Lecture 6: vascular disorders Flashcards
this is wrong, its diuretics first
Occlusive peripheral artery disease - so the peripheral arteries are occluded
* common in individuals >70, smokers, diabetes, metabolic syndrome (obesity, t2d, hypertension)
* Results in occlusion, thrombus formation, ischemia (cutting bf off = ischemia) –> results in necrosis of tissue
Occlusive peripheral artery disease symptoms not common until how much of a blockage?
70%
KNOW: People who have aneurysms are likely to have occlusive peripheral artery disease
What does occlusive peripheral artery disease start has (s/s)
* What happens to feet w/ elevation?
* name some trophic changes that happen as this disease progresses
* name some symptoms when this disease gets serious
* Tx
Starts w/ intermittent claudication
Leads to trophic changes such as: Hair loss, muscle atrophy, cool feet, skin/nail changes, pallor with elevation
SEVERE = nocturnal/resting pain, skin ulcers, gangrene
Tx:
* lifestyle modifications, exercise training
* RX - statins (helpful w/ maintaing BF), antihypertensives, antithrombotics, and prostaglandins
* Revascularization - stents, thromboembolectomy - take out dvt
* bypass grafts (fempop = most common, take part of femoral vein, and bypass part of artery thats impacted, to reestablish BF)
note: impact can dislodge a stent, and cause pooling at the ends of the bypass
Occlusive Peripheral Artery Disease:
* NOTE: most people w/ this have CAD and possibly cerebrovascular disease (artery stuff is systemic)
* Screen for AAA - pt in supine, palpate deeply next to belly button - do it slow, looking for abnormal pulsing (large pulse)
* Vital signs and REP w/ EX
* Pt education - proper foot care, hygiene, daily inspection
Aortic aneurysm:
* disruption of which layer of the artery?
* more common in what sex?
* s/s?
Destruction of the media and elastic tissues from aging, HTN (shear forces), or obstructive lesions
* arterial intima is torn, blood accumulates in the medial layers of the vessel
* so intima tears and outer layers are being pushed out by the blood
2-3 times more common in males
s/s = back pain, groin pain, abdominal discomfort, pain radiating to buttocks or legs
* thoracoabdominal AA will cause epigastric pain
note more common in lower aortia than high
what kind of aneurysm is this
fuseaform
* expansion of entire thing
* encompass entire diameter of vessel
* this is way more likely to result in death - more serious
Berry aneurysm
risk factors for aneurysm / complications
Aortic Aneurysm:
* Tx includes frequent monitoring and surgical repeair (put a stent in, don’t try and bypass)
* Refer - monitor closely if cardiac risk factors and complaints of back, neck, or abdominal pain
* Patient education on the reduction of risks
diabetes type 2
Cerebrovascular disease
* vascular disease the affects heart and brain - very linked when it comes to BF (direct vasculature that connects them)
* cerebrovascular ischemia: slow progression leads to collateral circulation development - transient ischemic attacks lead to a stroke if not treated (ischemia = slowing losing Bf through carotids)
* cerebrovascular accident = stroke
so if were going to treat someone for a stroke, were also going to treat them for a heart issue - they’re linked
Interal carotid –> middle cerebral artery
strokes typically on left because of where its thrown coming out of the heart
TIA = warning sign = some occlusion –> squeezing in, opening back up etc…
* turns into a stroke
circle of willis = prevents strokes from being really severe
slower occlusion happens = better chance circle of willis takes over
* lets the circle of willis compensate
TPA - tissue plasma activator - get this is they’re quick enough and its an ischemic stroke
* 10% mortality risk
* can make it convert from ischemic –> hemorhagic
What is thrombophlebitis
* s/s
inflammation of the vessel wall –> thrombus formation –> scarring
NOTE: DVT sometimes asymptomatic until PE develops
* so it has to get pretty bad before symptoms
* often dont notice until that pulmonary emblism
look like little black snakes
S/s:
* LE: dull ache, tightness/pain in the calf, TTP, swelling - might say tightness / acheing in leg - palpating might show you that that tissue is rock solid
* UE: pain, swelling, cyanosis
Tx: anticoagulants, thrombolytic therapy, thrombectomy (surgical removal), vena cava filter placement (come down from superior, –> inferior vena cava and sit there and collect blood clots, will actually cause you to develop clots around top part of filter)
going to tell you how likely it is for them to have a DVT
used to just squeeze calf to test, however can lead to embolism
so keep them moving
do ROM if you cant get them moving
what disease results from incompetent valves, inadequate muscle action, or venous obstruction
venous insufficiency
risk factors for venous insufficiency
advanced age, genetics, obesity, prolonged standing, sedentary lifestyle, smoking, female hormones
this staining is a classif cisng of chronic venous insufficiency
what may result from chronic venous stasis (incompetence)
* comes w/ chronic LE edema, itchiness, scaly appearance, skin ulceration, and hemosiderin staining
DVT
this staining is a classif cisng of chronic venous insufficiency
Do people w/ venous insufficnecy have lots of pain
No
KNOW: venous ulcers = hard to heal
What are varicose veins indicitive of?
Venous insufficiency
these are elongated, dilated, tortuous superficial veins
* often caused by obesity, pregnancy, ascities
do not have adequate valve function = backflow = expands
they’re immobilized for a long period of time
position where you’re not using muscles = no m pump action
might have been a turnicit applied, so weve lost BF and now were rebounding which has a tendency to break clots off
