Day IV Flashcards
1
Q
Peripheral Artery Disease
A
- Interferes with normal blood flow
- Affects arteries
- Results from atherosclerosis that usually occurs in the arteries of the lower extremities and is characterized by inadequate flow of blood
- Atherosclerosis is caused by gradual thickening of the intima and media of the arteries, ultimately resulting in the progressive narrowing of the vessel lumen
- Plaques can form on walls making them rough and fragile
- Progressive stiffening of the arteries and narrowing of the lumen dec blood supply to affected tissues and inc resistance to blood flow
- Actually a type of arteriosclerosis–>loss of elasticity of arteries overtime due to thickening of their walls
- Atherosclerosis is caused by gradual thickening of the intima and media of the arteries, ultimately resulting in the progressive narrowing of the vessel lumen
- Classified as inflow (distal aorta or iliac arteries) or outflow (femoral, popliteal, and tibial arteries) and can range from mild to severe
- Tissue damage occurs below arterial obstruction
2
Q
what is included under peripheral artery disease?
A
- Buerger’s disease,
- subclavian steal syndrome,
- thoracic outlet syndrome,
- Raynaud’s dz,
- popliteal entrapment
3
Q
risk factors for peripheral artery disease
A
- HTN
- Hyperlipidemia
- DM
- Smoking
- Obesity
- Sedentary lifestyle
- Familial predisposition
- Female gender
- Older clients
4
Q
expected findings for Peripheral Artery Disease
A
- Burning, cramping, and pain in legs–>intermittent claudication
- Numbness or burning pain primarily in feet when in bed
- Pain that is relieved by placing legs at rest in a dependent position
- Physical assessment:
- Bruit over femoral and aortic arteries
- Dec cap refill of toes (>3 seconds)
- Dec or nonpalpable pulses
- Loss of hair on lower calf, ankle, and foot
- Dry, scaly, mottled skin
- Thick toenails
- Cold and cyanotic extremity
- Pallor of extremity w/ elevation
- Dependent rubor (redness) of the extremity
- Muscle atrophy
- Ulcers and possible gangrene of toes
5
Q
list the diagnostics used for Peripheral Artery Disease
A
- arteriography
- exercise tolerance test
- plethysmography
- segmental SBP measurements
- magnetic resonance angiography
- ankle brachial index (ABI)
- doppler derived maximal systolic acceleration
6
Q
explain arteriography as a diagnostic for PAD
A
- involves arterial injection of contrast medium to visualize areas of decreased arterial flow on an x ray
- Usually done only to determine isolated areas of occlusion that can be treated during the procedure with percutaneous transluminal angioplasty and possible stent placement
- Nursing actions:
- Observe for bleeding and hemorrhage
- Palpate pedal pulses to identify possible occlusions
7
Q
explain exercise tolerance test as a diagnostic for PAD
A
- done with or w/o a treadmill w/ measurement of pulse volumes and BP prior to and following manifestations or 5 min of exercise
- Delays in return to normal pressures and pulse waveforms indicate arterial dz
- Used to evaluate claudication during exercise
8
Q
explain segmental SBP measurements
A
- doppler probe takes various BP measurements for comparison
- In the absence of PAD, pressures in the lower extremities are higher than those of upper extremities
- With PAD, pressures in the thigh, calf, and ankle are lower
9
Q
explain magnetic resonance angiography as a diagnostic for PAD
A
- contrast medium is injected to help visualize blood flow thru peripheral arteries
10
Q
explain ankle brachial index (ABI) as a diagnostic for PAD
A
- ankle pressure is compared to brachial pressure
- Expected finding is 0.9-1.3
- ABI less than 0.9 in either leg is diagnostic for PAD
11
Q
what is nursing care for PAD?
A
- encourage client to exercise to build up collateral circulation
- promote vasodilation and avoid vasoconstriction
- positioning
12
Q
what to do to encourage client to exercise to build up collateral circulation to help with PAD?
A
- Initiate exercise gradually and inc slowly
- Instruct client to walk until point of pain, stop, and rest, and then walk a little farther
13
Q
what to do to promote vasodilation and avoid vasoconstriction as a way to care for client with PAD?
A
- Provide a warm environment for the client
- Have client wear insulated socks
- Tell the client to never apply direct heat, such as a heating pad, to the affected extremity b/c severity is decreased, and this can cause a burn
- Avoid exposure to cold which causes vasoconstriction and dec arterial flow
- Avoid stress, caffeine, nicotine–cause vasoconstriction
- Vasoconstriction is avoided completely when the client completely abstains from smoking or chewing tobacco
- Vasoconstriction of the vessels lasts up to 1 hr after smoking or chewing tobacco
14
Q
how to position a client with PAD
A
- Avoid crossing legs
- Refrain from restrictive garments
- Tell client to elevate legs to reduce swelling, but not to elevate them above the level of the heart b/c extreme elevation slows arterial blood flow to the feet
15
Q
what are the 2 classes of meds most often used to tx PAD?
