Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Nurs G140 Exam 2 (MS) > Perfusion: Peripheral Vascular Disorders > Flashcards

Perfusion: Peripheral Vascular Disorders Flashcards

1
Q

Different parts of the vascular system

A
  • arteries, arterioles, and capillaries
  • veins, venules
  • lymphatic vessels
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What do lymphatic vessels do?

A

collects lymph back to venous circulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Functions of vascular system (5)

A
  • provides oxygen and nutrients
  • removes metabolites, toxins and CO2
  • fluid exchange across capillaries: interstitial fluid
  • sympathetic stimulation: vasoconstriction
  • constriction of arterioles
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What does the constriction of arterioles do?

A

increased vascular resistance to blood flow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Pathophysiology of Vascular System (6) (issues in the body)

A
  • pump failure
  • vessel alterations
  • arterial occlusion
  • lymphatic obstruction
  • edema
  • Increased risk for tissue breakdown and infection
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Pump failure patho

A

-right or left HF, a fib (blood stasis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

vessel alterations patho (happens from what diseases?)

A

-damage (HTN, DM), thromboembolism (DVT, arterial thrombus)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

arterial occlusion patho

A

tissue ischemia, venous occlusion, edema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

lympathic obstruction cause…

A

edema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Why is edema an issue with perfusion?

A

tissues receive less perfusion due to pressure from excess fluid causing less O2 and less nutrition

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Arterial insufficiency/ PAD

A

narrowing of the arteries, commonly the pelvis and legs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Clinical symptoms of PAD (3)

A

cramping, pain, tired legs or hip muscles that worsens during walking/activity and subsides with rest

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Venous insufficiency/PVD

A

inadequate return of venous blood from the legs to the heart

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

clinical symptoms of PVD

A

tired/heavy, achy cramping in the legs, pain worsens when standing and improves with leg elevation and activity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Vascular system- gerontological considerations (5)

A
  • less vessel elasticity
  • calcification
  • stiffen vessel’s, increased peripheral resistance, impaired blood flow
  • Ischemia, thrombosis, increased BP, LV hypertrophy
  • Increased risk for peripheral vascular disorders
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Vascular system physical assessment (5)

A
  • skin: Color (pallor, rubor, brown), temp, hair, nails, gangrene
  • pulses: dorsalis pedis, post-tibial, popliteal, cap refill
  • edema
  • sensation: numbness, tingling
  • motor: 1-5 motor strength
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Neuromuscular assessment (7)

A
  • color
  • temp
  • cap refill
  • peripheral pulses
  • swelling
  • movement
  • sensation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

PAD general characteristics (pain, pulses, skin characteristics)

A
  • pain: intermittent claudication to sharp, unrelenting, constant
  • pulses: diminished or absent
  • skin characteristics: elevation of pallor foot, loss of hair over toes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

PAD ulcer characteristics

A

-very painful, pale to black, minimal leg edema, deep depth of ulcer, circular

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

PVD general characteristics (pain, pulses, skin characteristics)

A
  • pain: aching, cramping
  • pulses: present, but may be difficult to palpate through edema
  • skin characteristics: pigmentation, skin thickened and tough.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

PVD ulcer characteristics

A

-minimal pain, superficial depth of ulcer. irregular border, granulation tissue (beefy to yellow), moderate to severe leg edema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

When is a doppler ultrasound used?

A

when pulses cannot be found

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is ABI?

A

ankle-brachial index

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

How is ABI calculated?

A

highest ankle SBP in each foot divided by higher brachial SBP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Result of 1 or higher ABI

A

no arterial insufficiency or incompressible vessel (ex: pediatric patients with calcified vessels)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Result of 0.50-0.90 ABI

A

mild to moderate arterial insufficiency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Result of < 0.50 ABI

A

ischemic rest pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Result of < 0.40 ABI

A

severe ischemia or tissue loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

When to assess ABI (5)

A
  • any patient with decreased pulses
  • any. patient with hx of poorly controlled diabetes or HTN
  • patient 50 or older with a hx of DM or smoking
  • pt who undergo an arterial interventional surgery or procedure
  • sudden cold or painful limb
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Vascular system diagnostic tests (5)

A
  • exercise testing
  • dupplex ultrasonography
  • CT scan
  • angiography
  • MRI angiography
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Exercise testing (what it is and normal response)

A

ABI in response to walking- normal response little or no drop in ABI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Dupplex ultrasonography assesses what?

A

assess blood flow, occlusion, stenosis, plaque

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

CT scan

A

images of soft tissues

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Renal patients require ….

