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NSG 470 > PAD PVD (EXAM 2) > Flashcards

PAD PVD (EXAM 2) Flashcards

1
Q

Normal Pulse

A

-Based on normal rate, Rhythm, and strength

-+2 is normal strength

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2
Q

Bounding pulse

A

3+

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3
Q

Absent pulse

A

0

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4
Q

Doppler ultrasound flow studies

A

-Used for non-palpable pulses (If you think there is no pulse use this before you document)
-Ankle brachial index (Used to diagnose PAD)
-Used in combination to assess for arterial stenosis or occlusion

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5
Q

Duplex Ultrasonography

A

-Assesses deep and superficial veins (Used to see DVT)

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6
Q

CT scan

A

-Used to assess aorta and branches for aneurism, stenosis and obstruction

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7
Q

Lymphoscintigraphy

A

Used to access lymphatic system

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8
Q

Diagnosis criteria for PAD

A

Ankle brachial index (ABI) <.90

-If there is chronic life threatening ischemia (its advanced and obvious they have it), they can diagnose based on
-Pain at rest (claudication)
-Tissue loss
-Non-healing ulceration
-Gangrene

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9
Q

Goals for pt with peripheral vascular disease

A

-Increase arterial blood supply
-Decrease in venous congestion
-Promote vasodilation and prevent vascular compression
-Pain relief
- Tissue integrity
-Self care, and prevention of complications

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10
Q

S+S PAD

A

-Intermittent claudication
-Leg numbness or weakness
-Ulcers (Usually below ankle line) that dont heal
-Coolness to leg or foot (no bloodflow=cool)
-Changes in color texture or temp of legs, reddish blue color (No blood flow), dependent on position
-Skin is thin and brittle, and shiny
-Hair loss on legs*
-Slowed growth of toenails
-Pulselessness
-Hypertension
-Arterial bruit
Gangrene of digits

-Think your 5 p’s

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11
Q

Intermittent claudication

A

-PAD, pain in legs when walking and is relieved by rest

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12
Q

S+S PVD

A

-Swelling in feet, ankles and legs
-Spider or varicose veins
-Legs feel achy/ tired
-Burning numbness or tingling in thighs and calves
-Itchy dry skin on the legs

-Brownish color

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13
Q

Peripheral arterial disease (PAD)

A

Obstruction or narrowing of the lumen or another great arterial vessel (Less blood flow to tissues), usually the lower extremities
-Cant meet blood flow demands during movement, causing buildup of waste which causes acidosis in the area, leading to pain
-Caused usually by atherosclerotic plaques, fatty cholesterol
-Prognosis depends on location and size of occlusion

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14
Q

PAD causes, Start with A

A

-Atheromatous debris (Plaques)
-Atherosclerosis
-Aneurysms
-Aortic dissection

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15
Q

PAD causes, Start with I

A

Indwelling arterial catheter
Immune arthritis

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16
Q

PAD causes, Start with E

A

Embolism (A fib)

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17
Q

PAD causes, Start with T

A

Thrombosis
Trauma

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18
Q

PAD causes, Start with F

A

Fibromuscular disease

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19
Q

PAD causes, Start with R

A

Raynaud disease

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20
Q

Aneurysm

A

-Weak point in an artery that forms a sac, classified by shape and form
-Most are saccular and fusiform

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21
Q

Pseudo aneurism

A

Lil bubble that occurs on the outermost payer of the artery, does not occlude blood flow, wall is in tact
-Can occur from trauma

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22
Q

True aneurism

A

Lil out-patching in arterial wall that includes all the layers, on one side of the vessel

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23
Q

Fusiform aneurism

A

-Out-patching of the vessel on both sides

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24
Q

Saccular aneurism

A

Iil aorta zit, outpatching is formed into a sac, which only has a small opening to the bloodstream

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25
Q

Raynauds

A

-Intermittent arterial vascular constriction in feet and fingers
-Can be idiopathic or from a disease
-Manifestations is sudden vasoconstriction, and color changes, parasthesis and pain
-Usually triggered by cold or stress

