
  • Dilate peripheral arteries (Pletal)
  • Antiplatelet meds to prevent clots (Trental)
28
Q

what is the patient education for PAD?

A
  • 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)
29
Q

what is an angiogram?

A

contrast injected into arteries using fluoroscopy to visualize blockages

30
Q

what is an angioplasty?

A

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
31
Q

what are the characteristics of a femoral-popilteal bypass?

A 
• Native or synthetic graft
• Monitor distal pulse
• Improved activity tolerance
• Antiplatelet medication
***should expect immediate perfusion and pulses
32
Q

what are the risk factors for chronic venous insufficiency?

A 
Sedentary lifestyle
obesity
pregnancy
standing for long periods
hypertension
smoking
trauma,
family history 
VTE history 
phlebitis
33
Q

what are the clinical manifestations of chronic venous insufficiency?

A
  • Discolored skin, eczema, ulcers
  • Edema
  • Pain
34
Q

how is chronic venous insufficiency diagnosed?

A

venous duplex ultrasound

35
Q

what is the tx for chronic venous insufficiency?

A
  • Compression stockings (edema)
  • Elevate to aid blood flow back to the heart
  • Debridement (ulcers) (infection)
  • Varicose vein ligation/stripping
36
Q

what are the potential complications of chronic venous insufficiency?

A
  • Venous stasis ulcer – poor healing
  • Osteomyelitis
  • Amputation
37
Q

what is venous thromboembolism (VTE/DVT)?

A

Thrombus with an inflammatory component
• Sudden or chronic limited mobility of lower extremity
• Virchow’s triad (stasis of blood flow, endothelial injury, hypercoagulability)

38
Q

what are the sxs of DVT/VTE?

A

Unilateral localized swelling, heat, pain, redness

39
Q

how is DVT/VTE diagnosed?

A

venous duplex ultrasound, D‐dimer lab test

40
Q

how are DVT/VTE prevented?

A
  • Anticoagulants
  • Early ambulation, range of motion
  • Sequential Compression Devices, elastic compression stockings
  • Pt and family education
41
Q

what are the complications of DVT/VTE?

A

Pulmonary Embolism
• Causes sharp thoracic pain, dyspnea
• Poor systemic oxygenation
• Elevated D‐dimer, suggestive VQ or CT scan chest

42
Q

what is the treatment for VTE?

A
  • Bedrest
  • Heparin drip or Lovenox or heparin subQ bridge
  • Coumadin or other long term blood thinner oral
43
Q

what are the surgical tx for VTE?

A
  • 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
44
Q

what is the patient education for VTE?

A
  • Early ambulation
  • Anticoagulants
  • Leg squeezers
  • Pt education – when to seek help
45
Q

what is an aortic aneurysm?

A

A weakening in an artery wall that causes bulging or dilation
• Susceptible to rupture
• Disrupted wall can cause turbulent blood flow within the artery

46
Q

what does the severity of an aortic aneurysm depend on?

A

location, type, size, rapidity of change

47
Q

what are the causes of aortic aneursyms?

A

congenital, degenerative (atherosclerosis), mechanical

48
Q

what are the risk factors of aortic aneursyms?

A

male, smokers, obesity, age, HTN, CAD, genetic

49
Q

what is the process of an aortic aneursym?

A
  • blood vessel has high blood pressure → blood vessel dilates → blood vessel bursts q
50
Q

where are the aortic aneurysm locations?

A
  • thoracic (ascending, arch, descending)

- abdominal

51
Q

what are the types of aneurysms?

A 
True
- saccular
- fusiform
False
- pseudoaneurysm
Dissection
52
Q

what are the clinical manifestations of aortic aneursym?

A

• 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

53
Q

what are the diagnostic studies for aortic aneurysm?

A
  • X‐rays
  • ECG—rule out MI
  • Echocardiography
  • Ultrasonography
  • CT scan – chest and abdomen
  • MRI
  • Angiography
54
Q

what are the sxs to monitor for a ruptured aneurysm?

A

• S/S hemorrhage or shock:
Sudden onset of tachycardia, hypotension, pain,
level of consciousness, diaphoresis, dyspnea, weakness

55
Q

what happens if there is a rupture into thoracic or abdominal cavity?

A
  • Massive hemorrhage

* Most do not survive long enough for hospital

56
Q

what happens if there is a rupture into the retroperitoneal space?

A
  • Bleeding may be tamponaded
  • Severe pain
  • May/may not have back/flank ecchymosis (Grey‐Turner’s sign)
57
Q

how can we prevent aneursym rupture?

A

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

58
Q

what are the surgical tx for aneurysms?

A

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

59
Q

what is an aortic dissection?

A

Tear in intimal lining allows blood to “track” between intima and media layers of arterial wall

60
Q

how do aortic dissections occur?

A
  • As heart contracts, each systolic pulsation ↑ pressure on damaged area
  • Further ↑ dissection
  • May occlude major branches of aorta
61
Q

what are the clinical manifestations of aortic dissection?

A
  • Pain characterized as sudden, severe pain in chest or back
  • Described as “sharp” and “worst ever”
  • May mimic that of MI
62
Q

what are the diagnostic tests for aortic dissection?

A 
Same - 
• X‐rays
• ECG—rule out MI
• Echocardiography
• Ultrasonography
• CT scan – chest and abdomen
• MRI
• Angiography
63
Q

what is the tx for aortic dissection?

A

surgery or stent

64
Q

what are the complications of aortic dissection?

A
  • Cardiac tamponade
  • Aortic rupture
  • Occlusion of major blood vessels
  • Hemorrhage, exsanguination

Nursing Semester 3 (29 decks)

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