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@ Nur 180 Exam 2 > PVD/DVT/Arteriosclerosis > Flashcards

PVD/DVT/Arteriosclerosis Flashcards

1
Q

are conditions affecting the peripheral arteries and veins. (can’t get blood back up)

A

PVD’s; Peripheral Vascular Disease

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2
Q

thickening, loss of elasticity and buildup of calcification on arterial walls.

A

Arteriosclerosis

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3
Q

a form of arteriosclerosis in which deposits of fat and fibrin obstruct and harden the arteries.
-These pathologic changes impair perfusion to the peripheral tissues and this is PVD.

A

Atherosclerosis

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4
Q

Inadequate venous return

DVT is most common cause

A

Chronic venous insufficiency

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5
Q

Peripheral Arterial Disease/Peripheral Atherosclerotic Disease

A

PAD

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6
Q

lesions obstruct vessel lumen

  • Collateral circulation develops; inadequate to meet tissue needs.
  • Manifestations occur when vessels are more than 60% occluded.
  • Arterial Ulcers may develop.
A

Peripheral Arterial Disease/Peripheral Atherosclerotic Disease (PAD)

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7
Q

Venous blood stagnates. (can’t get blood back to heart).

  • Pressures increase and may impede arterial flow.
  • Cells die. Red cell breakdown causes brown pigmentation. (hemosiderin; iron deposited)
  • Venous stasis ulcers develop
A

Chronic venous insufficiency (CVI)

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8
Q

Affects people in their 60’s and 70’s; Men more than women.

A

Etiology of Arterial insufficiency

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9
Q

Diabetes mellitus

  • hypercholesterolemia
  • hypertension
  • cigarette smoking
  • high homocystine levels; increasing PVT
  • obesity
  • sedentary lifestyle
A

Risk factors for Arterial insufficiency

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10
Q
  • thrombophlebitits
  • obesity
  • prolonged standing or sitting.
  • Right sided heart failure
A

Risk Factors for Venous insufficiency

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11
Q
  • Intermittent claudication
  • Rest pain
  • Paresthesias (numbness)
  • weak, absent pulses
  • Pallor with extremity elevation, dependent rubor (redness)
  • Thin, shiny, hairless skin, thickened toenails
  • Areas of discoloration/skin breakdown
A

Clinical Manifestations of Peripheral Atherosclerosis

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12
Q

-Edema
-Itching, dull leg pain increases with standing
-Thin shiny atrophic skin
-Cyanosis and brown skin pigmentation of lower leg and foot (hemosiderin)
-Possible weeping dermatitis
-Thick, fibrous (hard) SC tissue
-Recurrent ulcerations of medial or anterior ankle.
-

A

Clinical Manifestations of Chronic Venous Insufficiency

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13
Q
  • Toes, feet, shin
  • Ulcer appears-deep, pale
  • skin, normal to atrophic
  • pallor on elevation and Rubor when dependent
  • skin temp Cool
  • Edema; absent or mild
  • Pain; severe/intermittent claudication/rest pain
  • Gangrene may occur
  • Pulses decreased or absent
A

Arterial Ulcers

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14
Q
  • Ankle (medial and anterior)
  • Ulcer; pink superficial
  • Skin; brown, stasis dermatitis, Cyanosis on dependency (down)
  • Skin temp; normal warmer
  • Edema may be significant
  • Pain-usually mild/aching
  • No gangrene
  • pulses normal.
A

Venous Ulcers

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15
Q
  • Slow atherosclerosis
  • maintain tissue perfusion
  • keep legs dependent/down
A

Management of PAD; Peripherial Arterial Disease/ Atherosclerotic

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16
Q
  • Relieving symptoms, promoting adequate circulation and prevent tissue damage.
  • Reduce edema; diuretics.
  • Treat ulcers
  • Hosiery/teds
  • Elevation of the legs frequently during day and above heart level at night.
A

