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exam 2 > peripheral vascular disease > Flashcards

peripheral vascular disease Flashcards

1
Q

you deplete your peripheral vascular system of oxygen and blood and you will have

A

pain

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2
Q

Chronic PVD

A

•Is a progressive narrowing and degeneration of arteries of the neck, abdomen, & extremities.

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3
Q

what is responsible for most peripheral vascular disease

A

atherosclerosis

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4
Q

usually what age is PAD

A

65 and older but earlier with diabetes

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5
Q

what ethnicity has a great risk for pAD

A

african americans

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6
Q

gender differences with PAD

A

in 60’s men are 2Xs more likely to have PAD than women

abdominal aortic aneurysms more common in men

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7
Q

Buerger’s ( Thromboangitis Obliterans)

A

•predominantly seen in men less than 40 yrs.

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8
Q

Women and PAD

A
  • As women age, incidence of PAD is similar or greater than men. Have more decreased functioning, more bodily pain, & greater mood disturbances than men with PAD.
  • Women have smaller arteries so endovascular repair in AAA may not be an option.
  • Raynaud’s phenomena is primarily seen in women 15-40 yrs.
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9
Q

who is at risk of DVT’s

A

•greater in women over 35 yrs who smoke, use oral contraceptives or HRT, are pregnant or post-partal or have a family history of DVTs.

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10
Q

risk for varicose veins is greater

A

•women who use oral contraceptives or Hormone Replacement Therapy or are pregnant.

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11
Q

4 most significant risk fctors for PAD

A
  • Cigarette smoking
  • Hyperlipidemia
  • Hypertension
  • Diabetes

Also obesity and familial predisposition play a part

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12
Q

Chronic PAD of the extremeties

A
  • Can affect aortoiliac, femoral, popliteal, tibial and peroneal arteries or any combination.
  • Femoral-popliteal area most commonly affected in non-diabetics. Diabetics develop disease in arteries below the knees.
  • In advance stages, multiple levels of occlusions can be found.
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13
Q

stages of chronic PAD

A

asymptomatic

claudication

rest pain

necrosis/gangrene

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14
Q

asymptomatic PAD

A
  • No claudication present
    • Bruit or aneurysm may be present
    • Pedal pulses are decreased or absent
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15
Q

claudication PAD

A

Muscle pain, cramping, or burning with

  exercise and relieved with rest.  Symptoms

  are reproducible with exercise.
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16
Q

rest pain PAD

A

Pain while resting commonly awakens the

   patient at night.  Is described as numbness,

   burning, toothache-like pain.

- Usually occurs in distal portion of extremity

   ( toes, arch, forefoot, or heel ), rarely in the

   calf or the ankle.  Relieved by dependent

   position.
17
Q

necrosis/gangrene

A

Ulcers and blackened tissue occur on toes,

   the forefoot, and the heel.

- Distinctive gangrene odor is present
18
Q

inflow obstructions (PVD)

A

•involve distal end of the aorta and the common, internal and external iliac arteries. They are located above the inguinal ligament.

19
Q

outflow obstructions (PVD)

A

•involve the femoral, popliteal, and tibial arteries. They are located below the superficial femoral artery.

20
Q

symptoms of PVD

A

•Classic symptom is intermittent claudication which is ischemic muscle pain that is precipitated by a consistent level of exercise. It resolves within 10 minutes of rest or less and is reproducible.

a. Caused by end products of anerobic

   metabolism.

b. Once stop exercise, metabolites clear

   and pain stops.

. Disease of femoral or popliteal arteries

   causes claudication in calf, ankle, &

           toes.  Below popliteal, claudication in

   instep or foot.  OUTFLOW

d. Disease of aortoiliac causes claudication

   of lower back, buttocks, & thighs. 

           INFLOW
21
Q

outflow symptoms (PVD)

A

Disease of femoral or popliteal arteries

   causes claudication in calf, ankle, &

           toes.  Below popliteal, claudication in

   instep or foot.
22
Q

inflow symptoms (PVD)

A

Disease of aortoiliac causes claudication

   of lower back, buttocks, & thighs. 

           INFLOW
23
Q

paresthesia (PVD)

A

•toes & feet may result from nerve tissue ischemia. Common in Diabetes. Neuropathy can also cause excruciating pain. Diminishing perfusion to neurons produces loss of both pressure and deep pain sensation. Injuries can go unnoticed.