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26
Q

Modify-able risk factors for PAD

A

Nicotine
-Diabetes
-Hypertension
-Hyper lip
-Diet
-Stress
-Sedentary lifestyle
-C-reactive protein (Biomarker)
-Hyperhomocysteinemia: Elevated homocysteine that irritates endothelium, altering colagulation

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27
Q

Hyperhomocysteinemia

A

Modifiable risk factor for PAD
-Elevated levels can irritate endothelium, promoting clotting factors

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28
Q

Nonmodifiable risk factors for PAD

A

Age
Family disposition/genetics

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29
Q

Complications of PAD

A

-Severe ischemia (leading to skin ulceration, and chronic pain)
-Skin ulceration (Leading to gangrene)
-Gangrene (Leading to tissue loss)
-Limb loss

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30
Q

Arterial ulcers

A

-Dry well defined borders, and deep
-Look punched out
-Heal terrible

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31
Q

Dependent rubor

A

PAD, legs turn red when dangling (this is actually good because it means some blood flow)

-pallor can also occur for them if their legs are elevated, gravity isnt helping out anymore

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32
Q

Should you apply direct heat PAD

A

No

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33
Q

Treatment PAD

A

-Smoking cessation
-Treat hypertension, diabetes, hyper lip
-Foot and leg care (Wounds)
-Weight control
-Low fat, low cholesterol, high fiber diet
-Weight reduction if needed
-Regular activity as directed by provider
-Exercise programs and activities
-Positioning strategties

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34
Q

Meds for PAD: Anvihypertenives

A

-Reduce BP, SVR, After load

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35
Q

Meds for PAD: Antiplatelets

A

-Prevent ischemic events
-Low dose aspirin, clopidogrel, ticlopidine

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36
Q

Meds for PAD: Plt aggregation inhibitors

A

Suppress plt aggregation and promote arterial vasodilation
-Cilostazol

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37
Q

Meds for PAD: Lipid lowering agents

A

-Any statin
-Controls dyslipidemia

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38
Q

Meds for PAD: Hypoglycemic agents

A

Promote optimal glucose control, insulin or any oral anti-diabetic gent

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39
Q

Surgeries for PAD

A

-Endovascular surgery: anything modifying the internal vasculature like a balloon or stent, can be used for aneurysm
-Open bypass surgery: Bypass the occlusion by taking a vein from another area
-Embolectomy: Remove thrombus with catheter
-Abdominal aortic aneurysm repair, removes aneurysm and puts in an artificial plaque
-Endarterectomy: Succ out fat deposits and put in patches
-Laser angioplasty: zap fatty plaques
-Lumbar sympathectomy: Cut nerve for pain control
-Amputation: gangrene

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40
Q

The nurse is teaching a patient diagnosed with peripheral arterial disease (PAD). What should be included in the teaching plan?
Elevate the lower extremities
Exercise is discouraged
Keep the lower extremities in a neutral or dependent position
PAD should not cause pain

A

Keep the lower extremities in a neutral or dependent position

Dangle em

Rationale: For patients with PAD, blood flow to the lower extremities needs to be enhanced; therefore, the nurse encourages keeping the lower extremities in a neutral or dependent position. In contrast, for patients with venous insufficiency, blood return to the heart needs to be enhanced, so the lower extremities are elevated. Exercise can be prescribed to aid in the development of collateral circulation. Some pain is associated with PAD.

41
Q

Nursing intervention PAD

A

-Assess skin color integrity and temp
-Pulses, use doppler if you cant feel
-Document and notify if any changes occur
-Pain mgmt
-Foot and skin care, prevent injury
-Dont apply heat to affected extremity(?), dont elevate
-Give drugs
-Encourage independence, energy conservation

42
Q

Post op care

A

-ABC, IV fluids as ordered, nutrition, bowels
-Surgical site for infection and bleeding. preform dressing changes and wound care
-5 P’s
-Deep breathing, spirometry
-S+S hemorrhage
-Pain mgmt
-Early ambulation

43
Q

Venous disease

A

Decreased venous blood flow resulting in stasis and back flow
-Causes coagulation, edema, tissue breakdown and increased risk of infection

