Vascular disorder

Question 1

Age-Related Changes

Arteriosclerosis

Answer 1

Stiffening of the vessel walls results in compromised delivery of oxygen and nutrients to tissues; buildup of waste products in tissue
Decrease production of hemoglobin results in a decline in the oxygen-carrying capacity of the blood
Slowing or
ineffective heart
rate
Decrease in
stroke volume

Question 2

Chief Complaint and History of Present Illness

Answer 2

Focuses on the six classical “Ps” of peripheral vascular disease: pain, pulselessness, poikilothermy, pallor, paresthesia, and paralysis

Question 3

Past Medical History

Answer 3

Document a history of hypertension, coronary artery disease, myocardial infarction, or atheroscleros

Question 4

Family History

Answer 4

Relevant diseases: hypertension, coronary artery disease, myocardial infarction, atherosclerosis, aneurysm, and diabetes

Question 5

an organism (as a frog) with a variable body temperature that tends to fluctuate with and is similar to or slightly higher than the temperature of its environment:a cold-blooded organism

Answer 5

POIKILOTHERM

Question 6

Changes associated with PVD:

Review of systems

Answer 6

thick, brittle nails; shiny, taut, scaly, dry skin; skin temperature variations; skin ulcerations; muscle atrophy; localized redness and hardness; and hair loss on the extremities

Question 7

Review of systems

Assess for symptoms of aneurysms:

Answer 7

hoarseness, dysphagia, dyspnea, abdominal or back pain, or swelling of the head and arms

Question 8

Functional assessment PVD

Answer 8

Determines the effect of the disease on the patient’s life

Pain of PVD can interfere with the ability to perform activity leading to a more sedimentary lifestyle

Question 9

Assessment of the Vascular System
Physical examination
PVD

Answer 9

Inspect the skin for color and lesions
Capillary refill time in the nail beds
Palpate affected areas to evaluate temperature, detect edema, and assess peripheral pulses
Allen test: clench fist, occlude radial/ulnar arteries, open hand, and release ulnar artery. Color return?

Question 10

Diagnostic Tests and Procedures PVD

Answer 10

Ultrasonography
Pressure measurements
Plethysmography 
Segmental plethysmography 
Exercise (treadmill) test
Angiography
Tomographic angiography
Magnetic resonance angiography 
Arteriography
Venography

Question 11

Therapeutic Measures PVD

Answer 11

Exercise programs
Stress management
Pain management
Smoking cessation
Elastic stockings (TED)
Intermittent pneumatic compression (SCD)
Positioning
Thermotherapy
Protection 
Patient teaching

Question 12

is used to measure changes in volume in different parts of the body. This can help checkblood. The test may be done to check for blood clots in the arms and legs, or to measure how much air you can hold in your lungs.
Penile pulse volume recording is a type this test that is done on the penis to check for causes oferectile dysfunction.

Answer 12

Plethysmography

Question 13

Surgical procedures PVD

Answer 13

Embolectomy 
Percutaneous transluminal angioplasty 
Endarterectomy 
Sympathectomy
Vein ligation and stripping 
Sclerotherapy

Question 14

Preoperative nursing care PVD

Answer 14

Patient with severe cardiovascular disease may have activity restrictions to reduce demands on circulatory system until the surgical procedure is done
Affected extremity should be maintained in a level or slightly dependent position as ordered
Optimize peripheral circulation: keep extremity warm

Question 15

angiographic procedure for elimination of areas of narrowing in blood vessels.

Answer 15

angioplasty

Question 16

in which aballooncatheteris inflated inside an artery, stretching the intima and leaving a ragged interior surface after deflation, which triggers a healing response and breaking up of plaque.

Answer 16

balloon angioplasty

Question 17

a type ofballoon angioplastyin which the catheter is inserted through the skin and through the lumen of the vessel to the site of the narrowing.

Answer 17

percutaneous transluminal angioplasty

Question 18

percutaneous transluminal angioplasty to enlarge the lumen of a sclerotic coronary artery (see accompanying illustration). This provides an alternative to cardiacbypasssurgery for selected patients with ischemic heart diseas

Answer 18

percutaneous transluminal coronary angioplasty(PTCA)

Question 19

is asurgical procedureto remove theatheromatousplaquematerial, or blockage, in the lining of anarteryconstricted by the buildup of soft/hardening deposits. It is carried out by separating the plaque from the arterial wall.

Answer 19

Endarterectomy

Question 20

Preoperative nursing care PVD

Answer 20

Protect the limb from further injury

Question 21

Postoperative nursing care PVD

Answer 21

Primary goal of the postoperative period is to stimulate circulation by encouraging movement and preventing stasis within the extremity

Question 22

Drugs PVD

Answer 22

Anticoagulants Thrombolytics
Platelet aggregation inhibitors Vasodilators
NSAIDS Analgesics

Question 23

Dietary interventions PVD

Answer 23

Low-fat diets reduce serum cholesterol levels
Weight-reduction diet if the patient is obese
Adequate vitamin B, vitamin C, and protein needed to promote healing and improve tissue integrity

