Exam 2, Week 5: Vascular Disorders Flashcards

1
Q

Arterial Embolisms and Arterial Thrombosis are arterial clots. An Arterial Embolism and Arterial thrombosis can lead to what life-threatening conditions?

A

Arterial Thrombosis and Embolisms can both develop in, and travel to:

-The Brain and cause a stroke.
-The Heart and cause an MI.
-The Lungs and cause a Pulmonary Embolism (PE)
-Remain static in the arteries and cause DVT- Deep Vein Thrombosis

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2
Q

Treatment for Thrombosis and Embolisms depend on the symptoms.

IF a patient is presenting with Arterial Thrombosis manifesting as a peripheral edema, what would be a drug option to give them to allow blood to bypass the clot?

How would you measure the right amount for dosage?

What should be done if the patient develops Thrombocytopenia due to the drug?

A

Heparin would be best.

You would measure out the dosage based on the patient’s weight.

IF the patient develops thrombocytopenia, which is a decrease in thrombocyte levels, you will STOP the Heparin administration immediately.

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3
Q

A Patient is presenting with a sudden onset shortness of breath and Angina. The nurse recognizes this as a possible PE event. What are the nurses next 3 steps?

A

-Supply O2
-Place the HOB up
-Call Rapid Response

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4
Q

A patient is experiencing a PE.

What are the 2 main anticoagulants that would be used to treat this patient?

Besides anticoagulants, what is the other drug class that would be used?

If the patient survives the PE, what would they be placed on (drug wise)?

A

The two main anticoagulants are Heparin and Warfarin (Coumadin)

The other class of drug is a “Clot-buster”,aka “Thrombolytic”

If the patient survives the PE, they would be put on blood thinners

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5
Q

What would a nurse push for in a patient to help them avoid a PE?

ex: What would they encourage the patient to take or do?

A

A nurse should push for the patient to:

-Maintain a good fluid intake
-Use blood-thinners (Anticoagulants)
-Engage in exercise to promote good blood flow

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6
Q

Buerger’s disease, or as I remember it: “Black Buerger’s” or “Black Finger Buerger’s” is (you guessed it) a blackening of the fingertips.

Buerger’s disease causes Fibrosis, and the scaring of vessels and nerves in the fingertips. How does the scaring of blood vessels and nerves (through Fibrosis) lead to the blackening of the fingertips?

How can this disease be treated in a patient? Can it be reversed?

A

The blackening of the fingertips is caused by the lack of blood flow to the fingertips due to the arterial scaring and Fibrosis buildup. This lack of blood flow eventually causes necrosis of tissues.

The only real treatment is amputation. It is not reversable, but circulation can POSSIBLY return, but only through one way: Stop smoking.

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7
Q

Raynaud’s disease is “White Fingers”, meaning that your hands lose blood flow to the fingers due to intermittent arterial vasoconstriction.

What would be a way to treat Raynaud’s disease?

What is the nurses role in education on Reynaud’s disease?

A

Raynaud’s disease is often treated by simply warming the hands up.

The nurse’s role in education is to educate the patient on Raynaud’s possible triggers. Mainly cold temperatures.

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8
Q

An Aneurism is the abnormal dilation of a blood vessel. An aortic aneurism is an abnormal dilation or a ballooning (sack) at a weak point in an artery. They are named based on their location.

Fusiform and Saccular are the most common Aortic Aneurisms. Followed by Mycotic. It is caused by atherosclerosis in the aorta. Marfan Syndrome is a condition that has a great risk for Aortic aneurisms.

What president do you think of when you think of someone having Marfan Syndrome? What does their appearance tell you about Marfan Syndrome? How does this affect aortic aneurism formation?

A

Abraham Lincoln is a good example of Marfan Syndrome:
-Tall
-Lanky
-Long Fingers
-Long Chin

Marfan Syndrome is associated with a weak heart, because of abnormal lengths the heart has to pump blood out to, combined with weak Connective tissue that comes with Marfan syndrome.

Aortic Aneurisms occur in Marfan Syndrome due to the Aorta experiencing greater stress pumping out blood to meet O2 needs, causing the aneurism in the Aorta.

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9
Q

For an Aneurism, imagine a large ballooning cyst on the wall of a blood vessel. Now that you have that in your head, what are some symptoms you would associate with an aneurism, and what noise might you hear if you were to auscultate it?

Think: What sensations would a patient feel if there is a large ballooning in the arterial wall? What would this do to their HR and Bp?

A

Aneurisms can cause Pain at the site of ballooning, as well as dizziness, nausea, and vomiting from the lack of quality blood flow.

