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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
Q

what is Fem Pop bypass

A

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

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25
Q

How to know if treatment works

A

pain relief, wound healing, warmth and colour, improve ability to walk, increased pulses, cap refill quicker

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26
Q

Ccomplications in PAD

A

Delayed healing
Limited sensation
Infection
Tissue necrosis
Ischemic ulcers
Gangrene
Acute Arterial Ischemia
Amputation

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27
Q

Acute Arterial Ischemia

A

is a sudden decrease in blood supply to tissue, organ, extremity

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28
Q

what is Actute Arterial ischmia caused by

A

Embolism
Thrombus
Trauma
Aneurysm

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29
Q

What are the 6 P’s of PAD

A

-Pain
-Pallor
-Pulselessness
-Paresthesia
-Polar
-Parlysis

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30
Q

Physician orders CWSM what does this mean

A

Circulation, sensation, warmth, Movement

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31
Q

Saving the Limb

A

EARLY RECOGNITION
Anticoagulant
Thrombolysis
Embolectomy/ Thrombolectomy
TPA (recombinant tissue plasminogen activator)
Surgical Revascularization
Amputation

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32
Q

What leads to a amputation

A

Atrophy of skin and muscle
Delayed healing
Wound infection
Tissue necrosis
Can involve bone

Amputation

33
Q

Complications of amputations

A

Infection
DVT
PE
MI
Stroke
Phantom Pain

34
Q

Abdominal Aortic Aneurysm

A

Permanent dilation of the vessel wall
Aortic arch
Thoracic aorta
Abdominal aorta
Any combination

35
Q

Fusifrom aneurysm

A

uniform shape

36
Q

Saccular aneurysm

A

pouch like narrow neck

37
Q

True aneurysm

A

Wall of the artery forms an aneurysm
One vessel layer is still intact

38
Q

False aneurysm

A

Pseudo aneurysm
All layers of the artery affected
Bleeding
Trauma
Infection
Post CVS surgery

39
Q

Ascending Aorta symptoms

A

Hoarseness
Dysphagia
JVD
Edema

40
Q

AAA symptom s

A

Pulsating ABD mass
ABD or back pain
Epigastric pain
Constipation

41
Q

Inspection findings for aneurysm

A

Blue Toe Syndrome
Spontaneous plaque embolism
Still have palpable pedal pulses

42
Q

What bloodwork would indicate lack of circulating volume ??

A

Hgb, RBC, BUN

43
Q

Diagnostic tests

A

ABD x-ray
ABD ultrasound
ECG
Angiography
CT SCAN

44
Q

Goals for Aneurysm

A

-Prevent rupture
-Prevent extension of dissection

45
Q

Things to treat aneurysm

A
  1. Medical management
  2. Surgical repair
  3. Endovascular graft
46
Q

Dissection

A

-not an aneurysm, but a creation of a false lumen

47
Q

Clinicate manifestation of dissection

A

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
Q

Veins are parallel to

A

arteries

49
Q

Is there more veins or arteries

A

veins

50
Q

what is closer to the surface veins or arteries

A

veins

51
Q

inspiration makes the thoracic pressure do what

A

decrease and the abdominal pressure increase

52
Q

What do intraluminal valves fo

A

ensure undirectional flow

53
Q

What leads to a clot

A

Platelet aggregation, fibrin, RBC, WBC, Platelet =CLot

54
Q

who is at risk for Stasis

A

Obesity
Pregnancy
Immobility
Atrial Fibrillation
Intraop
Postop
Spinal cord injury
Venous Insufficiency
Smoking
Age

55
Q

Who is at risk for wall injury

A

Surgery
Trauma
#
Burns
Diabetes
Chemotherapy
Vasculitis
Previous VTE
IVDU

56
Q

Who is at risk for hypercoagulability

A

Polycythemia
Anemia
Cancers
Nephrotic Syndrome
Sepsis
Medicatoins
Steroids
Estrogen/HAART
Dehydration

57
Q

Symptoms of VTE

A

Symptoms < 50% of patients
Unilateral leg edema
Pain
Redness
Warmth
temp different from other extremity
Leg feels “full”

58
Q

tO do when someone has a VTE

A

Leg circumference
Bloodwork
INR
PTT
D Dimer
Hgb
RBC’s
Start heparin infusion
Bedrest
Oxygen

59
Q

3 goals in someone with VTE

A

Assess
Anticoagulate
Ambulate – early

Can use Pneumatic stockings

60
Q

how do most PEs arise

A

from thrombi in the deep veins of the legs

61
Q

symptoms of Pulmonary embolism

A

SOB
Tachypnea
⬇ O² sat
Cyanosis
Hemoptysis
Chest pain
Tachycardia
Hypotension

62
Q

Diagnostic test for PE

A

D Dimer
R/O thrombosis

Lung Imaging studies
CT Scan
Spiral CT
VQScan

63
Q

Things to do for a pateint on anti-coagulation meds

A

Risk for Bleeding
Labs
VS
Head to toe S/S Bleeding
Frank and occult blood in urine/ feces
LOC- why?
Discharge teaching

64
Q

things to teach in Anticoagulation

A

Medications
Mobility
Bloodwork
Follow up
AES
Diet
Travel
Work

65
Q

Peripheral venous disease includes

A

Chronis Venous Insufficency
Incompetent valves
↑ venous hydrostatic pressure
(ambulatory venous hypertension)
RBC and fluid leak into tissue
See edema
Deep Veins

66
Q

Non modifiable risk factors for PVD

A

Age, Female

67
Q

Modifiable risk factors for PVD

A

Varicose Veins
VTE’s
Fistulas

68
Q

Inspect for PVD

A

Colour
Symmetry
Wound bed
Wound drainage
Wound healing

69
Q

Palpate for PVD

A

Edema
Temperature
Texture
Turgor
Capillary Refill
Pulses= rhythm/ amplitude
Doppler

70
Q

Chronic Venous Insufficiency signs and symptoms in lower extremities

A

Leathery skin
Hemosiderin staining
Stasis dermatitis
Pruritus
Higher temperature

71
Q

Hemosiderin Staining

A

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
Q

Venous Leg ulcers

A

shallow, irregular borders, malodorous, yellow wound base, extensive drainage

73
Q

wound care for Venous Leg ulcers

A

Actisorb, acticoat, silvasorb gel, Silvasrob sheet

74
Q

what does silvernitrate do for wounds

A

speeds up healing, aids in coagulation

75
Q

why do we need to absorb wet wounds

A

Wet creates infectious bed and skin maceration

76
Q

Why do we wrap venous wounds

A

to create compression and adress venous insufficency. It reduces swelling, inhances healing, promotes venous return.

77
Q

Why don’t we wrap arterial wounds

A

Compression can worsen the condition ny furthering the resctriction of blood supply to the effected area. Reduced blood flow, risk of necrosis.

78
Q

Complication of PVD

A

Infection
Cellulitis
Lymphedema
Amputation- rare

79
Q

why are venous wounds wet

A

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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