PAD and PVD Flashcards
what is PAD
peripheral artery disease - progressive narrowing and degeneration of arteries in upper and lower extremities
what are the 4 stages of PAD
Asymptomatic, Claudication, Rest, Necrosis/gangrene
what does claudication in PAD mean
throbbing leg pain that stops with rest
what happens in the rest stage of PAD
pain does not stop with rest
what are some ss of PAD
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)
what is intermittent claudication
ischemic pain caused by constant exercise, goes away within 10 min of rest
what does paraesthesia mean and what could happen
numbness/tingling of toes, loss of pressure/deep sensation= injuries go unnoticed
what are some conservative treatment options for PAD
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)
what are some causes of PAD
1 cause is athersclerosis, other= smoking, chronic kidney disease, DM, hypercholesterolemia, HTN, age (50-55)
How does a ankle brachial pressure index test work
noninvasive using hand held doppler to get the ratio of systolic BP of upper and lower limbs (they should be pretty close)
what are the meds used in anti-platelet therapy
plavix, asprin,
what is the warnings for taking plavix
reduced by half when taken with omeprazole, dont take with orange juice
what are some complications for PAD
atrophy of the skin and underlying muscles, delayed healing, wound infection, tissue necrosis, arterial ulcers, gangrene
what is the teaching for taking statins
should be taken at night to decrease muscle pain
what are some nonsurgical options for PAD
exercise/positioning to promote vasodilation, avoiding cold, percutaneous vascular intervention balloon/stent, atherectomy,
how long is anti-platelet therapy used post intervention for PAD
1-3 months
can you use heat pads for PAD
no because they cant feel if the pad gets too hot and could burn their skin
what are some surgical options for PAD
peripheral artery bypass, autogenous vein or synthetic graft, endoartectomy
what is the purpose of doing autogenous vein or synthetic graft
to bypass blood around lesion
what is the purpose of doing endoarterectomy
opening the artery and removing the obstructing plaque
when does a graft occlusion happen
can happen within 24 hours
what are the ss of graft occlusion
dramatic increase in pain, loss of previously palpable pulses, extremity pallor or cyanosis, numbness or tingling
what are the meds or treatment used for graft occlusion
fibrinolytic therapy, IV heparin, fasciotomy
what are some post op complications of surgical interventions for PAD
bleeding, hematoma, thrombosis, embolization and compartment syndrome
what is the treatment for gangrene or critical limb ischemia
revascularization
what are the indications for treatment for PAD
intermittent claudication becomes incapacitating, pain at rest (movement from stage 1-2 to 2-3), ulceration/gangrene severe enough to threaten viability of limb,
what is a stent
a mesh wire cylinder to open arteries, restore blood flow, non invasive must take anticoagulants
after interventions for PAD what are the post op monitoring
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
what position should be avoided for PAD
knee flexed and crossed legs because it could reduce blood flow
what interventions can you do for PAD edema
elevate legs above heart,
what are some interventions for PAD
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,
what does heparin do
dissolves clot
what does coumadin (warfarin) do
prevent clots
what is the largest artery
aorta
what is the aorta responsible for
supplying oxygenated blood to almost all vital organs
what is the most common aneurysm
aortic - may include aortic arch, thoracic and/or abdominal aorta
what is a true aneurysm
arterial wall is weakened by congenital or aquired (plaque) problems
what is a fusiform aneurysm
growth of the artery creating 2 paths on walls of artery
what is a false/pseudoaneurysm
caused by trauma affects all 3 layers causes an tight bubble on the artery
what is a saccular aneurysm
outpouching with only distinct portion of the artery
what is a dissecting artery
formed when blood accumulates in the wall of the artery = emergency
what is a ruptured aneurysm
blood is not contained in the vessel anymore = emergency
what are the risk factors for getting an aneurysm
Atherosclerosis, age, htn, smoking, family history, high cholesterol, past medical history, obesity, coronary artery disease, pervious stroke
what are some ss of aortic aneurysm
often asymptomatic, may cause back/flank pain, epigastric discomfort, altered bowel elimination, intermittent claudication, pulsating abdomen
what are some genetic risk factors of aneurysm
bicuspid aortic valve, coarctation of aorta, marfans syndrome
what are some ss of aorta/aortic arch/thoracic aneurysm
angina, shoulder pain, transit ischemic attacks, coughing, SOB, hoarsness, and/or dysphagia
what are some ss of dissecting aneurysm
sharp/tearing/ripping pain that moves from point of orgin, diaphoresis, N/V, faintness, pallor, rapid weak pulses, decreased absent peripheral pulses, apprehension
what are some complications from aneurysm
cardiac tamponde, occlusion of supply to vital organs, renal ischemia, abdominal ischemia, rupture
what does a CT scan with contrast show you for aneurysm
most accurate gives length diameter and presence of thrombosis
what does a ultrasonography show for an aneurysm
useful in screening for aneurysm and can also monitor them
what is another diagnostic test for aneruysm other then CT with contrast or ultrasonography
TEE (transesophageal echocardiogram
what is the treatment goal for aneurysms
HR and BP control (HR 60 or less, systolic BP 110-100)
when should you operate for an aneurysm
when the opening 5.5 or less
what are some considerations for open aneurysm repair
