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Med Surg Exam 2 > PAD and PVD > Flashcards

PAD and PVD Flashcards

1
Q

what is PAD

A

peripheral artery disease - progressive narrowing and degeneration of arteries in upper and lower extremities

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2
Q

what are the 4 stages of PAD

A

Asymptomatic, Claudication, Rest, Necrosis/gangrene

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3
Q

what does claudication in PAD mean

A

throbbing leg pain that stops with rest

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4
Q

what happens in the rest stage of PAD

A

pain does not stop with rest

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5
Q

what are some ss of PAD

A

intermitten claudication, paraesthesia, thin/shiny/taunt skin, loss of hair on lower extremities, thickened toe nails, **diminished/absent pedal/femoral/popliteal pulses, pallor of foot with dependent position (AKA dependent rubor)

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6
Q

what is intermittent claudication

A

ischemic pain caused by constant exercise, goes away within 10 min of rest

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7
Q

what does paraesthesia mean and what could happen

A

numbness/tingling of toes, loss of pressure/deep sensation= injuries go unnoticed

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8
Q

what are some conservative treatment options for PAD

A

stop smoking, low impact exercise (walking), weight loss (BMI less then 25 with DASH diet), A1C less then 7 for DM, decrease hyperlipidemia with satins, Bp less then 140/90, anti-platelet therapy (asprin/plavix)

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9
Q

what are some causes of PAD

A

1 cause is athersclerosis, other= smoking, chronic kidney disease, DM, hypercholesterolemia, HTN, age (50-55)

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10
Q

How does a ankle brachial pressure index test work

A

noninvasive using hand held doppler to get the ratio of systolic BP of upper and lower limbs (they should be pretty close)

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11
Q

what are the meds used in anti-platelet therapy

A

plavix, asprin,

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12
Q

what is the warnings for taking plavix

A

reduced by half when taken with omeprazole, dont take with orange juice

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13
Q

what are some complications for PAD

A

atrophy of the skin and underlying muscles, delayed healing, wound infection, tissue necrosis, arterial ulcers, gangrene

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14
Q

what is the teaching for taking statins

A

should be taken at night to decrease muscle pain

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15
Q

what are some nonsurgical options for PAD

A

exercise/positioning to promote vasodilation, avoiding cold, percutaneous vascular intervention balloon/stent, atherectomy,

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16
Q

how long is anti-platelet therapy used post intervention for PAD

A

1-3 months

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17
Q

can you use heat pads for PAD

A

no because they cant feel if the pad gets too hot and could burn their skin

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18
Q

what are some surgical options for PAD

A

peripheral artery bypass, autogenous vein or synthetic graft, endoartectomy

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19
Q

what is the purpose of doing autogenous vein or synthetic graft

A

to bypass blood around lesion

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20
Q

what is the purpose of doing endoarterectomy

A

opening the artery and removing the obstructing plaque

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21
Q

when does a graft occlusion happen

A

can happen within 24 hours

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22
Q

what are the ss of graft occlusion

A

dramatic increase in pain, loss of previously palpable pulses, extremity pallor or cyanosis, numbness or tingling

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23
Q

what are the meds or treatment used for graft occlusion

A

fibrinolytic therapy, IV heparin, fasciotomy

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24
Q

what are some post op complications of surgical interventions for PAD

A

bleeding, hematoma, thrombosis, embolization and compartment syndrome

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25
Q

what is the treatment for gangrene or critical limb ischemia

A

revascularization

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26
Q

what are the indications for treatment for PAD

A

intermittent claudication becomes incapacitating, pain at rest (movement from stage 1-2 to 2-3), ulceration/gangrene severe enough to threaten viability of limb,

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27
Q

what is a stent

A

a mesh wire cylinder to open arteries, restore blood flow, non invasive must take anticoagulants

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28
Q

after interventions for PAD what are the post op monitoring

A

pain type (throbbing = repurfusion or aching pain= reocclusion) pulses (palpable, if doppler has to be used then mark where found), extremities (color, temp, pulse intensity), capillary refill, sensation/movement, monitor for infection

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29
Q

what position should be avoided for PAD

A

knee flexed and crossed legs because it could reduce blood flow

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30
Q

what interventions can you do for PAD edema

A

elevate legs above heart,

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31
Q

what are some interventions for PAD

A

keep feet clean /dry, deep ulcers treated with wound care (healing unlikely bc decrease blood flow), meticulous foot care, long term antiplatelet, avoid extreme hot and cold,

