problems with vascular system Flashcards
vascular system includes
arteries
veins
lymphatic vessels
Peripheral Arterial Occlusive Disease
- Involves progressive narrowing and degeneration of arteries of upper and lower extremities.
- Atherosclerosis is the leading cause in majority of cases.
what is pad caused by
- Atherosclerosis is the gradual thickening of the artery wall.
- Caused by deposits of cholesterol and lipids within the artery, which leads to narrowing.
Risk factors
- Cigarette smoking: vasoconstritor
- Hyperlipidemia
- Hypertension
- Diabetes mellitus
cad clinical manifestations
- Intermittent claudication: pain/cramping when walking, resolves with rest.
- Calf muscle atrophy.
- Skin appears shiny with hair loss and thickened toenails.
- Poor neurovascular integrity.
Tingling and numbness of toes - Necrotic ulcers.
- Cool extremities with poor pulses.
clautication
walking o2 decreases in legs
- stop walking helps
paresthesia
- Numbness or tingling in the toes or feet
- Produces loss of pressure and deep pain sensations
- Injuries often go unnoticed by patient
pain at rest symptoms
- Occurs in the foot or toes
- Aggravated by limb elevation
- Occurs from insufficient blood flow
- Occurs more often at night
- don’t elevate blood needs to stay
nursing interventions for pad
- Exercise therapy: walk to the point of pain three times a week.
- Encourage tobacco cessation.
- Promote weight reduction.
- Dependent position relieves pain.
- don’t put stockings or boots on
meds for pad
- pentoxifylline (Trental)
- cilostazol (Pletal)
Antiplatelet agents
- Aspirin
- Clopidogrel (Plavix)
exercise therapy for pad
- Exercise improves oxygen extraction in the legs and skeletal metabolism
- Walking is the most effective exercise for individuals with claudication
- 30 to 60 minutes daily, 3 times/week
pad complications
- Atrophy of the skin and underlying muscles
- Delayed healing
- Wound infection
- Tissue necrosis
- Arterial ulcers
surgical treatment
- Femoral popliteal bypass surgery
- Angioplasty
- Stenting
leg with critical limb ischemia
- Revascularization via bypass surgery
- Protect from trauma
- Decrease ischemic pain
- Prevent/control infection
- Improve arterial perfusion
Other strategies
- Spinal cord stimulation
- Angiogenesis
most common surgical approach
- A peripheral artery bypass surgery with autogenous vein or synthetic graft to bypass blood around the lesion
- PTA with stenting may also be used in combination with bypass surgery
- mark pulses
- know sensation, temperature
percutaneous transluminal balloon angioplasty (PTA)
- Involves the insertion of a catheter through the femoral artery
- Catheter contains a cylindrical balloon
- Balloon is inflated dilating the vessel by compressing atherosclerotic intimal lining
- Stent is placed
issues with artery stent
- platelets love it
- monitor for stroke
- piece break off = stroke
A nurse is caring for a client following peripheral bypass graft surgery of the left lower extremity. Which of the following findings pose an immediate concern?
(Select all that apply.)
a. Trace of bloody drainage on dressing
b. Capillary refill of affected limb of 6 seconds
c. Mottled appearance of the limb
d. Throbbing pain of affected limb that is decreased following IV bolus analgesic
e. Pulse of 2+ in the affected limb
B, C
cryoplasty
- Combines percutaneous transluminal angioplasty and cold therapy
- Liquid nitrous oxide
- solution
pad complications
- Nonhealing arterial ulcers and gangrene are most serious complications
May result in amputation
- If adequate blood flow is not restored
- If severe infection occurs
overall goals for patients with PAD
- Adequate tissue perfusion
- Relief of pain
- Increased exercise tolerance
- Intact, healthy skin on extremities
Frequently monitor after surgery:
- Skin color and temperature
- Capillary refill
- Presence of peripheral pulses distal to the operative site
- Sensation and movement of extremity
ambulatory and home care
- Management of risk factors
- Long-term aspirin therapy
- Importance of gradual physical activity after surgery
- Importance of meticulous foot care
- even stent it won’t be same perfusion
- Daily inspection of the feet
- Comfortable shoes with rounded toes and soft insoles
- Shoes lightly laced
aorta
- Largest artery in the body.
- Responsible for supplying oxygenated blood to essentially all vital organs.
aortic aneurysm
- Local distention of the aortic artery wall.
- Usually thoracic or abdominal.
- Monitored until above 5cm in size.
- Once above 5cm in size, rate of rupture increases and surgery is usually required.
