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Intro to MedSurg > Vascular > Flashcards

Vascular Flashcards

1
Q

what is Peripheral Artery Disease (PAD)

A

-Involves progressive narrowing and degeneration of arteries of neck, abdomen, and extremities

-Atherosclerosis (plaque)is the leading cause in majority of cases.

-causes ischemia

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2
Q

what is ischemia

A

-Lack of blood flow to an extremity
-Decreased oxygen delivery to the tissues

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3
Q

what are the causes of PAD

A

-Atherosclerosis
-Emboli formation (blood clot)
-Septic embolism
-Infection (swelling, necrotisis facitis caused by staff)
-Any thing that descreases blood flow and O2 delivery
-Thrombosis

Trauma fracture (compartment syndrome r/t broken bones)

Vasculitis- autoimmune, inflammation of the vasculature

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4
Q

what are the risk factors of PAD

A

-Cigarette smoking
-Hypercholesterolemia
-Hypertension
-Chronic kidney disease
-Diabetes mellitus
-Family History
-Coronary artery disease

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5
Q

what is Critical Limb Ischemia (CLI) characterized by (don’t forget the ulcers)

A

-Chronic ischemic pain at rest lasting more than 2 weeks
-Arterial leg ulcers or gangrene
-Can have it an any other extremities

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6
Q

what is pain at rest from Critical Limb Ischemia (CLI)

A

-(pt could be diabetic) wounds on the lower exreeties= check their blood sugar
-Occurs in the forefoot or toes (elevating makes the pain worst)
-Aggravated by limb elevation
-Occurs from insufficient blood flow
-Occurs more often at night

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7
Q

what are the characteristics of arterial diseases

A

-intermittent claudication pain
-no edema
-pulse or weak pulse
-no drainage
-round smooth sores
-black eschar

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8
Q

what are the 5 P’s that you need to recognize for PAD, what do you need to do for the pulses

A

-Pain
- pallor
-paresthesia,
-pulselessness,
-paralysis
-Doppler the pusles- you wont be able to feel them other wise

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9
Q

how will the the extremities feel and what will the wounds look like with PAD

A

-Wounds that are not healing/slow to heal, appear dy round and possibly necrotic
-Affected extremity cool
-Changes in skin color, texture, and hair growth
-Dependent rubor/pallor with elevation (redness/ flushed when it is dangled)

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10
Q

what is Intermittent claudication-

A

spasmotic pain, decreased blood flow or oxygenation of the tissue

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11
Q

what is the main diagnostic test of PAD

A

Angiography:
-imaging of the vessels
and magnetic resonance angiography
-can see all of the vessels, tells us the severity

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12
Q

what are the more general diagnostics for PAD

A

-Doppler ultrasound
-Ankle-brachial index (ABI)
-Severity of disease? (Acute vs Chronic)?

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13
Q

what will Interventional Radiology Procedures tell us

A

-Intermittent claudication: -symptoms become incapacitating (they can’t get up and move, stents placed or meds to dissolve the clot)
-Pain at rest

-Ulceration or gangrene (rotten tissue, no O2 or blood floow) severe enough to threaten viability of the limb

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14
Q

what is Percutaneous transluminal angioplasty (PTA)

A

-his is an interventional procedures
-Involves insertion of a catheter into an artery
-Catheter contains a cylindrical balloon that is inflated
-This compresses the atherosclerosis into the vessel wall
-if more than 90% occlusion then you run the risk of perforating the vessel wall if you place a balloon
Post op- check pulses more frequently (q15x2, q30x2, q1x2)

Atherectomy:
Removal of obstructing plaque using a cutting balloon, laser, or drill

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15
Q

what is surgical therapy for PAD

A

-Most common surgical approach
-Peripheral artery bypass surgery with autogenous(taking part of the pt original vasculature and graft it to where you need to do a bypass) vein or synthetic graft to bypass blood around the lesion
-PTA with stenting may also be used in combination with bypass surgery
-Amputation
-2 different types of graft are autogenous and synthetic

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16
Q

what are the goals for PAD

A

-Adequate tissue perfusion
-Relief of pain
-Increased exercise tolerance
-Intact, healthy skin on extremities
-Increased knowledge of disease and treatment plan

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17
Q

what interventions for PAD in an acute care setting

A

-Frequently monitor after surgery
-Skin color and temperature
-Capillary refill
-Presence of peripheral pulses distal to the operative site
-Sensation and movement of extremity
-This is all under peripheral vascular assessment
-Continued circulatory assessment
-Monitor for potential complications
-Edema, bleeding, thrombosis
-Knee-flexed positions should be avoided except for exercise
-Turn and position frequently

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18
Q

what is health promotion for PAD (this is an intervention)

A

-ambulatory care
-Importance of meticulous foot care
-Daily inspection of the feet
-Comfortable shoes with rounded toes and soft insoles
-Shoes lightly laced

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19
Q

what are the Risk Factor Modifications for PAD

A

-Tobacco cessation (constrictic vessels if you keep smoking)
-Diabetic
-Glycosylated hemoglobin <7.0% for diabetics
-Aggressive treatment of hyperlipidemia
-BP maintained <140/90 (you will releave the pressure on the arteries and makes blood flow easier)