Management of CVI; chronic venous insuff

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17
Q

Diagnostic tests
Segmental pressure measurements
Stress testing
Doppler ultrasound; DVT?
Transcutaneous oximetry evaluates oxygenation of tissues
Angiography or Magnetic resonance angiography. SP of ankle over SP of brachial

ankle pressure should be higher than brachial

A

Management of PAD and CVI
(Perpheral Arterial Disease/Peripheral Atherosclerotic Disease)
(Chronic Venous Insufficiency)

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18
Q
  • Aspirin; decreases PLT aggregation
  • Clopidogrel (Plavix)
  • Cilostazol (Pletal); vasodilator properties
  • Pentoxifylline (Trental); decreases viscosity; thickness of blood, better flow; Increase perfusion
A

Pharmacologic therapies

-Inhibit platelet aggregation

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19
Q
  • Smoking cessation (promotes atherosclerosis and Vasospasm)
  • Foot care
  • Pain relief
  • Progressive strenuous exercise (30-40 min walk daily)
  • Control
  • Diabetes
  • Hypertension
  • Cholesterol levels
  • Weight
A

Clinical Therapies Arterial/Venous Insufficency

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20
Q
  • Revascularization; jump the clot
  • Percutaneous transluminal angioplasty
  • Stent placement
  • Atherectomy (cut out plaque)
  • Endarterectomy (roto rooter; carotid artery)
  • Bypass grafts (jump over, block CABG)
A

Surgery for Arterial insufficiency

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21
Q
  • Aromatherapy
  • Biofeedback
  • Healing/therapeutic touch
  • Massage
  • Herbal therapy
  • Exercise/Yoga
  • Very low fat/vegatarian diet
  • Antioxidants
A

Complementary Therapies (Arterial/venous insufficiency)

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22
Q
  • Elevate legs at rest and sleep
  • Walk
  • Avoid sitting or standing for prolonged periods
  • Avoid Crossing legs
  • Avoid tight-fitting garments
  • Wear elastic hose as prescribed-tighter at foot instead of calf.
  • Foot care
A

Patient Education for Venous Insufficiency

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23
Q
  • Health Hx; evaluate Pain
  • CAD, PVD, Hyperlipidemia, HTN, DM, Smoking, Diet, Activity
  • Physical examination
  • Pulses
  • Sensation
  • Capillary refill
  • Temperature, warm venous, cool arterial
  • Color
  • Movement
  • hair distribution
A

Assessment PVD

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24
Q
  • Disturbed body image
  • Ineffective Health Maintenance
  • Risk for Infection
  • Impaired Physical Mobility
  • Impaired Skin Integrity
  • Ineffective Tissue Perfusion: Peripheral
  • Pain
  • Activity Intolerance
A

Nursing Diagnoses for PVD

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25
Q
  • Promote wound healing
  • Manage Pain
  • Promote tissue perfusion
  • Optimize activity tolerance
  • Educate on medications
A

Plan for PVD

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26
Q 
Assess peripheral pulses
Position extremities
Regular exercise benefits
Support extremities with foot cradle, warmth (arterial insufficiency)
Frequent position changes
A

Implementation;
Ineffective Tissue Perfusion: Peripheral
(PVD)

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27
Q

Assess q 4hr
Keep extremities warm
Pain relief strategies

A

Implementation;
Pain
(PVD)

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28
Q

Meticulous skin care
Bed cradle
Specialty mattress
Implementation

A

Implementation;
Impaired Skin Integrity
(PVD)

29
Q

Assist with care as needed
Gradual increase in activity/exercise
Diversional activities/stress reduction
Frequent position changes

A

Implementation;
Activity Intolerance
(PVD)

30
Q 
Positioning to promote perfusion to extremities
Abstinence from tobacco products
Appropriate wound care/healing
States symptoms to report to provider
Pain Control
A

Evaluation for PVD

31
Q

Virchow’s triad

  • stasis of blood
  • vessel damage
  • increased blood coagulability
A

3 pathological factors assoc with thrombophlebitis

Virchow’s triad

32
Q

Deep or superficial veins
Common complication hospitalization, surgery
OB, orthopedic procedures; genetics

