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NURSING 2 > PVD week 3 > Flashcards

PVD week 3 Flashcards

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1
Q

What does PVD involve?

A

Anything but the heart

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2
Q

What might objective cues will you see with arterial insufficiency?

A

discoloration (pale), muscular atrophy, hair loss

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3
Q

What might you see with foot elevation and foot dependence in arterial insufficiency?

A

Elevation - pallor, venous guttering

Dependence - rubor (red, rush of blood)

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4
Q

What are the 6 p’s to assess in PVD

A

Pulse, paralysis, pain, perishingly cold, pallor, paraesthesia

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5
Q

PVD: risk factors:

A

smoking, diabetes, high lipids, family hx, lifestyle, stress

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6
Q

PVD: assess

A

Claudication, 6P’s, perfusion, shiny skin, tight skin, hair loss, thick toenails, cap refill, segmental blood pressure

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7
Q

Claudication

A

pain the patient can get because lack of blood flow to tissues

If you do not have o2 for tissues, they are still going to perform metabolism, but they do into anaerobic metabolism because they do not have 02 the byproduct of anaerobic metabolism is lactic acid build up = aching, cramping sharp pain

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8
Q

What relieves claudication?

A

typically relieved with rest

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9
Q

PVD: labs/diagnostics

A 
Lipids
C-reactive protein (inflammation)
Duplex Doppler (can go all the way down artery)
Glucose and Hgba1c
Arteriogram (gold standard)
Ankle-brachial index
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10
Q

Arteriogram

A

Go into blood vessel with contrast and take picture of arterial blood flow

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11
Q

PVD: intervetions

A 
Risk modification
Control lipids
Diet
Medications
Exercise / weight loss
Skin care (do not soak) - regular inspections
Keep feet dependent
NO constriction
May need revascularization
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12
Q

PVS: complications

A

May progress to rest pain - ulceration - sepsis / gangrene = critical limb ischemia

Amputation

Acute arterial ischemia (sudden obstruction of blood flow caused by embolism, thrombosis, trauma, or atherosclerosis or artery)

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13
Q

PVD: priority nursing implications

A

assess extremities thoroughly and frequently to detect changes early

provide skincare and refrain from soaking feet or hands to avoid maceration

position clients to avoid constriction; do not bend knees, use knee gatch or cross legs

assess for an manage pain associated with obstruction and claudication

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14
Q

PVD: Asprin (ASA)

A

Antiplatelet
Doses of 75-325 mg/day
–> watch for bleeding

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15
Q

PVD: Clopidogrel

A

Antiplatelet - watch for bleeding

Client’s may receive Clopidogrel with ASA following revascularization

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16
Q

PVD: Cilostazol

A

Inhibits platelet aggregation and is a vasodilator

Used for intermittent claudication

May require additional antiplatelet therapy (Cloprodigrel, dipyridamole)

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17
Q

PVD: heparin

A

in acute setting to prevent thrombosis

– may be SQ, IV gtt

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18
Q

PVD: priority education/discharge

A

Teach about vigilant foot care, to wear white, all-cotton socks and to avoid extremities in temperature

Provide client with a complete list of changes to watch for in circulation - appearance of feel and for changes in sensation or function

Teach clients about optimal diet (high fiber, protein, low fat, refined sugars, sodium), and hydration; avoid caffeine

Teach client to relieve extremity pain by placing limb dependent; if edema exists, legs may be elevated by not above level of heart

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19
Q

Upper extremity arterial occlusive disease - cause

A

Likely caused by vasospasm, trauma, or arterial constrictive disorders

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20
Q

Upper extremity arterial occlusive disease - s/s

A

difference in BP is significant

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21
Q

Upper extremity arterial occlusive disease - treatment

A

surgical bypass or PTA

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22
Q

Upper extremity arterial occlusive disease - assessment

A

same as PVD

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23
Q

Compartment syndrome - patho

A

Swelling of muscles causing compression of nerves and blood vessels

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24
Q

Compartment syndrome: treatment

A 
Pharmacologic therapy
Thrombolysis
Surgical management
Endovascular intervention 
Fasciotomy
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25
Q

Compartment syndrome: goal

A

pain relief

maintain tissue integrity

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26
Q

Raynaud disease: causes

A

Emotional factors

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27
Q

Raynaud disease: patho

A

Cyanosis r/t vasospasm then vasodilation causes redness (rubor)

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28
Q

raynaud disease: manifestations

A

numbness, tingling and burning may occur

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29
Q

Raynaud disease: treatment

A

Avoid vasoconstrictive activity (cold, smoking, caffeine)

Ca2+ channel blocker to decrease s/s

Sympathectomy (interruption of the sympathetic nerves) may be also needed

30
Q

Thromboangitis Obliterans (Buerger Disease): patho

A

Autoimmune disease
Recurring inflammation of the intermediate and small arteries and vein resulting in thrombus formation and vessel occlusion

