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NURS 347 EXAM 3 > Peripheral Artery Disease ; Vascular Disease > Flashcards

Peripheral Artery Disease ; Vascular Disease Flashcards

1
Q

Peripheral artery disease is?

A

Involves thickening of the artery walls & progressive narrowing of arteries of upper & lower extremities

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2
Q

Symptomatic age of peripheral artery disease is ?
And can increase when patients have?

A

60 to 80
Diabetes

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3
Q

Over how many people have PAD? And it’s mainly found in which type of people?

A

8.5 million
Black people

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4
Q

Peripheral artery disease is strongly related to what?

A

Other cardiovascular disease & risk factors

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5
Q

Peripheral artery disease patients have a higher risk of ? (4)

A

CVD Mortality
major coronary events
Mortality
Stroke

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6
Q

What is the main leading cause of PAD, peripheral artery disease?

A

Atherosclerosis

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7
Q

What is atherosclerosis?
When does it occur?

A

Thickening or harden of the aterties

Occurs when plaque builds up in the inner lining of the artery

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8
Q

Atherosclerosis plaque is made up of?
And this plaque can what? (2)

A

Fats, cholesterol, other substances
Narrow the arteries & block blood flow

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9
Q

Etiology & pathophysiology
Risk factors are?
Multiple risk factors increase risk (3)
Often effects the? (3)
Symptoms occur when? %
Usually at what age ^

A

Same hypertension & heart failure
High cholesterol, hypertension, smoking
Coronary, carotid, lower extremity arteries
60-75% arteries are blocked
50

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10
Q

PAD of lower extremities may effect which artery’s? (5)

A

Femoral artery
Iliac artery
Peroneal artery
Popliteal artery
Tibial artery

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11
Q

What are the 6 p’s of limb ischemia?

A

Pain
Perishing cold
Pallor
Paresthesia
Pulselessness
Paralysis

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12
Q

Symptoms of PAD
What are the 4 symptoms of PAD?

A

Intermittent claudication
Paresthesia
Decreased blood flow to limb
Pain at rest

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13
Q

What is intermittent claudication?
And caused by?

A

Ischemic muscle pain that
Constant level of exercise

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14
Q

Intermittent claudication is the build up of ?
Resolved within?
Is it reproducible?

A

Build up of lactic acid from anaerobic metabolism
Resolves within 10min or less with rest
It is Reproducible

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15
Q

What does claudication mean?

A

Condition in which cramping pain in the leg is endured by exercise, like walking, typically caused by obstruction of the arteries

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16
Q

What Under anaerobic conditions mean?

A

Glucose is converted into lactic acid in order to produce energy for the cells

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17
Q

Once the patient stops exercising what happens to the lactic acid and pain?

A

Lactic acids clean
And pain subsides

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18
Q

What is Paresthesia?
From what?

A

Numbness or tingling in the toes, feet from nerve tissue ischemia

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19
Q

Paresthesia
Neuropathy causes what?

A

Severe shooting or burning pain

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20
Q

Paresthesia can produce what?
patients will typically not noticed what?

A

Loss of pressure and deep pain sensation from reduced blood flow

Injury

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21
Q

Decreased blood flow to limb may result in what symptoms? (5)
T, L, D, P, R

A

Thin, shiny, taut skin
Loss hair on legs
Dinisined or absent pulses
Pale foot with leg elevation
Reactive hyperemia of foot ( redness of foot ) Dependent rubor/position

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22
Q

What’s an anagram that can help me remember the results of decreased blood flow to limb (5)

A

Thin
Loss
Dimiy
Pale
Reacts

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23
Q

We always want to check what when we noticed a patient has decreased blood flow to the limb for PAD?

A

Check pulses!!!

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24
Q

Symptoms of PAD
Pain at rest
It’s what type of disease?
Occurs where?
Aggravated during?
Occurs from?
Occurs more often ?
How is pain relief?
( example of this ^ )

A

Progressive disease
Occurs in feet and toes
Aggravated limb elevation
Occurs from insufficient blood flow to distal tissues
Occurs more often at night
Pain relief by gravity
( dangle their leg over the side )