A

Etiology of Deep Vein Thrombosis

33
Q

Prevention Minimizes Risk
Special Considerations;
-Orthopedic procedures (bones)
-Atrial fibrillation (upper chambers arent’ pumping blood; stagnant)
-Acute myocardial infarcion; doesn’t pump well
-Ischemic stroke
-Genetic predisposition

A

Risk Factors DVT

34
Q

Protein C deficiency
Protein S deficiency
Antithrombin III deficiency
Factor V Leiden

A

Genetic Predisposition to DVT

Remember*

35
Q

Calf pain; dull, aching, increases with walking
Tenderness
Swelling
Warmth
Erythema
Cyanosis and edema;
**Could be bilateral with OB patients (DVT legs)
-get on anticoagulant then increase walking
**Rare; Palpaple cord along affected vein
Homan’s sign unreliable indicator

A

Clinical Manifestations of DVT

36
Q

Chronic venous and pulmonary embolism;
usually unilateral but can be bilateral (heart pts)
Flex pt. foot look for pain. Cont pain after flex DVT
Gold standard; Spiral CT Scan ; emboli

A

Complications DVT

37
Q 
Duplex venous ultrasonography
Plethysmography
MRI; decreased perfusion
Ascending contrast venography; injectable dye and see where it didn't go
Spiral CT
A

Diagnostic tests DVT

38
Q

-Low-molecular-weight heparins; lovenox
-Oral anticoagulation; warfarin, PTT, INR
-Elevating foot of bed, knees slightly flexed
-Early mobilization
-Leg exercises
-Intermittent pneumatic compression devices
-Elastic stockings; TEDS
Reverse heparin with Vitamin K

A

Prophylaxis DVT

39
Q

Anticoagulants;
Use of heparin.
-dosage calculated to maintain a PTT 2x control ; (usual double PTT range, if normal 23 would be 46)
-continuous infusion
-subcutaneous heparin; not looking @ PTT
IF PLT decrease count or less than 100 call Dr.; consider something else besides heparin.

Warfarin;
Given with IV heparin for 4-5 days.
Takes up to 5 days for full effects
Doses adjusted to maintain INR at 2-3 (level)
Cont. for at least 3 months; DVT coumadin for 3 months
Coumadin with heparin at 1st. takes 4 to 5 days to work
Can increase risk of clotting.

A

Pharmacologic therapies for DVT

40
Q

Venous thrombectomy; removed
Filters; Venal Caval filters; Green
(for recurrent thrombosis)
Vein Ligation; open vein and take out clot

A

Surgery for DVT

41
Q

Measures to reduce symptoms, inflammation.
-warm, moist compresses
-extremity rest
Anti-inflammatory agents
Bed rest
-elevate legs
-antiemolism stockings, PCD (put on other leg that doesn’t have DVT

A

Clinical Therapies for DVT

42
Q

Return to activity

  • encourage walking-when ordered. (been on heparin/coumadin long enough)
  • avoid prolonged sitting, standing
  • avoid tight-fitting garments
A

Clinical therapies for DVT

43
Q

Position to promote venous blood flow

  • Elevate feet with knees slightly bent
  • Avoid pillows under knees
  • Avoid sharply flexed hips, knees
  • Use recliner, foot stool
  • Early ambulation
  • Teach ankle flexion, extension exercises; foot pumps
A

Nursing Process: Assessment DVT

44
Q 
Apply elastic stockings, PCD
Avoid crossing legs
Possible prophylaxis with heparin, warfarin (high risk client)
Assess IV sites
(change location with evidence of inflammation)
Assessment
-health hx
-physical exam
-family hx
-vessel damage risk
A

Assessment DVT; nursing process

45
Q 
Pain
Ineffective Tissue Perfusion:Peripheral
Ineffective Protection; predisposing hereditary
Impaired Physical Mobility
Ineffective Tissue Perfusion: Cardiac
A

Nursing Diagnosis for DVT

46
Q

Client will:

  • control pain to allow for rest, comfort
  • have no complications, thrombosis will not embolize
  • Have increased tissue perfusion
A

Plan for DVT

47
Q

Assess regularly using pain scale
Sudden chest pain is emergency
Measure calf and thigh diameter
Apply warm moist heat; usually 20min/4xday
Maintain bed rest as ordered. then ambulate when oked.

