OA Perfusion: PVD Flashcards
PVD
Peripheral Vascular Disease
Peripheral vascular system
veins and arteries not in the heart and brain
peripheral arteries
supply oxygenated blood to the body
peripheral veins
lead deoxygenated blood from the capillaries in the extremities back to the heart.
Types of circulation disorders
- functional
- organic
Functional Circulation disorders
- short term effects
- spasms
- triggered by cold temperature, emotional stress, vibrating machinery, smoking
Organic Circulation disorders
- structural changes
- inflammation
- tissue damage
- PAD
PAD
peripheral artery disease
% of men over 50 that experience intermittent claudication of PVD
5%
% of women over 50 that experience intermittent claudication of PVD
2.5%
Manifestations of PVD
- diseases of blood vessels outside the heart and brain
- altered blood flow
- lower extremities most frequently, then kidneys and arms
- leads to “ischemia”
- cost of PVD overwhelming and expected to rise
Intermittent Claudication of PVD
- usual reason to seek treatment
- location depends upon area of occlusion
- experience dull cramping pain, burning, muscle discomfort or pain
- subside with rest
- distances walked become shorter
- eventually may occur at rest
Resting (ischemic) pain
- numbness or burning
- may awaken patients
- distal portion of extremities
- may result in limb loss
- collateral circulation
collateral circulation
growth/enlargement of additional blood vessels
Non-invasive Diagnostics
- ABI: Ankle Brachial Index
- CT Scan & MRI
- Doppler Ultrasound
- Duplex Imaging
Diagnostic Testing
- Peripheral Angiography
- Venography
ABI
Ankle Brachial Index
- differences between arms and legs
- normal=1
- mild obstr= 0.8 - 0.95
- moderate= 0.4 - 0.8
- severe=
Doppler Ultrasound
- reflected sound waves
- evaluates blood flow
- reveals: DVT and Plaque
Peripheral Angiography
- injection of contrast medium (iodine based)
- series of x-rays
- groin puncture site
- bed rest 4-6 hrs
complications of peripheral angiography
- bleeding
- infection
- contrast reaction
- clot formation
- artery damage
- hematoma
venography
- injection of contrast medium
- consent required
- used to locate thrombi, tumors, inflammation
venography is used to locate..
- thrombi
- tumors
- inflammation
Arteriosclerosis
thickening, loss of elasticity, and calcification of arterial walls
-most common chronic arterial disorder
Atherosclerosis
form of arteriosclerosis
-deposits of fat and fibrin obstruct and harden the arteries
When does atherosclerosis develop into PVD or PAD
when the hardened and obstructed arteries impair the blood supply to peripheral tissues, particularly the lower extremities
Pulse sites
- Temporal
- Carotid
- Brachial
- Radial
- Ulnar
- Femoral
- Popliteal
- Posterior Tibial
- Dorsalis Pedis
Pulse Checks
- Popliteal
- Pedal
Pedal Pulses
- Dosalis Pedis
- Posterior Tibial
3+ pulse
full and bounding
2+ pulse
normal
1+ pulse
diminished and weak
Absent
no pulse
-provider must be contacted after multiple attempts, RN double check
D pulse
found on doppler
Extremity Assessment
- Color
- Temp
- Cap Refill
- Ulceration
- Edema
Cap Refill
3 seconds: delayed
Ulceration types
- Arterial
- Venous
- Diabetic
Pedal Edema
measured after depressing a finger into the edematous area
0 Edema
no edema
1+ Edema
-2mm,
-slight indentation,
-no swelling of leg
-
2+ Edema
- 4mm
- indentation subsides rapidly
- 20-40 sec
3+ Edema
- 6mm
- indentation remains for a short time
- leg looks swollen
- 40-60 sec
4+ Edema
- 8mm
- indentation lasts a long time
- leg is very swollen
- > 60 sec
Arterial Obstruction Classifications
- Inflow
- Outflow
Inflow Obstruction
- distal end of the Aorta
- Iliac arteries
- do not cause significant tissue damage
Where is the discomfort with inflow obstruction?
- lower back
- buttocks
- thighs
Outflow Obstruction
- below the superficial femoral artery (femoral, popliteal, tibial)
- significant tissue damage
Where is the discomfort with the outflow obstruction?