31
Q

Thromboangiitis Obliterans (Buerger Disease) - cause

A

Tobacco use is a causative factor

32
Q

What are types of venous thrombosis

A

Deep vein thrombosis (DVT)
Thrombophlebitis
Venous thromboembolism

33
Q

Venous thrombosis: Virchow Triad

A

Stasis of blood
vessel wall injury
altered coagulation

34
Q

Venous thrombosis: clinical manifestations

A

edema, discoloration

35
Q

Peripheral venous disease: priority assessments

A
  1. Note calf, thigh or groin pain with or without swelling warmth and tenderness superficial to area of pain
  2. Measure calves and thighs for comparison and baseline
  3. Superficial venous thrombosis (SVT) – vein can be itchy swollen red or warm
  4. With venous thromboembolism – SVT + paresthesias – may have fever – marked edema, painful
36
Q

peripheral venous disease: priority labs and diagnostics

A
  1. Venous duplex ultrasound
  2. d-dimer- if elevated suggests VTE
  3. CT/MRI
  4. PTT, PT INR, Hgb, Hct bc on anticoag
37
Q

Peripheral venous disease: priority nursing interventions

A
  1. larger- anticoagulants
  2. Pain medications, compression stockings, light ambulation
  3. Acute VTE- bedrest, elevate extremity, antiembolic stockings (pneumatic compression boots), progressive activity
  4. Anticoagulation =prevent clot increase in size or new clot development
  5. Warm moist compress
38
Q

Peripheral venous disease: priority potential and actual complications

A
  1. Superficial may progress to VTE
  2. Pulmonary Embolism

Avoid – massaging clot site and pneumatic compression devices with VTE – may mobilize the clot

  1. Post-thrombotic syndrome-20-50% of clients with VTEvenous stiffening, hypertension, and scarring-symptoms include pain, swelling, tingling, venous ulceration
39
Q

Peripheral venous disease: priority nursing implications

A
  1. Assess clients at risk and provide preventive teaching and care-exercise, refraining from constrictive clothing
  2. Assess for risk for bleeding on hemorrhage in clients on anticoagulant therapy (bleeding precautions)
  3. Avoid massaging of clot site and avoid pneumatic compression devices with actual VTE -may mobilize clot
  4. Avoid antiplatelets or NSAIDs with anticoagulants
  5. Encourage clients on bed rest to turn
  6. Change position every two hours and perform leg exercises every two hours while awake
40
Q

Heparin

A

Anticoagulant ◦ Subcutaneously or continuous IV infusion
◦ Monitor aPTT (normal 25-35 seconds, on heparin-1.5-2.5 times the normal)
◦ Antidote is protamine sulfate
◦ With subcutaneous injection, deep into the tissue, do not aspirate or rub site
◦ Watch for heparin-induced thrombocytopenia
◦ Monitor for osteoporosis

41
Q

Warfarin

A

◦ Anticoagulant
◦ Monitor INR (International normalized ratio) (0.9-1.1 not on anticoagulants, 2-3 on warfarin, 2.5-3.5 for high-risk clients)
◦ Vitamin K is antidote

42
Q

Enoxaparin

A

◦ Low molecular weight heparin
◦ Monitor CBC at regular intervals
◦ Clients may be taught self-administration
◦ Rotate injection sites

43
Q

PVD: priority teaching

A

risk of VTE with oral contraceptives or hormone replacement, especially when combined with smoking

prevention for those at risk including leg exercises, increased activity, early ambulation, elastic stockings (must be fitted and worn correctly), sequential compression boots (while in hospital), avoid restrictive clothing or crossing legs when sitting

some herbs (ginger, garlic, ginseng, gingko) increase bleeding

avoid smoking or vasoconstrictive activities

44
Q

What is an abdominal aneurysm

A

Damage to the media layer of the vessel

>3 cm aorta

45
Q

Abdominal aneurysm: manifestations

A

Severe back pain

Pulsating mass in abdomen

46
Q

Abdominal aneurysm: treatment

A

Medicine

Surgical treatment – same as thoracic management

47
Q

Thoracic aortic aneurysm: cause

A

atherosclerosis

genetic mutation

48
Q

Thoracic aortic aneuysm: manifestations

A

pain or dyspnea, difficulty swallowing

49
Q

Thoracid aortic aneurysm: treatment

A

BP control

Post op assessments

50
Q

Dissecting aneurysm: cause

A

poorly controlled hypertension

blunt force trauma

51
Q

Dissecting aneurysm: manifestations

A

severe tearing pain

52
Q

Cellulitis

A

Bacteria enters the subcutaneous tissue

53
Q

Cellulitis: manifestations

A

swelling, redness, pain
systemic signs of fever, chills and sweating

mark it to see if infections of getting bigger or smaller

54
Q

Cellulitis: priorty lab / diagnostics

A

Complete blood count will show elevated white blood cell count

Wound culture will show the causative bacteria (if it is a seeping wound)