A

pre-procedure tx for prevention of contrast induced nephropathy: monitor output

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What needs to be administered for iodine/shellfish allergies before a contrast scan?

A

steroids/histamine blockers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

angiography. (What it is, monitor for what?)

A

contrast into arterial system for vessel visualization; monitor access site for bleeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

MRI angiography contraindications

A

metal implants or devices, old tattoo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Care for MRI angiography

A

similar to angiography; pt education; sedative if claustraphobic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

D-dimer test

A

positive may indicate presence of blood clot- diagnosis by CT scan

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

venography (what it is, may cause, monitor for)

A

contrast into veins; may cause inflammation, monitor for hematoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

lymphoscintigraphy

A

contrast injection into lymphatic system; injection site stain blue, blue drainage on incisions for several days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

arterial disorders (arteriosclerosis and atherosclerosis) What happens in the body for both

A
  • arteriosclerosis: hardening/thickening of arteries
  • atherosclerosis: accumulation of plaque; stenosis, thrombosis, aneurysm, ulceration, rupture, organ ischemia (fatty streaks, fibrous plaque)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Modifiable risk factors of PAD (9)

A
  • nicotine use
  • diet
  • HTN
  • diabetes
  • hyperlipidemia
  • stress
  • sedentary lifestyle
  • elevated C-reactive protein
  • hyperhomocyteinemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Nonmodifiable risk factors of PAD (3)

A
  • increasing age
  • female gender
  • familial predisposition/genetics
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

PAD prevention (4)

A
  • monitor lipid panel; diet and life style modification for hyperlipidemia and HTN
  • LDL < 100mg/dL (<70 for DM, tobacco, atherosclerosis, HTN)
  • total cholesterol < 200 mg/dL
  • regular exercise, weight management, statins, ASA, clopidogrel
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Clinical manifestations of PAD (6)

  • decreased or unequal _____, extremities ____, cool, decreased ____ refill, hair or no hair?
  • may have decreased ____ and ___
  • _____ _____: pain during activity due to quick drain of O2 from tissues
  • _____ disease
  • _____ disease
  • ____, ____, ___: decreased perfusion, sensation and movement
A
  • decreased or unequal pulses, extremity pale, cool, decreased cap refill, hairless
  • may have decreased sensation and movement
  • Intermittent claudication: pain during activity due to quick drain of O2 from tissues
  • raynauds disease
  • beurgers disease
  • hands, feet, toes: decreased perfusion, sensation and movement
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Raynauds disease

A

cold temperatures trigger acute vasospasm (blue fingers)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Buergers disease

A

tobacco use triggers chronic vasospasm

49
Q

PAD medical management

A
  • improvement of blood supply: angioplasty, stent placement, bypass
  • carotid atherosclerosis: endarterectomy
50
Q

PAD nursing collaboration: RN role

A

-promote perfusion, maintain function

51
Q

PAD nursing collaboration: post op patient priority

A

distal neuromuscular assessment

52
Q

PAD nursing collaboration: promote perfusion (2)

A
  • doppler US and ABI as ordered

- mental status, VS, UO, Hg

53
Q

PAD nursing collaboration (8)

  • how to keep lower extremities
  • application of ____. avoid ___ temp
  • careful with temp and very ____ heating pads or bottles
  • smoking ___, ____ management
  • promote ___ ___: Infection tx, avoid. ___
  • no ____between toes, no vigorous scratching, rubbing; no crossing ___
  • may need ____ for foot care, special footwear
  • good ____
A
  • keep lower extremities in neutral or dependent position
  • application of warmth, avoid exposure to cold temps
  • careful with temperature and very hot heating pads or bottles
  • smoking cessation, stress management
  • promote tissue integrity: infection tx, avoid trauma
  • no lotion between toes, no vigorous scratching, rubbing; no crossing legs
  • may need podiatrist for foot care, special footwear
  • good nutrition
54
Q

How to manage intermittent claudication

A

-walk to the point of pain, rest and resume walkin- increase of collateral circulation and endurance

55
Q

What is clopidogrel (plavix)?

A

FDA approved for intermittent claudication; may improve perfusion

56
Q

How to manage Raynauds disease?

A

avoid outside activity during cold weather; exercise indoors, heating only with body temp devices (gloves)

57
Q

How to manage beurgers disease?

A

immediate smoking cessation

58
Q

What happens in venous disorders?

A

reduced blood flow –> blood stasis

59
Q

Clinical manifestations of venous disorders

A

-based on pathophysiology (PE, DVT, venous insufficiency, varicose veins): may include dependent edema, skin brown and leathery, irregular border wounds around ankles

60
Q

What is Virchow’s triad?