24
Q

appearance of limb (PVD)

A

-Skin thin, shiny, & taut. Loss of hair on

       lower legs.  Decreased or absent pulses.
  • Dry, scaly, dusky, pale or mottled skin.
           Pallor may occur when extremity is

       elevated.  Reactive hyperemia ( Rubor )

       may occur when extremity is in
    dependent position.
  • Capillary refill greater than 3 seconds
  • Ankle-Brachial index less than 0.70
  • Edema absent unless limb constantly dependent.
25
Q

complications (PAD)

A
  • Progresses slowly. Prolonged ischemia leads to atrophy of skin and muscles. Will develop pain at rest. Without revascularization may develop ulcers and gangrene.
  • Decreased blood flow causes delayed healing, wound infection and tissue necrosis. Non healing ulcers can get gangrene
26
Q

diagnostic studies (PAD)

A
  • Health history and physical
  • Doppler ultrasound
  • Segmental blood pressures
  • Ankle-Brachial Index
  • Arteriography
27
Q

ankle-brachial index (PVD)

A

normal 0.91-1

mild- 0.71-0.90

moderate -0.41-0.70

severe - below 0.40

28
Q

risk factor modification (PVD)

A

Stop smoking

  • Aggressive treatment of hyperlipidemia
  • Treat hypertension
  • Control Diabetes
  • Weight reduction
29
Q

medications (PVD)

A
  • Antiplatelets: ASA, Plavix ( clopidogrel )
    • Trental ( Pentoxifylline )- (helps rbc be more flexible so it can go through blood vessels better )
    • Antihypertensives: Ace inhibitors etc.
30
Q

herbal preps (PVD)

A

Gingko Biloba- effective in increasing

        walking distance in claudication.
  • Carnitine- natural occurring derivative ofamino acid lysine. Improves musclemetabolism and improves exerciseperformance of ischemic muscles.
31
Q

walking/positioning (PVD)

A
  • Structured walking & exercise program to increase blood flow and to build up collateral circulation.
  • Positioning to promote circulation

  • If patient has edema can elevate legs butnot above heart level.
    • In severe cases patient may need to keeplegs dependent position
32
Q

care of an ischemic limb (PVD)

A

Protect from injury. Keep warm to

decrease vasospasm.
  • Prevent and control infection.
  • Maximize arterial perfusion
  • Careful inspection, cleansing &lubrication of skin.
  • Footware: Soft, roomy and protective
  • Avoid chemicals, heat and cold.
  • Keep heels free from pressure.
  • Drink adequate amount of fluids.
  • Avoid caffeine, emotional stress.
33
Q

surgical management (PVD)

A
  • Percutaneous transluminal angioplasty (PTA)
  • Laser-assisted Angioplasty
  • Atherectomy
  • Arterial Revascularization
  • Amputation
34
Q

post op management (PVD)

A
  • Monitor for patency of graft per hospital protocol. Check pulses, changes in skin color, temperature of skin’
  • Observe for reports of throbbing pain. May be sign of occlusion. Monitor for compartment syndrome.
  • Vital signs, coughing and deep breathing, incentive spirometer. Check dressings for bleeding, signs of infection.
35
Q

home care management (PVD)

A
  • Assess tissue perfusion
  • Assess adherence to therapeutic regimen
  • Assess ability to manage wound care and prevent injury
  • Assess coping ability of patient and family
  • Assess home environment for safety
36
Q

patient teaching (PVD)

A
  • Keep feet clean. Wash with mild soap & room temperature water. Keep feet dry especially ankles and between toes.
  • Wear comfortable, well-fitting shoes
  • Keep toenails clean and filed . Cut straight across.
  • Prevent dry, cracked skin with lubrication.
  • Prevent exposure to extreme heat or cold.
  • Avoid constricting garments. Avoid pressure on feet and ankles
  • Report any problems immediately
37
Q

acute PVD

A

sudden occlusion

caused by embolism,thrombus

without warning

severe pain

emboli tend to lodge at the branching of arteries

they also occluding at the narrowings

ischemia/tissue death

S &S : pale modeled limb, pulses severly diminished or not there at all, parastethia, burning, tingling , numbness, poikilothermia (limb becomes really cold to the touch),

eventually if there is no o2 to tissue in limbs they will become paralyzed. immobility is a sign of ischemic death.

could have heparin drip, TPA, directly go in for surgery and remove the clot

exam 2 (9 decks)

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