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Nursing 2 Exam 3 > Unit 12 Arterial Insufficiency > Flashcards

Unit 12 Arterial Insufficiency Flashcards

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1
Q

What are 4 general arterial conditions?

A

PAD
Buerger’s Disease
Raynaud’s Phenomenon
Arterial embolism

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2
Q

Arterial embolism can either block or rupture leading to what?

A

Ischemia

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3
Q

What is Atherosclerosis?

A

narrowing of the blood vessel causing plaque build up

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4
Q

What are the most significant modifiable risk factors for PAD?

A 
Tobacco use
Uncontrolled hypertension
Hyperlipidemia 
Obesity 
Dia betes
Elevated homocysteinemia
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5
Q

What is homocysteinemia?

A

Elevated homocysteine which means increased risk for PAD

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6
Q

What are two enzymes associated with inflammation?

A

CRP (C. reactive protein) and homocysteine

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7
Q

What is said about the clinical manifestations of PAD?

A

Asymptomatic mostly, minimal signs and symptoms being:

  • Pedal pulses are decreased
  • Coolness
  • Pale, shiny skin
  • Decreased hair distribution
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8
Q

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

A

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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9
Q

What is rest pain?

A
  • 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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10
Q

What is Rubor?

A

red blushed skin tone

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11
Q

How is rest pain relieved?

A

Dangle legs to provide easier blood supply

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12
Q

What does critical limb ischemia eventually lead to?

A

gangrene/necrosis

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13
Q

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

A

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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14
Q

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

A

0.9-1.3

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15
Q

How is Ankle Brachial Index (ABI) calculated?

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

A

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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16
Q

What are two non-invasive test for PAD?

A

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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17
Q

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

A

Arteriography

  • contrast die injected
  • visualize the exact location of blockage under fluoroscopy
  • definitive exam when surgery is considered
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18
Q

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

A

NPO before surgery

Monitor BUN/Creatinine

Ask PT allergies

Have PT drink fluids-

Consent needed

19
Q

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

A

Check pedal pulses

Extended affected leg 6-8 hours

Check for hemorrhage

PT needs to be able to urinate

Monitor BUN/Creatinine

20
Q

What are arteriography risks?

A

Hemorrhage
Thrombosis
Renal impairment
Allergic reaction to dye

21
Q

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

A

diphenhydramine

22
Q

Name a few nursing interventions for arteriography surgery.

A

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)

23
Q

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

A 
Pain
Pallor
Pulselessness
Paresthesia
Pokilothermia (temp)
24
Q

What is the conservative treatment for PAD?

A

Lifestyle modifications including:

  • Control BP
  • Smoking cessation
  • Low fat, Low cholesterol diet
  • Exercise program
  • Weight control/Maintain body weight
25
Q

What classes and examples of medications are used in PAD?

A

Antiplatelet

  • aspirin
  • clopidogrel

Vasodialotors
-Cilastazol

Hemorrheologic agents (they decrease viscosity of blood)
-Pentoxifylline 
Antihypertensives
Antilipid agents (statins)
26
Q

What are major side effect of statins?

A

Liver toxicity, muscle pain, kidney failure

27
Q

Name and describe a non surgical treatment for PAD.

A

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
28
Q

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

A

NPO
Groin site shave and prep
Intravenous access

29
Q

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

A 
Check for hemorrhage at insertion site
Vital sign assessment 
Neurovasuclar assessment
Bedrest 6-8 hours
Antiplatelet agents (to prevent thrombosis)
30
Q

What is an Atherectomy?

A

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

31
Q

What is a surgical treatment for PAD?

A

Arterial revascularization

  • PT put under general anesthesia
  • Check for 5 Ps after surgery
32
Q

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

A
  • 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.
33
Q

What can you monitor for complications of invasive diagnostic studies?

A
  • BUN/Creatinine to monitor for dye effect of angiography
  • Assessing groin for bleeding, hematoma
  • Assessing lower extremity for further impairment of circulation (neurovascular)
34
Q

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

A
  • 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
35
Q

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

A

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

36
Q

What is a flexion contracture?

A

Inability to bend/straighten whichever body part

37
Q

What is Raynaud’s Phenomenon and describe it?

A

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
38
Q

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

A

CCBs because they vasodialate

39
Q

What are the steps of Raynaud’s Phenomenon?

A

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

40
Q

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

A

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

41
Q

What is Buerger’s Disease?

A
  • 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

42
Q

What is the treatment for Buerger’s Disease?

A

Smoking cessation

Medications to promote vasodialation such as CCBs

43
Q

What are nursing interventions for Buerger’s Disease?

A

Preventing the progression of the disease

Avoiding vasoconstriction

Relieving pain

Wound and skin care

Nursing 2 Exam 3 (5 decks)

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