-Major concerns
VTE
Chronic venous insufficiency, post thrombotic syndrome
Leg Ulcers
Varicose veins

44
Q

Venous Thromboembolism

A

-Caused by Virchow triad
-Clot forms which can occlude blood flow or move and become an embolus, moving to another area (Lungs)

45
Q

Virchow triad

A

-Endothelial dmg
-Venous stasis
-Altered coagulation

46
Q

Virchow triad (Endothelial dmg)

A

-Central venous cath
-Dialysis Cath
-Local vein dmg
-Pacing wires
-Repetitive motion injury
-Surgery
-Trauma

47
Q

Virchow triad (Venous stasis)

A

Age, 65+
-Bed rest
-HF (think right)
-Obesity
-History of varicosities
-SCI
-Polycythemia (Blood is too thic to move fast)
-Dehydration

48
Q

Virchow triad (altered colagulation)

A

-Cancer
-Clotting factor elevation (2,8,9,11)
-Factor 5 leiden defect
-Hyperhomocysteinemia
-Preg
-Polycythemia
-Septicemia
-Oral contaceptives

49
Q

VTE prevention

A

-Early ambulation and leg execises
-Graduated compression stockings
-Intermittent pneumatic compression devices
-SubQ heparin or LMWH
-Lifestyle changes (Weight loss, hydration and all that)

50
Q

If ya suspect a clot do you massage the calf

A

NO

51
Q

Complication of VTE

A

-PE
-Post thrombotic syndrome
-Venous ulcers
-Venous gangrene
-Chronic venous insufficiency
-varicosities
-more DVT in the future

52
Q

History for VTE

A

-One or more risk factors
-Leg or arm pain
-Swelling and tenderness in the affected extremity
-Central venous cath or dialysis cath
-S+S of PE, (SOB, chest pain, resp distress)

53
Q

VTE S+S

A

-May be asymptomatic
-Homans sign (not Evidence based)
-Palpable cord indicating thrombosed vein
-Unilateral calf edema
-Warmth, tenderness, redness
-Superficial venous dilation
-Pain and tenderness in thigh and calf

54
Q

VTE diagnostics

A

Doppler ultrasound or compression ultrasonography
-Shows s presence of intraluminal thrombi
-Upper and lower extremities

CT angi of chest for PE
-Evaluates blood vessels, with contrast throughout the body
-Shows thrombi in lungs, abdomen or legs

Lung perfusion and vent scanning
-Nuclear
-Shows ration of vent and perfusion, showing decreased areas

55
Q

Meds in VTE: First 10 days

A

-LMWH (enoxaparin sodium, dalteparin sodium), ends with parin
-Activated factor X inhibitors
-Unfractionated Heparin
-Factor Xa inhibitors
-Direct thrombin inhibitors (dabigatran)

56
Q

Unfractionated heparin risk

A

Risk for HIT, hemolytic idopathic thrombocytopenia, need to monitor plt

57
Q

Factor Xa inhibitors

A

Have XABAN in the name
Rivaroxaban or apixaban

58
Q

Long term meds for VTE

A

10 day- 3mo
-Factor Xa inhibitors (XABAN)
-Direct thrombin inhibitors (dabigatran)
-Vitamin K antagonist, warfarin
-LMWH
-Activated factor X inhibitors, fondaparinuX sodium

59
Q

Low molecular weight heparin (LMWH)

A

Ends in parin like HePARIN

60
Q

Pt is unable to get anticoagulants or anti thrombolytics, VTE prevention

A

-Thrombectomy or catheter directed thrombolysis
-Ultrasound assisted thrombolysis
-Vena cava filter

61
Q

Post thrombotic syndrome

A

-After Dvt occurs due to increased venous pressure

-Leading to decreased calf muscle perfusion and increased tissue permeability (fluid moves into interstitial)
-Persistent venous obstruction, valvular reflux due to valvular dmg from thrombus and inflammation (can still have clot), leading to fluid going into interstital
-Inflammation my delay thrombus resolution and induce vein wall fibrosis which promotes valvular reflux, (Further pooling)