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32
Q

what does heparin do

A

dissolves clot

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33
Q

what does coumadin (warfarin) do

A

prevent clots

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34
Q

what is the largest artery

A

aorta

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35
Q

what is the aorta responsible for

A

supplying oxygenated blood to almost all vital organs

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36
Q

what is the most common aneurysm

A

aortic - may include aortic arch, thoracic and/or abdominal aorta

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37
Q

what is a true aneurysm

A

arterial wall is weakened by congenital or aquired (plaque) problems

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38
Q

what is a fusiform aneurysm

A

growth of the artery creating 2 paths on walls of artery

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39
Q

what is a false/pseudoaneurysm

A

caused by trauma affects all 3 layers causes an tight bubble on the artery

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40
Q

what is a saccular aneurysm

A

outpouching with only distinct portion of the artery

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41
Q

what is a dissecting artery

A

formed when blood accumulates in the wall of the artery = emergency

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42
Q

what is a ruptured aneurysm

A

blood is not contained in the vessel anymore = emergency

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43
Q

what are the risk factors for getting an aneurysm

A

Atherosclerosis, age, htn, smoking, family history, high cholesterol, past medical history, obesity, coronary artery disease, pervious stroke

44
Q

what are some ss of aortic aneurysm

A

often asymptomatic, may cause back/flank pain, epigastric discomfort, altered bowel elimination, intermittent claudication, pulsating abdomen

45
Q

what are some genetic risk factors of aneurysm

A

bicuspid aortic valve, coarctation of aorta, marfans syndrome

46
Q

what are some ss of aorta/aortic arch/thoracic aneurysm

A

angina, shoulder pain, transit ischemic attacks, coughing, SOB, hoarsness, and/or dysphagia

47
Q

what are some ss of dissecting aneurysm

A

sharp/tearing/ripping pain that moves from point of orgin, diaphoresis, N/V, faintness, pallor, rapid weak pulses, decreased absent peripheral pulses, apprehension

48
Q

what are some complications from aneurysm

A

cardiac tamponde, occlusion of supply to vital organs, renal ischemia, abdominal ischemia, rupture

49
Q

what does a CT scan with contrast show you for aneurysm

A

most accurate gives length diameter and presence of thrombosis

50
Q

what does a ultrasonography show for an aneurysm

A

useful in screening for aneurysm and can also monitor them

51
Q

what is another diagnostic test for aneruysm other then CT with contrast or ultrasonography

A

TEE (transesophageal echocardiogram

52
Q

what is the treatment goal for aneurysms

A

HR and BP control (HR 60 or less, systolic BP 110-100)

53
Q

when should you operate for an aneurysm

A

when the opening 5.5 or less

54
Q

what are some considerations for open aneurysm repair

A

requires clamping or aorta (so no blood flow), multiple blood transfusions, risk for post-op complications (espically if above renal arteries)

55
Q

what is a endovascular abdominal aortic aneurysm treatment

A

placement of suturelessgraft in abdominal aorta inside aneurysm, minimally invasive done through femoral artery

56
Q

what are some complications of endovascular abdominal aortic repair

A

infection (bc femoral artery), endoleak, bleeding, aneurysm growth/rupture/dissection, stent migration, graft thrombosis

57
Q

what are some ss of ruptured aneurysm

A

severe back pain, increase HR, decreased BP, pale clammy skin, decreased UOP, altered level of consciousness, abdominal tenderness, grey turners syndrome (purpura)

58
Q

what is some conservative treatment for aneurysms if no symptoms

A

pain relief, HR and BP control, via morphine, beta blockers, ACE inhibitors, ARBs, Satins, stop smoking, optimize lipid profile, close monitor with CT/US every 6-12 months

59
Q

what is an open aneurysm repair

A

cutting into disease segment of aorta, removing thrombus/plaque, putting in graft, suturing the wall around the graft

60
Q

what should you do pre-op for an aneurysm intervention

A

establish baseline data, note quality and location of pulses, dont palpate masses, insert 2 large bore IVs (one for sodium chloride one for meds), indwelling cath, pre antibiotics

61
Q

what should be included in discharge teaching after aneurysm intervention

A

avoid lifting heavy objects, wound care, ss of rupture/dissection, HTN control, stair restriction, no pulling or straining, no driving (bc of pain meds)

62
Q

what are the post op considerations after aneurysm intervention

A

monitor for infection, check pulses, skin assessment (color, temp, cap refill, sensation and movement), neuro status (level of consciousness, pupil size, facial symmetry, speech, quality of hand gras), UOP, ECG, Creatine, arterial lines (BP), pain meds, avoid high BP

63
Q

what is Buerger disease

A

associated with smoking, claudication in feet and lower extremities which is worse at night - causes ischemia and fibrosis of vessels sensitivity to cold, gangrene ulcers

64
Q

what are the priorities for Buerger disease

A

avoid cold, quit smoking, meds

65
Q

what is subclavian syndrome

A

caused by subclavian artery occlusion causing ishemia and pain in the arm paresthesia and numbness as well as differing BP in the arms

