Exam 2 Flashcards
What is a True aneurysm
True Aneurysm : involves the entire vessel wall
What is a false aneurysm
False Aneurysm : is formed when blood leaks outside of the artery but is contained by the surrounding tissues
What are some primary structures of PVA?
Primary structures of PVA: arteries, veins, capillaries
What are some risk factors that cannot be changed?
Risk factors that cannot be changed include the following:
Age: over 45
History of heart disease
Diabetes mellitus (type 1 diabetes)
Gender: Male
Postmenopausal women
Family history of dyslipidemia, hypertension, or PV disease
Risk factors that may be changed or treated include?
Risk factors that may be changed or treated include:
- Coronary artery disease
- Impaired glucose tolerance
- Dyslipidemia
- Hypertension
- Obesity
- Physical inactivity
- Smoking or use of tobacco products
(Diet modification, exercise ( 30 min a day),
Impaired glucose tolerance: prediabetic- watch sugars
Dyslipidemia: exercise, lower sat fats)
Symptoms of PVD?
Changes in the skin:
-Hair loss on the legs, Thickened, opaque toenails
-Reddish-blue discoloration of the extremities
-Pallor (paleness) when the legs are elevated
-Diminished pulses in the legs and the feet
-Non-healing wounds over pressure points
-Gangrene
-Numbness, weakness, or heaviness in muscles, Restricted mobility
Pain
-Impotence
(Look at hair on big toe: hair needs good blood flow to survive, if they have hair they are getting good arterial flow
If you cant feel pulses get a doppler: gently press on doppler until the edema allows you to get to the pulse
Heaviness, dull aching is venous but sharp rapid onset is typically arterial
Viagra, after 4 hours blood is clotted
Health history for PVA
Current medications OTC supplements, Caffeine Smoking, Alcohol, Illicit agents Surgeries/Procedures Syncopal episodes, palpitations Swelling (edema) Pain, Parasthesias ( numbness)
PVS assessment : Inspection
PMS CAUSES TENSION
P-Pulses. feel the most distal pulse possible on the assigned limbs BILATERALLY, this is a comparative assessment!.
M- Mobility is assessed by simply asking a person to move the limb or observing spontaneous movement.
S-Sensation. Elicit patient response to touch of the distal part of the extremity.
C-Color OR Capillary refill to assess perfusion. Look for pallor, cyanosis, pinkness etc.
T-Temperature can be assessed when sensation is being tested
Distal to central when checking sensation
PVS : Edema
*around the eye its periorbital edema
In the eye is scleral edema
*anasarca is edema all over the body
Techniques to assess arterial problems
Additional techniques to assess arterial problems
Angiography: arterial
Doppler: check for flow, pulses, listen for venous
Ankle brachial index: ON test, get familiar !!!!
Ankle brachial index
This test is done by measuring blood pressure at the ankle and in the arm while a person is at rest. Some people also do an exercise test. In this case, the blood pressure measurements are repeated at both sites after a few minutes of walking on a treadmill.
The ankle-brachial index (ABI) result is used to predict the severity of peripheral arterial disease (PAD). A slight drop in your ABI with exercise means that you probably have PAD. This drop may be important, because PAD can be linked to a higher risk of heart attack or stroke.
Why It Is Done
This test is done to check for peripheral arterial disease of the legs. It is also used to see how well a treatment is working (such as medical treatment, an exercise program, angioplasty, or surgery).
This test might be done to check your risk of heart attack and stroke. The results can help you and your doctor make decisions about how to lower your risk.1
Results
The ABI result can help diagnose peripheral arterial disease (PAD). A lower ABI means you might have PAD. A slight drop in the ABI with exercise, even if you have a normal ABI at rest, means that you probably have PAD.
Normal
A normal resting ankle-brachial index is 1.0 to 1.4. This means that your blood pressure at your ankle is the same or greater than the pressure at your arm, and suggests that you do not have significant narrowing or blockage of blood flow.2
Abnormal
Abnormal values for the resting ankle-brachial index are 0.9 or lower and 1.40 or higher. If the ABI is 0.91 to 1.00, it is considered borderline abnormal.2
Abnormal values might mean you have a higher chance of having narrowed arteries in other parts of your body. This can increase your risk of a heart attack or stroke
Deep vein thrombosis and emboli
Thrombus formation obstructs blood flow.
May occur anywhere in the body.
Thrombus on the move is called an embolus
Homans sign is no longer best practice: could release clot, also gave a lot of false positive and negatives
Plantar felxion would causes pain in calf if they have a clot
Redness, warmth at site for calf
True or false
DVT: venous so pain comes on more slowly
True
What are Varicose veins?
- Varicose veins are irregular, tortuous veins with incompetent valves
- People who stand a lot are prone to get VV: surg techs, OR nurses
-Use teds socks, elevate feet when sitting
Virchow’s Triad
Three factors leading to thrombosis: stasis, hypercoagulability and intimal change.
