Exam 2 - Peripheral Arterial Disease and DVT

Question 1

Diagnostic testing for peripheral arterial disease

Answer 1

CW Doppler and duplex ultrasonography with color - looks at blood flow
ABIs
Treadmill testing for claudication

Question 2

Manifestations of peripheral arterial disease

Answer 2

Sensation of coldness or numbness in extremities
Pale, cool extremity when elevated
Ruddy, cyanotic extremity when dependent
Shiny, thick, taut skin
Redness of foot when dependent (rubor) - usually one leg, if elevated it goes white
Bruits could be auscultated with stethoscope
Nail changes, ulcerations, gangrene, and/or muscle atrophy may be evident
Peripheral pulses may be diminished or absent

Question 3

What is a manifestation of PAD that has to do with pulses?

Answer 3

Unequal pulses between extremities or the absence of a normally palpable pulse is a sign of PAD

Question 4

Post-surgical nursing care for pt with PAD

Answer 4

Manage pain
Close monitoring of fluid intake
Maintain adequate resp function
Assess surgical dressing frequently
Monitor for bleeding
Assess GI function, for infection, and CTMPS carefully and consistently
Avoid knee flexion
Promote graft patency and early activity

Question 5

What is pentoxifylline (Trental) used for in PAD

Answer 5

treatment of symptomatic claudication

Question 6

What is the expected action of Trental?

Answer 6

Blood viscosity reducing agent - if blood is thinner, could flow to leg that has decreased blood flow easier

Question 7

Assessment for Trental and Pletal

Answer 7

Look for improvement of claudication

Question 8

Teaching for Trental and Pletal

Answer 8

Don’t smoke!

Question 9

What drug performs better than Trental?

Answer 9

Cilostazol (Pletal)

Question 10

How does Pletal work?

Answer 10

Antiplatelet that inhibits platelet aggregation and causes vasodilation

Question 11

Risk factors for DVT

Answer 11

Immobility
Smoking
Obesity
Surgery
Birth control pills

Question 12

What kind of medications are used to treat DVT?

Answer 12

Anticoagulants

Question 13

What is the action of warfarin (Coumadin)

Answer 13

Prevent thromboembolytic events - interferes with liver synthesized Vitamin K clotting factors

Question 14

Side effects of warfarin (Coumadin)

Answer 14

Cramps, nausea, bleeding

Question 15

Nursing management of warfarin (Coumadin)

Answer 15

Monitor for bleeding in all systems - GI, integumentary, genitourinary, etc.

Question 16

Teaching for warfarin (Coumadin)

Answer 16

Teach importance of INR lab draws
Avoid foods high in Vitamin K (leafy green veggies, asparagus, broccoli, brussel sprouts, cabbage, cauliflower, spinach, green tea, milk, and yogurt)

Question 17

Action of heparin

Answer 17

Neutralizes thrombin by preventing conversion of fibrinogen to fibrin

Question 18

Side effects of heparin

Answer 18

Bleeding, anemia, heparin induced thrombocytopenia (HIT)

Question 19

Why should you monitor platelets closely with pts taking heparin?

Answer 19

Because of heparin induced thrombocytopenia!

Question 20

What lab value should cause concern in pts taking heparin?

Answer 20

30% drop from baseline in platelets

Question 21

Nursing considerations for pts taking heprain

Answer 21

Assess for signs of bleeding, monitor aPTT and platelets

Teach pt to report bleeding

Question 22

Action of enoxaparin (Lovenox)

Answer 22

Used as prophylaxis for blood clots

Question 23

Side effects of enoxaparin (Lovenox)

Answer 23

bruising, bleeding

Question 24

Where is Lovenox given?

Answer 24

Love handles subq

Question 25

What should you do if platelets are low when a pt is getting Lovenox?

Answer 25

Hold Lovenox and call the healthcare provider

Question 26

Teaching for pts taking Lovenox

Answer 26

Report unusual bleeding - explain that this means bleeding gums when brushing teeth, coffee ground emesis, nosebleed, hematuria

Question 27

Teaching for pts with DVT

Answer 27

Elevate extremity periodically to help with venous blood drainage
Apply warm, moist packs to affected extremity

Question 28

Nursing considerations & interventions for pts with DVT

Answer 28

Make sure you know what level of pressure the healthcare provider wants with graduated compression stockings
Give analgesic agents
Walk pt as soon as anticoagulation therapy started - goal is to walk 10 min q1-2 hours
Bed exercises - repetitive dorsiflexion of foot