requires clamping or aorta (so no blood flow), multiple blood transfusions, risk for post-op complications (espically if above renal arteries)
what is a endovascular abdominal aortic aneurysm treatment
placement of suturelessgraft in abdominal aorta inside aneurysm, minimally invasive done through femoral artery
what are some complications of endovascular abdominal aortic repair
infection (bc femoral artery), endoleak, bleeding, aneurysm growth/rupture/dissection, stent migration, graft thrombosis
what are some ss of ruptured aneurysm
severe back pain, increase HR, decreased BP, pale clammy skin, decreased UOP, altered level of consciousness, abdominal tenderness, grey turners syndrome (purpura)
what is some conservative treatment for aneurysms if no symptoms
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
what is an open aneurysm repair
cutting into disease segment of aorta, removing thrombus/plaque, putting in graft, suturing the wall around the graft
what should you do pre-op for an aneurysm intervention
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
what should be included in discharge teaching after aneurysm intervention
avoid lifting heavy objects, wound care, ss of rupture/dissection, HTN control, stair restriction, no pulling or straining, no driving (bc of pain meds)
what are the post op considerations after aneurysm intervention
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
what is Buerger disease
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
what are the priorities for Buerger disease
avoid cold, quit smoking, meds
what is subclavian syndrome
caused by subclavian artery occlusion causing ishemia and pain in the arm paresthesia and numbness as well as differing BP in the arms
what is the treatment for subclavian syndrome
surgical intervention for unrelating symptoms
what are the priorities for thoracic outlet syndrome
health teaching, avoiding aggravating positions, monitor for new ss, neurovascular assessment
what is the treatment for Buerger disease
vasodilators, chronic pain managment and ulcer management
what is raynaud phenomenon disease
autoimmune trigger causes painful vasospasms, red and white skin color, more common in women
what is the treatment for raynaud phenomenon disease
vasodilators, chronic pain managment and ulcer management
what are the priorities for vasodilators, chronic pain managment and ulcer management
avoid cold, quit smoking, meds
what are the priorities for subclavian steal syndrome
monitor pt closely post op, check pulses, watch for ischemic changes, skin color, as well as severe pain
what is thoracic outlet syndrome
caused by compressing of subclavian artery by rib or muscle
what is the treatment for thoracic outlet syndrome
physcial therapy, avoid aggravating positions, surgery is the last resort for pain
what is a phelbothrombus
a clot without inflammation
what is a thrombophlebitis
clot with inflammation
how can you prevent venous thrombosis
early and frequent ambulation, pneumatic compression devices, drug therapy (heparin and low dose lovenox)
what are the risk factors for venous thrombosis
venous stasis- inasctive or damaged venous valves, damage of epithelium stimulates platelet activation, hypercoaguability of blood
who gets venous stasis
obese, pregnant, long trips, spinal cord injuries, fractured hip
what causes damage of epithelium
surgrey, trauma, burns, chemo, DM, sepsis
what causes hypercoaguability of blood
sepsis, malignancies, polycythemia (protein c or s deficiency), estrogen replacement, smoking
what are some ss of venous insufficiency
brownish/ thick skin (lethargy), itching, eczema, painful, leg edema, stasis, dermatitis
what is the treatment for venous insufficiency
always compression and elevation, can do moist dressing, diet high in protein/calories, control DM, all non surgical (unless stasis)
what are some ss of venous thrombosis
unilateral edema, pain, erythema
how do you diagnosis venous thrombosis
venous duplex US, d-dimer testing, venography, CT vs MRI
what is the biggest worry of venous thrombosis
pulmonary embolism
how is lovenox used for venous thrombosis
longer half life, no lab monitoring needed
what is lovenox reversal agent
protamine
who should not take lovenox
renal insufficency
how is IV heparin used for venous thrombosis
monitor therapeutic levels via aPTT or aXa
what is IV heparins reversal agent
protamine
what is an adverse effect of IV heparin
heparin induced thrombocytopenia
what should be known for warfarin with IV heparin for venous thrombosis
take both for 5 days then just PO warfarin monitor therapeutic levels via PT/INR (goal is 2-3)
what is warfarins reversal agent
vitamin K
what should be avoided with warfarin
green leafys
what is venous insufficency
prolonged venous hypertension that stretches veins and damages valves
what are some complications of venous insufficiency
rare - osteomyelitis which could lead to amputation
what are the risks for getting varicose veins
female, smoking, obesity, occupations that require long hours of standing
what is the teaching for PVD
wear compression stockings, get new stockings every 6 months, daily mositurizer, proper foot care, encourage walking, avoid standing/sitting for long periods
how do you diagnosis varicose veins
physical exam or duplex US
what are the 3 Es for conservative treatment for varicose veins
elevations, elastic stockings, exercise
what are some complications of varicose veins
superficial venous thrombosis
what are some ss of varicose veins
achy pain relieved with elevation or walking
what is sclerotherapy for varicose veins
direct IV infusion that chemically destroys the veins
what are the interventions for DVT/VTE
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
what are some ss of PE
SOB, chest pain, acute confusion
