Module 2: Vascular Conditions Flashcards

1
Q

Peripheral Arterial Disease (PAD)

A

Progressive, chronic obstruction of blood flow through large peripheral arteries causing arterial occlusion

Risk factors:

  1. Atherosclerosis (most common)
  2. Age
  3. Gender
  4. Ethnicity
  5. FHX

CMs:

  1. Vary depending on tissue involvement and severity of impaired blood flow
  2. May be asymptomatic
  3. Identified by a reduced ankle BP
  4. May present as symptoms of intermittent claudication (ache, cramp, numbness or fatigue that occurs during exercise and is relieved at rest)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Ankle-Brachial Index (ABI)

A

Interpreting ABI values (Ankle BP/Brachial BP):
1. >1.30 = Non-compressible (stiff) arteries

  1. 1-1.29 = Normal
  2. 0.91-0.99 = Borderline PAD
  3. 0.41-0.9 = Mild to moderate PAD
  4. 0-0.4 = Severe PAD
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

PAD: Staging

A

Stage I (Asymptomatic PAD):

  1. No claudication/pain experienced
  2. Bruit may be heard
  3. Pedal pulses decreased/absent

Stage II (Claudication):

  1. Muscle pain, burning, and cramping experienced with exercise, and relieved by rest
  2. Pain is reproducible with the same degree of exercise

Stage III (Rest pain):

  1. Pain experienced at rest
  2. Pain often awakens at night
  3. Pain described as numbness and burning, usually occurring in the distal portion of the extremity
  4. Pain relieved by putting the extremity in dependent position

Stage IV (Necrosis or gangrene):

  1. Ulcers and blackened tissue occur on toes, forefoot, or heel
  2. Gangrenous odor may be present
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

PAD: Complications

A

Complications:

  1. Critical limb ischemia
  2. Acute limb ischemia (“six P’s)

“Six P’s” of acute limb ischemia:

  1. Pain
  2. Pallor
  3. Pulselessness
  4. Paresthesia
  5. Paralysis
  6. Poikilothermia (cool)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

PAD: Management

A

Medical management of patients with PAD:

  1. Provide relief of symptoms
  2. Prevent progression of disease and complications
  3. Improve quality of life

Meds.:

  1. Pentoxigylline (Trental) — decreases blood viscosity
  2. Anti-hypertensives
  3. Platelet inhibitors (i.e. Aspirin, plavix)
  4. Statins
  5. ACE inhibitors

Nonsurgical management:

  1. Percutaneous transluminal angioplasty: catheter with ballon on end is used to widen narrowed/obstructed arteries
  2. Laser-assisted angioplasty
  3. Rotational atherectomy: removes atherosclerotic plaque by forward advancement of a rotating abrasive burr

Surgical management: Revascularization

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

PAD: Nursing Assessment & Interventions

A

Nursing assessment of patients with PAD:

  1. Palpate or doppler all pulses bilaterally
  2. Visual assessment of feet and limbs
  3. Temp. of extremities
  4. Assess muscle tone

Assessment findings:

  1. Delayed capillary refill
  2. Decreased or absent pulses
  3. Loss of hair on lower calf, ankle, foot
  4. Dry, scaly, mottled skin
  5. Thick toenails
  6. Cold, cyanotic extremities
  7. Pallor of extremity with elevation
  8. Rubor of the extremity when dependent
  9. Muscle atrophy
  10. Ulcers leading to possible gangrene

Interventions of patients with PAD:

  1. Med. admin. as ordered
  2. Keep extremities dependent to facilitate arterial blood flow
  3. Meticulous skin care and prevention
  4. Encourage activity
  5. Maintain bleeding precautions
  6. Maintain open discussion about quality of life
  7. Refer to palliative care
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

PAD: Education

A

Monitoring PAD progression:

  1. Green (Good): Patient is at baseline (determined by provider)
  2. Yellow (Call provider): Progressively worse pain, weak pulses, decreased ability to perform ADLs, and S/S of infection
  3. Red (Emergency): Absent pulses and sensation

Education:

  1. Avoid crossing legs
  2. Inspect feet daily
  3. Report chest discomfort or neurological symptoms immediately

Lifestyle changes:

  1. DASH diet
  2. Limit alcohol
  3. Smoking cessation
  4. Moderate exercise
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Peripheral Vascular Disease (PVD)

A

Pathophysiology of PVD:

  1. Inadequate muscle pump function
  2. Incompetent venous valves
  3. Pooling of blood, causing dilation of veins

CMs:

  1. Dilated veins
  2. Leg edema
  3. Stasis dermatitis: brown discoloration along the ankles that extends up the calf (relative to the level of insufficiency)
  4. Stasis ulcers
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

PVD: Assessment & Management

A

Assessment of patients with PVD:

  1. Skin/tissue assessment
  2. Edema

Management of patients with PVD:

  1. Elevate legs for 20 min., 4-5 times/day
  2. Exercise
  3. Compression stockings
  4. Topical dermatologic agents
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Arterial Leg Ulcers

A

S/S (Due to hypoxia):

  1. Pale/cyanotic
  2. Cool to touch
  3. Hairless
  4. Little to no exudate

Gangrene (tissue death caused by lack of oxygen supply):

  1. Black in color
  2. Cool temp.
  3. Malodorous
  4. Dry
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Venous Leg Ulcers

A

S/S (Due to pooling of blood/fluid overload):

  1. Dark in color
  2. Exudative
  3. Edematous

Cellulitis (inflammation and possibly infection):

  1. Red in color
  2. Warm-hot temp.
  3. Exudative
  4. Can be malodorous
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Leg Ulcers: Management

A

Management of patients with leg ulcers:
1. Prevent progression

  1. Wound care as ordered — Consult wound care specialist; wound vac, hyperbaric oxygen (especially for arterial ulcers)
  2. Chemical (enzymatic) or surgical debridement
  3. Pain med. admin.
  4. Manage expectations
How well did you know this?
1
Not at all
2
3
4
5
Perfectly