A
- antiplatelet meds
- statins
16
Q
antiplatelet meds for PAD
A
- aspirin, clopidogrel, pentoxifylline
- Reduce blood viscosity by decreasing blood fibrinogen levels, enhancing erythrocyte flexibility, and inc blood flow to the extremities
- Pentoxifylline: less common–may be used to help with intermittent claudication
- Client edu:
- Effects may not be apparent for several weeks
- Monitor for evidence of bleeding: abdominal pain, coffee ground emesis, black, tarry stools
17
Q
statins for PAD
A
- simvastatin, atorvastatin
- Can relieve manifestations of PAD (intermittent claudication)
18
Q
therapeutic procedures for PAD
A
- percutaneous transluminal angioplasty and laser assisted angioplasty
- mechanical rotational abrasive atherectomy
- arterial revascularization surgery
19
Q
explain percutaneous transluminal angioplasty and laser assisted angioplasty as a therapeutic procedure for PAD
A
- Percutaneous transluminal: invasive intraarterial procedure using a balloon to help maintain the patency of the vessel
- Laser assisted: invasive procedure in which a laser probe is advanced thru a cannula to the site of stenosis
- Laser can vaporize atherosclerotic plaque and open the artery
- Nursing considerations:
- Priority action: to observe for bleeding at puncture site
- Monitor V/S, peripheral pulses, cap refill
- Keep client on bed rest with limb straight for 2-6 hours before ambulation
- Anticoag therapy used during procedure, followed by antiplatelet therapy for 1-3 mos
20
Q
explain rotational abrasive atherectomy as a therapeutic procedure for PAD
A
- uses a rotational device to scrape plaque from the inside of the client’s peripheral artery
- Device is designed to cause minimal damage to the surface of the artery
- Nursing considerations:
- Priority action: to observe for bleeding at puncture site
- Monitor V/S, peripheral pulses, cap refill
- Keep client on bed rest with limb straight for 2-6 hours before ambulation
- Anticoag therapy used during procedure, followed by antiplatelet therapy for 1-3 mos
21
Q
explain arterial revascularlization surgery as a therapeutic procedure to help with PAD: what is it and nursing implications
A
- used with clients who have severe claudication and/or limb pain at rest, or with clients who are at risk for losing a limb due to poor arterial circulation
- Bypass grafts are used to reroute the circulation around the arterial occlusion
- Grafts can be harvested from client or made from synthetic materials
- Nursing:
- Priority: to maintain adequate circulation in the repaired artery
- Location of the pedal or dorsalis pulse should be marked, and its pulsatile strength compared to the contralateral leg on a scheduled basis using a doppler
- Color, temp, sensation, and cap refill should be compared w/ contralateral extremity on scheduled basis
- Assess for redness, warmth, edema as a result of inc blood flow in affected limb
- Monitor for pain
- Monitor BP
- hypoTN can result in an inc risk of clotting or graft collapse
- HTN inc the risk for bleeding from sutures
- Instruct client to limit bending at hip/knee to dec risk of clot formation
22
Q
explain arterial revascularlization surgery as a therapeutic procedure to help with PAD: client education
A
- Avoid crossing or raising legs about heart
- Wear loose clothing
- Instruct client on wound care if revascularization surgery was done
- Discourage smoking and cold temps
- Foot care: keep feet clean and dry, wear good shoes, never go barefoot, cut toenails straight across
23
Q
what are possible complications with PAD?
A
- graft occlusion
- wound or graft infection
- compartment syndrome
24
Q
explain graft occlusion as a complication of PAD
A
- serious complication of arterial revascularization and often occurs w/in first 24 hours after surgery
- Nursing:
- Notify surgeon of manifestations of occlusion, such as absent or reduced pedal pulses, inc pain, change in extremity color or temp
- Be prepared to assist with tx, which can include thrombectomy (removal of clot), local intra-arterial thrombolytic therapy with a tissue plasminogen activator, infusion of platelet inhibitor, or combo
- Assess for indications of bleeding
25
Q
explain wound or graft infection as a complication of PAD
A
- Nursing actions:
- Use sterile technique when changing dressing or providing wound care
- Indications of infection: localized induration, warmth, tenderness, erythema, edema, purulent drainage, elevated WBC
26
Q
explain compartment syndrome as a complication of PAD
A
- medical emergency
- Tissue pressure w/in a confined body space can restrict blood flow, and the resulting ischemia can lead to irreversible tissue damage
- Nursing actions:
- Manifestations:
- Tingling
- Numbness
- Worsening pain
- Edema
- Pain on passive movement
- Unequal pulses
- Loosen dressings
- Prepare to assist with fasciotomy
- Manifestations:
27
Q
what is an aneurysm and what are the 2 types?
A
- A weakness in a section of a dilated artery that causes a widening or ballooning in the wall of the blood vessel is called an aneurysm
- Can be saccular (only affecting 1 side of the artery) or fusiform (involving both sides)
28
Q
health promotion and dz prevention of aneurysms
A
- Promote smoking cessation
- Maintain appropriate weight for height and body frame
- Encourage a healthy diet and physical activity
- Control BP w/ regular monitoring and medication if needed
29
Q
risk factors for aneurysms
A
- Male gender
- Atherosclerosis: MOST COMMON CAUSE
- Uncontrolled HTN
- Tobacco use
- Hyperlipidemia
- Family hx
- Blunt force trauma
- Hx of syphilis
- w/ age, arterial stiffening caused by loss of elastin in arterial walls, thickening of intima of arteries, and progressive fibrosis of media occurs
- Older clients are more prone to aneurysms and have a higher mortality rate from aneurysms than younger individuals
30
Q
expected findings with an abdominal aortic aneurysm (AAA)
A
- Most common, related to atherosclerosis
- Constant gnawing feeling in abdomen
- Flank or back pain
- Pulsating abdominal mass (do not palpate–>can cause rupture)
- Bruit over the area of the aneurysm
- Elevated BP (unless in cardiac tamponade or rupture of aneurysm)
31
Q
expected findings with thoracic aortic aneurysm
A
- Severe back pain (most common)
- Hoarseness, cough, SOB, and difficulty swallowing
- Dec in urinary output (secondary to hypovolemic shock)
