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kol- Med Surg 320 Spring > PVD/PAD > Flashcards

PVD/PAD Flashcards

1
Q

define pvd

A

Reduced blood flow to OR away from the limbs (Typically) due to narrowing of vessels

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2
Q

what causes PAD

A

atherosclerosis

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3
Q

PAD patho

A
  • Result of atherosclerosis
  • –>Partial or complete occlusion of artery in peripheral circulation
  • –>Results in tissue death below area of occlusion
  • –>Increased risk of MI and Stroke
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4
Q

PAD is increase risk for

A

MI/ stroke

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5
Q

PAD risk factors

A
  • Hypertension
  • Hyperlipidemia
  • Diabetes mellitus
  • Smoking
  • Obesity
  • Hypercholesterolemia
  • Family history
  • Advanced age

(all same risk factors as HTN + addition of HTN)

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6
Q

define 4 stages of PAD

A

I Asymptomatic-reduced pulses
II Claudication- pain when walking
III Rest pain- pain at rest
IV necrosis/ gangrene- ulcers

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7
Q

inflow vs outflow PAD

A

Inflow = Aorta, common, internal and external iliac arteries are effected

Outflow = Femoral, popliteal, tibial arteries are effected

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8
Q

s/s of PAD

A
  • Pain > due to lack of O2
  • Diminished pulses - lack of blood flow
  • Pale - lack of blood flow
  • Hair loss - lack of nutrients
  • Dryness- lack of nutrients
  • Scaling- lack of nutrients
  • Ulcers - lack of O2
  • Thickened toenails
  • Dependent rubor- if someone has legs up then dangle the lower extremity will return red
  • Muscle atrophy - lack of nutrients/blood

—> all of these are coming from lack of blood/O2/nutrients

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9
Q

Inflow disease symptoms:

A

Experience discomfort in the back, buttocks, or thighs

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10
Q

Outflow disease symptoms:

A
  • Burning or cramping in the calves, ankles, feet and toes

- Obstruction below the popliteal associated with foot and instep pain

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11
Q

Diagnostics for PAD

A
  • MRA
  • CTA
  • Segmental systolic blood pressure- take BPs down the leg
  • **ABI
  • Doppler
  • Exercise tolerance testing
  • plethysmography
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12
Q

what is an ABI

A

ankle brachial index

take BP of ankle and of brachial and should be similar ratio of 1 but if blood flow is decreased then we would have ABI of

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13
Q

PAD vs PVD - leg positions

A

PAD (^) - legs pointing down

PVD ( v)- legs up

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14
Q

should you exercise with PAD?

A
  • Not for severe disease/ulcers -

- Exercise until pain. stop. start —> increase collateral circulation

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15
Q

heat or cold with PAD?

A
  • head (avoid cold)
  • No Heating pad due to loss of sensation- not aware that they are being burned
  • use warm socks with arterial disease
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16
Q

FLuids with PAD?

A

increase fluids

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17
Q

drugs for pad

A 
Antiplatelets
Hemorheologic
Phosphodiasterase inhibitors
Antihypertensives
Lipid Lowering medications
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18
Q

non surgical procedures for pad

A
  • Percutaneous vascular intervention - stint to keep it open

- Atherectomy- remove the plaque

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19
Q

surgical intervention for PAD

A

bypass

  • Autogenous (saphenous, cephalic, basilic veins) *preferred
  • Synthetic grafts

-Do not remove plaque/artery - blood just takes path of least resistance

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20
Q

special line for PAD Bypass surgery?

A

arterial line to monitor BP

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21
Q

preoperative care: arterial bypass

A
  • Infection prevention
  • One or more IV lines or a central line
  • Arterial line to monitor BP
  • Urinary catheter- monitor output
22
Q

How often to mark and assess pulses postop arterial bypass?

