Unit 6 PVS Flashcards
Arterial disease involves
occlusive disease and aneurysms
Venous disease involves
Venous Thrombosis VTE and Chronis Venous insufficiency
what is happening in PAD
thickening of the arterial, narrowed lumen, loss of elasticity
who is at risk for PAD
Older, diabetes, CVS disease, smoking, hyperlipidemia, uncontrolled hypertension, family history, obesity, stress, male, sedentary lifestyle
Occlusive disease
Decreased or absent blood flow to the lower extremities, most commonly from femoral and popliteal.
Why is occlusive disease popular in pateints with diabetes
because diabetes affects the lining around the cells in teh blood veessels. Making the blood vessels less felxible.
Diabetes and blood clotting
The blood is hypercoagulable platelets clump together more often which speeds up the process of PAD.
What does insulin resistants have to do with PAD
throws off cellular homeostasis- the balance of chemicals and other substances coming in and out of the cells that line the blood vessels means the cells can’t work as well as they should, which increases the chances of PAD.
Signs and Symptoms of PAD
Intermittent Claudication
Erectile dysfunction
Paresthesia
Peripheral Neuropathy
Wounds that don’t heal
Change in skin colour
Changes in skin
Delayed wound healing
Intermittent Claudication
Narrowing involving the femoral or popliteal arteries causes claudication in the calf/buttock during exercise
-This causes lactic acid accumulation
Findings for PAD in inspection
Shiny taut skin, decreased hair growth, purple/red colour, Elevation is pallor and pain
Skin changes in PAD
Thin
Shiny
Hair loss
Elevation pallor
Dependent Rubour
Ulceration
Delayed healing
Gangrene
Loss of palpable peripheral pulses
Why is there so many skinn changes in PAD
Because the skin is not getting enough oxygenated blood and therefore is not able to do its job properly
Arterial wounds are also known as
Arterial ulcers and ischemic ulcers
why are arterial wound beds dry
due to reduced blood flow to the affected area which causes decreased oxygenated blood and arterial insufficiency
Diagnostic tests for PAD
Angiography
Ankle Brachial Index
Doppler Ultrasound
MRI
Segmental BP
When does C-reactive protein increase
with inflammation in the body
What is a C reactive protein test
is more sensitive than a standard test, also can be used to evaluate your risk of developing coronary artery disease
D Dimer test
Rules out VTE, PE, DIC. Protein gragments found when a clot is present and starting to degrade
Priority interventions for PAD
think ABC
1. Determine extent if arterial damage
2. Restore blood flow
3. prevent complications
Doppler ultrasound
-Looks at the velocity of flow
-This is NOT the saem as the doppler pulse assessment
Things a nurse can do for a PAD patient (Gravity is our friend)
Arterial flow needs gravity
Hanging the foot over the bed will increase arterial flow by gravity.
Raising the limb or horizontal position will decrease the flow and increase pain
what is a ankel brachial index
The ankle blood pressure. Ankle systolic pressure over brachial systolic pressure
Normal and abnormal ABI
Normal: 1-1.4
Severe PAD: under o.4 (decreased blood flow)
what is Fem Pop bypass
Surgical procedure that is used to restore blood flow to the lower legs when one or more arteries in the led are blocked or narrowed due te PAD
How to know if treatment works
pain relief, wound healing, warmth and colour, improve ability to walk, increased pulses, cap refill quicker
Ccomplications in PAD
Delayed healing
Limited sensation
Infection
Tissue necrosis
Ischemic ulcers
Gangrene
Acute Arterial Ischemia
Amputation
Acute Arterial Ischemia
is a sudden decrease in blood supply to tissue, organ, extremity
what is Actute Arterial ischmia caused by
Embolism
Thrombus
Trauma
Aneurysm
What are the 6 P’s of PAD
-Pain
-Pallor
-Pulselessness
-Paresthesia
-Polar
-Parlysis
Physician orders CWSM what does this mean
Circulation, sensation, warmth, Movement
Saving the Limb
EARLY RECOGNITION
Anticoagulant
Thrombolysis
Embolectomy/ Thrombolectomy
TPA (recombinant tissue plasminogen activator)
Surgical Revascularization
Amputation
What leads to a amputation
Atrophy of skin and muscle
Delayed healing
Wound infection
Tissue necrosis
Can involve bone
Amputation
Complications of amputations
Infection
DVT
PE
MI
Stroke
Phantom Pain
Abdominal Aortic Aneurysm
Permanent dilation of the vessel wall
Aortic arch
Thoracic aorta
Abdominal aorta
Any combination
Fusifrom aneurysm
uniform shape
Saccular aneurysm
pouch like narrow neck
True aneurysm
Wall of the artery forms an aneurysm
One vessel layer is still intact
False aneurysm
Pseudo aneurysm
All layers of the artery affected
Bleeding
Trauma
Infection
Post CVS surgery
Ascending Aorta symptoms
Hoarseness
Dysphagia
JVD
Edema
AAA symptom s
Pulsating ABD mass
ABD or back pain
Epigastric pain
Constipation
Inspection findings for aneurysm
Blue Toe Syndrome
Spontaneous plaque embolism
Still have palpable pedal pulses
What bloodwork would indicate lack of circulating volume ??
