Perioheral Vascular Disease Flashcards
Hyperlipidemia
Plaque formation
Hypertension
Narrowing of vessels, creates resistance to flow
Diabetes
High glucose levels damage blood vessels
Obesity
Increased body mass=decreased tissue perfusion
High cholesterol
Clogging of vessels
Genetic predisposition
Family history
Aging
Vessels get weaker and less pliable
Assessment
- pain
- pallor
- pulses
- parenthesias
- paralysis
- poikilothermy:coolness to touch
Intermittent claudication
- severe cramping and pain of extremities,happens during activity
- stage 2 of PVD
Persistent pain at rest
- Sign of stage 3 of PVD
- if pain is prolonged it may feel as if it has gone away due to nerve damage
Homan’s sign
- Calf pain with dorsiflexion of foot
- suggestive of thrombophlebitis
- not considered reliable
Changes in skin appearance(pallor) & temperature (poikilothermy)
- may be unilateral or bilateral
- Adequate blood flow appears rosy in color and feels warm
- decreased blood flow feels cool and can appear rubor or cyanotic
Rubor
Reddish blue color, occurs a few seconds to minutes after that extremity is dependent
Cyanosis
Amount of oxygen reduced in the circulation
Other changes in extremities
- loss of hair
- brittle or thickened nails
- dry or scaling skin
- atrophy
- ulcerations
- edema
- gangrene:prolonged severe ischemia that results in necrosis
Pulses
- presence or absence is important
- quality(+1,+2,+3)
- changes are important
- if there is an absent pulse there is probably an obstruction near that site
Paresthesias
- tingling or crawling sensation
- pins and needles
- blood is being diverted away from peripheral nerves
Paralysis
- results from severe ischemia
- not often seen
Plaque
Accumulation of lipids lining a vessels wall
Thrombus
Blood clot
Embolus
Mass that is inside of a vessel and can move
Common diagnostic tests done for PVD
- Doppler
- stress test(treadmill) looking at the body on how they respond to activity
- MRI and CT
- veinograms
PAD peripheral arterial disease
Arteriosclerosis
Atherosclerosis
Arteriosclerosis
- hardening of the arteries
- loss of elasticity
- mostly small arteries& arterioles
- becomes thicker and less pliable
- seen most often in carotid arteries, coronary arteries, and renal arteries
Atherosclerosis
- formation of plaque within arterial wall
- a form of arteriosclerosis
- mostly in main arteries
- generalized process in intima of arteries(inner)
- accumulation of plaque
- leading factor of cardiovascular disease
Sudden arterial occlusion
- Sudden blockage of blood flow
- leads to profound(often reversible) ischemia and tissue death
Gradual arterial occlusion
- Slow build up of plaque and narrowing of artery
- Leads to development of collateral circulation: new vessels that grow to compensate where blood is not being delivered
Common sites of atherosclerotic obstruction in major sites
- renal arteries
- carotid arteries
- popliteal
- coronary arteries
Non-surgical management of arterial disease
- exercises
- positioning: legs to be supported and elevated at or below level of heart
- promoting vasodilation
- percutaneous transluminal angioplasty
- laser assisted angioplasty
- atherectomy
Percutaneous transluminal angioplasty
Balloon that will open that vessel
Laser assisted angioplasty
Laser to open up the vessel
Atherectomy
Removal of the plaque narrowing the vessel, by use of catheter
Smoking
Nicotine is a vasoconstrictor
Arterial revascularization
- Take a grapht and rerouted around the occluded vessel
Inflow
- Inflow: obstruction involving the distal end of the aorta to the iliac arteries
- bypass ABOVE the superficial femoral arteries
Outflow
Obstructions involving the femoral, popliteal, and tibial arteries
- bypass is BELOW the superficial femoral arteries
Thrombectomy
Invasive removal of a clot
Important assessment data after any vascular surgery
- check incision site for bleeding
- color
- distal pulses: pulses below surgical site
- edema
- mobility
- sensation
- temperature
Aneurysms
- Weakness or herniated area of vessel wall
- at risk for a rupture of vessel
Peripheral venous disease
Venous alterations caused by:
- obstruction of vein by thrombus
- incompetent venous valves
- reduction in effectiveness of pumping actions of surrounding muscles
Edematous tissue
Decrease in veinous flow leads to edema
Edematous tissue cannot receive adequate nutrition, it can lead to infection in the extremities
High risk for thrombophlebitis
Bed rest, MI, CHF, SEPSIS, Traction, general surgery in patients over 40
Treatment for thrombophlebitis
- bed rest: prevent movement of clot is broken apart, it could move breakage to more severe area
- elevate extremities
- inferior vena cava filtration
- thrombectomy
Varicose veins
Distended protruding veins, can be superficial or deep inside of the tissue (deep are usually more painful)
Invasive treatment of varicose veins
- vein ligation and stripping
- sclerotherapy: injecting an irritating chemical into that vein causing it to occlude
- endovenous ablation laser treatment or radio frequency
Arterial ischemic ulcer
- Caused by chronic occlusion of small arterioles and the arteries
- results in skin breakdown and ulceration
Venous stasis ulcer
- caused by venous blood pooling in tissues of extremities
- pooling provides medium for bacterial growth, causing skin lesions and infections
Unfractionated heparin therapy
- often given subcut or IV
- has a shorter half life
- faster absorption rate
Low molecular weight heparin
- ex: lovenox
- preferred for prevention of DVT
- typically 1 mg per 1kg body weight
- longer half life
PTT
Partial thromboplastin time
-checking clotting cascades
APTT
Activated Partial Thromboplastin Time
Anti-factor Xa test
- looking at factor X in the blood
- therapeutic range is 0.1-1 if on heparin
-on low molecular weight heparin 0.3-0.7
Important when giving heparin
- watch for signs of bleeding
- be aware of any other medications patient may be recieving with anti-coagulant effects
Antidote for heparin
Protamine Sulfate
PT
-prothrombin time
-normal value: 11-16 seconds
-
Antidote for Coumadin
Vitamin K
Decrease in venous congestion
- elevate Lower extremities
- discourage smoking
- avoid emotional stress
- avoid constrictive clothing
- avoid leg crossing
- patient should test bath water and and avoid heating pads
INR
1.5-2.0
Contact practitioner if 4.0 or higher
Prothrombin time
Normal value 11-16 seconds
Desired value is 1 1/2 times control value
Virchows triad
-factors that cause clots to develop
- stasis of blood
- injury to vessel wall
- altered blood coagulation
Lymphatic system
- consists of a set of vessels that spread throughout most of the body
- not from heart but back toward heart
Lymph nodes
Act as filters keeping matter, especially bacteria, from gaining entrance to blood stream
Lymphangitis
Acute inflammation of the lymphatic channels
Lymphadenitis
Enlarged inflamed lymph nodes
Lymphedema
-an abnormal collection of excessive tissue proteins, edema, chronic inflammation, and fibrosis
Primary Lymphedema
Abnormality in the lymph system
Secondary Lymphedema
Due to an injury or surgical reasoning
