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Semester Two - Nursing 112 > Impaired Peripheral Circulation Complimentary Alternative Treatment > Flashcards

Impaired Peripheral Circulation Complimentary Alternative Treatment Flashcards

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1
Q

What is peripheral arterial disease?

A

occurs when plaque builds up in the arteries causing them to harden and narrow, which is known as athersclerosis

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2
Q

Signs and symptoms of PAD

A

pain or cramping in the legs after walking

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3
Q

Claudication

A

pain or cramping in the legs after walking. occurs because the leg muscles do not receive adequate O2 and nutrients

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4
Q

Risk factors PAD

A
  • smoking
  • diabetes
  • high cholesterol
  • hypertension
  • heredity
  • age
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5
Q

How is PAD diagnosed?

A
  • pulses in leg
  • ankle-brachial index
  • color duplex scan
  • arteriogram
  • CT scan
  • MRA
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6
Q

Treatment for PAD

A
  • reduce risk factors
  • exercise
  • medication
  • angioplasty with or without stenting
  • endarterectomy
  • lower limb bypass surgery
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7
Q

Angioplasty with or without stenting

A

a catheter with a balloon is inserted into the femoral artery and inflated to dilate the artery. a stent may be placed to keep the artery open

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8
Q

What are the overall goals for the patient with lower extremity PAD?

A
  • adequate tissue perfusion
  • relief of pain
  • increased exercise tolerance
  • intact, healthy skin on extremities
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9
Q

What post-operative assessments are of highest priority for PAD treatment?

A
  • ABCs: Assess vital signs closely and frequently
  • CMS including the 6 P’s
  • Observe extremity closely and very frequently (every 15 minutes initally, then hourly)
  • Notify surgeon immediately with any changes
  • Assess for S/S of infection
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10
Q

What discharge teaching is important after treatment (surgery) of PAD?

A
  • examine feet daily
  • report worsening symptoms to healthcare providor
  • NEVER walk barefoot
  • well fitting shoes
  • quit smoking
  • regular exercise
  • low fat, low cholesterol, high fiber diet
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11
Q

What is the most common cause of PAD?

A

atherosclerosis, which is a narrowing of a blood vessel lumen which interferes with the normal flow of blood, oxygen and nutrients to the tissue

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12
Q

Atherosclerosis is

A
  • leading cause of critical limb ischemia
  • primarily affects the larger arteries
  • gradual narrowing of the vessel lining due to the deposit of cholesterol and lipids
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13
Q

Arteriosclerosis is

A
  • Arterial disorder
  • Characterized by thickening, loss of elasticity, and calcification of arterial walls which results in decrease blood supply to tissues
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14
Q

Modifiable risk factors PAD

A
  • oral contraceptives
  • lifestyle
  • stress
  • type 2 diabetes
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15
Q

6 P’s

A
  1. Pain(monitor pain with exercise, at night, or with rest)
  2. Pallor (monitor color)
  3. Paralysis (monitor mobility)
  4. Pulses (check peripheral pulses - PT, DP)
  5. Paresthesia (monitor sensation)
  6. Poikilothermia (monitor temperature of extemity)
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16
Q

Assessment of peripheral arterial disease with critical limb ischemia

A
  • Diminished/Absent Pulse
  • No Edema
  • Hair loss on legs
  • Ulcers present body prominences and pressure points, round margins with minimal drainage
  • Pain: intermittent claudication
  • Thick, brittle nails
  • Thin, shiny, dry, friable skin
  • Cool Skin
  • Numbness, tingling of toes, feet d/t nerve ischemia
17
Q

Conservative Management of PAD

A
  • Slow progression of atherosclerosis thorough modification of risk factors (smoking cessation, slow progressive activity to improve oxygen extraction in the legs, tight glucose control in diabetics, control of BP, treatment of hyperlipidemia)
  • antiplatelet agents (ASA, plavix)
  • Angiotension-converting enzyme (ACE) inhibitors
18
Q

Ankle-Brachual Index (ABI)

A
  • Evalutes the adequacy of circulation to the legs. Measures the BP of the ankle compared to the BP of the arm. The ratio between the two is the ABI
  • Non-invasive
19
Q

