Exam 2, Week 5: Vascular Disorders Flashcards
Arterial Embolisms and Arterial Thrombosis are arterial clots. An Arterial Embolism and Arterial thrombosis can lead to what life-threatening conditions?
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
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?
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.
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?
-Supply O2
-Place the HOB up
-Call Rapid Response
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)?
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
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 nurse should push for the patient to:
-Maintain a good fluid intake
-Use blood-thinners (Anticoagulants)
-Engage in exercise to promote good blood flow
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?
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.
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?
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.
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?
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.
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?
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.
Should you ever palpate the site of a bruit? Why or why not?
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.
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?
Sudden, acute abdominal or lower back pain in a patient with an AAA.
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?
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.
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 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.
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.
An Aortic Dissection is a catastrophic event caused by poorly controlled Hypertension.
In addition, it can also be caused by trauma, and cocaine use.
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?
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