You might be able to hear a bruit from the exertion of arteries to push past the blockage/ballooning, causing a “whooshing” sound like a river.

The aneurism would cause tachycardia (elevated heart rate) to exert more blood, but the cystic ballooning would counteract the increased heart rate, lowering blood pressure, and INCREASING further blockage/ballooning.

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10
Q

Should you ever palpate the site of a bruit? Why or why not?

A

No, NEVER palpate a bruit.

A bruit can mean an Aneurism or a general arterial clot. You may dislodge the clot and cause an MI, stroke, or PE. You could also rupture the aneurism and cause internal hemorrhaging and a stroke.

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11
Q

The most frequent complication of an AAA (Abdominal Aortic Aneurism) is a rupture. What sudden onset symptom would be seen during a rupture of an AAA?

A

Sudden, acute abdominal or lower back pain in a patient with an AAA.

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12
Q

There are 2 factors involved with assessing how to treat an aneurism, Aortic aneurism, and an AAA (as well as ruptures). What are these 2 factors that must be assessed in order to treat an aneurism?

Can you treat an Aneurism systemically?

A

Treatment depends on the location and the severity of the aneurism. So its treatment is specific.

You can’t really directly treat an aneurism systemically. You can manage risk-factors like smoking, exercise, blood-thinner medications, and even the use of a stint to lower the risk of an aneurism rupturing.

But these do not address the aneurism itself. The only real treatment of an aneurism is excision via surgery, not systemic treatment.

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13
Q

What would the nurse’s role be in the treatment of an aneurism like an aortic or AAA?

What would the nurse be looking/inspecting for?

Say a patient undergoes surgery. What would the nurse be monitoring?

A

A nurse would be inspecting for signs of swelling/edema, bruising, a bruit, and signs of heart failure (HF).

A nurse would also be looking for signs of an aneurism rupturing, like sudden onset pain in the afflicted area.

In a post-surgery situation, a nurse would monitor kidney function, their heart status, Bp, hemorrhaging, and signs of infection.

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13
Q

Something more common than an Aortic aneurism is an Aortic Dissection. An Aortic Dissection is a catastrophic event that is caused by poorly controlled “X”.

In addition to poorly controlled “X”, it can also be caused by “Y” and “Z” use.

A

An Aortic Dissection is a catastrophic event caused by poorly controlled Hypertension.

In addition, it can also be caused by trauma, and cocaine use.

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14
Q

The catastrophic event in the aorta known as Aortic Dissection is a tear in the aortic wall, specifically in the inner layer that eventually tears the other layers.

What is the nurse’s role in treatment for an Aortic Dissection?

What symptoms would you expect to see in a patient experiencing Aortic Dissection? Are they dizzy? What’s their bp? Hr? Pain? What could a patient tell you that would suggest an Aortic Dissection?

A

The nurse’s role in treatment is the same for an aneurism.

Symptoms are similar to a ruptured aneurism:
-Nausea or vomiting
-“I have a tearing pain in my chest!”
-Sudden onset acute pain in the chest
-Tachycardia
-Rapid Hypotension, not hypertension, because the aortic wall is dissected so blood cannot adequately flow and put pressure on the arterial walls.
-Absent or decreased pulses

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15
Q

Where does a DVT/Venous Thromboembolism MOST OFTEN occur?

a.) Aorta
b.) Arterioles
c.) Pericardium
d.) Legs
e.) Arms

A

DVT most often occurs in the legs.

16
Q

The most common cause(s) for DVT is known as the “Virchow’s Triad. The Virchow’s Triad is a medical term that describes three factors that come together to form a DVT.

1st is Venous stasis. What does Venous stasis mean?

2nd is damage to the Endothelium. What might “damage to the endothelium” manifest as?

3rd is “hypercoagulability”. Looking at the word, what might “Hypercoagulability” mean in a patient?

A

Virchow’s Triad:

1st: Venous stasis means blood flow that is static and unmoving. Basically, it’s blood pooling in an area, like the legs, from inactivity or poor circulation.

2nd: Damage to the endothelium means skin damage, so this can manifest as trauma like fractures or broken bones that bring inflammation into the walls of the vein

3rd: Hypercoagulability refers to the ability of a patient’s blood to “coagulate”, or, a person’s ability to form a blood clot. In “hypercoagulability”, a person clots too easily.

17
Q

What does Virchow’s Triad refer to, and what are the 3 factors that make up the triad?

A

Virchow’s triad refers to the 3 factors that occur to cause a DVT/Venous Thromboembolism.

The 3 factors of the triad are:

1.) Venous stasis: Blood pooling
2.) Trauma to the endothelium
3.) Hypercoagulability

18
Q

How might a nurse help to manage DVT, considering the Virchow’s Triad?