X-ray or computed tomography (CT) scan to look for foreign objects in wound (as in an object left in a surgical wound) or examine deep tissues for signs of infection

55
Q

Cellulitis: assessments

A

Assess client for fever and chills, indicative of an infection

  • Assess wound for tenderness, swelling, warmth, malodorous and purulent drainage
  • Assess pain level. There is usually pain with an infected wound and with cellulitis
  • Assess size of wound. Examine wound for dead tissue as necrotic tissue is often present in infected wounds
  • Assess complete blood count, expect increase in white blood cells due to infection and fever
  • Assess vital signs, expect temperature elevation.
  • Assess for cellulitis, manifested as inflammation to surrounding skin and soft tissues under the skin, and red streaking to the skin
  • If there is cellulitis, perform ongoing assessments to determine if fever, tachycardia and tachypnea are resolving with treatment
  • Assess for septicemia, manifested as chills, fever, tachycardia and tachypnea. Confusion, reduced urine output and shock are likely if septicemia progresses without treatment
  • Perform a complete physical assessment
  • Complete a detailed health history
56
Q

Cellulitis: interventions

A

Collect wound samples for culture and sensitivity and send to the lab promptly

  • Administer prompt treatment of septicemia. If present, to prevent progression to sepsis and septic shock.
  • Administer antibiotics promptly as prescribed and monitor for effectiveness
  • Administer wound treatment as prescribed
  • Monitor wound to determine effectiveness of treatment
  • Monitor blood test to determine decrease in white blood cell count
  • Monitor skin with cellulitis to determine if inflammation is resolving
  • Administer analgesics for pain, especially before performing wound care
  • Assist with wound debridement procedure to remove dead tissue from wound
  • If foreign body in wound, prepare client for procedure to remove the object
  • Apply wound vacuum to assist with wound healing, if prescribed and monitor wound drainage
57
Q

Cellulitis: complications

A

Chronic infection

Loss of limb as a result of untreated infected wound

Septicemia, which is bacteria in the blood that can result in sepsis. Some still refer to septicemia as blood poisoning or bacteremia.

-Septicemia occurs when bacteria gets into the bloodstream from another part of the body, as in an infected wound. Client can have chills, fever, fast heart rate and respirations, confusion, reduced urine output and shock

Sepsis is a widespread and potentially fatal inflammation of the body in response to bacteria in the bloodstream. Both septicemia and sepsis must be treated promptly

58
Q

cellulitis: nursing implications

A

Cellulitis can occur as a result of a wound infection, but it can also be seen in other conditions such as a foreign body in the skin, a tear to the skin, or chronic conditions such as eczema. Cellulitis must be treated promptly

59
Q

Cellulitis: Cephalexin 250-500mg

A

Q6

First generation cephalosporin –tx bacterial and skin infections

60
Q

Cellulitis: Amoxicillin 250-500mg

A

Q6

In PCN family –skin infections

61
Q

Cellulitis: augmentin

A

f

62
Q

Cellulitis: education

A

finish all the antibiotics prescribed

how to care for wound at home to prevent re-infection

signs and symptoms of septicemia

signs and symptoms of wound infection and when to contact the healthcare provider

importance of follow-up medical care

healthy nutrition to promote wound healing

management of other health conditions the client has, especially those associated with poor wound healing, like diabetes

management of other health conditions the client has, especially those associated with poor wound healing, like diabetes

schedule visits to a wound care clinic if client is unable to care for wound

63
Q

Describe an arterial ulcer

A

end of toes, top of feet, lateral ankle region

very little drainage; little tissue granulation (pale, very light pink, or necrotic/black)

deep “punched out” with noticeable margins/edges that gives it a round appearance

64
Q

describe venous ulcer:

A

Medial parts of lower legs; medial ankle region

Swollen with drainage
Granulation present (deep pink to red)
Irregular edges
Shallow

65
Q

Chronic venous insufficiency: manifestations

A

Increases pigmentation of the skin (hemosiderosis)

Varicosities and telangiectasis

66
Q

Chronic venous insuffiency: cause

A

Edema?

67
Q

Vascular ulcers: patho

A

result of increased venous pressure or external trauma

- venous or arterial

68
Q

Vascular ulcers: treatment

A

Medication
Wound cleaning and debridement
wound dressing

69
Q

Lymphedema and elephantiasis - what

A

obstruction of lymph vessels

70
Q

Lymphedema and elephantiasis treatment

A

pharm therapy
exercise and compression
surgery

NURSING 2 (12 decks)

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