pvd ppt 14 Flashcards
right side of heart
pumps blood through lungs to pulmonary circulation
left side of heart
pumps blood to all other body tissues through the systemic circulation
poor circulation: gerontologic considerations
changes in vessels
increased peripheral resistance
impaired blood flow
increased left ventricular workload
physical assessment
skin: cool, pale, loss of hair, brittle nails, dry/scaly skin, atrophy, ulcerations, rubor
pulses: absent or weak in extremities
doppler US
handheld US device to detect blood flow in vessels
ankle brachial index (ABI)
exercise testing
determines how long pt can walk
measures ankle systolic BP in response to walking
duplex US
determines level of venous disease
evaluates flow of distal vessels
significance of plaque causing stenosis
angiography/MRA
confirms dx of occulsive arterial disease
contrast phlebotomy (venography)
contrast dye injected to reveal an unfilled segment of vein if thrombus is present
standard to dx lower extremity thrombosis
peripheral arterial occlusive disease
ischemia in distal extremity causes intermittent claudication (aching, cramping pain that occurs with activity or at rest)
PAD assessment
sensation of cold/numb extremities extremity elevated: cool/pale extremity in dependent position: ruddy, cyanotic skin/nail changes ulcerations/gangrene
to improve circulation
walking isometric exercise positioning strategies smoking cessation stress reduction
PE/DVT
caused by endothelial damage, venous stasis, altered coagulation
can occur after period of immobility
clinically silent; often undiagnosed
risk factors for endothelial damage
trauma
surgery
dialysis access catheter
chemical irritation from IV solution
risk factors for venous stasis
bedrest
obesity
spinal cord injury
>65 y/o
risk factors for altered coagulation
cancer pregnancy factor V Leiden defect septicemia protein C and S deficiencies
DVT prevention
compression stockings pneumatic compression devices early ambulation subq heparin lifestyle changes
enoxaparin (lovenox)
low molecular weight heparin
treatment for DVT and prophylaxis if at risk
wafarin (coumadin)
used to treat current DVT
rivaroxaban (xarelto)
oral factor Xa inhibitor
fixed dose regimen for acute DVT
dabigatran (pradaxa)
oral direct thrombin inhibitor
first-dose regimen for DVT
alteplase (activase, t-PA)
thrombolytic
dissolves existing clot
arterial ulcer
small, deep ulcerations on tips of toes or between toes
intermittent claudication not relieved by rest
pain not relieved by opioids
venous ulcers
medial/lateral malleolus large, superficial, highly exudative achy/heavy pain 6-12 months to heal recurrence rate is near 100% without compression therapy
medical mgmt of ulcers
abx
compression
debridement
negative pressure wound therapy