Question 24

Usually forms in the heart, but a roughened atheromatous plaque in any artery also can lead to thrombus formation
If a thrombus breaks loose, it becomes an embolus and travels through the circulatory system until it lodges in a vessel, blocking blood flow distal to the occlusion

Answer 24

Arterial Embolism

Question 25

Signs and symptoms

Arterial Embolism

Answer 25

Severe, acute pain
Gradual loss of sensory and motor function in the affected areas
Pain aggravated by movement or pressure
Absent distal pulses
Pallor and mottling (irregular discoloration)
Sharp line of color and temperature demarcation: tissue beyond the obstruction is pale and cool

Question 26

Medical and surgical treatment

Arterial Embolism

Answer 26

Intravenous anticoagulants and thrombolytic agents

Embolectomy

Question 27

Atherosclerosis obliterans, arterial insufficiency, and peripheral vascular disease
Pathologic changes in the arteries, typically plaque formations that arise where the arteries branch, veer, arch, or narrow
Common sites for arterial occlusion are the distal superficial femoral and the popliteal arteries
Occlusions prevent delivery of oxygen and nutrients to the tissues
Hypoxia affects all tissues distal to the occlusion

Answer 27

Peripheral Arterial Occlusive Disease

Question 28

Signs and symptoms

Peripheral Arterial Occlusive Disease

Answer 28

Intermittent claudication (aching,cramping, tiredness & weakness in leg when walking & relieved by rest)
Absence of peripheral pulses below occlusive area
Rest pain (persistent and aching pain developing during rest)
Tingling or numbness or both in the toes
Extremity is cold, numb, and pale
Shiny, scaly skin; subcutaneous tissue loss; hairlessness on the affected extremity; and ulcers with a pale gray or yellowish hue, especially at ankles
Eventually necrosis and gangrene

Question 29

Medical diagnosis

Peripheral Arterial Occlusive Disease

Answer 29

Duplex imaging (combines 2 types of ultrasonograpy…providing a 2-dimensional image of the blood vessels)
Angiography

Question 30

Medical and surgical treatment

Peripheral Arterial Occlusive Disease

Answer 30

Lifestyle changes
Smoking cessation, exercise, weight management
Treatment for hypertension, hyperlipidemia, or diabetes
Drugs for claudication: cilostazol and pentoxifylline
Surgical interventions
Percutaneous transluminal angioplasty, atherectomy, and endarterectomy

Question 31

Assessment

Peripheral Arterial Occlusive Disease

Answer 31

Assess the pulses distal to the surgical site and compare with the same pulses in the unaffected extremity
Assess vital signs, color, and temperature of affected extremity, fluid intake and output, central venous pressure, and mental status

Question 32

Also called Buerger’s disease
Inflammatory thrombotic disorder of arteries and veins in lower and upper extremities
Cause is unknown, but it occurs only in smokers

Answer 32

Thromboangiitis Obliterans

Question 33

Signs and symptoms

Thromboangiitis Obliterans

Answer 33

intermittent claudication, rest pain, skin color/temperature changes in affected areas, cold sensitivity, abnormal sensation, ulceration, gangrene

Question 34

Diagnosis/ treatment

Thromboangiitis Obliterans

Answer 34

Diagnosis based on physical findings and arteriography
Most important treatment is smoking cessation
Palliative treatments include sympathectomy and drugs, such as calcium channel blockers, antibiotics, and anticoagulants

Question 35

is caused by small blood vessels that become inflamed and swollen. The blood vessels then narrow or become completely blocked by blood clots (thrombosis). Blood vessels of the hands and feet are especially affected. Arteries are more affected than veins. Average age when symptoms begin is around 35. Women and older adults are affected less often.
Thisconditionmostly affects young men ages 20- 40, whoare heavy smokers or chew tobacco.

Answer 35

Thromboangiitis obliterans (Buerger disease

Question 36

Thromboangiitis obliterans (Buerger disease
signs and symptoms

Answer 36

Fingersortoes canbe pale, red, or bluish and feel cold
Pain in the hands and feet
Acute, severe
Burning or tingling
Often occurring at rest
May be worse with cold exposure or with emotional stress
Pain in the legs, ankles, or feet when walking (intermittent claudication),often located in the arch of the foot
Skin changes or small painful ulcers onfingers or toes
Usually two or more limbs are affected

Question 37

Intermittent constriction of arterioles; affects hands primarily, but it can affect the toes and tip of the nose;
Raynaud’s Disease: the primary condition (has no identifiable cause)
Raynaud’s Phenomenon: vasospasm caused by other diseases

Answer 37

Raynaud’s Disease

Question 38

Signs and symptoms

Raynaud’s Disease

Answer 38

Chronically cold hands, numbness, tingling, and pallor

During an arterial spasm, the skin color changes from pallor to cyanosis to redness with throbbing

Question 39

Medical diagnosis

Raynaud’s Disease

Answer 39

Based on the signs and symptoms and on the absence of evidence of occlusive vascular disease

Question 40

Medical and surgical treatment

Raynaud’s Disease

Answer 40

Drugs: calcium channel blockers, transdermal nitroglycerin, an endothelin receptor antagonist, phosphodiesterase inhibitors, and intravenous prostaglandins
Sympathectomy