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Adult Health Nursing I > Peripheral Vascular Disorders > Flashcards

Peripheral Vascular Disorders Flashcards

1
Q

Pathophysiology of Disorders of Peripheral Vascular System

A

Related to inefficiency of the heart, blood vessels, incompetent valves, lymphatic obstruction

Normal aging: inner walls of blood vessels become thick and less flexible, which increases vascular resistance

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2
Q

Risk Factors of Disorders of the Peripheral Vascular System

A

Age, gender, heredity, race, diet, exercise, smoking, stress, hyperlipidemia, obesity, diabetes (increased blood glucose)

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3
Q

Arterial Assessment

A

First symptom of decreased arterial circulation is pain

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4
Q

Ischemia

A

Caused by lack of oxygen-rich blood getting to the muscles

Pain frequently in lower extremities, dull ache in calf muscles, occurs even with rest

Accompanied by fatigue and cramping

Precipitated by exercise

Alleviating factor is rest (initially)

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5
Q

Intermittent Claudication

A

Weakness and cramp-like pain in the calves related to poor circulation of the arterial blood

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6
Q

Arterial/Venous Assessment

A 
Pulses
Appearance
Temperature
Capillary refill
Hardness
Edema
Sensation
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7
Q

Venous Assessment

A

First symptom is edema

Dark pigmentation, dryness, and scaling due to chronic venous insufficiency

Chronic edema and stasis leads to stasis ulcerations caused by the pooling of blood

Achy pain and cramps

Alleviated by activity or raising the legs above heart level

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8
Q

Noninvasive Tests of Vascular Insufficiency

A

Treadmill test (taking blood pressures in extremities and monitoring for pain)

Plethysmography (measures changes in volume in different parts of the body)

Doppler ultrasound (continuous recording, color flow, used for looking at claudication and obstruction)

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9
Q

Invasive Tests of Vascular Insufficiency

A

Phebography or venography (injection of dye into an IV)

Angiography (dye in an IV)

Doppler/Duplex Scanning Tests (combines ultrasound and doppler)

D-Dimer (looks for blood clots, thrombus present if test shows > 1591 ng/mL of D-Dimer)

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10
Q

Characteristics of Arterial Insufficiency

A

Pulses decreased or absent

Color is pale, dusky rubor present

Temperature is cool

No edema

Skin is shiny and has absence of hair, ulcers on the toes

Pain aggravated with exercise and relieved with rest

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11
Q

Characteristics of Venous Insufficiency

A

Pulses are present

Color is pink to cyanotic with brown pigmentation at ankles

Temperature is warm

Edema is present

Skin shows ulcers on ankles

Pain is aggravated by long standing or sitting and is alleviated by elevation of legs, lying down, or walking

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12
Q

Pathophysiology of Hypertension

A

Sustained elevated systolic blood pressure greater than 140 mmHg and sustained elevated diastolic blood pressure greater than 90 mmHg

Increases vascular resistance, hastens atherosclerosis and arteriosclerosis, and makes the heart work harder

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13
Q

Essential Hypertension

A

No exact cause, makes up 90-95% of all diagnosed cases

Includes malignant hypertension

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14
Q

Malignant Hypertension

A

Severe, rapidly progressive elevation of blood pressure of over 250/120 mmHg

Medical emergency

Symptoms include headache, visual disturbances, nosebleeds

Can lead to heart attack, stroke, renal failure, or problems with the eyes

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15
Q

Secondary Hypertension

A

Related to something else and can be fixed by fixing the root issue

Examples are hyperthyroidism, fluid overload, kidney problems

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16
Q

Risk Factors for Hypertension

A

Age/Gender (older than 30 increases risk for hypertension; men are more likely to be at risk)

Race/Heredity (higher risk for African Americans)

Smoking/Obesity

High sodium/Elevated cholesterol

Oral contraceptives or estrogen

Alcohol (increases catecholamines that lead to vasoconstriction)

Emotional stress/Sedentary lifestyle

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17
Q

Signs and Symptoms of Hypertension

A

Headache (especially upon awakening)

Blurred vision, spots before eyes

Epistaxis

Complications can occur in the heart, brain, eyes, and kidneys

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18
Q

Pharmacological Management of Hypertension

A

Patients should report signs and symptoms and should not stop taking abruptly

Antihypertensive medications (teach about taking as ordered, teach about side effects such as hypotension, drowsiness, erectile dysfunction)

Diuretics (help to get rid of the extra fluid in the body)

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19
Q

Medical Management of Hypertension

A

Diet (low sodium, reduction of saturated fats, reduce alcohol)

Exercise (30-45 minutes, 3-4 times a week)

No smoking

Relaxation techniques/Stress management

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20
Q

Peripheral Arterial Disease

A

Narrowing or occlusion of the blood vessels

Common sites are iliac, common femoral arteries and superficial femoral arteries

Signs and Symptoms include pain, pulselessness, pallor, paresthesia, paralysis

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21
Q

Diagnosis of Peripheral Artery Disease

A

Ankle Brachial Index (blood pressure taken in both arms and one in the legs; ABI < 0.9 is abnormal)

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22
Q

Treatment of Peripheral Artery Disease

A

Anticoagulants/Fibrinolytics/ACE Inhibitors

Embolectomy, Endarterectomy, Arterial Bypass, Percutaneous Transluminal Angioplasty, Amputation

