Impaired Peripheral Circulation Complimentary Alternative Treatment #2 Flashcards
Why does paralytic ileus occur following open AAA surgery?
- anesthesia
- manipulation and displacement of the bowel during surgery
Nursing interventions for paralytic ileus
- NG insertion intermittent wall suction
- Client is NPO and IVF begun for hydration
- Assess for flatus and BS
- increase activity
Why might decreased renal perfusion occur following surgery?
- embolization of a fragment of thrombus or plaque from the aorta that lodges in a renal artery
- hypotension
- dehydration
- prolonged aortic clamping during aneurysm repair
- blood loss
- can lead to decreased renal perfusion
WBC
5000-9000
Hgb
12-18
RBC
3.5-5 million
Goal of amputation surgery
- preserve limb length
- preserve extemity function while removing all infected, pathologic or ischemic tissue
Closed Amputation
done to create a weight bearing residual limb (skin flap sutured)
Disarticulation
amputation performed through a joint
Open amputation
control of actual or potential infection, wound later closed by a second surgical procedure or by skin traction surrounding the residual limb
Nursing Diagnoses Amputation
- Disturbed body image r/t injury, trauma, surgery
- acknowledge denial, anger, or depression as normal feelings in adjusting to body changes or life-style changes
- encourgage client to participate in care, make own decisions
- encourage celient to continue same personal care routine
- Acute or Chronic pain r/t phantom limb sensation
- explain the possible occurrence of phantom limb sensation and phantom limb pain following limb removal
- Impaired physical mobility r/t amputation of a lower extremity
- instruct client/family that the residual limb is wrapped with a compression bandage postop to facilitate healing
- client must elevate the res. limb for the first 24 hours only to reduce edema
- after 24 hours client prevents hip contractures by encouraging them to lie on their abdomen for 30 minutes 3-4 times a day
- Impaired skin integrity r/t immobility and improperly fitted prosthesis
- do not use alcohol, oils, lotions, or powders on res limb unless prescribed because toughening of the skin is desired for prosthesis
Virchow’s triad
- Venous Stasis
- blood pools d/t dysfunction of valves
- Damage to endothelium
- IV lines, varicose veins
- Hypercoagulability of the blood
- woman
Superficial vein thrombosis
inflammation of a superficial vein. palpable, firm, SC complication. the area around the vein may be tender, reddened and warm. Most common cause of upper extremity is trauma to a vein from an IV catheter and in lower extremity is varicose veins. treatment is elevation, removal of IV cath, moist heat, compression stockings when acute episode resolves
Deep vein thrombosis
development of a clot in one of the deep veins, most commonly in the iliac or femoral veins. most serious complication is embolization of a segment of the clot to the lung, causing a PE. symptoms are unilateral leg swlling, extemity pain, warm skin, erythema, possible temp elevation. homan’s sign
D-Dimer Test
blood study. fragment of fibrin formed due to fibrin degradation and clot lysis. elevation results suggestive of DVT
Non-invasive venous studies
- venous doppler evaluation
- duplex scanning
- combo of US and color doppler (most widely used tes to diagnose DVT)
Venogram
Invasive venous study. involves an injection of a radiopaque dye into venous system to determine location and extent of clot. series of xrays then taken to detect filling defects or to define collateral circulation in the venous system
Treatment of DVT
- PREVENTION
- early ambulation
- compression stockings
- SCDs
- LE exercses
- prophylactic heparin or lovenox
- Anticoagulants. Heparin therapy or low-molecular weight heparin and coumadin therapy
- Elevation
- BEDREST NOT RECOMMENDED
- Vena cava interruption device such as the greenfield filter
Chronic venous insufficiency
decrease of return of venous blood from LE to heart. causes are valve incompetence, obstruction of the deep beins, or calf muscle failure. edema, brownish coloration of skin.
