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NRSG 227 > PVD and VTE > Flashcards

PVD and VTE Flashcards

1
Q

What are examples of conditions that can cause altered perfusion

A
  • atherosclerotic plaques…
  • blood clots (or thromboemboli).
  • pieces of medical devices.
  • air emoblism
  • fat embolism
  • A-fib
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2
Q

What is the MOST important risk factor for developing peripheral arterial disease?
 Use of corticosteroid medications
 Repetitive lower limb injury
 Smoking
 Hepatic steatosis

A

Smoking

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3
Q

What can PAD lead too if blockages are extensive enough or if the plaque ruptures or a blood clot forms?

A

arterial ulcers or necrosis

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4
Q

Risk factors for PAD

A

older age > 70
HTN
diabetes
metabolic syndrome
hyperlipidemia
CKD

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5
Q

Clinical manifestations of PAD

A
  • Skin of the legs becomes pale when elevated.
  • Becomes red when lowered
    = dependant rubor.
  • Pale, cool and dry. (sebaceous glands starved)
  • Hairless legs (hair follicles starved)
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6
Q

What is peripheral artery disease

A

atherosclerosis in the blood vessels of extremities.

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7
Q

atherosclerosis produces tiny elevations in what blood test marker

A

hs-CRP

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8
Q

What does a CRP greater than 3mg/l indicate a person is at risk for

A

heart attack and stroke

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9
Q

what is a angiogram

A

catheter is inserted into femoral artery and an IV contrast agent is injected.
This allows X-ray or CT scans to capture images of blood vessels and show cirulation.

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10
Q

What is a ABI

A

-Used to screen for and evaluate the extent of PAD.
-Compared the systolic BP in the anles to the BP of the upper arms

ankle-brachial index

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11
Q

**What does it mean if a nurse finds that a client has an ankle-brachial index (ABI) of 0.40? **
 Chronic venous insufficiency
 Venous thromboembolism
 Calcified and non-compressible arteries
 Severe arterial ischemia

A

 Severe arterial ischemia

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12
Q

How do you calculate ABI

A

ankle blood pressure divided by brachial blood pressure

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13
Q

What is considered a normal range on a ABI

A

0.9-1.3

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14
Q

what ABI reading will indicate PAD and less arterial blood flow to the lower extremities

A

ankle blood pressure less than the arm blood pressure and calculated ABI less than 0.9

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15
Q

What ABI value indicates mild-moderate PAD

A

0.41-0.9

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16
Q

What ABI values indicate severe PAD and indicates greater risk of getting arterial ulcers

A

0.40 or less

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17
Q

What explanation would describe why a patient may have a ankle blood pressure higher than the arm blood pressure?

A

calcium and minerals may build uo in the atherosclerotic plaques, causing calcification of the peripheral arteries. When this happens it makes arteries stiff, so that they don’t easily compress or stretch. (this may make it seem that the person has strong pedal pulses but in reality alot of damage is occuring)

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18
Q

What position should patients with PAD be placed in and why?

A

reversed trendelenburg as gravity helps to improve lower extremity circulation which reduces ischemic leg pain

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19
Q

A client with advanced atherosclerosis experiences severe leg pain, even while sitting or lying down. This is
most characteristic of:
 Intermittent claudication
 Thrombophlebitis
 Critical limb ischemia
 Varicose veins

A

 Critical limb ischemia

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20
Q

A client is admitted to hospital following a motor vehicle collision. His medical history indicates he was diagnosed with a medium-sized abdominal aortic aneurysm that has been managed with medications for the past three years.

What manifestation should warn the nurse that the aneurysm has ruptured?

Bradycardia
Hypotension
Abdominal bruit
Lower limb numbness and paresthesia

A

hypotension

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21
Q

A nurse takes a client’s health history and finds that the client experiences lower leg pain after walking. If the client sits down and rests, the pain usually disappears within 5-10 minutes. The physical assessment shows that the client’s legs have shiny, dry skin and the pedal pulses are difficult to palpate. What do these signs and symptoms indicate?
Dissecting aneurism of the femoral or iliac arteries
Deep vein thrombosis
Peripheral arterial disease with intermittent claudication
Raynaud’s phenomenon

A

Peripheral arterial disease with intermittent claudication

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22
Q

What nursing intervention is most important to include in the plan of care for a hospitalized client with peripheral arterial disease?
Apply anti-embolism (TED) stockings
Keep feet elevated
Maintain client in Trendelenburg position
Administer oral clopidogrel

A

Administer oral clopidogrel

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23
Q

Should antiembolic stocking (TED) be worn by people with acute arterial ischemia?