A

-Mark and assess pulses of affected extremity - every 15 min for an hour, every 30 for 4 hours, ever hour for 24 hours

23
Q

reperfusion pain =

24
Q

2 PAD bypass surgery complications

A

graft occlusion

graft infection

25
signs of graft occlusion and how do we treat?
Severe aching continuous pain with graft occlusion (versus throbbing from normal reperfusion) -Often treated with thrombectomy or Thrombolytic agent
26
What is an acute aterial occlusion?
- When an embolus travels and lodges in an artery - On rarer occasion, caused by a local thrombus - Usually travels from the heart due to A-fib (blood pooling in Atria and clots form) or MI
27
what are the 6 p's of ischemia
``` Pain Pallor Pulselessness Parasthesia Paralysis poikilothermy- coolness ```
28
Acute arterial occlusions: Interventions
- Arteriotomy - Catheter guided intra-arterial thrombolytic therapy - done in IR , thread sheath in, guide wire/catheter is threaded in, put in TPA to break down clot - can leave sheath in for a couple of days while clot is slowly broken down
29
3 types of Peripheral Venous disease
1. Venous insufficiency 2. Venous thromboembolism 3. Varicose veins
30
who gets stasis ulcers? PAD or PVD
PVD
31
What is stasis dermatitis?
breakdown of iron --> discoloration blue/red/purplish + thickening of skin
32
Venous insufficiency assessment (3)
- Stasis dermatitis = breakdown of iron --> discoloration blue/red/purplish + thickening of skin - Edema - Stasis ulcers
33
Venous insufficiency: Interventions
- Prevent stasis and wound formation - promote wound healing - Prevent infection - cellulitis risk + ulcer infection - Compression stockings/SCD - Elevations of legs for 20 minutes, 4-5 times per day (for venous insufficiency) (V) - Elevate legs above the level of the heart - Use of pump devices
34
PAD vs PVD ulcers
Peripheral Arterial Disease (PAD) - Painful - Often develop on toes first - Eventually become gangrenous - Difficult to manage - Round and small/ well defined - Cool - Absent arterial pulses Vascular Insufficiency (Venous Ulcer) - Often develop over inner ankle area - Irregular borders - Chronic and difficult healing, exudate - warm - pulses present or variable
35
Venous thromboembolism = Where likely to occur
=Blood clot (thrombus or embolus) in the vein | -most likely to occur in deep veins in lower extremities but can occur in upper extremities
36
Deep vein thromboembolism =
=deep vein thrombophlebitis or DVT
37
What is the most important risk of a dvt?
PE
38
Who is at risk of developing DVT?
- Hip or knee surgery - Open prostate surgery - Ulcerative colitis - Heart failure - Cancer - Oral contraceptives - Immobility - Phlebitis - Most hospitalized people due to immobility and other conditions
39
Virchows Triad
determines risk of developing DVT 1. Hypercoagulability of blood 2. Vascular damage to the vessel 3. Circulatory stasis
40
Dvt assessment
- Calf or groin tenderness - Sudden onset of Pain and - *Unilateral swelling of the leg - Positive homan’s sign (unreliable) - dorsiflex foot and feel pain in calf - Redness - Warmth
41
DVT Diagnosis
- *Venous duplex ultrasonography - most helpful - Doppler flow tests - Impedance plethysmography - MRI - D-Dimer- looks at breakdown of firbinogen, all it tells us is that there is a clot somewhere
42
D Dimer looks at what and tells us what?
looks at breakdown of firbinogen, all it tells us is that there is a clot somewhere
43
Top 3 goals with DVT interventions
1. *Preventing complications ---> Clot Traveling to lung - assess respiratory status! 2. Preventing clot from getting bigger - anticoagulant 3. Preventing more clots from forming - anticoagulant
44
Do you massage area where DVT is?
heck no
45
Venous thrombosis surgery
- In general, surgery is rare for venous thrombi =Thrombectomy - Inferior vena cava filtration is more common - use for people who cannot be anticoagulated for some reason - prevents DVT from travling past inferior vena cava preventing PE
46
varicose veins =
Distended, protruding veins that become darkened and tortuous *most common in >30 yr
47
varicose veins caused by and associated with
-Caused by: Prolonged standing or heavy lifting -Associated with Obesity Estrogen Family history
48
varicose veins assessment
- Itching - Edema - Feeling of fullness in legs - Signs and symptoms of venous insufficiency
49
Varicose Veins diagnosis
- Ultrasonography | - Duplex ultrasonography
50
Varicose veins: Interventions
- Elevate - Elastic Compression stockings - Exercise
51
Varicose veins: surgery (3)
- Vein ligation or removal - tie the ends of the varicose vein and they collapse b/c no blood going through - Sclerotherapy- injection of substance into vein causing sclerosis and blood moves somewhere else - Endovenous ablation- runs catheter into vein, ablates it, vein goes away and blood uses healthier vein

kol- Med Surg 320 Spring (43 decks)

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