PAD/PVD (Module 4) Flashcards
PAD Patho
atherosclerosis of extremities (usually lower) causing ischemia
buergers disease (fingers and toes turn black in smokers)
PAD Disease Course and Expected Findings
assess for 6 P’s of arterial insufficiency
mild PAD may be asymptomatic or cause intermittent claudication (burning, cramping and pain in legs during exercise)
severe PAD may cause rest pain with skin atrophy, hair loss, cyanosis, ischemic ulcers, gangrene (numbness/burning pain primarily in feet when in bed, pain relieved by placing legs at rest in a dependent position)
PAD Labs and Diagnostics
arteriography
exercise tolerance testing
plethysmography
segmental systolic blood pressure measurements
MRA (contrast medium is injected to help visualize blood flow through peripheral arteries)
doppler-derived maximal systolic acceleration (a technique that is helpful for evaluating PAD in clients with DM)
Plethysmography (PAD)
used to determine the variations of blood passing though an artery, identifying abnormal arterial flow in affected limb
BP cuffs attached to UE, a LE and the machine; variations in peripheral pulses are recorded
decrease in BP of LE indicates possible blockage
Segmental Systolic BP Measurements (PAD)
a Doppler probe is used to take various BP measurements for comparison; in absence of PAD, pressures in LE are higher than UE
with PAD, pressures in thigh, calf and ankle are lower
Ankle-Brachial Index (PAD)
ankle pressure is compared to brachial pressure; expected finding for ABI is 0.9-1.3
ABI less than 0.9 is PAD
Meds (PAD)
antiplatelets (inhibit platelet aggregation and prolong bleeding time)
blood viscosity reducing agent (Pentoxifylline)
Procedures (PAD)
percutaneous transluminal angioplasty and laser-assisted angioplasty
mechanical rotational abrasive atherectomy
arterial revascularizarion surgery
PAD Nursing Care
encourage exercise
promote vasodilation and prevent vasoconstriction (never apply direct heat but wear insulated socks)
avoid triggers
positioning (avoid crossing legs, elevate legs to reduce swelling but not above heart)
prevent complications (wound/graft infection, compartment syndrome)
VTE Patho
a blood clot believed to form as a result of Virchows triad (venous stasis (1), endothelial injury (2), and hypercoagulability (3))
thrombus formation can lead to pulmonary embolism (life threatening)
thrombophlebitis refers to a thrombus that is associated with inflammation
Venous Insufficiency Pathology
occurs secondary to incompetent valves in the deeper veins of the LE, which allows pooling of blood and dilation of the veins
the veins inability to carry fluid and wastes from the LE precipitates the development of swelling, venous stasis ulcers, and cellulitis
Varicose Veins Patho
enlarged, twisted and superficial veins that can occur in any part of the body; commonly observed in LE and esophagus
VTE (DVT) Risk Factors
Virchows Triad
surgery: hip, TKR, open prostate
HF
immobility
pregnancy/oral contraceptives
active cancer
Venous Insufficiency Risk Factors
sitting/standing in one place for a long time
obesity
pregnancy
thrombophlebitis
Varicose Veins Risk Factors
female/age >30/family history
occupations with lots of standing
pregnancy
obesity
heart disease
VTE/DVT Expected Findings
deep leg pain of sudden onset which occurs secondary to occlusion
dull ache more common with varicose veins; if thrombus is large enough there’ll be pain
a tingling sensation is associated with an alteration in arterial blood flow
UNILATERAL SWELLING
Venous Insufficiency Expected Findings
stasis dermatitis (brown discoloration) along the ankles that extends up the calf relative to the lvl of insufficiency
edema
stasis ulcers (ankles)
DVT/Thrombophlebitis Labs and Diagnostics
D-dimer*
imaging
venous duplex ultrasonography
doppler flow study
impedance plethysmography
venogram
MRI
venography is gold standard
D-Dimer (PVD)
measures fibrin degradation products present in the blood produced from fibrinolysis
positive test indicate thrombus formation has possible occurred
Trendelenburg Test (Varicose Veins)
client supine with legs elevated
when client sits up, veins fill from proximal and if varicosities are present (veins normally fill from distal end)
DVT/Thrombophlebitis Meds
anticoagulants and prophylaxis
• unfractionated heparin (IV)
• low molecular weight heparin (SQ) prevention
• enoxaparin (Lovenox) (SQ)
• fondaparinux (Arixta) (SQ)
• warfarin (PO)
thrombolytics and platelet inhibitors (TPA)
Unfractioned Heparin (DVT)
prevent clots or prevent enlargement of existing clot
DVT Procedures
IVC filler
Varicose Veins Procedures
sclerotherapy
vein stripping
endovenous laser treatment
application of radio frequency energy
Sclerotherapy
solution injected into varicose vein to produce localized inflammation, which will close the lumen of the vessel over time
pressure dressing applied for approx. 1 week after each procedure to keep vessel free of blood
Vein Stripping
removal of large varicose veins that can’t be treated with less invasive procedures
Endovenous Laser Treatment
laser fiber inserted into the vessel proximal to the area to be treated and then threaded to the involved area, where heat from the laser is used to close the dilated vein
Application of Radio Frequency Energy
uses small catheter with radio frequency electrode, instead of a laser, that is instructed into the vessel proximal to the area to be treated that scars and closes a dilated vein
DVT/Thrombophlebitis Nursing Care
encourage client to rest (facilitate bed rest and elevation of extremity above heart lvl as prescribed; avoid using a knee gatch or pillow under knees)
administer intermittent or continuous warm moist compresses as prescribed
don’t massage affected limb
provide thigh-high compression or antiembolism stockings
prepare the client for an inferior vena cava interruption surgery (a filter traps emboli and prevents them from reaching the heart) as indicated
Venous Insufficiency Nursing Care
elevate legs for at least 20 min., 4-5x a day
elevate legs above heart when in bed
instruct clients to avoid crossing legs and wearing constrictive clothing/stockings
instruct clients to wear elastic compression stockings and apply them after legs have been elevated and when swelling is at a minimum
Prophylaxis Nursing Care
assessment
early ambulation
active/passive ROM
extremity elevation
SCDs
teaching
core measures
