Peripheral Arterial Disease (Exam 2) Flashcards
Arterial Disorders
PAD
Aneurysms
Raynauds
Difference between arteries and veins
Arteries are high pressure carrying blood away from the heart. The blood is oxygenated. Where peripherals pulses come from
Veins carry blood back to the heart. The blood is deoxygenated. Veins have valves that helps enhance blood flow to through the heart
Who gets Peripheral Arterial Disease?
Atherosclerosis
Tobacco use
DM
Hyperlipidemia
Increase CRP
HTN
Family history
Intermittent Claudication
Symptom of PAD
Location of pain correlates with location of occulusion
Arterial Ulcers
Often distal digits and bony prominences
Deep lesions
Punched out
No exudate
Lack of arterial perfusion leads to
Hair loss
Dry scaly dusky pale skin
Thickened toenails
Cool to touch
Decrease cap refill
Decreased pedal pulses
Dependent rubor
Muscle atrophy
PAD: Diagnostic Test
Doppler ultrasound
Ankle brachial index
Doppler ultrasound
Can determine degree of blood flow
Ankle-brachial index
Screening tool
Hand held doppler on all 4 extremities
for example Right Leg ABI =
Highest pressure in the RIGHT foot divided by highest pressure in BOTH arms
Know how to calculate patient ABI
ABI numbers
Normal = 0.9-1.3
Occlusive arterial disease = <0.9
PAD with claudication = 0.9-0.4
Non healing ulcers PAD = <0.4
Medications for PAD
Statins
Antihypertensives
Antiplatelets
cilostazol (drug for intermittent claudication)
cilostazol
First line drug therapy for intermittent claudication if exercise/smoking cessation not effective
(inhibits platelet aggregation and increases vasodilation)
What is the first line drug therapy for intermittent claudication?
cilostazol
Inhibits platelet aggregation
PAD: Collaborative Care (Teaching)
Walking exercises (walk till pain - stop rest - walk till pain)
Proper foot care (patient cannot feel feet)
Angioplasty / stenting
Catheter based procedures
Bypass (cabg)
Amputation
Interventional radiology catheter based procedures
Similar to angiography / Specialized catheter inserted via femoral artery:
-Percutaneous transluminal angioplasty (balloon)
-Stents
-Atherectomy (removal of plaque)
-Cryoplasty (PTA + cold therapy)
Percutaneous Transluminal Angioplasty
Balloon therapy of the atherosclerosis
Atherectomy
Removal of plaque
Cryoplasty
PTA + Cold therapy
Types of PAD bypass surgerys
What they are called is determined by location of blockage
-Aorto bifemoral
-Axillobifemoral
-Fem-fem
-Iliofemoral
-Fem-pop
PAD Post-op Surgery Nursing Care
Frequent PVS assessment
Knee flexed position should be avoided
Early ambulation
Meticulous foot care
Notify HCP post op PAD surgery if
Dramatic increase in level of pain
Loss of pulses distal to site (doppler prn)
Extremity pallor of cyanosis
Change in other PVS status
What should be avoid followed PAD surgery?
Knee flex position. Impeded arterial flow
T/F: Early Ambulation is important follow PAD surgery?
True
Abdominal Aortic Aneurysm
Tripple
Permanent localized outpouching of vessel wall
Aortic Aneurysm: Clinical Manifestations
Often asymptomatic
Back pain
Frequently found during routine exams
Pulsatile mass in periumbilical area
Bruit present
Most serious complication of aneurysm
Rupture
AA: Collaborative Care
Early detection (familial)
Prevent rupture
What is considered a small aneurysm?
<4mm
Collaborative Care: Small Aneurysms
Watchful waiting:
-Decrease Risk factors (CV)
-Decrease BP
-Annual monitoring of size
Surgery of AA if
AA grows larger
Elective
If rupture the mortality is high
Open aneurysm repair (OAR)
Open surgery that involves large abdominal incision
Clamp artery
Sew synthetic graft
Endovascular Aneurysm Repair
Preformed inside vessel
Less invasive
Similar outcome to OAR
AA: Nursing Management Post - Op
ICU after surgery
Monitor graft patency (maintain adequate BP)
CV status (risk of MI)
Infection
Peripheral perfusion
Renal perfusion
Raynaud’s Phenomenon
episodic vasospastic (autoimmune) disorder of small cutaneous arteries, most often in fingers and toes
may occur in isolation or with other disease (SLE , RA)
What other disease might raynaud’s occur with?
SLE (lupus)
RA (Rheumatoid Arthritis)
Raynaud’s Diagnosed based on
2 years of symptoms
Raynaud’s characterized by
vasospasm induced color changes
Raynaud’s is precipitated by
Sensitivity to cold
Emotional upset
Tobacco
Caffeine
How long does raynaud’s last?
Minutes to hours
Raynaud’s Cold/Numb is followed by
Throbbing
Aching
Tingling
Swelling
Raynauds: Nursing Management
Wear layered clothing; gloves when handling cold item
Avoids temperature extremes
Immerse hands in warm water to decrease spasm
Avoid caffeine, alcohol, and stressors
Raynauds: Drug Therapy
Calcium-channel blockers
