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NSG 320 - MED SURG > Topic 5: Peripheral Vascular Disease > Flashcards

Topic 5: Peripheral Vascular Disease Flashcards

covers PVD & PAD; not VTE

1
Q

PAD clinical manifestations

A

1) Intermittent claudication
2) paresthesia;
3) elevation pallor
4) dependent rubor 5)skin that is thin, shiny & taut, hair loss on limb, thickened toe nails
6) diminished/absent pedal/popliteal/femoral pulses,
7) RUBOR = reactive hyperemia (redness) when limb is in dependent position; dependent rubor;
8) arterial ulcerations (usually “dry” ulcers that do not leak)

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2
Q

PAD 6 P’s

A

*Paralysis
*Paresthesia
*Pallor
*Pulse
*Pain
*Poikilothermia

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3
Q

Diagnostic Testing/Labs for PAD

A

*Ankle Brachial Index (ABI)
*Doppler Ultrasound
*Duplex Imaging
*Angiography
*Magnetic resonance angiography

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4
Q

arterial ulcer

A

A wound caused by impaired arterial blood flow to the lower leg and foot. Impairment in blood flow results in tissue ischemia and necrosis.

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5
Q

associated skin characteristics for PAD

A

-Cool skin temperature
-Thin, shiny skin
-Decreased or absent skin hair
-Pain my increase when the leg is elevated
-Pain may decrease or be relieved when the leg is in a dependent position
-Decreased pulse strength in extremity

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6
Q

PVD clinical manifestations

A

*Affected Extremity
*Hyperpigmentation of lower calf and ankle skin from hemosiderin staining.
*Firm/hardened skin
*Dry scaly skin; may be itchy, WARM
*Edema may or may not be present

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7
Q

prevention for those at risk of PVD include:

A

*Patient education
*Leg exercises
*Early ambulation after procedure
*Compression stockings
*Anticoagulation therapy
*Avoid Oral Contraceptives
*Drink adequate fluids to avoid dehydration
*Exercise during long periods of bed rest or sitting

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8
Q

*Venous Ulcer

A

*A wound caused by a decrease of blood flow return from the lower extremities to the heart.

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9
Q

when can compression stockings be used

A

in PVD

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10
Q

what kind of dressings are used on venous ulcers

A

moist dressings

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11
Q

what are the nutritional needs for PVD/PVD ulcers

A

Evaluate nutrition: High protein, vitamin A and C and zinc

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12
Q

client teaching for arterial diseases

A

-Control cardiovascular disease
-Control diabetes
-Smoking cessation
-Medication use
-Exercise tolerance
-Foot care
-Daily foot exams
-Post-Op care (if applicable)

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13
Q

client teaching for venous diseases

A

-Nutrition - adequate protein, Vitamin A, Vitamin C, Zinc
-Medications (Drug Therapy)

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14
Q

PVD s/s

A

· Voluptuous pulses = warm legs
· Edema (blood pooling)
· Irregular shaped sores
· No sharp pain (dull pain)
· Yellow & brown ankles***

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15
Q

ABI for PVD

A

> 0.9

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16
Q

cap refil for PVD

A

<3 sec

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17
Q

what does the skin look like in PVD

A

· Skin color: bronze-brown pigmentation, varicose veins may be present
· Skin temperature: warm
· Skin texture: think, hardened, indurated
· Dermatitis and pruritis often present

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18
Q

edema in PVD

A

lower leg edema

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19
Q

pain in PVD

A

dull ache or heaviness in calf or thigh

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20
Q

periperal pulses in PVD

A

present

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21
Q

ulcers in PVD

A

irregularly shaped; moderate to large amount of drainage; yellow or dark red “ruddy” granulation

22
Q

hair and nails in PVD

A

Hair: may be present or absent
· Nails: normal or thickened

23
Q

PAD s/s

A

· Absent pulses, thin, shiny, hairless legs = cool legs
· Round, red sores (hyperemia; redness of the foot dependent rubor)
· Toes & Feet pale or black “eschar”
· Sharp pain in calf (with exercise INTERMITTENT CLAUDICATION or when feet are elevated)

24
Q

ABI in PAD

A

<0.9

25
Q

Cap refill in PAD

A

> 3 sec

26
Q

edema in PAD

A

absent in legs unless constantly in dependent position

27
Q

hair and nails in PAD

A

· Hair: loss of hair on legs, feet, toes
· Nails: thickened, brittle

28
Q

pain in PAD

A

· INTERMITTENT CLAUDICATION or rest pain in foot; ulcer may or may not be painful

29
Q

peripheral pulses in PAD

A

· decreased or absent

30
Q

skin in PAD

A

· Skin color: dependent rubor; elevated pallor
· Skin temperature: cool
· Skin texture: thin, shiny, taut