A
  • shows an increased risk of VTE

- endothelial damage, venous stasis, altered coagulation

61
Q

Risk factors of endothelial damage (7)

A
  • trauma
  • surgery
  • pacing wires
  • central venous catheters
  • dialysis access catheters
  • local vein damage
  • repetitive motion injury
62
Q

risk factors for venous stasis (5)

A
  • bed rest or immobilization
  • obesity
  • hx of variscosities
  • spinal cord injury
  • age > 65
63
Q

Risk factors for altered coagulation (13)

A
  • cancer
  • pregnancy
  • oral contraceptive use
  • protein C. deficiency
  • protein S deficiency
  • antiphospholipid antibody syndrome
  • Factor V leiden defect
  • prothrombin G20210A defect
  • hyperhomocysteinemia
  • elevated factors II, VIII, IX, XI
  • antithrombin III deficiency
  • polycythemia
  • septicemia
64
Q

DVT clinical manifestations (4)

A
  • nonspecific (may go undetected)
  • may lead to edema, pain, feeling of limb heaviness; increased temp of affected leg
  • measure limb circumference, no Homan’s sign -> calf pain at dorsiflexion (no clinical value)
  • unusual edema, redness after orthopedic surgery (call provider)
65
Q

DVT or PE diagnosis

A

-D-Dimer test

66
Q

D-Dimer results (negative, positive, false positive, what is used for final VTE diagnosis)

A
  • negative result rules out DVT; positive result not diagnostic: must have imaging result (CT scan)
  • false positive: inflammatory disease, malignancy, pregnancy, recent surgery or trauma
  • final VTE diagnosis: US, CT, MRI
67
Q

DVT Prevention (8)

  • increased ___ intake for at-risk patients
  • graduated compression stockings, intermittent pneumatic devices
  • early ____ after surgery, leg exercises
  • LWMH: ____, ____
  • lifestyle changes: ____ loss, ____ cessation, regular ____
  • Prevention of ___ growth and fragmentation with _____.
  • ____ therapy: clot dissolution, ICU patient monitoring
A
  • increased fluid intake for at-risk patients
  • graduated compression stockings, intermittent pneumatic devices
  • early mobilization after surgery, leg exercises
  • LWMH: enoxaparin, dalteparin
  • lifestyle changes: weight loss, smoking cessation, regular exercise
  • Prevention of clot. growth and fragmentation: anticoagulation.
  • thrombolytic therapy: clot dissolution, ICU patient monitoring
  • anticoag meds
68
Q

examples of anticoagulants (6)

A
  • heparin,
  • LMWH
  • warfarin
  • fondaparinux
  • dabigatran
  • rivaroxaban
69
Q

Heparin (____ tx, if drip, ____ monitoring: reduced dosage for ______ patients)

A

acute treatment, if drip, intensive monitoring; reduced dosage for renal patients

70
Q

what to monitor when on heparin

A

APTT, INR, platelets

71
Q

therapeutic level for heparin

A

1.5-2 times control level (follow facility policy)

72
Q

What is normal APTT?

A

30-40 seconds

73
Q

What is the antidote for heparin?

A

protamine sulfate

74
Q

Ex of LMWH

A

enoxaparin (lovenox), dalteparin

75
Q

What is LMWH? What is it based on?

A

Low molecular weight heparin; subq tx based on patients weight

76
Q

Difference between Heparin and LMWH

A

fewer bleeding complications than heparin.

77
Q

What to monitor for LMWH

A

platelets

78
Q

antidote for LMWH

A

protamine (partial action)

79
Q

What to use for extended treatment of warfarin

A

Vitamin K antagonist for extended treatment

80
Q

Interactions for warfarin

A

other meds, OTC, herbs and food contains vitamin k (dark greens, beans, prunes, tuna, peas, soy)

81
Q

warfarin causes an increase risk of ___

A

bone fractures

82
Q

Pt ed about warfarin

A

-must tell providers about warfarin use, use bracelet, assess for symptoms of bleeding, regular follow up

83
Q

Bridge therapy with ___ for ___to ___ days until full warfarin effect

A

heparin, 3-5 days

84
Q

Normal INR

A

2-3

85
Q

Antidote for warfarin

A

vitamin K

86
Q

ex of Factor Xa inhibitors

A

fondaparinux subq injection, apixaban (eliquis), rivaroxaban (Xarelto), Dabigatran (pradaxa)

87
Q

Caution with what patients for Factor Xa inhibitors

A

renal disease

88
Q

Lab monitoring for factor Xa inhibitors

A

no lab monitoring necessary

89
Q

What are factor Xa inhibitors used for

A

prophylaxis ortho surgeries, VTE tx

90
Q

Apixaban issue

A

33% of pts on axiban used at least one non prescription drug that may cause dangerous side effects in combination with this blood thinner

91
Q

Nursing ed for apixaban

A

no OTC or prescription med without review from provider

92
Q

Antidotes for Xarelto and Eliquis

A

Andexxa

93
Q

Antidotes for Pradaxa

A

idarucizumab

94
Q

What do thrombolytic drugs do?

