UNIT 6 EMBOLI (ARTERIAL OCCLUSION) CHAPTER 33 Flashcards
What is an Emboli?
a blood clot
Is PAD or Arterial occlusion more life-threatening?
A. Arterial occlusion
B. Peripheral Arterial Disease
A. Arterial occlusion
Although chronic peripheral arterial disease (PAD) progresses slowly the onset of acute arterial occlusion is sudden and dramatic. An embolus (piece of a clot that travels and lodges in a new area) is the most common cause of peripheral occlusions, although a local thrombus may be the cause. Occlusion may affect the upper extremities, but it is more common in the lower extremities.
Emboli originating from the heart are the most common cause of acute arterial occlusions. Most patients with an embolic occlusion have had an acute myocardial infarction (MI) and/or atrial fibrillation within the previous weeks.
What manifestations are present in a patient with Acute Artial Occlusion?
Patients with an acute arterial occlusion describe severe pain below the level of the occlusion that occurs even at rest. The affected extremity is cool or cold, pulseless, and mo led. Small areas on the toes may be blackened or gangrenous due to lack of perfusion. Those with acute arterial insufficiency often present with the “six Ps” of ischemia:
* Pain
* Pallor
* Pulselessness
* Paresthesia
* Paralysis
* Poikilothermy (coolness)
What drug would you anticipate the HCP to order for a patient who is currently experiencing Acute Arterial Occlusion?
A. Heparin
B. Nitroglycerin
C. Atorvastatin
D. Lisinopril
A. Heparin
The primary health care provider must initiate treatment promptly to avoid permanent damage or loss of an extremity. Anticoagulant therapy with unfractionated heparin (UFH) is usually the first intervention to prevent further clot formation. The patient may undergo angiography.
Treatment for Emboli
The primary health care provider must initiate treatment promptly to avoid permanent damage or loss of an extremity. Anticoagulant therapy with unfractionated heparin (UFH) is usually the first intervention to prevent further clot formation. The patient may undergo angiography.
A surgical thrombectomy or embolectomy with local anesthesia may be performed to remove the occlusion. The health care provider makes a small incision, which is followed by an arteriotomy (a surgical opening into an artery). A catheter is inserted into the artery to retrieve the embolus. It may be necessary to close the artery with a synthetic or autologous (patient’s own blood vessel) patch graft.
Interventions: Must prevent injury from complications by removing clot, often with medications.
Which medications help remove clots?
*Heparin
*Warafrin
*Alteplase
What is an appropriate PTT if using it for anti-clot therapy.
30-75 seconds
- Treatment: anticoagulation therapy, rest, elevate extremity, compression stocking, IVC filter
What are the risk factor for Emboli?
surgeries, especially in the legs or hips
* Prolonged sitting
* Obesity
* Oral contraceptives
* Pregnancy
* Cardiac issues such as Congestive Heart Failure
* smoking
Emboli Complications
Pulmonary embolism – if clot travels from leg to lungs it can block a
vesses in the lungs, which can cause tissue death in lungs, and can
cause decreased oxygen exchange.
* Seriousness of complication depends on where the clot lodges.
* Stroke – if clot travels from leg to brain it can lead to a CVA. Which
can lead to cell death in the brain.
Nursing assessment post op from thromobectomy
After an arterial thrombectomy, observe the affected extremity for improvement in color, temperature, and pulse every hour for the first 24 hours or according to the postoperative surgical protocol. Monitor patients for manifestations of new thrombi or emboli, especially pulmonary emboli (PE). Chest pain, dyspnea, and acute confusion (older adults) typically occur in patients with PE. Notify the health care provider or Rapid Response Team immediately if these symptoms occur.
What should you monitor for during thromboectomy therapy?
During infusion, monitor the patient for complications such as bleeding and hemorrhagic stroke. Maintaining a normal blood pressure is essential in preventing a potential stroke. As the clot dissolves, the patient typically experiences severe pain due to reperfusion that requires patient-controlled analgesia (PCA).
Symptoms of an Emboli
Symptoms: calf or groin pain/tenderness with sudden onset of swelling, hardness (induration),
warmth
Antidote for Warfarin
For patients taking warfarin, assess for any bleeding, such as hematuria or blood in the stool. Ensure that vitamin K, the antidote for warfarin, is available in case of excessive bleeding. Report any bleeding to the health care provider and document in the patient’s health record. Teach patients to avoid foods with high concentrations of vitamin K, especially dark green leafy vegetables. These foods interfere with the action of warfarin, which is a vitamin K synthesis inhibitor.