A

No, because they may reduce blood flow and make ischemia worse

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24
Q

A client with chronic venous insufficiency is admitted to hospital with severe lower leg edema and an open weeping wound on his lower right leg. The client reports that he has had this ulcer for several months and it is not healing. What treatment is MOST likely to be prescribed for this client to promote wound healing?
Paint wound with povidone-iodine solution and wrap with dry gauze
Apply compression wrap to lower legs
Administer low molecular weight heparin (LMWH)
Apply warm, moist compresses to the lower leg

A

Apply compression wrap to lower legs

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25
**A client with a pulmonary embolus is being treated with warfarin. Lab tests reveal that the client's INR = 2.5. What is the nurse's priority action?** Prepare to administer Vitamin K Prepare to administer protamine sulfate Prepare to administer a higher dose of warfarin Continue to monitor the client
Continue to monitor the client
26
**A nurse is caring for a postoperative client who is on bedrest and receiving heparin for a deep vein thrombosis. Which is the MOST concerning finding that should cause the nurse to immediately call the physician?** Client reports 6/10 pain in the left calf Onset of dyspnea and increased work of breathing Blood pressure 158/94 mm Hg (increased from 136/86) Oral temperature of 38.1° C
Onset of dyspnea and increased work of breathing
27
**A client is receiving a continuous intravenous infusion of unfractionated heparin for acute arterial ischemia. Upon reviewing laboratory test results, the nurse finds that the client’s platelet count is 62 x 109/L. What should the nurse recognize?** The client may be developing heparin-induced thrombocytopenia (HIT syndrome) The client is in the appropriate therapeutic range for heparin therapy The client has developed essential thrombocythemia The client has an increased susceptibility to infection and should be placed in protective isolation
The client may be developing heparin-induced thrombocytopenia (HIT syndrome)
28
**A client with cardiovascular disease tells a nurse, “I try to get some daily exercise, but after walking about 2 blocks, I get really bad pain in my thighs and buttocks.” What should the nurse advise the client?** A) After warming up, walk until you begin to feel discomfort, then stop and rest until the pain goes away, then resume walking until the discomfort returns. Try to walk for a total of 30 minutes each day. B) After warming up, walk at a slow pace for a total of 30 minutes without stopping. If you begin to feel pain, try to push through it. C) If you begin to feel pain when you are walking or exercising, stop. D) Apply graduated compression wrap to lower legs before beginning exercise
A) After warming up, walk until you begin to feel discomfort, then stop and rest until the pain goes away, then resume walking until the discomfort returns. Try to walk for a total of 30 minutes each day.
29
**A client is diagnosed with acute arterial ischemia of the right leg. What medication should the nurse expect will initially be prescribed for this client?** A calcium channel blocker (e.g. nifedipine) A statin (e.g. rosuvastatin) A thrombolytic (e.g. tPA) An antiplatelet agent (e.g. ASA)
A thrombolytic (e.g. tPA)
30
**Which of the following clients should the nurse assess FIRST?** Client who reports severe, “tearing” chest pain Client who has black, gangrenous ulcers on both feet Client who is taking anticoagulants and has bloody stools Client who has unilateral calf tenderness, redness, and swelling
Client who reports severe, “tearing” chest pain
31
What is the most common signs of a fat embolism
- resp symptoms such as decreased SPO2, OB, tachypnea. - - neuro symptoms such as confusion or anxiety and a petechial rash!
32
what causes intermittent claudication
atherosclerotic plaques in the peripheral arteries reduce blood flow to the legs.
33
What is pain from a blockage in the - lower aorta - iliac or common femoral arteries - superficial femoral artery
- pain in the butt or below - thigh and calf muscle - calf
34
how do people with intermittet claudication typically describe the pain
- burning, aching, cramping pain that is percipitated byt consistent amount of exercise. - with rest, pain resolves in minutes
35
What ABI would the nurse expect to find in a patient with intermittent claudication
usually less than 0.9 with reduced or absent pedal pulses
36
What is critical limb ischemia
worse than intermittent claudication. - people experience leg pain even when they are at rest. - symptoms get worse when the limb is elevated. | pts may sleep sitting to keep there legs lowered
37
What would a nurse expect to find in a patient with critical limb ischemia
extremely difficult to find pedal pulses and a ABI less than 0.4.
38
What are patients with critial limb ischemia at risk for developing
non-healing wounds or gangrene
39
what medication is often perscribed for PAD management
statins!!! the goal is to keep cholesterol levels in the normal range.