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25
What is critical limb ischemia? Where does this occur? ( this is a very serious form of PAD )
Severe blockage in the arteries of the lower extremities This blockage significantly reduces blood from to the hands, legs, feet. This is a serious form of PAD
26
Critical limb ischemia is characterized by? (2)
Chronic ischemic rest pain lasting more than 2 weeks No healing arterial leg ulcers or gangrene
27
People who have these 3 history’s are at a high increase risk of getting critical limb ischemia ( CLI )
Diabetes Heart failure History of stroke
28
Prolonged ischemia leads to Complications What are they?(5)
Atrophy of skin & underlying muscles Arterial ulcers over honey prominences Delayed healing Tissue necrosis Wound infection
29
Arterial ulcers over honey prominences, non healing ulcers will develop into what? And often results in?
Gangrene Amputation
30
Arterial leg ulcers (4) Vs Venous leg ulcers (4)
Punched out appearance Well defined borders Pain at night Very little discharge Irregular shape Shallow Superficial Pus discharge
31
Arterial ulcers tend to be more what ? Venous ulcers may cause a what throughout the leg?
Painful in affected area Dull ache throughout leg
32
Arterial vs venous Which has intermittent claudication pain? Which has edema? Which has no pulse/weak pulse? Which has drainage? Which has round smooth sores? Which has black eschar? Which has dull achy pain? Which has sores with irregular borders? Which has yellow slough rough skin? Which is on toes & feet? Which is on ankles? Which gets better to dangle legs? Which feels cold to the touch?
A V A V A A V V V A V A A
33
What are the diagnostic studies for PAD?(4)
Doppler ultrasound &Duplex imaging Segmental blood pressure Angiography&Magenitic reasonance angiography Ankle brachial index
34
How does the Doppler ultrasound and duplex imaging help diagnose PAD?
Sound waves to create procured of the arteries & locate blockages
35
What is the segmental blood pressure diagnosis for PAD? How do you do it? What’s the percentage of drop of Seg BP that confirms PAD?
A noninvasive vascular test that measures blood flow in the upper and lower extremities Blood pressure cuffs and ultrasound to detect difference in blood pressure at specific locations in different limbs 30
36
What’s the angiography & Magnetic resonance angiography (MRI) that helps us diagnose PAD? And what do we use?
MRI scan to look at blockages in the arteries Use a iodine dye to see the blood vessels
37
What’s an ankle brachial index to help diagnosis PAD? How do you do it? What’s the number that indicated PAD from ABI? The lower the number the more?
Calculate the ABI for each leg by diving the ankle systolic over the highest brachial systolic Ankle systolic / brachial systolic 0.9 More severe the disease
38
Calcified and stiff arteries in patients who are older or have diabetes often show what?
Falsely elevated ABI
39
Interprofessional care Risk factor modification for PAD What’s the goal? We want what type of control? We want to reduce and follow what? We want what cessation? What do want for diabetics? What type of medication?
Reduce cardiovascular disease factors Blood pressure control Reduce sodium Follow dash diet Tobacco Hemoglobin less than 7.0 hyperlipidemia ( statins & diet )
40
What are some good low sodium foods?
Dry peas Fruit Yogurt Unsalted nuts & seeds Vegetables Anicent grains Herbs & spices
41
What does DASH stand for And what is it rich in?(4)
Dietary approaches to stop hypertension Fruits,vegetables, whole grains, low fat dairy foods
42
What is low cholesterol diet? (3)
Vegetables Fruits Lean meats
43
What type of drug therapy are we going to give our PAD patients? (3)
Ace inhibitors Antiplatelet Intermittent claudication meds
44
Ace inhibitors function how? And helps how? 2D 1I (3)
Prevent an enzyme in the body from making angiotension 2 that narrows blood vessels Decreases cardiovascular morbidity Decreases mortality Increase Peripheral blood flow
45
What does Antiplatelet agents do? Medication examples? (2) It’s effectiveness becomes reduced when also taking what?
Blood thinner Aspirin Clopidigrel (Plavix ) Omeprazole
46
What are the two medications we can give to help treat intermittent claudication?
Cilostazol (Pletal) pentoxifylline (Trental)
47
What does Cilostazol (Pletal) do? (2)
Inhibits platelet aggregation Increase vasodilation
48
What does Pentoxifylline ( Trental ) do?(2)
Improves flexibility of RBC & WBC Decrease Fibrinogen concentration, platelet adheresivness, blood viscosity
49
What’s the 2 interprofessional care for overall PAD?
Walking Weight/nutrition
50
