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NSG 2202 > Peripheral Arterial Disease of the Lower Extremities/Test 2 > Flashcards

Peripheral Arterial Disease of the Lower Extremities/Test 2 Flashcards

1
Q

PAD (Peripheral Arterial Disease) is

A
  • Insufficient blood supply to periphery
  • Angina of the extremities
  • Plaque/atheroma process of extremities
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2
Q

Description of PAD-it may affect

A

*Femoral artery
*Aortoiliac artery
*Tibial artery
*Popliteal artery
*Peroneal artery
(FATPP)

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3
Q

Risk factors for PAD

A
  • increased cholesterol, lipids
  • Smoking
  • HTN
  • ETOH abuse
  • Obesity
  • Sedentary lifestyle
  • Diabetic
  • increased use of vasoconstrictors
  • Genetic predisposition
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4
Q

Clinical manifestations of PAD

A
  • Classic symptoms of PAD

- intermittent claudication

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5
Q

Intermittent Claudication

A
  • Pain when walking (ischemic muscle)
  • Resolves within 10 minutes or less with rest
  • Reproducible
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6
Q

Assessment for clinical manifestations of PAD

A
  • The 5 P’s
  • Pulseless, or diminished pulses <2
  • Pain
  • Pallor
  • Polar
  • Paresthesia
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7
Q

Clinical Manifestations of PAD

A

Associated signs

  • thin, shiny, and taut skin
  • loss of hair on the lower legs
  • most important assessment is quality of pulses
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8
Q

PAD is a

A

progressive disease-rest pain as disease progresses

  • occurs in the forefoot or toes and is aggravated by limb elevation
  • occurs from insufficient blood flow
  • occurs more often at night
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9
Q

Complications r/t decreased arterial blood with PAD

A
  • atrophy of the skin and underlying muscles
  • delayed healing
  • wound infection
  • tissue necrosis
  • arterial ulcers
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10
Q

Diagnostic Studies

A
  • Doppler ultrasound
  • sound waves reflect off RBC’s as they move through the legs
  • Ankle-brachial index (ABI)
  • done using a handheld doppler
  • sys ankle pressure/sys brachial pressure
  • normal ankle pressure same or higher than brachial or 1 or >
  • abnormal
  • duplex imaging
  • both audible and visual waveforms of blood flow
  • Angiogram
  • Magnetic Resonance Angiography (MRA)
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11
Q

For Diagnosis of PAD, include

A
  • Health and physical examination
  • include palpation of peripheral pulses (Most significant)
  • the other 5 p’s
  • risk factors
  • related diseases
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12
Q

Nursing Diagnoses for PAD

A
  • Ineffective tissue perfusion: periphery r/t narrowing of peripheral vessels Aeb:
  • Pain: legs r/t ischemia with lactic acid release, hypoxia to the leg muscles aeb:
  • Activity Intolerance r/t ischemia of the lower extremities aeb
  • Impaired skin/tissue integrity r/t ischemia of the extremities aeb
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13
Q

Collaborative Care/Risk factor modification for PAD

A
  • Smoking cessation
  • Aggressive treatment of hyperlipidemia
  • Hypertension and diabetes mellitus
  • BP maintained <7.0% for diabetes
  • Weight, habits controlled
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14
Q

Drug therapy for PAD

A
  • Antiplatelet agents
  • aspirin
  • ticlopidine (Ticlid)
  • clopidogrel (Plavix)
  • dipyridamole (Persantine)
  • cilostazol (Pletal)
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15
Q

Drugs prescribed for treatment of intermittent claudication

A
  • pentoxifylline (Trental)
  • takes 3-6 months to relieve pain
  • Heparin, lovenox
  • Coumadin
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16
Q

Exercise therapy

A
  • exercise improves oxygen extraction in the legs and skeltal metabolism
  • walking is the most effective exercise for individuals with claudication
  • 30 to 40 minutes/day
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17
Q

Nutritional Therapy

A
  • Dietary cholesterol less than 200 mg/day
  • Decrease intake of saturated fat
  • Soy products can be used in place of animal protein
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18
Q

Care of the leg with critical limb ischemia

A
  • Protect from trauma
  • keep warm
  • think diabetic limb/foot care
  • decrease vasospasm
  • prevent/control infection
  • maximize arterial perfusion
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19
Q

Disease progression

A

Indications

  • intermittent claudication symptoms become incapcitating
  • progresses to pain at rest
  • ulceration or gangrene severe enough to threaten viability of the limb
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20
Q

Interventional Radiologic Procedures

A
  • percutaneous transluminal balloon angioplasty

- balloon is inflated dilating the vessel by cracking the confining atherosclerotic intimal shell

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21
Q

Surgery for PAD

A

-Most common surgical approach
A peripheral arterial bypass operation with autogenous vein or synthetic graft material to bypass blood around the lesion

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22
Q

Collaborative care/surgical therapy

A
  • Endarterectomy
  • Patch graft angioplasty
  • amputation
23
Q

Types of bypass grafting surgery

A
  • Femoral-popliteal
  • fem-fem
  • popliteal-tibial
  • axillo-femoral
  • amputation
24
Q

Nursing post op interventions

A
  • Assessment of graft pulses
  • mark pulses
  • -compare pulse quality
  • Assess skin color temperature cap refill
  • Report changes in the 5 P’s
25
Q

Bypass grafting collaborative care

A
  • IV fluid-low molecular weight dextrose
  • plasmanate
  • ntg possible
  • heparin IV-check PTT
  • rationale- keep patent
  • serious danger of reocclusion
26
Q

