Peripheral Vascular Disease Flashcards
Where does the left side of the heart pump blood?
to body tissues through systemic circulation
What degree of ABI indicates arterial disease?
< 1
True claudication will show what in exercise testing?
A drop in ankle pressures
What does reduced ejection fraction HF cause?
accumulation of blood in the lungs, reduced CO, and inadequate arterial blood flow to tissues
What are the procedural risks of an angiography?
acute arterial occlusion, bleeding, contrast nephropathy
lymph nodes are enlarged, tender, and red
acute lymphadenitis
Types of emboli that can be impacted
air, fat, amniotic fluid, and septic
localized sac or dilation formed at a weak point in the wall of the artery
aneurysm
involves injecting radiopaque contrast agent directly into arterial system to visualize the vessels; confirms obstruction or aneurysm
angiography
What are the different endovascular therapies?
angioplasty, atherectomy, stent/stent graft placement
balloon-tipped catheter maneuvered over area of stenosis to improve blood flow by overstretching vessel or “cracking” and flattening plaque
angioplasty/percutaneous transluminal angioplasty (PTA)
Types of Peripheral Arterial Disease
aneurysms, aortic dissection, embolism and thrombosis, and Raynaud’s Phenomenon
sudden onset of symptoms
severe and persistant chest pain; can extend into shoulder, epigastric region, or abdomen
MAY BE MISTAKEN FOR AN MI
pale, diaphoresis, tachychardia
aortic dissection
How can vasodilation be promoted?
applying warmth, avoiding cold, avoiding smoking, reducing stress, wearing unrestrictive clothes, avoiding crossing legs
hardening of the arteries
arteriosclerosis
antiplatelet agent; prevents formation of thromboemboli; treatment for symptomatic patients; reduces risk of cardiac events; contraindicated in pts with GI problems
Aspirin or Clopidogrel (Plavix)
Nursing management of DVTs
asses/monitor anticoagulant therapy, monitor/manage potential complications, pain management, position body and encourage exercise
Describe the nursing actions for a MRA
assess for presence of incompatible devices
When do patients often report rest pain being worst?
at night
reduces the plaque buildup using a cutting device or laser
atherectomy
accumulation of lipids, calcium, etc. on the artery; “plaques”
atherosclerosis
What is the most common cause of an AAA?
atherosclerosis
What can cause arterial alterations in blood vessels?
atherosclerotic plaque, thromboembolus, infection or inflammatory processes
How can one maintain tissue integrity?
avoid trauma to area
Lab studies for DVT diagnosis
baseline CBC, prothombin time (PT), activated partial thromboplastin time (aPTT), international normalized ration (INR)
What is the most common site for formation of an aortic aneurysm?
below the renal arteries
BP control meds for a thoracic aortic aneurysm
beta-blockers, ARBs, hydralazine, and nitroprusside
symptoms of Raynaud’s are always…
bilateral and symmetrical
Aneurysm treatment and management varies on severity and other factors, but what are the possible options?
BP control
IV fluid and/or blood administration
surgical repair or endovascular repair
CSF drainage to increase spinal perfusion
femoral-popliteal the most common; greater or lesser saphenous vein or combination of one of saphenous veins and upper extremity vein such as cephalic vein are used to provide length
bypass grafting
What drug is effective in treating Raynaud’s? Why?
calcium-channel blockers because they are vasodilators
occurs when microbe enters through broken skin and release their toxins in the SQ tissues
cellulitis
Thoracic aortic aneurysm patients can be asymptomatic, but what are common clinical manifestations that are seen when they are?
