Peripheral vascular disease: venous and arterial Flashcards
peripheral vascular disease
Disrupt the flow of blood through the arteries and veins
Most clients with a PVD have arterial disease rather than venous involvement (some have both)
Atherosclerosis is most common cause
peripheral artery disease
More common and results in possible limb loss. Would expect to see pale, cool, thin shiny skin on limb due to lack of blood supply with weak or absent pulses
key features of PAD
PAD is term that denotes stenotic, occlusive, and aneurysmal diseases of the aorta and its branch arteries
Fatty deposits build up in artery walls decreasing blood flow to vital organs
Patients at significant risk for: stroke, heart attack, kidney failure, and loss of limb
complications of PAD
Obstructed arterial flow & tissue death
Embolus (clot that breaks away and is moving)
risk factors of PAD
Smoking High blood pressure Abnormal Cholesterol levels Prior heart disease or stroke Overweight Not physically active Age >50 Family History of heart or CV disease
extensive list of signs/sx of PAD
Depends on which arteries are affected (most are leg arteries)
Cramping, pain/discomfort, fatigue in legs and buttocks during activity that stops when activity stops (Claudication)
Numbness, tingling, (paresthesia) or coldness in lower legs or feet
Sores or infection on feet/legs that heal slowly (*still have sensation of pain)
High blood pressure that is hard to control with medication
Decrease in kidney function
stages of chronic PAD
Stage 1: Asymptomatic, bruit or aneurysm may be present, pedal pulses may be decreased but can still feel them
Stage 2: Claudication, pain and cramping with exercise so decreased activity
Stage 3: Rest Pain, pain at rest, may awaken patient at night. Typically when pt seeks medical help
Stage 4: Necrosis/Gangrene, feet ulcers
diagnosis for PAD
Medical history and physical exam ABI or ankle brachial index Stress (exercise) testing Duplex ultrasound, graphs of arterial flow MRA magnetic resonance angiogram CT angiogram Regular (catheter-based) angiogram
diet changes for PAD
low fat, low cholesterol
medical management for PAD
Treatment includes antiplatelet agents Pletal (cilostazol) and Trentol (pentoxifylline)
Other antiplatelets include: ASA & Plavix
Anticholesterol medication taken at night bc stomach is empty and cholesterol is made at night
PVD
Defects or damage in the peripheral veins
Peripheral venous disorders include: Thrombophlebitis varicose veins venous insufficiency Effects deep veins, not necessarily superficial
thrombophlebitis
Occurs when a blood clot blocks one or more of your veins, typically in your legs and causing inflammation.
Thrombophlebitis can be caused by trauma, surgery or prolonged inactivity. Superficial thrombophlebitis may occur in people with varicose veins.
Warmth, pain, swelling
Heat, elevate, NSAIDs
Varicose veins
Weakened valves and veins in legs. Blood pools and veins become weak, large, and twisted.
Run in families
Also obesity and standing long periods increase pressure
Wear compression stockings
Sclerotherapy or Laser Ligation and stripping
Venous insufficiency
Vein walls are weakened and valves are damaged. This causes the veins tostay filled with blood, especially when you are standing.
Risk with age, obesity, pregnancy, hx DVT, sit or stand for long periods of time
Dull, aching, cramping feeling in legs
Long-term condition
Reddish skin in lower extremities with swelling
Vericose veins superficial and this is deeper
Elevate LE and wear compression stockings, do not sit for long periods of time, keep moving, get proper care for any wounds
cause/ etiology of PVD
Injury or surgical trauma, especially IV catheters
Major medical illnesses
Physical inactivity
Sitting or standing for long periods of time
signs/ sx (50% have 0 or mild sx)
Mild inflammation
Fever
Swelling, redness and tenderness to touch, especially in the calf or thigh
Warmth in the affected area
Pain and discomfort with Homan’s sign *no longer reliable
DVT
clot in deep vein, 98% in LE (those in UE likely due to central line), may lead to PE
signs/ sx of PE
SOB, unexplained inc in HR, CP
preventative measures for DVT
SCD, TED hose, lovenox injectoins, anticoag
cause of DVT
Virchow’s triad: Stasis of blood, Trauma to vessel, Hypercoagulability
pathophys of DVT
Platelet adherence to endothelium and become clumpy and thick
Platelet Aggregation
predisposing factors to DVT
immobility (recent travel/ bedrest), disease process (DM, PVD), pressure on area, clotting dysfunction, recent surgery
manifestation of DVT
None obvious Related to size and location of thrombus Unilateral edema Vital signs (slight inc in temp) Warmth and pain in calf
Severe pain is not a sign of DVT!
most reliable test for DVT
US
nursing assessment of pt with DVT (history)
history of clot, description of pain, duration of pain, injury or immobility to limb, dehydration
nursing eval for pt with DVT
Degree of edema
Skin color, compare both sides, temp, assess areas of pain
Peripheral pulses
Assess for Pulmonary Emboli (SOB, CP, inc HR)
DVT management
Prevention Immobilization Anticoagulant therapy Thrombolytic therapy (TPA) Compression stockings Peripheral Intervention Cath lab Surgical management
PVD treatment
Exercise affected extremity Compression and Bandaging Anticoagulation Smoking cessation Weight control Low salt diet Anticoagulation therapy
anticoagulation of patient with DVT
IV Heparin (unfractionated heparin) and (Warfarin) Coumadin
Low-molecular weight heparin LMWH (Lovenox)
Pradaxa
Thrombolytic therapy (t-PA)
dietary precautions for patient taking heparin and warfarin
Reversal of coumadin: vitamin K (green leafy veggies)
venous insufficiency
normal color, cyanotic when dependent, normal temp, normal pulse, marked edema, brown pigmentation of skin around ankles with stasis dermatitis
arterial insufficiency
pale skin color which worsens when extremity is elevated and is dusky red when lowered, cool to the touch (b/c blood flow blocked), absent or weak pulse, absent or mild edema, skin appears thin and shiny with hair loss and thickened nails
How many adults in the US have one or more types of cardiovascular disease?
81 million
In preparation for home care the nurse initiates a teaching plan about home care after DVT. The effectiveness of the plan can be determined when the patient tells the nurse she will:
Not sit or cross legs for prolonged periods