40
What medication is often prescribed for patients with PAD in order to prevent cardiovascular events such as a stroke, MI, or death from occuring
antiplatelet agents such as - Low-dose ASA - Clopidogrel
41
what can nurses recommend patients with PAD and intermittent claudication in order to help improve circulation.
supervised exercise program - shown to increase blood flow and may decreaese inflammation due to atherosclerosis. | slow progression of PAD
42
what does supervised exercise programs entail
pt walks on treadmill till these experience pain, than stop and rest till pain subsides, than walk again and keep repeating this for 30-60 minutes 3x days a week.
43
**A nurse is reviewing self-care with a client who has critical limb ischemia. What client statement indicates a misunderstanding that requires further clarification? **  “I will use a heating pad on my feet at night to increase the circulation in my feet”  “I will wear loose clothing that won’t be too tight across my waist or legs”  “I will change my position every hour and avoid long periods of sitting or lying with my legs elevated”  “I will eat a diet that is low in cholesterol, saturated fats, and sodium”
 “I will use a heating pad on my feet at night to increase the circulation in my feet”
44
non-surgical tmt for patients with PAD
- protect extremities from trauma (wear shoes) - inspect feet daily and report non healing wounds - opioids for severe pain management - positioning in reverse tredelenburg - hyperbaric oxygen therapy - spinal cord stimulation
45
surgical tmt for PAD
- percutaneous transluminal balloon angioplasty w/ stent placement. - atherectomy. - peripheral artery bypass surgery
46
what reasons would make amputation needed for a patient with PAD
- wound that develops infectious gangrene - if tissue necrosis is extensive - osteomyelitis (bone infection) - or if major arteries in the limb are occluded.
47
**What clinical manifestations should warn a nurse that a client’s abdominal aortic aneurysm has ruptured? **  Increasing hypertension  Increasing jugular venous distension  Severe back pain  Hematuria
 Severe back pain
48
What is grey turners sign
clinical sign that appears as bruising or discoloration on the flanks. It’s often a bluish-purple color and usually indicates internal bleeding, especially into the retroperitoneal space.
49
why would a client with a medium-sided aneurism not have it surgically removed
medium sided aneurism are at a lower risk to rupture than a large aneurism. In this case a more conservative approach may be taken, especially if the pt has other chronic health conditions that make surgery risky | "watch and wait"
50
if a nurse reads in a client’s chart that he has a “fusiform aneurysm”, what does that mean?  There is a symmetrical bulge in the wall of the artery  There is a bulge in only one side of the artery  This is not a true aneurysm, because it does not involve all three layers of the artery  There is a bulge in the artery caused by a tear in the intima, allowing blood to flow between the layers of the artery
there is a symmetrical bulge in the wall of the artery
51
what is a fusiform aneurysm
a spindle shaped, involving a symmetrical bulge in the wall of the artery. | Common in the aorta
52
What is a dissecting aneurysm
Occurs when a tear in the intimal layer of the aorta allows blood to split the vessel wall layers. Most dangerous in the aorta – can rapidly become fatal
53
* Why can aortic dissection lead to hypotension and shock?
- Because the dissection can rupture the aorta or reduce blood flow to vital organs causing - internal bleeding, - decreased cardiac output, and - hypovolemic shock.
54
Whats the difference between a Type A and Type B dissection
- Type A: Involves the ascending aorta and possibly the arch—more dangerous, surgical emergency. - Type B: Involves the descending aorta—often managed medically unless complications arise.
55
* What is the treatment for a Type A aortic dissection?
- Emergency surgical repair (open or endovascular)
56
* What is the treatment for a Type B aortic dissection?
- Medical management with blood pressure control (beta-blockers), with surgery if complications develop.
57
* What is the treatment for a small, asymptomatic aneurism?
* Regular monitoring with imaging * Lifestyle modifications (smoking cessation, BP control)
58
what is a saccular (or berry) aneurysm
Berry-shaped bulge on one side of the vessel Common in the brain Often the cause of subarachnoid hemorrhage if ruptured
59
* What is the treatment for a medium-sized aneurism?
* Depends on growth rate and symptoms * May monitor or consider surgical repair
60
What are some assessment findings of a aneurysm
-visible pulsation on the location of the aneurysm. - able to hear a bruit: thrumming sound with every heart beat
61
What clinical manifestation indicates acute arterial ischemia in an extremity?  Warmth  Edema  Loss of sensation in the extremity  Capillary refill < 2 seconds in the extremity
 Loss of sensation in the extremity
62
* What signs and symptoms are associated with an aortic dissection?