- calves
- ankles
- feet
- toes
Acute Arterial Occlusive Disorders
sudden interruption of blood flow
-usually in the lower extremities
Most common cause of acute arterial occlusive disorders
embolism
Complications of acutre arterial occlusive disorders
- gangrene
- muscle necrosis
- limb amputation
Degree of Reaction
- Six P’s
- Increased severity
- Extremity assessment
Six P’s
- Pain
- Pallor
- Pulselessness
- Paraesthesia
- Paralysis
- Poikilothermia (coolness)
Severity is increased when…
- extremity is cyanotic
- pallor if elevated
- rubor if lowered
- muscle atrophy
What will the extremity look like with acute arterial occlusion disorder?
- dusky, pale, mottled
- hair loss
- thick toenails
Therapeutic Management for Acute Arterial Occlusion Disorders
- Recognition
- Anticoagulation
- Surgical Intervention
- Fibrinolytics (intra-arterial)
- Continuing Assessment
Surgical interventions
- embolectomy
- thrombectomy
Antiplatlet Meds
- ASA
- Ticlopidine
- Clopidogrel
Anticoagulant Meds
- Heparin
- Warfarin
- Lovenox (enoxaparin)
Warfarin
oral heparin
Fibrinolytics
Dissolves clot
How soon does a Fibrinolytic need to be given after S/S onset with acute occlusion disorder?
-Must be given first 4-8 hours after S/S onset
Types of Fibrinolytics
-tPA, Streptokinase, Retavase
PAD
Peripheral Arterial Disease
- Usually the aorta, Iliacs, and lower limbs
- Segmental Narrowing or Obstruction of the Arterial Tree
What is PAD a common manifestation of?
Systemic Atherosclerosis
Pathophysiology of PAD
- onset is insidious
- collateral circulation
- occurs at bifurcations
Stages of Arteriosclerosis
- Fatty Streaks
- Altered Endothelium
- Lipid infiltration (intima)
- Smooth muscle migration
- Fibrious plaque
- Complicated lesion
Unmodifiable Risk Factors for Chronic PAD
- age
- gender (male)
- genetics
- ethnicity
Modifiable Risk Factors for Chronic PAD
- smoking
- hyperlipidemia
- HTN
- Physical inactivity
- Obesity
- Diabetes mellitus
S/S of Chronic PAD
- Variable
- based on vessel affected
- collateral circulation
- intermittent claudication or rest pain
- ischemic rest pain or ulceration
- paresthesia
When will S/S of PAD start?
75% occluded
Diagnosis for PAD is based on…
ABI (
How will the extremity look with PAD?
- cool, dry, thin, shiny
- pallor if elevated
- rubor if dependent
- nails thick and brittle
- hair loos to toes, feet, and legs
- pulses often absent or diminished
- edema is infrequent
Goal of Therapeutic Management for PAD
- eliminate ischemic symptoms
- prevent CV complications
- Avoid exposure to cold
- Daily foot care
- Regular walking program
Pharmacologic Management for PAD
- antiplatlet agents
- Lipid lowering agents
- antihypertensives
- Pentoxitylline (Trental)
Antiplatlet Agents for PAD
- ASA
- Dipyridamole (Persantine)
- Clopidogrel (Plavix)
- Cilostazol (Pletal)
Lipid lowering agents for PAD
- Statins
- Niacin
- Bile Sequestrants
antihypertensives for PAD
ace inhibitors
What does Pentoxitylline (Trental) do?
lower blood viscosity
Radiologic Interventions for PAD
Interventional Radiology
- Percutaneous Transluminal Angioplasty
- Stents
- Atherectomy
- Laser Thermal Angiography
Surgical Interventions for PAD
Open Surgical Procedures
- Endarterectomy
- Bypass Graft Surgery
- Amputation (last resort)
Post-Procedural Care
- pulses marked
- surgical site assessment
- avoid constrictive clothing
- don’t cross legs
- quit smoking
- keep warm but avoid direct heat
- pain management
- avoid sharp flexion
Common risk factors for Aortic Aneurysm
- HTN
- Smoking
- Atherosclerosis
- More common in men
- Increases with age
- Strong genetic component
Common risk factors for Aortic Dissection
- HTN
- Progression: influenced by mechanical stress, can rupture at any time
Types of Aneursym
- True
- False
Types of True Aneurysm
- Saccular
- Fusiform
Saccular Aneurysm
thin area pouches out
Fusiform Aneurysm
- spindle shaped
- involves the entire circumference of the arterial wall
False or Pseudo-Aneurysm
- complete tear of arterial wall
- formation of a pseudo-wall