Post op care

A
  • Pain mangement
  • Positioning- never crimp or occlude a graft
  • bed cradle
  • oxygen
  • nutrition
  • telemetry
27
Q

Evaluation after surgery

A
  • Check the 5 p’s
  • Improve perfusion
  • Improve activity
  • Less pain
28
Q

Discharge teaching

A
  • Control risks
  • Begin progressive ambulation
  • Avoid crossing extremeties
  • Get rid of cigarettes
  • Control BP
29
Q

Sudden acute occlusion/embolism

A
  • Sudden ischemic pain-maybe an embolism
  • May occur with injury to already compromised vessel
  • May occur after vascular procedure
  • or from an injury to a limb
  • or from plaque progression to total occlusion
30
Q

Symptoms of excruciating pain

A
  • MI of the leg
  • Cold
  • Mottled to dusky
  • Pulseless
  • Compare both sides
  • Compare to prior assessment
31
Q

Embolism in toe/Acute intervention

A
  • Reperfuse
  • thrombolytics-tPA
  • Prevent extension of clot
  • heparin
  • PTCA
  • Surgery-Embolectomy
  • Possible bypass grafting
32
Q

Collaborative Care/Embolism in toe

A

*Treat as post op graft patient

33
Q

Untreated or untratable PAD List outcomes

A
  • Raynaud’s Syndrome
  • Arterial Ulcers
  • Venous disorders
  • DVT
  • Thromophlebitis
34
Q

Raynaud’s Syndrome

A
  • small arteries/arterioles constrict
  • more common in women
  • more common in upper extremities
  • associated with autoimmune disorders
35
Q

Raynaud’s is aggravated by

A

*stress, cold, exacerbations of chronic diease

36
Q

Treatment for Raynaud’s

A
  • Control underlying conditions
  • Stay warm, protect extremities
  • Stop smoking, caffeine and associated risks
  • Calcium channel blockers-reduce spasm
  • Antiplatelet meds
37
Q

Arterial Ulcers

A
  • Cause: ischemia-decreased blood flow
  • Location: between toes, tip of toes, heels, ankles
  • Depth- deep, well defined edges
  • Appearance-pale grey base, decreased blood necrotic
  • Painful
38
Q

Nursing diagnoses for Arterial Ulcers

A
  • Ineffective tissue perfussion
  • Pain
  • infection
  • PC: sepsis
39
Q

Outcomes and interventions for arterial ulcers

A
  • Maximize perfussion
  • free from gangrene, sepsis, loss of limb
  • pain reduced to 4
  • healing of site without infection
40
Q

Treatment/Wound care for arterial ulcer

A
  • Dressing changes
  • Gauze-to debride
  • Saline, elase or chemical wound debridement
  • Pain management
  • Oxygen
  • antibiotics
  • eventually bypass grafting
41
Q

Evaluation of arterial ulcer

A
  • Free from necrosis

* Consider bypass graft and skin graft

42
Q

Venous disorders

A
  • Varicose veins
  • Venous insufficiency
  • risks of gentics, multiple pregnancies, standing or sitting professions
  • valves weaken-backflow
  • symptoms of swelling, tired, heavy legs
  • relieved by elevation
  • antiembolic hose comforting
  • Thrombophlebitis-DVT
43
Q

Thrombophlebitis/DVT

A
  • inflammation of the wall of the vein, clot formation
  • *Risks-surgery, injury, increased clotting factors from inflammatory diseases ie CA, inactivity, obesity, venous insufficiency
44
Q

Nursing diagnoses/Outcomes for DVT

A
  • Ineffective perfusion: impaired venous return
  • Pain: inflammation
  • PC: PE
45
Q

Symptoms PAD vs. DVT

A
    • Homan’s sign
  • Pain in calf of affected side
  • Redness
  • Swelling
  • Warmth
46
Q

Diagnostics for DVT

A
  • Venous duplex scanning
  • Doppler ultrasound
  • D-Dimer
  • VQ scan
47
Q

Collaborative Care for DVT:

A
  • Bedrest
  • Moist heat
  • Anticoagulation
  • conservative lovenox SQ at home
  • advantage-slow continuous release
  • Acute care
  • Heparin therapy PTT 1 1/2- 2 1/2 xs control
  • Possible coumadin- INR- 2.0-3.0
48
Q

Prevention of DVT

A
  • Ambulation best
  • Exercise
  • Dorsi/plantar flexion
  • Rotation of ankles
49
Q

Prevention of DVT’s

A
  • promote venous return
  • position
  • antiembolic stockings/SCDs
  • reduce risks
  • early recongmition of s/s
50
Q

Evaluation for DVT

A
  • Decrease pain, redness, swelling
  • Negative scans
  • Knowledgeable about prevention
51
Q

Venous ulcers:

A
  • Cause venous congestion
  • Sites-ankles, medial common
  • Depth-more superficial
  • Appearance- uneven edges, pink or dark red base d/t venous congestion
  • discomfort but NOT pain of arterial
  • Compare to arterial
52
Q

Collaborative care for Venous Ulcers

A
  • Antibiotics
  • Wet-dry dressing changes
  • Gauze
  • Vicodin
  • elevate limb
  • no debridement usually needed, no grafting, should heal
53
Q

Evaluation of Venous ulcer

A
  • healing of ulcer
  • understanding of prevention
  • control risks

NSG 2202 (22 decks)

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