Virchow’s triad trio of elements essential to thrombosis; i.e. blood stasis (secondary to immobility, congestive heart failure, vein compressions), alteration to a vein wall (secondary to previous thrombosis, vein inflammation/infection, direct vein wall trauma, varicose veins) and blood hypercoagulability (e.g. antiphospholipid syndrome, hyperhomocysteinaemia, lower-limb surgery/trauma, childbirth, polycythaemia, neoplastic disease, oral contraceptives); thrombosis requires a minimum of two of the three elements
Types of arterial Occlusion
Chronic limb: mummified toes (get to parasteia then really sharp pain)
Critical limb: mottled hand, purple fingers
The 5 P”s of arterial occlusion
Pain Pallor Pulselessness Parasthesia Paralysis Additionally: Poikilothermia may be present
Medication management for PVD
ANTICOAGULANTS
Vitamin K Antagonists Unfractionated Heparin Low Molecular Weight Heparin Direct Thrombin Inhibitors Factor Xa Inhibitor Thrombolytic Therapy Lab Tests of Blood Coagulation INR aPTT ACT PT
Hypertension
Hypertension (HTN) is defined as: Persistent SBP >/= 140 mm Hg
DBP >/= 90 mm Hg
Currently on antihypertensive agent
What is DASH?
DASH: dietary approach to stop hypertension
Collaborative management for PVD
- DASH eating plan
- Dietary Na Reduction
- Moderation of Alcohol Intake
- Physical Activity
- Tobacco Avoidance
- Stress Management
Nursing diagnosis for hypertension
Common Nursing Diagnoses:
Ineffective Health Maintenance
Anxiety related to complexity of management regimen
Sexual dysfunction related to side effects of antihypertensive medications
Ineffective therapeutic management related to ______________
Disturbed body image related to _________________
Where do aneurysm develop?
Where do aneurysm develop: aorta, femoral, circle of willis in brain, iliac, popliteal
90% of people with popliteal will have one on the other side
What is a pseudo aneurysm ?
A pseudoaneurysm, (false aneurysm) is an enlargement of only the outer layer of the blood vessel wall. A false aneurysm may be the result of a prior surgery or trauma
True or false
Aneurysms occur most frequently in men ages 40 and 70 yrs
True, Aneurysms occur most frequently in men ages 40 and 70 yrs
True or false
About one third of patients with thoracic aortic aneurysms die of rupture of the aneurysm
True, About one third of patients with thoracic aortic aneurysms die of rupture of the aneurysm
Aneurysms are more likely to occur with..
Smoking Chronic obstructive pulmonary disease Hyperlipidemia Poorly controlled diabetes Connective tissue disorders : Marfan’s syndrome Mycotic aneurysms (pus inside)
Abdominal aortic aneurysm
Wanna know if its suprarenal, infrarenal
Renalscontrol flow to kidneys, patient could have reduced urine output
If someone has an aneurysm what would you do different in your exam: palpate really gently, listen to it you will hear turbulent blood flow
If you fix someone’s aneurysm: you could do an endovascular surgery which involves a stent
Know whether they cross clamp above renal arteries: their could be kidney damage because of the lack of flow
Post op assessment: urine output, watch labs values hemoglobin hematocrit, incision site for bleeding, perfusion/confusion, when you open an aneurysm theres a lot of debris like fibrin which can cause clots
Put graft in sew aorta back around it
Document and mark on patients feet where pulses were before surgery so you know where they are
Thoraco-Abdominal Aortic Aneurysms
Wont get blood to brain
What is between aorta and ventricles: what connects heart and the arch: a valve
If arch ahs aneurysm and its growing then it affects the valve connecting and you have to replace both: that’s called a composite graft
When can aneurysms rupture?
*A lot of them can rupture with valsalva maneuver, and when surgeon opens peritoneal cavity which changes pressure and could cause aneurysm to rupture (hemodynamic monitoring)
MI can happen at the induction of surgery
Describe aneurysm repair
Surgical repair consists of replacing the aneurysmal portion of the abdominal aorta with a synthetic graft. If the iliac arteries are involved, the graft must be extended to include them. If the aneurysm extends above the renal arteries, the renal arteries must be reimplanted into the graft, or bypass grafts must be created.
Placement of an endovascular stent-graft within the aneurysmal lumen via the femoral artery is a less invasive alternative and is indicated when risk of perioperative complications is high. This procedure excludes the aneurysm from systemic blood flow and reduces risk of rupture. The aneurysm eventually thromboses, and 50% of aneurysms decrease in diameter. Short-term results are good, but long-term results are unknown. Complications include angulation, kinking, thrombosis, migration of the stent-graft, and endoleak (persistent flow of blood into the aneurysm sac after endovascular stent-graft placement). Thus, follow-ups must be more frequent after endovascular stent-graft placement than after a traditional repair.
* Stenting procedure
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