66
Q

what is the treatment for subclavian syndrome

A

surgical intervention for unrelating symptoms

67
Q

what are the priorities for thoracic outlet syndrome

A

health teaching, avoiding aggravating positions, monitor for new ss, neurovascular assessment

68
Q

what is the treatment for Buerger disease

A

vasodilators, chronic pain managment and ulcer management

69
Q

what is raynaud phenomenon disease

A

autoimmune trigger causes painful vasospasms, red and white skin color, more common in women

70
Q

what is the treatment for raynaud phenomenon disease

A

vasodilators, chronic pain managment and ulcer management

71
Q

what are the priorities for vasodilators, chronic pain managment and ulcer management

A

avoid cold, quit smoking, meds

72
Q

what are the priorities for subclavian steal syndrome

A

monitor pt closely post op, check pulses, watch for ischemic changes, skin color, as well as severe pain

73
Q

what is thoracic outlet syndrome

A

caused by compressing of subclavian artery by rib or muscle

74
Q

what is the treatment for thoracic outlet syndrome

A

physcial therapy, avoid aggravating positions, surgery is the last resort for pain

75
Q

what is a phelbothrombus

A

a clot without inflammation

76
Q

what is a thrombophlebitis

A

clot with inflammation

77
Q

how can you prevent venous thrombosis

A

early and frequent ambulation, pneumatic compression devices, drug therapy (heparin and low dose lovenox)

78
Q

what are the risk factors for venous thrombosis

A

venous stasis- inasctive or damaged venous valves, damage of epithelium stimulates platelet activation, hypercoaguability of blood

79
Q

who gets venous stasis

A

obese, pregnant, long trips, spinal cord injuries, fractured hip

80
Q

what causes damage of epithelium

A

surgrey, trauma, burns, chemo, DM, sepsis

81
Q

what causes hypercoaguability of blood

A

sepsis, malignancies, polycythemia (protein c or s deficiency), estrogen replacement, smoking

82
Q

what are some ss of venous insufficiency

A

brownish/ thick skin (lethargy), itching, eczema, painful, leg edema, stasis, dermatitis

83
Q

what is the treatment for venous insufficiency

A

always compression and elevation, can do moist dressing, diet high in protein/calories, control DM, all non surgical (unless stasis)

84
Q

what are some ss of venous thrombosis

A

unilateral edema, pain, erythema

85
Q

how do you diagnosis venous thrombosis

A

venous duplex US, d-dimer testing, venography, CT vs MRI

86
Q

what is the biggest worry of venous thrombosis

A

pulmonary embolism

87
Q

how is lovenox used for venous thrombosis

A

longer half life, no lab monitoring needed

88
Q

what is lovenox reversal agent

A

protamine

89
Q

who should not take lovenox

A

renal insufficency

90
Q

how is IV heparin used for venous thrombosis

A

monitor therapeutic levels via aPTT or aXa

91
Q

what is IV heparins reversal agent

A

protamine

92
Q

what is an adverse effect of IV heparin

A

heparin induced thrombocytopenia

93
Q

what should be known for warfarin with IV heparin for venous thrombosis

A

take both for 5 days then just PO warfarin monitor therapeutic levels via PT/INR (goal is 2-3)

94
Q

what is warfarins reversal agent

A

vitamin K

95
Q

what should be avoided with warfarin

A

green leafys

96
Q

what is venous insufficency

A

prolonged venous hypertension that stretches veins and damages valves

97
Q

what are some complications of venous insufficiency

A

rare - osteomyelitis which could lead to amputation

98
Q

what are the risks for getting varicose veins

A

female, smoking, obesity, occupations that require long hours of standing

99
Q

what is the teaching for PVD

A

wear compression stockings, get new stockings every 6 months, daily mositurizer, proper foot care, encourage walking, avoid standing/sitting for long periods

100
Q

how do you diagnosis varicose veins

A

physical exam or duplex US

101
Q

what are the 3 Es for conservative treatment for varicose veins

A

elevations, elastic stockings, exercise

102
Q

what are some complications of varicose veins

A

superficial venous thrombosis

103
Q

what are some ss of varicose veins

A

achy pain relieved with elevation or walking

104
Q

what is sclerotherapy for varicose veins

A

direct IV infusion that chemically destroys the veins

105
Q

what are the interventions for DVT/VTE

A

patient education, leg exercise, early ambulation post-op, adequate hydration, compression stocking/devices, venous foot pump, anticoagulant, never massage, slow gradual ambulation better then bed rest, elevate extremies when in chair, monitor for ss of PE

106
Q

what are some ss of PE

A

SOB, chest pain, acute confusion

Med Surg Exam 2 (8 decks)

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