Hgb, RBC, BUN
Diagnostic tests
ABD x-ray
ABD ultrasound
ECG
Angiography
CT SCAN
Goals for Aneurysm
-Prevent rupture
-Prevent extension of dissection
Things to treat aneurysm
- Medical management
- Surgical repair
- Endovascular graft
Dissection
-not an aneurysm, but a creation of a false lumen
Clinicate manifestation of dissection
Depend on the location & extent of tear
Subclavian = B/P difference between arms
Acute – sudden, severe “tearing or ripping”
S/S profound shock
Mimics S/S of MI
Veins are parallel to
arteries
Is there more veins or arteries
veins
what is closer to the surface veins or arteries
veins
inspiration makes the thoracic pressure do what
decrease and the abdominal pressure increase
What do intraluminal valves fo
ensure undirectional flow
What leads to a clot
Platelet aggregation, fibrin, RBC, WBC, Platelet =CLot
who is at risk for Stasis
Obesity
Pregnancy
Immobility
Atrial Fibrillation
Intraop
Postop
Spinal cord injury
Venous Insufficiency
Smoking
Age
Who is at risk for wall injury
Surgery
Trauma
#
Burns
Diabetes
Chemotherapy
Vasculitis
Previous VTE
IVDU
Who is at risk for hypercoagulability
Polycythemia
Anemia
Cancers
Nephrotic Syndrome
Sepsis
Medicatoins
Steroids
Estrogen/HAART
Dehydration
Symptoms of VTE
Symptoms < 50% of patients
Unilateral leg edema
Pain
Redness
Warmth
temp different from other extremity
Leg feels “full”
tO do when someone has a VTE
Leg circumference
Bloodwork
INR
PTT
D Dimer
Hgb
RBC’s
Start heparin infusion
Bedrest
Oxygen
3 goals in someone with VTE
Assess
Anticoagulate
Ambulate – early
Can use Pneumatic stockings
how do most PEs arise
from thrombi in the deep veins of the legs
symptoms of Pulmonary embolism
SOB
Tachypnea
⬇ O² sat
Cyanosis
Hemoptysis
Chest pain
Tachycardia
Hypotension
Diagnostic test for PE
D Dimer
R/O thrombosis
Lung Imaging studies
CT Scan
Spiral CT
VQScan
Things to do for a pateint on anti-coagulation meds
Risk for Bleeding
Labs
VS
Head to toe S/S Bleeding
Frank and occult blood in urine/ feces
LOC- why?
Discharge teaching
things to teach in Anticoagulation
Medications
Mobility
Bloodwork
Follow up
AES
Diet
Travel
Work
Peripheral venous disease includes
Chronis Venous Insufficency
Incompetent valves
↑ venous hydrostatic pressure
(ambulatory venous hypertension)
RBC and fluid leak into tissue
See edema
Deep Veins
Non modifiable risk factors for PVD
Age, Female
Modifiable risk factors for PVD
Varicose Veins
VTE’s
Fistulas
Inspect for PVD
Colour
Symmetry
Wound bed
Wound drainage
Wound healing
Palpate for PVD
Edema
Temperature
Texture
Turgor
Capillary Refill
Pulses= rhythm/ amplitude
Doppler
Chronic Venous Insufficiency signs and symptoms in lower extremities
Leathery skin
Hemosiderin staining
Stasis dermatitis
Pruritus
Higher temperature
Hemosiderin Staining
Enzymes in the tissue eventually break down RBCs, causing the release of hemosiderin, which causes a brownish skin discolouration.
Over time, the skin and the subcutaneous tissue around the ankle are replaced by fibrous tissue, resulting in thick, hardened, contracted skin.
Venous Leg ulcers
shallow, irregular borders, malodorous, yellow wound base, extensive drainage
wound care for Venous Leg ulcers
Actisorb, acticoat, silvasorb gel, Silvasrob sheet
what does silvernitrate do for wounds
speeds up healing, aids in coagulation
why do we need to absorb wet wounds
Wet creates infectious bed and skin maceration
Why do we wrap venous wounds
to create compression and adress venous insufficency. It reduces swelling, inhances healing, promotes venous return.
Why don’t we wrap arterial wounds
Compression can worsen the condition ny furthering the resctriction of blood supply to the effected area. Reduced blood flow, risk of necrosis.
Complication of PVD
Infection
Cellulitis
Lymphedema
Amputation- rare
why are venous wounds wet
Venous wounds are wet because of increased pressure in the veins, causinf fluid and protein to leak out of the blood vessels and into surrounding tissue