chest or upper back pain (often feels more severe when supine)
results from obstruction of the venous valves in the legs or a reflux of blood through the valves
chronic venous insufficiency/postthrombotic syndrome
vasodilator that inhibits platelet aggregation; treatment for claudication; contraindicated in pts with HF
cilostazol (Pletal)
fluid in a space that cannot be expanded
compartment syndrome
Types of compression therapy
compression stocking, external compression devices and bandages, intermittent pneumatic compression devices
cross-sectional images of soft tissues, bones, and blood vessels
Computed Tomography Study (CT)
Characteristics of an AAA rupture
constant, intense back pain
falling BP
decreased hematocrit
injection of radiopaque contrast agent into venous system
contrast phlebography
What is the point of managing BP in a patient with an aneurysm?
controlled BP reduces the risk of rupture
What are the physical signs of PAD upon inspection of the skin?
cool to touch, pale, pallor, rubor and cyanosis (depending on severity)
thrombus formation in the deep veins in the thigh, calf, and sometimes arms (mainly patients with PICC lines)
deep vein thrombosis
What is the purpose of anticoagulant therapy for DVTs?
delays clotting time, prevents thrombus formation in post-op patients, forestalls extension of thrombus after formation
What is the most common cause of PEs?
dislodgement or fragemented DVT
What are the possible complications of stent placement?
distal embolization, dissection, and dislodgment
BP control meds for an abdominal aortic aneurysm
diuretics, beta-blockers, ACE inhibitors, ARBs, and calcium-channel blockers
What are the nursing actions for Ankle-Brachial Index?
don’t use abnormally low blood pressures in assessment
stents with antiplatelet meds on them
drug-eluting stents
Symptoms of varicose veins
dull aches, muscle cramps, increased muscle fatigue in lower legs, ankle edema, heaviness in legs, nocturnal cramps
assess blood flow and locate disease (stenosis vs occlusion)
Duplex Ultrasonography
Two types of VTEs
DVT and PE
What are the most common symptoms of PEs?
dyspnea, tachypnea, and chest pain
Signs/Symptoms of Chronic Venous Insufficiency
edema, altered pigmentation, pain, stasis edema
What is the main concern of edematous tissues?
edematous tissues are more prone to breakdown and infection
Ways to increase venous blood flow
elevating legs, avoiding prolonged sitting and standing in one position, avoiding cross legs, avoid constricting garments, use of graduated compression stocking
Virchow’s Triad is…
endothelial damage, hypercoagulation, and venous stasis
smaller and less invasive option to surgery
endovascular therapies
What are the nursing actions for exercise testing?
ensure the patients that running is not required
How often should pulses, color/temp, capillary refills, and sensory and motor functions be monitored in a post-op patient with PAD?
every 15 minutes initially and progressively longer if pt is stable
How often should small aneurysms be evaluated?
every 6 months
How often should ABI be monitored in a post-op patient with PAD?
every 8 hours in the first 24 hours and then once a day until discharge
patients walk for a max of 5 minutes to the point of claudication and ankle SBP are measured
Exercise Testing
Lymphedema complications
flap necrosis, hematoma, abscess under flap, cellulitis
aneurysm where the entire arterial segment becomes dilated
fusiform aneurysm
What are possible complications of both an angioplasty and an atherectomy?
hematoma formation, embolus, dissection, acute arterial occlusion, and bleeding
Pharmacologic treatment options of arterial embolism and thrombosis
heparin and t-PA
increase in protein that promotes coagulation
hyperhomocystemia
Stable PE priority management is…
immediate anticoagulation therapy
What are the main focuses of nursing care for patients with PAD?
improving peripheral arterial circulation, promoting vasodilation, relieving pain, maintaining tissue integrity
When can PAD lead to the formation of gangrene?
In extreme and prolonged cases of ischemia
vessels stiffening causes:
increased peripheral resistance, impaired blood flow, and increased left ventricular workload
What are the potential complications of leg ulcers?
infection and gangrene
improves blood supply from aorta into femoral artery
inflow procedures
muscular, cramp-type pain, or fatigue with any degree of activity and relieved at rest; seen in arterial insufficiency
intermittent claudication
Clinical manifestations of arterial leg ulcers
intermittent claudication, foot pain at rest, ischemic pain unrelieved by opioids, small circular ulcerations on the tips of toes or on toe webbing
Vessels failing to respond to increases blood flow needs causes this
ischemia
Edema formation with PAD is usually caused by what?