31
Q

ulcer in PAD

A

rounded, smooth, looks “punched out,” minimal drainage; tissue-black eschar or pink granulation

32
Q

PAD is an OXYGEN PROBLEM: 6 P’s

A

· Pain*
· Paresthesia*
· Pulses
· Polar
· Pallor (blanching of the foot)
Paralysis

33
Q

diagnostic assemnt for vascular disorders

A

· Health Hx and physical examination, including palpation of peripheral pulses
· Doppler ultrasound studies
· Segmental BPs
· ABI
· Duplex imaging
· Angiography

34
Q

IN PVD how should the legs be set for treatment

A

· ELEVATE LEGS; to help get blood back to the heart

35
Q

IN PAD how should the legs be set for treatment

A

· HANG LEGS; to help blood get to periphery

36
Q

PVD interventions

A

· Early and aggressive mobilization is easiest and most cost-effective method to decrease VTE risk
· change position every 2 hours
· TEACH patients to flex and extend their feet, knees and hips at least every 2-4 hours
· Patients who can get out of bed need to be in a chair at all meals and walk at least 4-6 tomes a day
· Compression stockings
· Intermittent pneumatic compression devices (IPCs)
· anticoagulant therapy to prevent clot formation

37
Q

PAD intervention: CVD risk factor modification

A

o Tobacco cessation
o Regular physical exercise
o Achieve or maintain ideal body weight
o DASH diet
o Tight glucose control
o Thigh BP control
o Treatment of hyperlipidemia
o Antiplatelet agent
o ACE inhibitors

38
Q

treatment of claudication symptoms

A

o Structured walking or exercise program

39
Q

other interventions for PAD

A

· Nutritional therapy
· PT/OT
· Proper foot care

40
Q

in acute car setting how often should the PAD pateint be assess and what are the assessed for

A

· Check operative extremity every 15 minutes initially and then hourly for color, temperature, cap refill, presence of peripheral pulses, sensation and movement

41
Q

when should the HCP b enotified immediately in a PAD patient

A

if loss of palpable pulses or change in doppler sound over pulse

42
Q

PAD teaching: anticoagulant therapy

A

· Take drug at same time each day (preferably afternoon or evening)
· Watch for signs of unusual bleeding
· Avoid any trauma or injury that may cause bleeding
· Avoid all aspirin-containing drugs and NSAIDS
· Limit alcohol intake
· Wear medic alert bracelet that says anticoagulant is being taken
· Give stool softeners to avoid straining and hard stools
· Use soft toothbrushes or foam swabs for oral care
· Use electric razors

43
Q

when taking warfarin what should be avoided?

A

foods high in vitamin K (broccoli, spinach, kale, greens)

44
Q

Thromboangiitis obliterans (Buerger disease)

A

A non-atherosclerotic, segmental, recurrent inflammatory disorder of the small and medium arteries and veins of the arms and legs.

45
Q

who does Thromboangiitis obliterans (Buerger disease) mostly occur in

A

Mostly occurs in men younger than 45 years of age with long Hx of tobacco and/or marijuana use without other CVD risk factors

46
Q

s/s of Thromboangiitis obliterans (Buerger disease)

A

BLACK FEET AND HANDS
·Color and temperature changes of the limbs, paresthesia, superficial vein thrombosis and COLD sensitivity

47
Q

main treatment for Thromboangiitis obliterans (Buerger disease)

A

· Cessation of tobacco and marijuana use in any form
· Use of nicotine replacement products are CONTRAINDICATED

48
Q

management for Thromboangiitis obliterans (Buerger disease)

A

· Avoid limb exposure to cold temperatures
· Supervised walking program
· Antibiotics to treat any infected ulcers
Analgesics for pain

49
Q

Raynaud’s phenomenon

A

Episodic vasospastic disorder of small cutaneous arteries, most often involving the fingers and toes, mostly occuring in women

50
Q

what often brings of symptoms of raynauds phenomenon

A

Exposure to cold, emotional upset, tobacco use, and caffeine

51
Q

S/S of Raynaud’s Disease

A

· Vasospasm induced color changes of fingers, toes, ears, and nose (white, blue and red)
· Client describes coldness and numbness in vasoconstrictive phase
· Throbbing, aching pain , tingling
Swelling in hyperemic phase (when blood flow is restored)

52
Q

management for raynauds disease

A

· Focus on teaching about how to prevent episodes
o Avoid temperature extremes
o Wear looks warm clothing as protection from the cold (including gloves)
o Stop using tobacco products
o Avoid caffeine
· Stress management techniques
· Immersing hand in warm water often decreases vasospasm
· Sustained-release CCB are he first-line drug therapy

NSG 320 - MED SURG (63 decks)

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