Chronic Venous Insufficiency Assessment
- Present pulses
- edema around lower leg, ankles
- hair present
- ulcers present around ankle
- pain is dull ache, heaviness
- nails are normal
- skin color is dependent cyanosis, brown pigmentation
- scaling eczema, dermatitis
- warm skin temp
Action of heparin
inhibits thrombin formation by potentiating the affects of antithrombin. this prevents the formation of new clots
Commonalities between anticoagulants
- do not dissolve blood clots
- used to prevent clot formation or to prevent extension of a clot
- medication dose is titreated based on results of clotting studies
Action or lovenox
inhibits thrombin formation by potentiating the affects of antithrombin. this prevents the formation of new clots
Action of coumadin
inhibits the hepatic synthesis of vitamin k dependent clotting facotrs by blocking vitamin K
Route of Heparin
IV or SC, works immediately if IV
Route of lovenox
SC, unknown onset byt duration of 12 hours
Route of coumadin
PO(3-5 days to achieve desired effect)
Normal aPTT Heparin
24-36 sec
Usual therapeutic value aPTT Heparin
1.5-2.5 times the mean of the normal lab pTT value
Heparin blood test monitoring
APTT
Lovenox blood test monitoring
no lab test is needed since it is based on weight (1mg/kg)
Coumadin blood test monitoring
PT
INR
Normal PT Coumadin
12-15 sec
Therapeutic value coumadin
1.5-2.5 X normal
INR coumadin
1-1.4
INR therapeutic value coumadin
2-3
Side/ Adverse Effects Heparin
- hemmorhage
- anemia
- thrombocytopenia
- HIT (heparin-induced thromocytopenia
- decreased platelet counts
- thrombosis
- when patient platelet has fallen 50% or more from its baseline, heparin must be discontinued and an alternative anticoagulant mmust be given to maintain anticoagulation
Side/Adverse Effects Lovenox
- hemmorhage
- thombocytopenia
Side/Adverse Effects Coumadin
- hepatitis
- hemmorhage
- leukopenia
- herbal substances taken with coumadin can increased the risk of bleeding
Heparin Antidote
Emergency: protamine sulfate
otherwise: time (1/2 life is 1-2 hours)
Lovenox antidote
Emergency: Protamine Sulfate
Coumadin Antidote
Emergency: Fresh Frozen Plasma (clotting factors)
Otherwise: Vitamin K (takes 36-42 hours)
What is used in patients allergic to heparin or patient that develops HITTS?
- Direct Thrombin Inhibitors
- Agrantroban
- continuous IV infusion
- aPTT(1.5-2.5 times normal)
- No Antidote
- Agrantroban
- Factor Xa Inhibitor
- No lab test needed
- SC
- No antidote
Platelet Aggregation Inhibitors
- Aspirin
- Plavix
- Pletal
Asprin Action
powerful platelet aggregation inhibitor
Plavix Action
inhibits platelet aggregation
Pletal Action
Inhibits platelet aggregation and increases vasodilation
Aspirin route
PO, PR, qd to tid dosing
Plavix route
PO qd dosing
pletal route
PO BID
aspirin side/adverse effects
- thrombocytopenia
- leukopenia
- neutropenia
- hemolytic anemia
- GI bleeding
- hepatitis
- reye’s syndrome
plavix side/adverse effects
- gi bleeding
- neutropenia
- hemorrhage
pletal side/adverse effects
- bleeding
- thrombocytopenia
- stevens-johnson syndrome
aspirin nursing responsibilities
- prolong bleeding time
- affects PT
- minimize gastric irriation by administering with full glass of water food or enteric coated
- monitor for c/o fullness in ears, tinnitus, and hearing loss, symptoms of salicylate toxicity
- discontinue 7 days prior to surgery
plavix nursing responsibilities
- NSAIDS and ASA use may increase risk for bleeding
- D/C 7 days prior to surgery
- do not give with omeprazole, the antiplatelet effect is reduced by half when given together
pletal nursing responsibilities
- therapeutic effects may take 2-4 weeks
- successful treatment is improved walking distance and duration, decreased pain
- give 1 hour before meals or 2 hours after meals
- do not give with grapefruit juice
- D/C 7 days prior to surgery