Keeping the extremity in a dependent position for too long
an excavation of the skin surface that occurs when inflamed necrotic tissue sloughs off
leg ulcers
What is most usually affected by PAD?
legs
Duplex Ultrasonography is the standard in diagnosing what?
lower extremity DVTs
inflammation or infection of the lymph nodes
lymphadenitis
inflammation or infection of the lymphatic channels
lymphangitis
tissue swelling related to obstruction of lymphatic flow
lymphedema
provides computer images of blood vessels
Magnetic Resonance Angiography (MRA)
Nursing management considerations for PEs
monitor thrombolytic therapy, pain management, manage oxygen therapy, relieve anxiety, monitor for complications, proved post-op care
List the prevalence of AAAs
most common in white men over the age of 65
What can help relieve rest pain? How does this work?
moving the extremity into a dependent position to improve perfusion to distal tissues
What patient prep is required for Duplex Ultrasonography?
none except NPO for 6 hours prior if it’s an abdominal study
What is an important thing to keep in mind when assessing a pt with an aneurysm?
nursing assessments should be focused on anticipation of rupture
What are the requirements of “high risk” PAD pts?
older than 65, diabetes mellitus, nicotine use, people undergoing arterial interventions/surgery
When is surgery of an AAA performed?
only when surgery to prevent the rupture outweighs the risk of all the possible complications of the surgery
What is procedural treatment for renal impaired pts undergoing a CT scan?
oral or IV hydration for 6-12 before (or sodium bicarb administration)
provides blood supply to vessels below femoral artery
outflow procedures
Clinical manifestations of venous ulcers
pain described as aching or heavy, foot/ankle edema, ulcerations around the ankle, discoloration, ulcerations on the side of the foot
What can pain tell us about PAD?
pain is usually in the muscle group distal to the occlusion
Main signs/symptoms of arterial embolism and thrombosis
pain, pallor, paresthesia, pulselessness, paralysis, and poikilothermia
clinical manifestations of DVT
pain, warmth, tenderness, edema of extremity
Contraindications of compression stocking therapy
patients with PAD, severe cardiac insufficiency, allergy to compression material, severe diabetic neuropathy with sensory loss
Intermittent claudification is a hallmark sign of…
peripheral arterial disease
Leg ulcer management
pharmacologic therapy, compression therapy, cleansing/debridement, topical therapy, wound dressing, simulated healing, hyperbaric oxygen, negative pressure wound therapy
How can peripheral arterial circulation be improved?
positioning affected body part below heart level
walking and isometric exercises
SET program for pts with claudication
begins 24hrs post stent graft placement; spontaneously occurring fever, leukocytosis, transient thrombocytopenia
post implantation syndrome
What is the primary objective of DVT management?
preventing the thrombus from extending and fragmenting
congenital malformations leading to lymphedema
primary lymphedema
varicose veins without involvement of deep veins
primary varicose veins
Venous insufficiency management
protect extremities from trauma, report signs of ulceration ASAP, increase venous blood flow
obstruction of pulmonary artery or one of its branches by a thrombus that originates somewhere in the venous system or in the right side of the heart
pulmonary embolism (PE)
Assessment of an AAA may reveal…
pulsatile mass in the middle/upper abd
systolic bruit heard over mass
What are the nursing interventions in the case of compartment syndrome?
put the limb in a flat, neutral position at heart level
How often should doppler assessments be performed on a patient post-endovascular repair of an aneurysm? Temperature?
q15mins initially; longer intervals when stable
q24h for temp
no underlying disease causing Raynaud’s
Raynaud’s Disease (Primary/Idiopathic)
Raynaud’s caused by an underlying disease
Raynaud’s syndrome (secondary Raynaud’s)
What are the indications for endovascular managements of DVTs?