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20
Q

what type of drug therapy would be the priority

A

Antiplatelet agents (aggregate):
-Agent that inhibits platelet aggregation and thus reduces the risk of thrombus formation
e.g. Aspirin, Clopidogrel (Plavix)

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21
Q

Describe what ACE inhibitors would do for PAD

A

-↑ Peripheral blood flow
-↑ ABI (ankle-brachial index)
-↑ Walking distance

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22
Q

Describe cholesterol medications and what they do for PAD

A

-statin used to drop the amount of cholesterol in the blood
-To treat hyperlipidemia

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23
Q

describe what excersise can do for PAD

A

-Helps blood flow
-Exercise improves oxygen extraction in legs and skeletal metabolism
-Walking is most effective exercise for individuals with claudication
-30 to 45 minutes daily, 3 times/week

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24
Q

descibe what nutrition and monitoring for bleeding risk can do for PAD

A

-Recommend reduced calories and salt for obese or overweight persons
-Long-term antiplatelet therapy

25
Q

what are the expected outcomes for PAD

A

-Increased perfusion (pulses present)
-CMS returns to baseline
-Wound healing
-Pain controlled or alleviated
-Increased activity tolerance
-Participation in walking program
-Verbalizing step to improve health (diet, exercise, smoking cessation)
-Able to afford and obtain medications

26
Q

what are the manifestations of Chronic venous insufficiency (brings deoxygenated blood)

A

-Swelling in feet/lower legs that improves with elevation (priority)
Itching
-Pain or numbness
-Discoloration of lower extremities (rubor)
-Wounds on legs
-History of obesity, diabetes, DVT, pregnancy, varicose veins
-Changes in skin color, texture, and hair growth
-Warm skin
-Leathery brownish skin- -Hemosiderin staining
-Edema
-Pruritus (stasis dermatitis)

Ulceration- wounds are wet/sloughy with irregular borders
-Pain
-Palpable pulses

27
Q

what are the diagnostics for CVI

A

-Doppler ultrasound
-Venogram(to see the veins all coiled up) (priority)
-CT scan (priority)
-Severity of disease?

28
Q

what are the goals that we have for CVI

A

-Improve venous return (priority)
-Decrease swelling/pressure in legs
-Restore skin integrity
-Improve nutritional status
-Increase/promote activity
-Decrease pain

29
Q

what are the interventions for CVI (Increase venous blood return, decrease pressure)

A

Increase venous blood return, decrease pressure:

-Compression therapy and elevation of legs: TED hose, ACE wraps

30
Q

what are the interventions for CVI (Treat venous stasis ulcers & restore skin integrity)

A

-wound care, bed cradle

31
Q

what are the interventions for CVI (adequate nutrition)

A

Diabetic diet, monitoring blood glucose (high during infection)- weight management and wound healing

32
Q

what are the interventions for CVI (medication therapy)

A

Topical agents- hydrocortisone (steroid anti inflammatory cream), antifungal (bc it is a wet open wound, at risk for yeast infection), zinc oxide

Antibiotics (blood cultures to check for bacterial infections)

33
Q

what are the expected outcomes for CVI

A

Edema-Reduction in severity

Wound Care:
Healing/prevention of stasis ulcers

Most management will be outpatient:
Lifestyle modification
Adherence to compression therapy

34
Q

what is the signs of arterial disease (away)

A

color-Pale when elevated
Rubor in dependent position

edema-None or minimal

nails-tick and brittle

pulse- Decreased, weak or absent

temp of the extremity-cool

pain-Worse with elevation, claudication,
worsening disease-pain at rest

ulcers- dry and necrotic

35
Q

what is the signs of venous disease (towards)

A

color-Ruddy (brownish/red)-hemosiderin
Cyanotic (if dependent)

edema-present

nails-normal

pulse-normal

temp of extremity-warm
pain-Better with elevation; dullness or heaviness

ulcers-Moist andMalleolar (ankle)

36
Q

what diagnostics test do you run for varicose veins

A

-Manual compression test
-Doppler ultrasound- a non-invasive diagnostic

37
Q

what are the treatment options for varicose veins

A

Sclerotherapy: Injecting a saline solution closes those veins

Laser: fades the appearance of veins

Vein stripping: Outpatient procedure surgical removal vein removal

Ambulatory phlebectomy: Removal smaller varicose veins through a series of tiny skin punctures.

Endoscopic vein surgery: A small video camera inserted in your leg to visualize and close varicose veins, and then removes the veins through small incisions

Angiogenesis: can happen with arteries and veins

38
Q

what is the main nursing intervention for varicose veins

A

-Compression stockingsandSCDs

39
Q

what are the non priority nursing interventions for varicose veins

A

Prevent skin breakdown
Pain relief
Prevention/Reduce risk factors

40
Q

what are the expected outcomes for varicose veins after all of the interventions

A

-Relief from discomfort
-Improved circulation
-Avoidance of complications (blood clot and ischemia)

41
Q

what is Venous thrombosis/thromboembolism

A

Formation of a thrombus in association with inflammation of the vein.