A

-Encourage exercise to facilitate blood flow and fight blood pooling
-Take blood thinning medication like Heparin or warfarin (Coumadin) to counteract their hypercoagulability
-Assess/Inspect the damaged tissues for an edema/swelling, inflammation, infection, fracture, etc.

19
Q

A patient presents with a DVT in their left leg. What would be the nurse’s role be in the daily assessment of a patient’s leg that is affected by DVT?

Think: What would you want to know about the affected leg every shift? Would you use any tools?

What would you provide/do for the patient with a DVT? (Besides medicine)

A

-MEasure the circumference of the affected leg of the patient with a tape measure every shift.

-Assess the color (Is it pallor? Ruber? Inflamed?)
-Assess the temperature (Is it Poikilothermic?)
-Is there Pain?

Tools:
-Tape measure
-Compression hoes

Provide/Do for:
-Education on preventative measures
-Pump the feet/Elevate the legs to promote Venous circulation
-Ambulate (If possible)
-Provide hydration to loosen the thickness of the blood.

20
Q

Heparin dosage amount takes into account the “X” of the patient.

After checking their weight, what should you assess for in the patient before administering a Heparin dose?

After assessing that, what is the next assessment?

Before the administration of Heparin, you should check the PLT levels of the patient. What should healthy PLT levels be at?

A

Heparin dosage amount takes into account the “weight” of the patient.

You should always check a patients PT/INR before the administration of an anticoagulant.

After PT/INR is checked, check the patients PTT.

PLT (Platelet) levels should be between 150K-450K.

21
Q

Varicose veins are abnormally “blank” and incompetent veins. They are “blank” colored, because they are veins and not arteries, and they look like cracks and ribbons along someone’s leg.

A

Varicose veins are abnormally “dilated” and incompetent veins.

They are “blue” in color and look like cracks and ribbons along someone’s leg.

22
Q

“Characterized by cramps, ankle edemas, and vein protrusion. Common in people who stand for several hours at a time for their work.”

This describes which affliction?

a.) DVT
b.) Venous Thromboembolism
c.) Cortical Arteries
d.) Varicose veins

A

d.) Varicose veins are characterized by cramps, ankle edemas and protrusion of the veins. They appear as blue, protruding, crack-like and ribbon-like veins stretching up or across someone’s leg.

Common in people whose work has them standing for hours.

23
Q

Considering that Varicose veins are a “Venous” issue, and not an arterial issue, how would you position a patient’s legs if improve venous circulation?

A

You would position the legs “above the heart” to promote venous return to the heart, because it is a venous issue.

24
Q

Would the treatment of ambulation and negating bed rest be indicated or contraindicated in a patient with Varicose veins?

What would be a good nursing goal for Sclerotherapy of a patient experiencing Varicose veins?

A

Ambulation and neglecting bed rest would be INDICATED in a patient with Varicose veins. You want to encourage blood circulation and avoid stasis.

Looking at the word: “Sclerotherapy” is seeing that Sclero is Sclerosis, aka hardening/Thickening. And Therapy is…well, therapy. So what would be good anti hardening therapy for the veins?

Well, since ambulation is encouraged for Varicose veins, a good nursing goal may be to walk 1-2 miles a day to encourage circulation, as well as the wearing of compression socks.

25
Q

In Leg ulcers, they are classified by location. There are Venous and Arterial ulcers and they occur either below the ankle, or above the ankle.

Which happens below the ankle? Which one happens above the ankle?

A

Arterial ulcers happen below the ankle and are smaller.
-Toes
-Heels
-Over Malleoli (those little bone bumps on the sides of your feet)

Venous ulcers happen at or above the ankle and are larger.

26
Q

Treatment for leg ulcers may include debridement of an open wound, and the use of a wound vac. What would a wound vac be used for?

A

To use negative pressure (negative is suction) to pull drainage out of the wound.

27
Q

If you see someone with a bug bite or any version of cellulitis, and they start to develop a “red streak”, that is a problem. Why is this a problem?

A

The localized infection is now becoming systemic and has entered the lymph system. The Lymph system is connected to the circulatory system, which is connected to all the other organs.

28
Q

A bacterial infection in the subcutaneous tissue that is typically localized, but can become a systemic infection, is known as what?

A

Cellulitis

29
Q

What simple method would you use on an expected cellulitis infection to see if the infection gets any worse in the coming days?

A

Draw a circle around the infection area to see if it gets any bigger

30
Q

What is the most common bacterial reason for cellulitis?

A

Streptococcus infection in the subcutaneous tissue.