A

Implementation: Pain, DVT

48
Q 
Assess skin of affected extremity
Elevate extremity
Limb care
Use specialty mattress
Encourage frequent position changes
If swollen; lotion relieves stretching
A

Implementation: Ineffective Tissue Perfusion: Peripheral

DVT

49
Q

Encourage ROM exercises q 8hr.
Encourage frequent position changes; deep breathing and coughing
Encourage increase in fluids and dietary fiber
Assist with ambulation as needed
Encourage diversional activities (if bored on bedrest)

A

Implementation: Impaired physical mobility

DVT

50
Q 
Ineffective Protection
-monitor lab results
Ineffective Tissue Perfusion: Cardiac
-frequent assessment of respiratory status
-signs of pulmonary embolism
A

Implementation DVT

51
Q

Pain controlled
No complications
Strategies to prevent reoccurrence of DVT

A

Evaluation; DVT

52
Q

aka thrombophlebitits. is a condition in which a blood clot (thrombus) forms on the wall of a vein and is accompanied by inflammation of the vein wall and some degree of obstructed venous blood flow.

A

venous thrombosis

53
Q

deep vein of the body?

A

those leading to the vena cava

54
Q

Stimulates the clotting cascade.

  • inflammation response triggered
  • causes tenderness, swelling and erythema in area of thrombus.
  • thrombus floats in vein @ 1st,
  • then travels as emboli
  • fibroblasts invade thrombus, scarring vein wall and destroying venous valves.
A

Vessel trauma

55
Q

pelvis, thigh or calf

A

Deep Vein locations

56
Q

thrombus

A

blood clot

57
Q

emboli?

A

piece of thrombus that has broken off and is traveling through vein.

58
Q

tend to occur @ sites where the vein may be normal, but blood flow is Low.

A

Venous thrombi

59
Q

tend to occur @ sites of arterial plaque rupture.

A

arterial thrombi

60
Q 
immobilization
surgery
cancer
trauma
pregnancy
hormone therapy
coagulation disorders
A

Factors assoc with venous thrombosis

61
Q

indomethacin (Indocin)
naproxen (Naprosyn)
reduce inflammation in veins and provide symptomatic relief (part with superficial veneous thrombosis)

A

NSAIDS DVT

62
Q

prevent clot extension and reduce risk of pulmonary embolism

A

Anticoagulants

63
Q

prothrombin times; clotting

A

INR

64
Q

interfers with the clotting cascade by inhibiting the effects of thrombin and preventing the conversion of fibrinogen to fibrin;
prevents the formation of a stable fibrin clot

A

Heparin

65
Q

aPTT

A

partial thromboplastin time
IV; immediate
SubQ; within the hour

66
Q

most bioavailable fraction of heparin. more precise and predictable anticoagulant effect than unfractionated heparins

A

LMW; low-molecular weight heparins

67
Q

ardeparin (Normiflo)
dalteparin (Fragmin)
enoxaparin (Lovenox)!!
tinzaparin (Innohep)

A

Drug ex of LMW heparins

68
Q

done when thrombi lodge in the femoral vein and its removal is necessary to prevent pulmonary embolism or gangrene.

A

Venous thrombectomy

69
Q 
Lab values 
INR
aPTT
H & H
Encourage Mobility
ROM active q 8hr; prevent contractures and muscle atrophy
Encourage freq. position change
Deep breathing
airway clearance
coughing
Increase fluids and dietary fiber intake
Encourage diversional activities
A

Promote Effective Protection

@ Nur 180 Exam 2 (6 decks)

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