62
Q

S+S of post thrombotic syndrome

A

-S+S of PVD
-Leg pain, legs feel heavy/ fatigued, swelling
-Dusky red cyanosis for legs when in the dependent position
-New varicose veins, stasis, hyperpigmentation, Leg Ulcers
-lipodermatosclerosis: Thickening of skin and subq tissue

-Symptoms are persistent or intermittent , aggravated by movement and relieved with rest and elevation

63
Q

Which patient is at highest risk for venous thromboembolism?
A 50-year-old postoperative patient
A 25-year-old patient with a central venous catheter in place to treat septicemia
A 71-year-old otherwise healthy older adult
A pregnant 30-year-old woman due in 2 weeks

A

A 25-year-old patient with a central venous catheter in place to treat septicemia

They got 2 risk factors, sepsis and cath, everyone only has one

Some risk factors for venous thromboembolism include but are not limited to age older than 65 years, patients undergoing surgery, central venous catheter placement, septicemia, and pregnancy. The client in this question with two risk factors is the 25-year-old with a central venous catheter in place to treat septicemia. All other patients only have one risk factor.

64
Q

Pulmonary Embolism (PE)

A

-Clot that gets dislodged and travels to the pulmonary artery, or a branch of that artery
-Caused by VTE or DVT
-Can be asymptomatic by can also cause rapid heart death and Pulmonary infarction and HF
-The clot also causes the alveoli in the lungs to stop producing surfactant which leads to collapse and atelectasis

65
Q

Causes of PE

A

-DVT
-Renal, pelvic or hepatic vein thrombosis
-fat embolism
-Air embolism
-Amniotic fluid
-Tumors
-Foreign body

-Right heart thrombus
-Valvular heart disease

66
Q

Predisposing factors for PE

A

Cardiac arrhythmias
-Lung disorders
-Cardiac disorders
-Infection
-DM
-History of this
-Sickle cell
-Autoimmune hemolytic anemia
-Polycythemia
-Osteomyelitis
-Long bone fracture
-Manipulation or disconnection of central lines

67
Q

Risk factors for PE: Venous stasis

A

-Immobility
-Obesity
-Over 40
-Burns
-recent childbirth
-Ortho cast

68
Q

Risk factors for PE: Venous injury

A

-Surgery, especially the lower 1/2 body
-Legs or pelvic fractures or injuries
-IV drug use
-IV therapy

69
Q

Risk factors for PE: Hyper coagulability

A

-Cancer
-Oral contraceptives
-Hypertension
-Cigarette smoking

70
Q

S+S PE

A

-Tachypnea
-Tachycardia
-Restlessness

-Crackles
S3 and S4
-Low grade fever
-Weak and rapid pulse
-Hypotension
-Productive cough
-Calf warmth, pain tenderness or edema
-Wheezing

71
Q

PE diagnostics

A

-CT of the chest, shows DVT
-Pulmonary angiography, shows pulmonary vessle filling defect or an abrupt vessel ending
-Reveals the location and extent of the PE

72
Q

PE mgmt

A

-O2 therapy, mechanical vent
-Anticoagulants
-Oral rivaroxaban (Xa inhibitor)
-Thrombolytics
-Antibio (Sepsis)
-Vena cava filter
-Cath directed procedure for removal of clot
-Pulmonary embolectomy

73
Q

Monitoring and interventions post PE

A

-Vitals, pulse ox, temp
-Fluid balance and I+O
-Cardiopulmonary status : heart and lungs sounds and cardiac rate and rhythem
-ABG
-PTT + PT/INR
-Plt level
-Dont massage legs

-Monitor for S+S of bleeding (urine, stool IV sites gums)
-Have antidote for heparin and warfarin

74
Q

Antidote for Heparin

A

Protamine sulfate

75
Q

Antidote for warfarin

A

Vitamin K

76
Q

Venous ulcer

A

-Above ankle below knee usually (Gaiter)
-Irregular shape, granular wound , Mild to moderate exudate
-Wet looking
-Not as deep as arterial
-Lipodermasclerosis (Thickening of skin)
-Firm edema
-Can be sloughy