A

lyses and dissolves clots

95
Q

Ex of thrombolytic meds

A

alteplase, reteplase, tenecteplase, urokinase

96
Q

When should thrombolytic meds be given

A

within 3 days of acute thrombosis

97
Q

How are thrombolytic meds administers

A

through a catheter

98
Q

Thrombolytic meds require ____

A

extensive monitoring

99
Q

Ex of antiplatelet action med

A

clopidogrel

100
Q

What does clopidegrol do?

A

prevents clots

101
Q

The FDA approved Clopidegrol for what? Risk for?

A

intermittent claudication, risk for heart disease and stroke

102
Q

What must be screened for a patient on clopidegrol? What must be monitored?

A

bloody urine or stools

monitor platelets

103
Q

What needs to be monitored for a pt on anticoagulation therapy?

A

monitor for bleeding: labs, VS, physical assessment

104
Q

PT ed for pt on anticoagulant therapy

A

-monitor stool (red and dark) and urine, teeth brushing, shaving, symptoms of bleeding (unusual fatigue, tachycardia)

105
Q

Compression therapy

A
  • stockings: place before leaving bed with no uneven pressure points
  • physical assessments: must take off stockings
  • extremity elevation at rest: promote venous return
  • promote early and regular exercise
106
Q

Chronic venous insufficiency

A
  • obstruction of partial closure of venous valves: venous HTN
  • vein distention: back flow of venous blood
  • dependent edema, hemosiderin staining (degeneration of RBC in peripheral tissue)
  • dry, lethal skin, subq fibrosis, ulcers
107
Q

Management of venous insufficiency

A
  • elevate extremity (15-20 mini four times daily)
  • no prolonged sitting or standing, no leg crossing
  • no constricting clothes, socks
  • compression stocking essential
  • protect extremity from trauma
108
Q

Arterial leg ulcer characteristics

A

small, circular, deep, unrelenting pain

109
Q

venous leg ulcer characteristics

A

medial or lateral malleolus, aching pains or painless, larger, superficial, moist, irregular borders

110
Q

Leg ulcer treatment

A
  • compression therapy for venous ulcers
  • debridement
  • Infection tx
  • wound dressing
  • skin graft, hyperbaric oxygenation
111
Q

varicose veins

A
  • due to incompetent venous valves
  • lower extremities (Saphenous veins), esophagus, lower trunk
  • dull ache, muscle fatigue, ankle edema, feeling of extremity heaviness
  • Duplex US: ID reflux site and severity
112
Q

Varicose veins prevention

A
  • avoid activities that promote venous stasis: tight socks/clothes, crossing legs, long periods of sitting or standing
  • change position frequently, elevate extremity higher than heart several times a day
  • get up and walk for several minutes every hours; walk 1-2 miles/day
  • graduated compression stockings: place while still in bed with no uneven pressure points
  • weight reduction
  • good nutrition
113
Q

Varicose veins medical management

A
  • ligation (occlusion) and stripping (removal)

- sclerotherapy: injection of irritating chemical causing vein lumen obliteration; palliative not curing

114
Q

Perioperative varicose vein management

A
  • bed rest discouraged: ambulate as soon as sedation wears off
  • walk hourly for 5-10 min while awake during first 24 hours
  • graduated compression stockings for 1 week
  • Implement prevention measures
115
Q

What is lymphedema?

A

tissue swelling due to inefficient lymphatic drainage

116
Q

What are lymphedema characteristics?

A

firm, non-pitting, unresponsive to tx

117
Q

When can lymphedema happen?

A

congenital or secondary to node dissection

118
Q

lymphedema management

A

reduce, control edema, prevent infection: exercises, GCS, annual drainage, skin care, no BP cuffs, diuretics, elevation

119
Q

RN Role for Venous diseases

A

promote perfusion, maintain or improve function

Nurs G140 Exam 2 (MS) (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions