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N102 > Disorders of the Veins > Flashcards

Disorders of the Veins Flashcards

1
Q

Normal blood flow depends on

A

Extremity muscle action unidirectional valves

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2
Q

Phlebitis

A

inflammation of superficial veins WITHOUT thrombus (clot)

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3
Q

Thrombus

A

Clot

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4
Q

Embolus

A

clot “on the move”

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5
Q

Venous Thrombosis

A

formation of thrombus + inflammation (aka Thrombophlebitis)

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6
Q

SVT

A

Superficial Vein Thrombosis – Clot in smaller vein

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7
Q

DVT

A

Deep Vein Thrombosis –Clot in deep vein Requires aggressive treatment

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8
Q

Venous Thromboembolism

A

VTE WHOLE SPECTRUM of conditions (DVT-PE)

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9
Q

Thrombophlebitis

A

Venous Thrombosis

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10
Q

Most common venous disorder

A

Venous Thrombosis

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11
Q

Virchow’s Triad

A

Hypercoagulability

Damage to the Intima of the Vein Wall

Venuous Stasis

(Airplane Ride)

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12
Q

made up of RBC, WBC, platelets entrapped by fibrin

A

Thrombus

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13
Q

SVT Risk Factors

A

IV therapy Varicose veins Pregnancy Chronic venous insufficiency

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14
Q

Dx of SVT

A

Visual

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15
Q

Goal of SVT Tx

A

Prevent increase in size and recurrence decrease risk of emboli

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16
Q

DVT Risk Factors

A

Prolonged Bedrest General Sx (pt 40+ yo) Leg Trauma Previous Vein Insufficiency Obesity Aging Pregnancy/ Oral Contraceptives Malignancies Hematolgical Disorders Long Trips (Economy Class Syndrome)

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17
Q

DVT (Common Sites)

A

Saphenous Femoral Popliteal Calf veins IVC/ SVC 50% Asymptomatic!

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18
Q

DVT Clinical Manifestations

A

50% ASYMPTOMATIC The other 50% Unilateral leg edema Extremity pain Skin warm & red Temp 100.4+ + Homan’s Sign

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19
Q

PE

A

Pulmonary Embolism Clot that travels to lungs Acute/ life-threatening

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20
Q

Chronic Venous Insufficiency

A

Persistent Edema

Increased Pigmentation

Ulcers (wet and weepy)

Dependent Cynosis

2nd to valvular destruction

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21
Q

Phlegmasia cerulea dolens

A

SUDDEN Swelling

Pain to leg

Cyanosis

Gangrene can occur

Very Rare

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22
Q

Use for 2 yrs post DVT to support vein wall and valves & decrease extremity swelling

A

TED Hose

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23
Q

Thromboembolic Disease Hose (TEDs)

A

Promote venous return, decreases stasis & dilation MD Order needed

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24
Q

3 Complications of DVT

A

PE Chronic vein insufficiency Phlegmasia cerulea dolens

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25
Q

EPC’s (SCD’s)

A

NOT used on pt’s with DVT’s Used until a pt is ambulatory

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26
Q

DVT Treatment Requires

A

Hospitalization

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27
Q

DVT Treatment Positioning

A

William’s Position Legs elevated above the heart Ensure knees are NOT BENT

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28
Q

Anticoagulants

A

Do NOT dissolve clots Prevent new clot formation, clot enlargement, and embolization

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29
Q

3 Anticoagulants

A

Heparin Lovenox Coumadin

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30
Q

Fibrinolytic

A

body system that dissolves clots

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31
Q

Thrombolytics IV

A

clot busters –>bleeding

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32
Q

2 types of Sx for DVT

A

Venous Thrombectomy Inferior Vena Cava Interruption

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33
Q

Venous Thrombectomy

A

Incise vein, Extract Clot Best for Short Clots

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34
Q

IVC Interruption

A

Umbrella filter in VC –>prevent passage of emboli to vital organs aka Greenfield or ivc Filter

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35
Q

Modifiable Risk Factors for DVT

A

Weight Stop smoking Caution w/ BC Activity level Avoid crossing legs at knees TEDs

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36
Q

Teach DVT

A

s/s of PE & Medications

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37
Q

Varicose Veins (Varicosities)

A

Dilated, tortuous, SQ veins

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38
Q

Primary Cause of Varicosities

A

genetic

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39
Q

Secondary Cause of Varicosities

A

from previous DVT or Valve Injury

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40
Q

Dx of Varicose Veins

A

Visual

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41
Q

Veins become enlarged and tortuous due to

A

increased venous pressure

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42
Q

Risk Factors for Varicose Veins

A

Congenital weakness Obesity Pregnancy Prolonged standing

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43
Q

S/S Varicose Veins

A

Ache/ pain (pressure/ cramp like) after standing - relieved by walking or elevations Swelling and nocturnal leg cramps may occur Disfigurement

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44
Q

Complications of Varicose Veins

A

SVT Rupture of Varicose Vein

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45
Q

Duplex Ultra Sound

A

Detects obstruction & vein reflux (varicose veins)

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46
Q

Sclerotherapy

A

Injection of sclerosing agent–> inflammation & thrombosis of vein –>eliminates spider veins Ace wrap for 24-72h after–> = pressure on area Local tenderness 2-3 weeks Compression stockings recommended post-procedure

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47
Q

Laser therapy

A

Tx Varicose Veins Laser heats Hgb, injures endothelium, vessel sclerosis requires 1+ session

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48
Q

Pulsed Light Therapy

A

Tx Varicose Veins spectrum of light instead of single wavelength

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49
Q

Indications for Sx intervention of Varicose Veins

A

Recurrent SVT CVI that cannot be controlled conservatively

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50
Q

Ligation Tx Varicose Veins

A

Usually Saphenous Slice completely open

51
Q

Ambulatory Phlebectomy Tx Varicose Veins

A

Varicosity pulled through stab incision then excised Outpatient

52
Q

Endovenous Ablation Tx Varicose Veins

A

Laser Less invasive “zap zap”

53
Q

Post Op Vein Ligation Surgery

A

Legs elevated 15 degrees Compression stockings Deep Breathe 6 P’s Assessment

54
Q

Long term goals- Varicose Veins

A

Improve circulation Relieve discomfort Improve cosmetic appearance Proper care of extremities

55
Q

Varicose Veins: Prevention

A

Avoid long periods standing/sitting Maintain ideal body wt Avoid constrictive clothing Daily walking program

56
Q

Chronic Venous Insufficiency: Pathophysiology

A

Leaking of serious fluid & RBC’s into tissue –> edema, RBC break down (hemosiderin –> discoloration (brown)); Tissue becomes fibrous

57
Q

Not Life-Threatening Can lead to venous leg ulcers

A

Chronic Venous Insufficiency (Valves)

58
Q

S/S Chronic Venous Insufficiency

A

L.T. Leg Edema Skin leathery, brownish/ brawny, Flaky, Warmer skin at ankles High Risk for Venous Leg Ulcers

59
Q

Venous Stasis Ulcers

A

Painful - above medial melleolus Irreg. Shape Ruddy Color Wet edges (extensive drainage)

60
Q

Infection risk, amputation rare Costly- chronic Debilitating and adversely affect pt’s life

A

Venous Stasis Ulcers

61
Q

Care for CVI and Ulcers

A

Compression stockings (different from teds) Moist dressings to ulcers Intake high in protein & calories Monitor/ control blood sugar Skin graft to close (pen) Antibiotics (if infected)

62
Q

Buerger’s Disease

A

Thromboangiitis Obliterans

63
Q

Thromboangiitis Obliterans

A

Constricted or obstructed arteries and veins (Hands and feet) • Young men (less than 40y) • Occurs with tobacco users • No CVD risk factors

64
Q

• Rare • No atherosclerosis • Not well understood • Related to tobacco use • Inflammatory process with clots • Leads to thrombosis and tissue ischemia • Ischemia to distal then proximal vessels

A

Thromboangiitis Obliterans

65
Q

Thromboangiitis Obliterans: Diagnosis

A

Based on age of onset Tobacco use history Exclude other diseases(DM, autoimmune, source of emboli and thrombi)  Higher Hct, blood viscosity, RBC rigidity

66
Q

Higher Hct, blood viscosity, RBC rigidity

A

Thromboangiitis Obliterans

67
Q

Thromboangiitis Obliterans: Treatment

A

Stop Tobacco! -Eliminate 2nd hand smoking NO nicotine replacement products Conservative treatment: Avoid Injury & Abx prn If severe: amputation

68
Q

Sympathectomy

A

Thromboangiitis Obliterans: Treatment Improves blood flow Reduces pain

69
Q

Raynaud’s Phenomenon

A

vasospasm small cutaneous arteries –>color changes Affects fingers, toes, ears, and nose Young women (15-40y)

70
Q

Raynaud’s Phenomenon: White

A

decreased perfusion/vasospasm

71
Q

Raynaud’s Phenomenon: blue

A

cyanosis; lack of oxygenated blood

72
Q

Raynaud’s Phenomenon: Red

A

restored perfusion

73
Q

Raynaud’s Phenomenon:Diagnosis

A

Persistent symptoms for 2ys Primary –No underlying disorder May be secondary to RA/SLE

74
Q

vasoconstrictive substances

A

Tobacco, Caffeine, cocaine

75
Q

Raynaud’s Phenomenon: Meds

A

Calcium channel blocker

76
Q

Diltiazem (Cardizem)

A

Calcium channel blocker Relaxes arteriole smooth muscles

77
Q

Most common problems affecting aorta

A

Aortic Aneurysms Aortic Dissection

78
Q

Aortic Aneurysms

A

Outpouchings/ dilations of the arterial wall men more than women Incidence ↑ with age

79
Q

Main cause of Aortic Aneurysms

A

Degenerative

80
Q

Risk Factors of Aortic Aneurysms

A

Male 65 + Tobacco CAD or PAD HTN High Cholesterol

81
Q

Thoracic aorta aneurysms

A

Ascending aorta and aortic arch Often asymptomatic; may have deep defuse chest pain

82
Q

Ascending aorta/aortic arch aneurysms

A

Angina Hoarseness Dysphagia

83
Q

If Ascending aorta/aortic arch aneurysm presses on superior vena cava

A

Decreased venous return • Distended neck veins • Edema of face and arms

84
Q

Most common location of Aortic Aneurysms

A

Abdominal aortic aneurysms (AAA)

85
Q

Abdominal aortic aneurysms (AAA)

A

Often asymptomatic Frequently detected On physical/ exam for unrelated problem (i.e., CT scan, abdominal x-ray

86
Q

• Pulsatile mass -Palpate over 5cm • Bruits • Back pain • Epigastric discomfort/altered bowel elimination • “Blue toe syndrome”

A

Aortic Aneurysms

87
Q

Aortic Aneurysms Rupture – Retroperitoneal space

A

Bleeding may be tamponaded by surrounding structures Severe pain May/may not have Grey Turner’s sign (flank bruise)

88
Q

Aortic Aneurysms Rupture Thoracic or abdominal cavity

A

Massive hemorrhage –Most do not survive long enough to get to the hospital. If survive, active resuscitation and immediate Sx

89
Q

Massive hemorrhage –Most do not survive long enough to get to the hospital

A

Aortic Aneurysms Rupture Thoracic or abdominal cavity

90
Q

Small aneurysm (<5 cm)