42
Q

what is the biggest clue of Venous thrombosis/thromboembolism

A

Sudden onset:
-Shortness of breath (SOB)
-Chest pain that worsens with inspiration
-Check for pulmonary embolism

(neuro can respiratory checks are also done)
-Hemoptysis

43
Q

what are the risk factors Venous thrombosis/thromboembolism

A

-Prolonged immobility
-Smoking
-Using oral contraceptives
-Recent injury to extremity
-Pregnancy/Post-partum

44
Q

what do you check for when you suspect Venous thrombosis/thromboembolism

A

-Unilateral edema
-Red and warm
-Pain/tenderness with palpation
-Dilated superficial veins
-Full sensation in calf or thigh
-Paresthesia in affected extremity
-Positive Homan’s sign (dorsiflextion of the foot hurts in the calf)

45
Q

what are the acute symptoms of Pulmonary Embolism

A

-Rapid onset
-Chest pain - Stabbing
-Shortness of breath
-Hypoxia, hemoptysis

46
Q

what are the interventions for a pulmonary embolism and what is the primary diagnostic tool

A

-Rescue positioning: Fowlers/O2
-Call for HELP!!!
-CT and VQ scan is the primary diagnostic tool for PE

47
Q

what are the other diagnostics for pulmonary embolism

A

-Doppler ultrasound
-Manual compression test
-Venogram

Echocardiogram:
-we want to see if there is any pressure on the lung caused by a clot
-MRI lung

Lab results:
-D-dimer (specific to clot formation, if + it means we havea clot but we don’t know where), coagulation studies (PT, INR, CBC

48
Q

what are the goals for VTE and PE

A

-give O2 and anticoagulants- give through IV so that it is absorbed faster. this is so you can get rid of it to prevent the formation of more
-improve venous return
-decrease swelling/ pressure
-restore skin integrity
-improve nutritional status
-increase nutritional status
-increase activity
-reduction of risk factors (surgery or cancer)

49
Q

how would you prevent VTE and PE

A

-THIS IS KEY!
-TED hose, Early ambulation
-Sequential compression device
-No massage
-Assess for more blood clots

50
Q

what are the medications that we could give for VTE and PE

A

-Low molecular weight heparin
-Unfractionated heparin
-Coumadin

Thrombolytics (tPa)–> don’t do it unless you know a lot of history and the clot cannot be resolved

Complications of therapy- bleeding precautions

51
Q

what are the priority actions for emergency VTE and PE treatment

A

-Initial priority actions
-Call Rapid Response Team (RRT) and provider
-Administer oxygen
-Need to reduce hypoxemia
-Non rebreather mask
-Place patient in high fowlers
-Continuous monitoring of VS
-Medications(whatkind?)
-Emotional support for patient and family
-Watch for increasing pain or changes in LOC
-DOCUMENTATION OF EVENTS

52
Q

what is the surgical interventions for VTE and PE

A

Pulmonary embolectomy for massive PE:
-For hemodynamically unstable patients in whom thrombolytic therapy is contraindicated

Inferior vena cava (IVC) filter:
-Prevents migration of clots in pulmonary system

53
Q

what are the risks for anticoagulation

A

-bleeding!
-bleeding from the gums
-bleeding from the liver
-rectal bleedings
-dark or bloody stools

54
Q

what do you have to monitor for anticuagulation

A

-Monitor VS and bleeding

Obtain Baseline labs (over/under coagulated):
-Troponin, ABG, BNP
-PTT and anti-Xa: Heparin
-PT, INR: Coumadin, INR goal >2

D-Dimer: Blood clots slowly break down after they are formed, and this process releases D-dimer into the blood.
Platelets: concern for HIT (platelet count) (Heparin‐induced thrombocytopenia)

55
Q

what are the antidotes for anticoagulation

A

Coumadin: Vitamin K
Heparin: Protamine Sulfate

56
Q

what do you (and the pt) need to know about anticoagulation upon discharge (blood work and safety measures)

A

Blood work:
-Anticoagulant therapy for at least 6 months

Safety measures:
-Taking other medications- MANY drugs interact with anticoagulants
-Soft toothbrushes
-Report signs of bleeding to physician
-Shoes when ambulating- NO bare feet
Coumadin- check blood levels every week bc low therapeutic indes

57
Q

what do you (and the pt) need to know about anticoagulation upon discharge (symptoms of bleeding and nutrition)

A

Symptoms of bleeding:
-Hematuria
-Dark or blood stools
-Bleeding gums

Nutrition:
Food restrictions due to anticoagulation
Many foods contain Vitamin K (kale, green leafy veggies) do not give these foods

58
Q

what are the outcomes expected outcomes for VTE and PE

A

-Stable vital signs
-Mentation at baseline
-Anxiety alleviated; Pain decreased/resolved
-Absence/resolution of chest pain
-Prevention of further thromboembolic phenomena
-Education
-Understanding of medications and therapeutic dosing- INR goals?
-Dietary education if on warfarin

Intro to MedSurg (4 decks)

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