Vascular and Peripheral Circulation Disorders Flashcards
peripheral vascular disease
disorders that alter the natural flow of blood through the arteries and veins of the peripheral circulation
arteries and arterioles
thick wall
away from heart
big to small
muscle around the vessel causes it to dilate and constrict
veins and venules
no muscle so it cannot dilate or constrict
has valves
function of the vascular system
provide oxygen and nutrients to the tissues
what is a supply and demand issue
demand is how much oxygen is needed by the tissues
supply is how much oxygen/blood is reaching the tissues
these need to be equal to avoid harm
supply does not equal demand causes what
ischemia
injury
infarct
what causes an increase in demand
exercise
fever
infection
illness
exercise (or other situations causing increase in demand) causes
increase HR RR
vasodilation
if the heart rate cannot increase or if the vessels are unable to deliver blood in times of higher demand what will happen
ischemia
injury
infarct
what occurs in the body during rest
vasoconstriction
decrease HR RR
why do the vessels constrict during rest
tissues do not demand much oxygen
why do the vessels dilate during exercise
tissues demanding more oxygen
what should we assess when assessing pain
PQRST
what are two pain types people might have
intermittent claudication
rest pain
intermittent claudication
- pain with exercise due to lack of blood flow and ultimately lack of oxygen
- pain is relieved with rest
- arterial disorder
- decrease supply increase demand
- rest causes decrease in demand so pain subsides
- supply is adequate with rest
rest pain
- pain at rest
- lack of blood flow majority of the time
- supply issue most of the time
- supply is greatly decrease to not meet any demands
what should we assess during the skin
color
temp
apperence
skin color
arterial
bright red when dependent
pale when elevated
skin color
vein
brown sock apperence
skin temp
arterial
cold
skin temp
vein
warm
skin apperence
arterial
shiny
hair loss (due to no nutrients)
dry
pulses
arterial
diminished/absent
what do we do if we cannot feel arterial pulses
varifiy with doppler and mark where pulses are
why do we make where the pulses are
to save us time and the other nurses time
sometimes we have to check pulses every 15 mins so this will save us time
arterial sensations
decrease sensation feeling
since arterial disorders have decrease sensation feeling
need meticulous foot care
since CT scan and angiography both use contrast what are we going to do
allergies
kidney (BUN/CR)
increase fluids
if the patients are allergic to contrast what do we do
premeditate with mucomist
why do we increase fluids after contrast
flush out contrast
MRI what do we assess for
implanted devices
the type of metal depends
if unsure ask
modifiable risk factors
nicotine
hypertension
diabetes (1 and 2)
obesity
stress
sedentary lifestyle
c reactive protein
diet
nonmodifiable risk factors
age
female gender
genetics
nicotine
modifiable
hypetension
modifiable
diabetes
modifiable
obesity
modifiable
stress
modifiable
sedentary lifestyle
modifiable
c reactive protein
modifiable
diet
modifiable
age
nonmodifiable
female gender
nonmodifiable
genetics
nonmodifiable
segmental systolic blood pressure measurement
blood pressure of whole leg
normal is no change
arterial peripheral vascular disorder
cap refill
delayed
primary goals
relief of pain
maintence of tissue integrity
APVD
- exercise
promote collateral circulation
*consult primary health care provider before prescribing an exercise routine
APVD
- positioning
neutral
dependent
APVD
- temp
cool temp
APVD
- use of cold and hot therapy
avoid
- cannot tell if it is too hot or cold
APVD
- why not use cold
causes vascoconstriction which will worsen
APVD
- where do we apply heating pad
abdomen
APVD
- smoking
STOP
APVD
- medications
lipid lowering
BP
pain
APVD
- protection of extremities and avoidance of trauma
shoes
APVD
- nutrition
low fat
APVD
- gangrene type
dry
APVD
- gangrene who is at highest risk
elderly
*symptoms more pronounced
APVD
- why is gangrene left undisturbed
wound would not heal after amputation
APVD
- hallmark sign and symptom
intermittent claudication
APVD
- sensation
cold or numbness
APVD
- color
pale when elevated
lobster when dependent
APVD
- pulses
diminished
APVD
- position
neutral or dependent
APVD
- PTA
similar to cath lab for the arteries
APVD post op bypass
- monitoring
pulses
- doppler
color
temp
cap refill
sensory
motor
* 15 min
APVD post op bypass
- incision
infection
ansyrusm
weak area and bigger
aneurysm management
lower BP
are all aneurysms the same
no they depend on the location and vary
do all aneurysm patients have symptoms
no some can be asymptomatic
what is the most prominent symptom in aneurysm
pain
aneurysm
thoracic aortic
- symptoms
dyspnea
cough
hoarsness
strdor
aneurysm
aortic
- symptoms
many are asymptomatic
pulsing in abdomen
low back pain
signs and symptoms of impending abdominal rupture
severe back/abdominal pain
decreasing BP
decreasing HGB
hematoma in flank
feeling of impending doom
after aneurysm repair
- HOB and position
supine 6 hours
HOB 45 degrees 2 hours
after aneurysm repair
- monitoring
VS
Doppler
peripheral pulses
bleeding
pulsation
swelling
pain
hematoma (flank)
after aneurysm repair
why monitor temp
body rejecting the graft
after aneurysm repair
why monitor urine output
may be a period of time where the kidneys were not perfused
need to know if the kidneys are damaged
signs of bleeding
hemoglobin
pulse
respirations
urine output
mental status
DVT risk factors
vessel trauma
venous statsis
hypercoagulopathy
DVT prevention
SCD
heparin (short term)
warfarin (long term)
mobility
movement
positioning elevation
DVT signs and symptoms
calf or groin tenderness
unilateral leg swelling
redness
localized edema
s/s of PE might be first symptom
if someone has a DVT do we use SubQ or IV heparin
IV
why do we have an overlap of heparin and warfarin
warfarin takes a long time to start working so we start them at the same time since heparin starts working fast
do we use unfractionated heparin or LMWH
unfractioned
what precautions are someone on heparin should be on
bleeding and falls
heparin dosage is monitored on
aPTT
INR (iv only)
platelet counts
why do we monitor platelet for heparin
heparin induced thrombocytopenia
heparin reversal
protamine sulfate
warfarin reversal
vit K
warfarin monitoring
INR
INR therapeutic for warfarin
2-2.5
thrombolytic therapy is a high risk for
bleeding
why would we monitor hemoglobin on patients on anticoagulants
bleeding
IV heparin is always administered via a
infusion pump
normal aPTT
25-31 seconds
what is theraputic for aPTT
1.5x control
new generation med reversal
platelet
FFP
vitamin K
what clothing do we want for surgery for these patients
normal
VPVD
- stasis dermatitis
brown sock
VPVD
- ulcer
moist
infection
VPVD
- varicose veins cause
prolonged standing
lymphedema
lymph node removal
cellulitis apperence
scaly
red
warmth
swelling
trauma for bacteria to be introduced
complications of VPVD
infection
venous ulceration
if suspected infection what should we get
culture
venous ulcer pharm treatment
antiseptic agents
antibiotics
venous ulcers another form of treatment
hyperbaric treatment
cellulitis
infection and swelling of skin tissues
cellulitis is a common infectious cause of
limb swelling
cellulitis can occur
as a single isolated event or series of recurrent events
cellulitis entry point
through normal skin
cellulitis
s/s
pain
swelling
localized redness and pain
fever
chills
sweating
what pharm treatment is required for cellulitis
antibiotics and if severe IV