A

Conservative therapy used

91
Q

Conservative therapy

A

Risk factor modification ↓ blood pressure Ultrasound, MRI, CT scan monitoring annually

92
Q

Threshold for repair Aortic Aneurysms

A

5.5 cm Intervention at >5 cm in women with AAA

93
Q

mortality rate with ruptured AAAs

94
Q

Endovascular graft procedure (EVAR)

A

Placement of sutureless aortic graft into abdominal aorta inside aneurysm  Femoral artery  Dacron graft Alternative to conventional surgical repair

95
Q

Benefits Endovascular graft procedure (EVAR)

A

↓ anesthesia and operative time Smaller operative blood loss ↓ morbidity and mortality More rapid resumption of physical activity Shortened hospital stay & Quicker recovery Higher patient satisfaction Reduction in overall costs

96
Q

Endoleak

A

Most common complication of EVAR Blood leaks back into aneurysm

97
Q

Aortic Dissection

A

Not a type of aneurysm men more than women 60-70 Classified by location and duration of onset

98
Q

Aortic Dissection: Risk Factors

A

• Age • Male • Trauma • Cocaine • Cardiac surgery • Atherosclerosis • HTN

99
Q

Due to degen of the elastic fibers in the medial layer –>Tear in intimal lining allows blood to “track” between intima and media –>heart contracts, systolic pulsation ↑ pressure on damaged area –>Further ↑ dissection May occlude major branches of aorta–>Cutting off supply to organs

A

Aortic Dissection

100
Q

Pain described as: “worst ever” “Tearing” “Ripping”“sharp”

A

Aortic Dissection

101
Q

Aortic Dissection-Ascending aorta –>

A

Cardiovascular defects

102
Q

Aortic Dissection-Aortic arch involvement –>

A

neuro defects

103
Q

Aortic Dissection: Complications

A

Cardiac tamponade Rupture Occlusion of blood supply to vital organs

104
Q

Cardiac tamponade

A

Blood into pericardial sac Hypotension, narrowed pulse pressure, JVD, muffled heart sounds, pulsus paradoxus

105
Q

Aortic Dissection: Initial goal—Conservative Treatment

A

↓ BP and myocardial contractility to diminish pulsatile forces within aorta

106
Q

Emergency surgery for

A

acute ascending aortic dissection

107
Q

Standard to treat acute descending aortic dissections with complications

A

Endovascular dissection repair

108
Q

Aortic Dissection: Nursing Care

A

Control BP Bedrest—Semi-fowler’s position Pain relief Assess: VS, PP, LOC, Pain level

109
Q

6 P’s

A

Pain, Pallor, Pulses, Parathesia, Paralysis, Poikilothermia

110
Q

Intermittent Claudication (Venous or Arterial)

111
Q

Homan’s Sign (Venous or Arterial)

A

Venous Bend knee, dorsiflex toes –> pain in shin +May indicate blood clot Do NOT do w/ known DVT

112
Q

Cool to sudden coldness (Venous or Arterial)

A

Arterial Warm= Venous

113
Q

Elevation Pallor (Venous or Arterial)

A

Arterial Pale when above heart, rubber when dropped below heart

114
Q

Brown Discoloration (Venous or Arterial)

115
Q

Decreased sensation, Pins & Needles (Venous or Arterial) Think sitting on feet

116
Q

Paralysis (Venous vs Arterial)

A

Venous- not a normal problem Arterial- if ischemia

117
Q

Absent of hair (Venous or Arterial)

118
Q

Thick, Brittle Nails (Venous or Arterial)

119
Q

Shiny, taut skin (Venous or Arterial)

120
Q

Ulcers are symmetrical/ circular

121
Q

Trash Foot Blue Toe (Venous or Arterial)

122
Q

Wet and weepy ulcers Often painful (Venous or Arterial)

123
Q

Rest pain, pain at night (Venous or Arterial)

N102 (13 decks)

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