Duplex Ultrasound

A
  • Combination of US imaging and doppler capabilities to map blood flow through the entire region of artery. also used to determine location and extent of thrombus within veins
  • Non-invasive
  • Can be painful when US probe is pressed on a diseased leg or on an incision
  • Patient will be either transported to the radiology or vascular department or a portable unit will be brought to the bedside
  • offer to clean site of excess gel
20
Q

Arteriogram (Arteriography)

A
  • Injection of radiopaque dye into arteries: serial x-rays then taken to detect atherosclerotic plaques, occulsion, aneurysms or traumatic injury
  • Invasive procedure
  • Review allergies - looking for previous reactions to contrast dye, seafood, or iodine
  • explain that they may feel a warm feeling when dye is injected
  • occasionally a sedative is prescribed
  • instruct patient to stop anticoagulants, ASA, plavix per MD orders
  • Signed consent present
  • Assess VS (RISK FOR BLEEDING)
  • Will need to lay flat (no bending of leg) for a speicifc period of time 4-12 hours
  • Assess puncture site for bleeding/hemmorhage, pulsation, swlling, or hematoma formation
  • Assess CMS distal to the puncture site including neurovascular assessment using 6 Ps
  • Observe for adverse reaction to the contrast dye
  • IV or PO hydration
21
Q

What is critical limb ischemia?

A

Chronic critical limb ischemia is manifested by pain at rest, nonhealing wounds and gangrene. Ischemic rest pain is typically described as a burning pain in the arch or distal foot that occurs while the patient is recumbent but is relieved when the patient returns to a position in which the feet are dependent.

22
Q

Surgical therapy for critical limb ischemia

A
  • Peripheral arterial bypass sugery utilizing either an autogenous saphenous vein graft made of PTFE or dacron
    • Common bypass grafts include: femoral-popiteal (around occluded superficial popliteal) and femoral posterior-tibial (around occluded superficial femoral, popliteal, and proximal tibial arteries)
    • Endarectomy (removing plaque)
    • Amputation
    • Angioplasty with or without stent
23
Q

Interventions for a client with acute arterial ischemia

A
  • anticoagulation
  • surgical
  • ampuation
  • removal of emboli
24
Q

What is an aneurysm?

A

a bulge that can develop on any blood vessel. it is a weak spot or thinning in the artery wall

25
Q

What is the risk of an aneurysm?

A

it may burst. a client would experience severe abdominal pain and hypotension

26
Q

How is an aneurysm found?

A

usually by chance. ultrasound or xray of the abdomen for other reasons. ct scans and angiography of aorta as well

27
Q

What is the aneurysm replaced with?

A

a fabric prosthetic graft

28
Q

What are risk factors for aortic aneurysm?

A
  • male
  • smoking
  • atherosclerosis
  • genetic factor
29
Q

When is surgery recommended for patients with aneurysms?

A

with aneurysms bigger than 5.5cm in diameter and aneurysms that rapidly increase in size

30
Q

What are the two approaches to surgery for aortic aneurysm?

A
  1. Traditional (open) Repair
    1. involves an incision in the abdomen which allows the diseased vessel to be replaced with a graft made of a synthetic material
  2. Endovascular repair
    1. placing the grafts using catheters that are inserted through the femoral arteries in the groin. this approach avoids a large abdominal incision and allows for a more rapid recovery (not all patients are candidates)
31
Q

Nursing Diagnoses and Nursing Considerations for AAA

A
  1. Risk for Infection
    1. monitor for infection
    2. take antibiotics as prescriped
    3. nutritional intake to support healing
    4. prophylactic antibiotics before future invasive procedures, including dental work
  2. Ineffective peripheral tissue perfusion
    1. Perform comprehensive appraisal of peripheral circulation
    2. provide warmth
    3. encourage patent to exercise 30-60 minutes a day
    4. instruct patient on factors that interefere with circulation
    5. proper foot care
  3. Risk for ineffective renal perfusion r/t vascular embolism
    1. maintain normal BUN and CR levels
    2. 30ml/hr urine output
    3. serum electrolytes WNL
  4. Risk for ineffective gastrointestinal tissue perfusion r/t surgical procedure; vascular disease
    1. remain free from distention
    2. tolerate feedings
    3. pass stool normally
    4. monitor fluid and electolytes and lab values

Semester Two - Nursing 112 (90 decks)

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