Walking is the most effective ? Give Time as well And who it helps most^ Women vs Men Increased what?
Most effective exercise with unsocial with claudication 30-45mins 3 times a week Women have faster decline and mobility loss than men Survival rates
51
Weight and nutrition BMI of what? Waist for men & women % of weight loss yields improvement
Less than 25 40 men 35 women 3-5%
52
Interprofessional care Complementary & alternative therapies Patients should always consult with HCP before taking what 2 things if they take What two medications (2) Because of the potential risk? (2)
Dietary or herbal supplments NSAIDS and anticoagulants Potential interactions & bleeding
53
Nurses must always asses what? And where?
Bleeding!! Stool, hemopytsis
54
How are nurses going to monitor anti coagulates, which tests ? Means what?
PTT/INR PT- long to form blood clot INR - type of calculation from PT
55
Interprofessional care Leg with critical limb ischemia We are going to what type of treatment ? (5) PRESIDENT!! PROTECT!! FOOT!!
Conservative treatment Protect from trauma Decrease ischemic pain Prevent/control infection Improve arterial perfusion Foot care lotion ( no soaking & between toes )
56
What’s An anagram to help me remember care for critical limb ischemia?
Conservative Protects Decreasing President Important Foot
57
Why are avoiding lubrication between toes and soaking the patients feet? To prevent what?
Skin maceration ( breakdown )
58
We can also do a PTA, which stands for and what’s the procedure? Stent helps hold it in place but the stent is coded in which drug? To limited growth of ?
Percutaneous transluminal Angioplasty Catheter has ballon Inflate ballon Increase vasodsiltion Paclitaxel New tissue in treated area
59
What are the two catheter procedure?
Arthrectomy Cryoplasty
60
What is an arthrectomy? Performed how?
Removal of obstructing plaque Performed using a cutting disc, laser or rotating diamond tip Cuts right through Atheromas
61
What is cryoplasty? Balloons fills up with what and goes down to What F* Limits restenosis by reducing what?
Combines Percutaneous transluminal angioplasty & cold therapy Balloon filled with liquid nitrous oxide that changes to gas The gas expands and cools to 14F Smooth muscle cell activity
62
Surgical therapy Interprofessional care What is peripheral artery bypass surgery with? What’s the two main things used for graft? Can PTA be used with this too?
Auto genius vein or synthetic graft to bypass blood around lesion Umbilical vein composites sequential Yes
63
What are 3 other surgical options for PAD?
Endarterectomy Patch graft angioplasty Amputation
64
What’s an endarterectomy?
Open artery and remove plaque
65
What’s a patch graft angioplasty?
Open artery remove plaque Sew patch to widen the lumen
66
What’s amuptation and consider if what?
Complete Removal Necrosis Gangrene Osteromyelitis
67
Nursing assessment Subjective vs Obective
Health history Functional health patterns ( Health perception, nutritional, activity ) Skin, heart, brain, diagnostic findings
68
Nursing management for PAD Nursing diagnosis (2) Ineffective what?? Nursing goals (5) Want to promote what?
Ineffective tissue perfusion Activity intolerance Tissue perfusion Relief of pain Increased exercise Intact skin Knowledge of disease
69
Nursing implementation What are we as nurses going to do to help promote health? (5) We are going to want identify what? What with food? What with feet? Avoid what type of stuff? And come again?
Identify risk patients Diet Proper feet care!! Avoid injury Regular follow up
70
Nursing implementation Acute care What are the 5 main things to check At the hospital what are we touching physical on patient
Skin color Temperature Capillary refill Peripheral pulses distal to operative site Sensation & movement
71
The nurse should always report what? (5)
Increased pain Loss of pulse Pallor Cyanosis Numbness or tingling
72
We should always recommend the usage of what?
Graduated compression stockings!!!
73
The nurses should avoid and do what?
Avoid knee flexed position Turn and position frequently Ambulating!!
74
What is ambulatory care for PAD? (7) What are the 7 things we as nurses will want our patient to do SC, LA, SE, MFC, DIF, CS, ST
Smoking cessation! Usage of long term Antiplatelet Supervised exercise Meticulous foot care Daily insecption of feet Comfortable shoes Skin temperature/capillary refill/palpate pulses
75
What are the 4 nursing managements of PAD?
Adequate peripheral tissue perfusion Increased activity tolerance Effective pain management Knowledge of disease & treatment plan

NURS 347 EXAM 3 (9 decks)

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