- Awakens you form your sleep - PT feels paresthesia (burning, tingling, numbness) - Happens with 60% or more occlusion - Reactive hyperemia (excess of blood to the effected area) looks "rubor" - Elevation pallor

Unit 12 Arterial Insufficiency Flashcards by Tony Maselli

What are 4 general arterial conditions?

PAD
Buerger’s Disease
Raynaud’s Phenomenon
Arterial embolism

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Arterial embolism can either block or rupture leading to what?

Ischemia

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What is Atherosclerosis?

narrowing of the blood vessel causing plaque build up

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What are the most significant modifiable risk factors for PAD?

Tobacco use
Uncontrolled hypertension
Hyperlipidemia 
Obesity 
Dia betes
Elevated homocysteinemia

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What is homocysteinemia?

Elevated homocysteine which means increased risk for PAD

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What are two enzymes associated with inflammation?

CRP (C. reactive protein) and homocysteine

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What is said about the clinical manifestations of PAD?

Asymptomatic mostly, minimal signs and symptoms being:

Pedal pulses are decreased
Coolness
Pale, shiny skin
Decreased hair distribution

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What is often one of the first symptom noticed of PAD?Describe it and what to teach PT.

Intermittent claudication:

pain with exercise, relieved at rest

shows with 50% or more occlusion

burning, cramping pain

Teach PT to exercise then stop when pain begins

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What is rest pain?

Awakens you form your sleep
PT feels paresthesia (burning, tingling, numbness)
Happens with 60% or more occlusion
Reactive hyperemia (excess of blood to the effected area) looks “rubor”
Elevation pallor

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What is Rubor?

red blushed skin tone

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How is rest pain relieved?

Dangle legs to provide easier blood supply

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What does critical limb ischemia eventually lead to?

gangrene/necrosis

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Where are ulcers usually in PTs with PAD and describe them.

Toes, forefoot, heel

Ulcer bed usually pale or black eschar and the margins are rounded, smooth, looking punched out.

Minimal drainage
Dry

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What is the normal range for Ankle Brachial Index (ABI)?

0.9-1.3

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How is Ankle Brachial Index (ABI) calculated?

And to obtain Ankle Brachial Index how is it actually obtained?

Left or Right Ankle systolic BP (depending whichever you want) divided by highest brachial BP

Example 130 - Left ANKLE systolic BP
125 - Highest BRACHIAL systolic BP

Obtained by BP cuff and doppler

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What are two non-invasive test for PAD?

Duplex ultrasound imaging

high frequency ultrasound
visualizes blood flow using color

Segmental systolic pressure measurements
-plethysmography
-cuffs on extremities
-attach a pulse volume recorder
-pulse waveforms,
>small lines means weak, PAD visible

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What is the invasive diagnostic test for PAD? Describe it.

Arteriography

contrast die injected
visualize the exact location of blockage under fluoroscopy
definitive exam when surgery is considered

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What is the pre-procedure nursing care for an arteriography?

NPO before surgery

Monitor BUN/Creatinine

Ask PT allergies

Have PT drink fluids-

Consent needed

What is the post-procedure nursing care for an arteriography?

Check pedal pulses

Extended affected leg 6-8 hours

Check for hemorrhage

PT needs to be able to urinate

Monitor BUN/Creatinine

What are arteriography risks?

Hemorrhage
Thrombosis
Renal impairment
Allergic reaction to dye

If PT has allergic reaction to dye in arteriography exam what Rx would you give?

diphenhydramine

Name a few nursing interventions for arteriography surgery.

Explain diagnostic tests to patients and family

Assess risk factors and discuss appropriate lifestyle modifications

Physical assessment of nuerovascular status of lower extremities (baseline and ongoing)

What are the 5 p’s to the PAD physical assessment?

Pain
Pallor
Pulselessness
Paresthesia
Pokilothermia (temp)

What is the conservative treatment for PAD?

Lifestyle modifications including:

Control BP
Smoking cessation
Low fat, Low cholesterol diet
Exercise program
Weight control/Maintain body weight

What classes and examples of medications are used in PAD?

Antiplatelet - aspirin - clopidogrel Vasodialotors -Cilastazol ``` Hemorrheologic agents (they decrease viscosity of blood) -Pentoxifylline ``` ``` Antihypertensives Antilipid agents (statins) ```

What are major side effect of statins?

Liver toxicity, muscle pain, kidney failure

Name and describe a non surgical treatment for PAD.

Percutaneous transluminal angioplasty - artery dilated with balloon - may or may not use a stent - laser may be used - .20 gauge and 2 IV sites used

What is the pre-op care for a Percutaneous transluminal angioplasty?

NPO Groin site shave and prep Intravenous access

What is the post-procedural care for Percutaneous transluminal angioplasty?

``` Check for hemorrhage at insertion site Vital sign assessment Neurovasuclar assessment Bedrest 6-8 hours Antiplatelet agents (to prevent thrombosis) ```

What is an Atherectomy?

procedure that utilizes a catheter with a sharp blade on the end to remove plaque from a blood vessel.

What is a surgical treatment for PAD?

Arterial revascularization - PT put under general anesthesia - Check for 5 Ps after surgery

What is the post-operative regimen for the surgical treatment of CAD?

- 24-48 hr ICU or step-down unit stay - Arterial line for continuous BP measurement - Titration of medication to maintain BP within tight range - Foley with urometer for hourly urine outputs - Neurovascular assessment - Mobility - Monitoring of anticoagulation - Pain assessment - Discharge teaching- home care monitoring, diet, etc.

What can you monitor for complications of invasive diagnostic studies?

- BUN/Creatinine to monitor for dye effect of angiography - Assessing groin for bleeding, hematoma - Assessing lower extremity for further impairment of circulation (neurovascular)

For amputation, what are some factors/things for consider/remember?

- Failed bypass surgery or not a candidate - ? level of amputation - Phantom limb pain (give pain Rx) - Need for inpatient rehabilitation and physical therapy - Prevention of flexion contractures - Prothesis adjustment-stump must be healed

After amputation surgery, what is the protocol with what to do with the stump?

Elevate stump for 24 hrs w/pillow, after discourage so flexion contracture does not develop

What is a flexion contracture?

Inability to bend/straighten whichever body part

What is Raynaud's Phenomenon and describe it?

Vasospasms of small arterioles of extremities - Response to cold or emotional stress - Etiology unknown- associated with connective tissue disease - Young females - White, Blue, and Red disease

What can be given to a PT who has Raynaud's Phenomenon if needed?

CCBs because they vasodialate

What are the steps of Raynaud's Phenomenon?

White(pallor) *vasospasm Blue (cyanosis) *hypoxia Red (circulation improved) *hyperemic

What PT teaching will you provide for Raynaud's Phenomenon?

-Protect from cold -Avoid temperature extremities -Stop all tobacco and avoid caffeine -Avoid drugs with vasoconstrictive effect such as: Amphetamines, Cocaine, Psuedoephedrine

What is Buerger's Disease?

- uncommon occlusive disease - involves medium and small arteries and veins most often effects upper and lower limbs - strong association with smoking Men <40 years old

What is the treatment for Buerger's Disease?

Smoking cessation | Medications to promote vasodialation such as CCBs

What are nursing interventions for Buerger's Disease?

Preventing the progression of the disease Avoiding vasoconstriction Relieving pain Wound and skin care