77
Q

Causes of venous ulcers

A

-Diabetes
-Preg
-Age
-Deep vein thrombosis
-CHF
-Malnutrition
-Obesity
-Immobility

78
Q

Wet Gangrene

A

Open and putrid smelling, Draining exudate
-Gas gangrene is included in this

79
Q

Dry Gangrene

A

Eschar like appearance across the wound bed, no drainage

80
Q

Medical mgmt of patient leg ulcers

A

-Antibiotics
-Compression therapy
-Debridement (Slough)
-Dressings
-Hyperbaric chamber

81
Q

Complications of leg ulcer

A

Gangrene/Infection

82
Q

Nursing interventions with leg ulcers

A

-Restoring skin integrity, wound care
Cleaning wound, avoiding trauma, AVOIDING heat
-Improve mobility
Promoting nutrition

83
Q

Cellulitis

A

Infection of skin, subq tissue , causing inflammation
-Characterized by redness, edema, warmth and pain
-May be caused by dmg to skin by wound/bite
-Good prognosis if you dont let it fester

84
Q

Risk factors cellulitis

A

Venous and lymphatic compromise
-PAD
-Edema
-DM
-Underlying skin lesion
-Prior trauma
-Burns
-Immune suppression
-Advanced age

85
Q

Complications of Cellulitis

A

-Sepsis
-DVT
-Local abscesses
-Thrombophlebitis
-Super infection
-Necrotizing fasciitis

86
Q

S+S cellulitis

A

-Tenderness and warmth of an area
-Pain at the site and surrounding area
-Redness with distinct margins
-Visible red streaking in skin around infection
-Blisters, skin compromise
-Skin breakdown

-Fever, malise, skin dimpling, edema

87
Q

Treatment cellulitis

A

-Antibiotics
-Elevation of extremity
-Warm moist packs every 2-4 hours
-CBC, blood culture
-Hydration, nutrition, DVT prophylaxis
-Wound care

-Surgery for wound debridement

88
Q

Prevention of varicose veins

A

-Avoid activities that cause venous stasis
-Elevate legs 3-6 inches above heart
-Walk 30 min a day if not contraindicated
-Wear compression socks
-Weight reduction

89
Q

Lymphangitis

A

Infection of lymph system

90
Q

Lymphadenitis

A

Inflammation or infection of the lymph nodes

91
Q

Lymphedema

A

Swelling related to obstruction of lymph flow, water moving into interstitial space
-Chronic obstruction causes this to become fibrotic impairing vascular flow and o2 to tissues
-Can occur in upper and lower extremities at the same time
-Primary is congenital, secondary is acquired
-Requires compression

92
Q

Causes of lymphedema

A

-Surgery
-Radiation, cancer
-Infection
-Trauma
-CHF
-Portal hypertension
-Lipectomy
-Burns
-Insect bites

93
Q

Complications of lymphedema

A

-Abscess formation
-Recurrent cellulitis
-Amputation (lymphangiosarcoma)
-Sepsis
-DVT
-Severe quality of like issues*

94
Q

S+S lymphedema

A

-Edema, nonpitting in extremity
-Fissuring/ulcerations, skin breakdown with clear or yellow fluid
-Thickened skin in the affected area along with redness
-Stemmer sign is positive

95
Q

Stemmer sign

A

Cannot lift thickened skin between the first and second digit when pinched, skin too thick to pinch away from fat

96
Q

Lymphedema mgmt

A

-Skin care, and debridement
-Compression stockings(compression in general)
-Elevation when able
-Manual drainage of lymph
-Low level laser therapy

97
Q

Lymphedema meds

A

-Retinoid like agents ( Acitretin)
-Anthelmintic agents (Albendazole)
-anti bio

98
Q

Which of the following is an effective strat to promote lymph drainage and prevent edema in clients with lymphedema

-Antibiotics for 14 days
-Constant elevation of the affected extremity
-Heat therapy 2x per day
-Daily exposure to the sun

A

-Constant elevation of the extremity

NSG 470 (26 decks)

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