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CNUR 203 midterm > Unit 6 PVS > Flashcards

Unit 6 PVS Flashcards

1
Q

Arterial disease involves

A

occlusive disease and aneurysms

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2
Q

Venous disease involves

A

Venous Thrombosis VTE and Chronis Venous insufficiency

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3
Q

what is happening in PAD

A

thickening of the arterial, narrowed lumen, loss of elasticity

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4
Q

who is at risk for PAD

A

Older, diabetes, CVS disease, smoking, hyperlipidemia, uncontrolled hypertension, family history, obesity, stress, male, sedentary lifestyle

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5
Q

Occlusive disease

A

Decreased or absent blood flow to the lower extremities, most commonly from femoral and popliteal.

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5
Q

Why is occlusive disease popular in pateints with diabetes

A

because diabetes affects the lining around the cells in teh blood veessels. Making the blood vessels less felxible.

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6
Q

Diabetes and blood clotting

A

The blood is hypercoagulable platelets clump together more often which speeds up the process of PAD.

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7
Q

What does insulin resistants have to do with PAD

A

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.

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8
Q

Signs and Symptoms of PAD

A

Intermittent Claudication
Erectile dysfunction
Paresthesia
Peripheral Neuropathy
Wounds that don’t heal
Change in skin colour
Changes in skin
Delayed wound healing

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9
Q

Intermittent Claudication

A

Narrowing involving the femoral or popliteal arteries causes claudication in the calf/buttock during exercise
-This causes lactic acid accumulation

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10
Q

Findings for PAD in inspection

A

Shiny taut skin, decreased hair growth, purple/red colour, Elevation is pallor and pain

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11
Q

Skin changes in PAD

A

Thin
Shiny
Hair loss
Elevation pallor
Dependent Rubour
Ulceration
Delayed healing
Gangrene
Loss of palpable peripheral pulses

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12
Q

Why is there so many skinn changes in PAD

A

Because the skin is not getting enough oxygenated blood and therefore is not able to do its job properly

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13
Q

Arterial wounds are also known as

A

Arterial ulcers and ischemic ulcers

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14
Q

why are arterial wound beds dry

A

due to reduced blood flow to the affected area which causes decreased oxygenated blood and arterial insufficiency

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15
Q

Diagnostic tests for PAD

A

Angiography
Ankle Brachial Index
Doppler Ultrasound
MRI
Segmental BP

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16
Q

When does C-reactive protein increase

A

with inflammation in the body

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17
Q

What is a C reactive protein test

A

is more sensitive than a standard test, also can be used to evaluate your risk of developing coronary artery disease

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18
Q

D Dimer test

A

Rules out VTE, PE, DIC. Protein gragments found when a clot is present and starting to degrade

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19
Q

Priority interventions for PAD

A

think ABC
1. Determine extent if arterial damage
2. Restore blood flow
3. prevent complications

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20
Q

Doppler ultrasound

A

-Looks at the velocity of flow
-This is NOT the saem as the doppler pulse assessment

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21
Q

Things a nurse can do for a PAD patient (Gravity is our friend)

A

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

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22
Q

what is a ankel brachial index

A

The ankle blood pressure. Ankle systolic pressure over brachial systolic pressure

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23
Q

Normal and abnormal ABI

A

Normal: 1-1.4
Severe PAD: under o.4 (decreased blood flow)

