Lecture 9 Vascular Disorders Flashcards by Isabel Ostroski

what is peripheral vascular disease?

disorders that alter natural blood flow outside of the brain and heart

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what is the path of blood flow by vessel type?

arteries > arterioles > capillaries > venules > veins

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oxygenation VS circulation VS perfusion

oxygenation = supplying with oxygen

circulation = movement of blood through vessels

perfusion = forcing a fluid through an organ or tissue via the blood vessels

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vascular assessment

CSMT = color, sensation, motion, temperature
skin inspection
palpation of peripheral pulses
pain - will occur distal to diseased vessel r/t poor perfusion. pain is cellular death from lack of oxygen

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how can peripheral vascular disease be diagnosed?

doppler
ankle brachial index
exercise testing
ultrasound
CT scan
angiography

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risk factors for PAD (similar to CAD)

smoking
diet
HLD
HTN
diabetes
stress
obesity and sedentary lifestyle
age
female gender
genetics

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intermittent claudication

muscle aching, cramping d/t lack of blood during exercise
pain distal to occlusion - legs, thighs, butt
pain worse with exercise, relieved with rest

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ischemic rest pain

arterial insufficiency severe, pain also present at rest
persistent, aching, piercing
usually worse at night

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general signs and symptoms of PAD in lower extremities

cool extremities
palor
dependent rubor
diminished or unequal pulses
hair loss distal to occlusion
thick opaque nails
numbness, tingling
poor healing

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signs and symptoms of PAD in upper extremities

less severe symptoms
arm fatigue and pain with exercise
coolness, pallor
difference in BP between arms

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treatment for PAD

walking
aspirin, plavix, statins
angioplasty
stenting
surgery - endarterectomy or bypass
foot care

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6 Ps of arterial embolism and thrombosis

pain (severe, shooting)
pallor
pulseless
poikilothermia - coolness
paresthesia
paralysis

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6 Ps of arterial embolism and thrombosis

pain (severe, shooting)
pallor
pulseless
poikilothermia - coolness
paresthesia
paralysis

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acute arterial occlusion treatment

embolectomy
IV heparin

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nursing management for PAD

CSMTs, pulses, cap refill
avoid crossing legs
monitor IOs, VS, mental status, and monitor incision

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abdominal aortic aneurysm

asymptomatic, only symptomatic 40% of the time
affects men 2-6X more than women
more prevalent after 65 years

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how deadly is abdominal aortic aneurysm rupture?

80% mortality

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signs and symptoms of abdominal aortic aneurysm

heart beat in abdomen
throbbing mass

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signs and symptoms of impending abdominal aortic aneurysm rupture

severe low back pain
abdominal pain - middle lower, left of midline
low BP

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managing abdominal aortic aneurysm

stable = 5.5 cm or less
BP control with BB, CCB, ACE, ARB, diuretics
ultrasound every 6 months for monitoring

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surgical management of AAA

open repair or endovascular aortic repair
ICU after repair
6 hours bedrest after EVAR
check groin site, VS, CSMTs

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what is Raynaud phenomenon?

intermittent arteriolar vasoconstriction
causes coldness, pain, pallor in fingers or toes

Raynaud triggers

stress
cold
smoking

common locations for arterial ulcers

tips of toes
webs of toes
medial side of foot
lateral pinkie toe

describe arterial ulcers

painful small and deep circular pale

what causes venous vascular disease?

difficulty for blood to get back to heart from legs

what are varicose veins?

incompetent valves in the legs

what can cause varicose veins?

pregnancy prolonged standing

signs and symptoms of varicose veins

dull ache muscle cramps ankle edema

preventing varicose veins

avoid prolonged standing walk regularly avoid crossing legs

treating varicose veins

thermal ablation ligation and stripping schlerotherapy

what is hemosiderin?

brown staining of the legs seen with chronic venous insufficiency occurs from RBC breakdown byproducts leaving the capillaries

nursing management of chronic venous insufficiency

elevate legs for venous return TED hose (thrombo-embolic deterrent hose) ambulation (muscles act like pumps) ROM and PT ulcer prevention

why is venous insufficiency a risk for DVT and PE?

stagnant blood can clot more easily, small piece can break off and travel

what is virchow's triad of thrombosis?

stasis vessel wall injury hypercoagulability

signs and symptoms of DVT

swelling and pain in leg

signs and symptoms of PE

severe SOB and chest pain

how are DVT and PE diagnosed?

ultrasound CT

medical/surgical management of DVT and PE

heparin or lovenox warfarin thrombectomy Inferior Vena Cava filter elevate legs control pain movement

describe venous ulcers

dull pain if superficial, worse pain if deeper pain worse with dependency usually around ankle large and irregular shape itching cellulitis

difference in ulcer drainage?

venous has moderate-high drainage arterial has very little drainage

wound care of arterial vs venous ulcers

arterial - keep dry, may require amputation venous - surgical debridement, wet-to-dry dressing pain control, emotional support, education across the board

what is an unna boot?

cast-like dressing on foot and lower leg used to reduce edema and help heal venous ulcers changed weekly, should be kept dry in the shower

what are the causes of amputations and their frequency?

54% secondary to vascular disease and diabetes 45% due to trauma

nursing management for amputations

pain control emotional support and coping stump care and skin care rehab

complications of amputation

hemorrhage infection skin breakdown phantom limb pain joint contracture

what is lymphedema

localized fluid retention because it is stuck in the tissue and unable to re-enter bloodstream

what can cause lymphedema?

infection blockage radiation and cancer growth can block drainage

where is lymphedema common and why

axillary and arms s/p mastectomy legs s/p prostate or gyn cancer surgery

lymphedema treatment

compression sleeves or stockings massage

nursing considerations for lymphedema

no BP or IV on affected extremity affected extremity at increased risk for infection from trauma

what is the most common infectious cause of limb swelling?

cellulitis

what are the signs and symptoms of cellulitis?

swelling redness warmth pain fever, chills, sweating

how is cellulitis treated?

oral antibiotics for mild, IV antibiotics if severe