recurrent or extensive thrombi, high risk for PE, or anticoagulant therapy is contraindicated
What is the goal of chronic venous insufficiency treatments?
reduce venous stasis and prevent ulceration
persistent pain in the anterior portion of the foot during rest
rest pain
Leg ulcer nursing interventions
restoring skin integrity, improving physical mobility, promoting adequate nutrition, promoting home and community-based care
reddish/blue skin discoloration that occurs anywhere from 20 seconds - 2 minutes of the limb being in a dependent position
rubor
aneurysm only on one side of the vessel
saccular aneurysm
acquired obstruction leading to lymphedema
secondary lymphedema
varicose veins resulting from obstruction of deep veins
secondary varicose veins
Rest pain is indicative of what?
severe adrenal insufficiency and critical state of ischemia
Pulses in patients with PAD are often…
severe and diminished
List the signs and symptoms of compartment syndrome.
severe edema, pain, decreased sensation of toes or fingers in affected extremity
Many patients with an AAA are asymptomatic, but those that are present what clinical manifestations?
signs of HF or large bruit
abd pain localized in middle/lower abdomen to left of midline
cyanosis
mottling of toes
DVT prophylaxis options
SQ heparin or lovenox
DVT prophylaxis options
SQ heparin or lovenox
Unstable PE priority management…
stabilizing cardiopulmonary system first priority, followed by lysing the embolus
Clinical manifestations of venous insufficiency
stasis ulcers, discoloration of tissues (hemosiderin staining), skin dry and cracked, SQ tissue fribrose and atrophy
What is the first-line therapy for atherosclerosis?
statins
improves endothelial function and reduces severity of intermittent claudication, increases walking distance to the onset of claudication; decreased rates of repeat events reported
Statins
reduces risk for restenosis, patients must take antiplatelet meds for 6 mo. post-op
stent/stent graft placement
Assessment of a thoracic aortic aneurysm will often show…
superficial veins
edematous areas of chest wall
cyanosis
unequal pupils
What is the sitting tolerance and ambulation precautions of patients post-endovascular repair of an aneurysm?
supine for 6 hours
HOB to 45-degrees after 2 hours
pts can roll side to side
ambulating to bathroom w/ assistance 6 hrs post-op
lymph nodes have become necrotic and form an abscess
suppurative lymphadenitis
What does preserved ejection fraction HF cause?
systemic venous congestion and reduced CO
What does preserved ejection fraction HF cause?
systemic venous congestion and reduced CO
What is the reason aging can cause peripheral vascular disorders?
the blood vessels start to stiffen
70% of cases caused by atherosclerosis, most common in hypertensive men ages 50-70; most common site for a dissecting aneurysm
thoracic aortic aneurysm
Endovascular management options for DVTs
thrombectomy or vena cava filter
What can cause venous alterations in blood vessels?
thromboembolus obstructing vein, incompetent venous valves, or reduced effectiveness of surrounding muscles
Where does the right side of the heart pump blood to?
through the lungs to pulmonary circulation
What can cause alterations in lymphatic vessels?
tumors, mechanical trauma, and inflammatory processes
4 options of anticoagulant therapy for DVTs are…
unfractioned heparin, low-molecular weight heparins (lovenox), oral anticoagulants (coumadin), oral direct factor Xa inhibitors (apixaban)
abnormally dilated, tortuous, superficial veins caused by incompetent venous valves
varicose veins
transvenous placement of a grid or umbrella filter in the vena cava to block the passage of emboli, prevent PE
vena cava filter
What is the most common cause of leg ulcers?
venous etiologies (PAD leading cause)
Name the different venous disorders
venous thromboembolism (DVTs and PEs), chronic venous insufficiency (Posthromboemobolitic syndrome), leg ulcers, varicose veins
What is the most serious complication of chronic venous insufficiency?
venous ulceration
When should preprocedural treatments be done for CT scans?
when the patient is renal impaired