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24
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
25
How to know if treatment works
pain relief, wound healing, warmth and colour, improve ability to walk, increased pulses, cap refill quicker
26
Ccomplications in PAD
Delayed healing Limited sensation Infection Tissue necrosis Ischemic ulcers Gangrene Acute Arterial Ischemia Amputation
27
Acute Arterial Ischemia
is a sudden decrease in blood supply to tissue, organ, extremity
28
what is Actute Arterial ischmia caused by
Embolism Thrombus Trauma Aneurysm
29
What are the 6 P's of PAD
-Pain -Pallor -Pulselessness -Paresthesia -Polar -Parlysis
30
Physician orders CWSM what does this mean
Circulation, sensation, warmth, Movement
31
Saving the Limb
EARLY RECOGNITION Anticoagulant Thrombolysis Embolectomy/ Thrombolectomy TPA (recombinant tissue plasminogen activator) Surgical Revascularization Amputation
32
What leads to a amputation
Atrophy of skin and muscle Delayed healing Wound infection Tissue necrosis Can involve bone Amputation
33
Complications of amputations
Infection DVT PE MI Stroke Phantom Pain
34
Abdominal Aortic Aneurysm
Permanent dilation of the vessel wall Aortic arch Thoracic aorta Abdominal aorta Any combination
35
Fusifrom aneurysm
uniform shape
36
Saccular aneurysm
pouch like narrow neck
37
True aneurysm
Wall of the artery forms an aneurysm One vessel layer is still intact
38
False aneurysm
Pseudo aneurysm All layers of the artery affected Bleeding Trauma Infection Post CVS surgery
39
Ascending Aorta symptoms
Hoarseness Dysphagia JVD Edema
40
AAA symptom s
Pulsating ABD mass ABD or back pain Epigastric pain Constipation
41
Inspection findings for aneurysm
Blue Toe Syndrome Spontaneous plaque embolism Still have palpable pedal pulses
42
What bloodwork would indicate lack of circulating volume ??
Hgb, RBC, BUN
43
Diagnostic tests
ABD x-ray ABD ultrasound ECG Angiography CT SCAN
44
Goals for Aneurysm
-Prevent rupture -Prevent extension of dissection
45
Things to treat aneurysm
1. Medical management 2. Surgical repair 3. Endovascular graft
46
Dissection
-not an aneurysm, but a creation of a false lumen
47
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
48
Veins are parallel to
arteries
49
Is there more veins or arteries
veins
50
what is closer to the surface veins or arteries
veins
51
inspiration makes the thoracic pressure do what
decrease and the abdominal pressure increase
52
What do intraluminal valves fo
ensure undirectional flow
53
What leads to a clot
Platelet aggregation, fibrin, RBC, WBC, Platelet =CLot
54
who is at risk for Stasis
Obesity Pregnancy Immobility Atrial Fibrillation Intraop Postop Spinal cord injury Venous Insufficiency Smoking Age
55
Who is at risk for wall injury
Surgery Trauma # Burns Diabetes Chemotherapy Vasculitis Previous VTE IVDU
56
Who is at risk for hypercoagulability
Polycythemia Anemia Cancers Nephrotic Syndrome Sepsis Medicatoins Steroids Estrogen/HAART Dehydration
57
Symptoms of VTE
Symptoms < 50% of patients Unilateral leg edema Pain Redness Warmth temp different from other extremity Leg feels “full”
58
tO do when someone has a VTE
Leg circumference Bloodwork INR PTT D Dimer Hgb RBC’s Start heparin infusion Bedrest Oxygen
59
3 goals in someone with VTE
Assess Anticoagulate Ambulate – early Can use Pneumatic stockings
60
how do most PEs arise
from thrombi in the deep veins of the legs
61
symptoms of Pulmonary embolism
SOB Tachypnea ⬇ O² sat Cyanosis Hemoptysis Chest pain Tachycardia Hypotension
62
Diagnostic test for PE
D Dimer R/O thrombosis Lung Imaging studies CT Scan Spiral CT VQScan
63
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
64
things to teach in Anticoagulation
Medications Mobility Bloodwork Follow up AES Diet Travel Work
65
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
66
Non modifiable risk factors for PVD
Age, Female
67
Modifiable risk factors for PVD
Varicose Veins VTE’s Fistulas
68
Inspect for PVD
Colour Symmetry Wound bed Wound drainage Wound healing
69
Palpate for PVD
Edema Temperature Texture Turgor Capillary Refill Pulses= rhythm/ amplitude Doppler
70
Chronic Venous Insufficiency signs and symptoms in lower extremities
Leathery skin Hemosiderin staining Stasis dermatitis Pruritus Higher temperature
71
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.
72
Venous Leg ulcers
shallow, irregular borders, malodorous, yellow wound base, extensive drainage
73
wound care for Venous Leg ulcers
Actisorb, acticoat, silvasorb gel, Silvasrob sheet
74
what does silvernitrate do for wounds
speeds up healing, aids in coagulation
75
why do we need to absorb wet wounds
Wet creates infectious bed and skin maceration
76
Why do we wrap venous wounds
to create compression and adress venous insufficency. It reduces swelling, inhances healing, promotes venous return.
77
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.
78
Complication of PVD
Infection Cellulitis Lymphedema Amputation- rare
79
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

CNUR 203 midterm (10 decks)

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