23
Q

Arterial Embolism Signs and Symptoms

A

Pain

Absent distal pulses

Pale, cool, and numb extremity

Necrosis

24
Q

Management of Arterial Embolism

A

Anticoagulants and fibrinolytics

Endarterectomy

Embolectomy

25
Risk Facters for Arterial Aneurysm
Congenital issue, hypertension, arteriosclerosis, atherosclerosis
26
Signs and Symptoms of Arterial Embolism
Large pulsating mass inside of the abdomen Pain Thoracic Aorta: pain in the neck, shoulders, lower back, abdomen, syncope, dyspnea, increased pulse, color changes, weakness, hoarseness, difficulty swallowing Abdominal Aorta: bruit, tenderness with deep palpation, lower abdominal and back pain
27
Management of Arterial Aneurysm
Goal is to limit the progression and prevent straining of the body Assess pain, color changes Pre-Op: teach how to splint, educate on how to get out of bed, give pain medication, check lab work, teach about incentive spirometry, mark the pulses Post-Op: monitor pulses, vital signs, restrict HOB to less than 45 degrees, watch intake and output, NG tube, manage pain
28
Pathophysiology of Thromboangitis Obliterans (Buerger's Disease)
Occlusive disease of the medium and small arteries and veins that affects the distal portions of the upper and lower limbs Men between 35-40 years of age who smoke are most affected
29
Signs and Symptoms of Thromboangitis Obliterans
Pain, sensitivity to cold Skin cold and pale Ulcerations on feet or hands; gangrene Superficial thrombophlebitis
30
Treatment of Thromboangitis Obliterans
Goal is to prevent progression NO SMOKING Exercise to develop collateral circulation Amputation of gangrenous extremities Sympathectomy: cutting into the SNS by interrupting nerve pathways in order to eliminate pain and vasospasms Educate, prevent necrosis, hydrate, clean infected areas, encourage well-fitting shoes and socks
31
Pathophysiology of Raynaud's Disease
Intermittent arterial spasms in the lower and upper extremities related to exposure to cold Mostly affects the ears, toes, fingers, and nose Women more likely to have this
32
Signs and Symptoms of Raynaud's Disease
Chronically cold hands and feet Pallor, coldness, numbness, cyanosis, and pain during spasms Erythema following a spasm Ulcerations on the fingers and toes Diaphoresis, numb and prickly sensations
33
Pharmacological Management of Raynaud's Disease
Vasodilators/Calcium antagonists Sympathectomy No smoking Avoid exposure to cold, add warmth Amputation for gangrene
34
Thrombophlebitis
Inflammation of the vein caused by venous stasis, trauma to a blood vessel, immobilization, dehydration, and/or childbirth
35
Phlebothrombosis
Clots in the vein
36
Signs and Symptoms of Thrombophlebitis
Pain Edema Positive Homan's sign Erythema, warmth, tenderness along the vein
37
Management of Superficial Thrombophlebitis
NSAIDs/Anticoagulants Bedrest to keep clot where it is Moist heat Elevate extremity Never massage or rub area
38
Management of Deep Thrombophlebitis
Anticoagulants/Fibrinolytics Bed rest, elevate extremity Anti-embolism stockings Thrombectomy Vena cava umbrella (Greenfield filter)
39
Varicose Veins
Dilated veins with incompetent valves Blood collects in the veins and is not returned to the heart in an efficient manner People with prolonged standing have an increased risk
40
Signs and Symptoms of Varicose Veins
Dark, raised, tortuous veins Fatigue, dull aches Cramping of the muscles Heaviness or pressure of extremity, tired legs Edema, pain, changes in skin color Slow healing/ulcerations
41
Management of Varicose Veins
Elastic stockings Rest Elevate legs Sclerotherapy: injection of a solution in a vein that leads vein to collapse and scar so that the body reroutes the blood deeper into the muscles instead Vein ligation and stripping
42
Post-Op Care for Ligation and Stripping
Monitor for pain, bleeding Vital signs Elevate foot of bed ACE wraps Early ambulation Avoid prolonged standing, walk as much as possible, do not strain
43
Venous Stasis Ulcers
Caused by varicose veins, burns, trauma, sickle cell anemia, diabetes mellitus, neurogenic disorders, hereditary factors
44
Signs and Symptoms of Venous Stasis Ulcers
Pain Ulceration with dark pigmentation Edema
45
Management of Venous Stasis Ulcers
Increased protein, vitamins A and C, and zinc Debridement of necrotic tissue Antibiotics Unna boot
46
Function of Lymphatic System
Maintenance of fluid balance Production of lymphocytes Absorption and transportation of lipids from the intestine to the bloodstream
47
Lymph
Specialized fluid that is transported through the lymphatic vessels
48
Lymph Nodes
Act as a filter, keeping particulate matter such as bacteria from entering the bloodstream
49
Lymphangitis
Inflammation of the lymphatic vessels, usually after a staph or strep infection of an extremity
50
Signs and Symptoms of Lymphangitis
Local pain Chills, fever Red streaks from the affected area Edema, enlarged lymph nodes Headache, myalgia
51
Treatment of Lymphangitis
Penicillin Moist heat Elevate extremity
52
Lymphedema
Accumulation of lymph in the soft tissue Primary: cause unknown, could be malformed lymphatic system Secondary: usually related to cancer
53
Signs and Symptoms of Lymphedema
Massive edema and tightness of affected extremity Pain
54
Treatment of Lymphedema
Antibiotics Special massage Compression pump, elastic stocking or sleeve Restrict sodium, maintain a healthy weight, exercise regularly, avoid constrictive clothing, avoid trauma

Adult Health Nursing I (22 decks)

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