* Sudden, severe chest or back pain (tearing/ripping in nature) * Weak or absent pulses * Hypotension or shock * Neurologic symptoms (stroke-like) * Syncope * Shortness of breath
63
What are the 6 P's that ar typically manifested in acute arterial ischemia
1. Pulseness 2. Pallor (or mottling) 3. Pain (severe) 4. Paralysis 5. Paresthesia (numbness, itching, pins or needles) 6. Poikilothermia or "polar" (limb becomes cold | same symptoms as compartment syndrome
64
* What types of diagnostic tests are used to detect an aortic dissection?
* CT angiography (gold standard) * MRI * Transesophageal echocardiogram (TEE) * Chest X-ray (may show widened mediastinum)
65
* Describe a thoracic aortic aneurism
- A dilation or bulging in the wall of the thoracic portion of the aorta, often asymptomatic until rupture or compression of nearby structures.
66
* What is the difference between a “true” and “false” aneurism
* True aneurysm: Involves all 3 layers of the vessel wall. * False aneurysm (pseudoaneurysm): Blood escapes the vessel and is contained by surrounding tissue, not all vessel layers.
67
* Why are aneurisms bad (either thoracic or abdominal aneurisms)?
- They can rupture, causing life-threatening internal bleeding, and may compress nearby organs or vessels.
68
What is blood called that is pumped into the ventricles by the coordinated contraction of the atria? - What % of CO does this account for
atrial kick | 30 %
69
What are three problems present in A-FIB
1. Erratic electrical activity in the atria= decreased CO 2. May cause severe tachycardia 3. Formation of thrombi in the atria due to stasis
70
**What is the target INR for people being anticoagulated for atrial fibrillation? **  Less than 1.0  0.8-1.2  1.2-2.0  2.0-3.0
 2.0-3.0
71
What is a normal INR range
0.8-1.2
72
What would the target INR range be for a client with an artifical heart valve
3-4.5
73
What symptoms will be present in a client with a pulmonary embolism
- dyspnea - pleuritic chest pain (worse with a deep breath or cough) - swelling in one leg - cough (may produce hemoptysis) - tachypnea - decreased O2 sat
74
What are the three points of Virchow's triad that put people at risk for Venous Thromboembolism
- hypercoagulability (blood) - vascular damage (vessel) - circulatory stasis (flow)
75
- what does a positive D-dimer test indicate. - when is D-dimer test most helpful
products from clots are being degraded in the body - Most helpful to RULE out DVT or PE's are possible
76
What is one of the most reliable test to detect a PE
helical (or spiral) CT scan
77
Examples of Factor Xa inhibitors and how do they work
- Rivaroxaban - Apixaban - directly inhibit factor Xa They both have a "Xa" in there name
78
What medications may be used for a patient with a DVT or PE
Vitamin K antagonist, Factor Xa inhibitor, LMWH (dalteparin), unfractionated heparin
79
What test can heparin therapy be monitored with
PTT and aPTT
80
what is the normal range for PTT
60-70 seconds
81
What is the normal range of aPTT
25-35 seconds
82
Is aPTT or PTT more sensitive
aPTT
83
What laboratory finding should alert the nurse that a client is developing heparin-induced thrombocytompenia (HIT) syndrome?  Sudden increase in PTT level  Sudden decrease in leukocyte count  Sudden increase in C reactive protein level  Sudden decrease in platelet count
 Sudden decrease in platelet count
84
What is HIT syndrome
- immune reaction in which the bodies produces antibodies to heparin. - 5-10 days after initiation of therapy - (liver, spleen, and bone marrow) remove platelets from the circulation - remaining platelets get activated and cause clotting
85
A client receiving IV heparin develops a nosebleed and hematuria. His aPTT test result is 200 sec. What treatment should the nurse anticipate being ordered for this client?  Vitamin K  Apixaban  Protamine sulfate  Anexate
 Protamine sulfate
86
* What are the 3 layers of the aortic wall?
- Intima (inner layer) - Media (middle muscular layer) - Adventitia (outer layer)
87
* What medications are used to prevent aneurisms from getting worse?
* Beta-blockers * Statins * Antihypertensives (especially ACE inhibitors and ARBs)
88
What is acute arterial ischemia
sudden interruption of blood flow to an extremity which can threaten limb viability (medical emergency)
89
What causes acute arterial ischemia
embolus, usually from the heart
90
Where do emboli often travel too
lower limbs, tend to lodge in arterial bifurcations such as the femoral or popliteal arteries
91
What tmt is used to treat arterial ischemia
-depend on severity and onset. - anticoagulation with IV heparin - surgery (embolectomy or thrombectomy) - thrombolytic
92
What is venous thromboembolism?
- a condition that includes both (DVT) and (PE). - It involves the formation of blood clots in the venous circulation, which can dislodge and travel to the lungs, causing life-threatening complications.
93
how would people with venous ulcers be instructed to sit
-avoid prolonged sitting - raise legs above heart to promote venous return.
94

NRSG 227 (11 decks)

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