Vascular Disorders Flashcards
Vascular Disorders - what are they?
Include disorders of arteries and veins
- peripheral arterial disease (PAD)
- peripheral venous disease (PVD)
Peripheral Arterial Disease
- conditions affecting arteries of the neck, abdomen, and extremities
- subdivision into occlusive disease, aneurysmal disease, and vasospastic phenomenon.
- atherosclerosis is responsible for majority of PAD (occlusive and aneurysmal)
- PAD is a marker of advanced systemic atherosclerosis
Peripheral venous disease (PVD)
- primarily effects lower extremities & categorized as venous thrombosis or chronic venous insufficiency
PAD of lower extremities: what arteries does it effect? and how is it diagnosed?
- aortoiliac, femoral, popliteal, tibial or peroneal arteries or any combination
- can be chronic
- Diagnostics - ABPI index, doppler, S & S and CT
what determines the severity of the PAD?
- site
- extend of obstruction
- amount of collateral circulation
Clinical manifestations of PAD
- intermittent claudication
- impotence
- paresthesia - numbness in extremities
- erectile dysfunction
- skin changes
- signs of decreased arterial circulation
- dependent rubor & decreased skin integrity
- Good skin care and foot care is key for preventing complications
Intermittent claudication
- muscle ache or pain that is precipitated by consistent level of exercise
- resolves within 10 min or less
- reproducible
Skin changes in PAD
- shiny, thin, taut
- loss of hair
- elevation pallor, reactive hyperemia
- coolness of skin
- poor wound healing - ulceration
Signs of decreased arterial circulation
- decreased pulses
- skin cool to touch
- pallor
- increased cap refill time
Advanced PAD
continuous pain at rest
gangrene
PAD Care: risk factor modification
- healthy body weight, physical activity, smoking cessation, BP & glycemic control, treatment of hyperlipidemia (diet and statins)
Drug Therapy for PAD
antiplatelet (e.g., aspirin), statins, ACE inhibitors, meds to treat intermittent claudication
Exercise therapy for PAD
- formal, supervised exercise training
- walking is most effective, stop and rest with discomfort
- do not exercise if: leg ulcers pain at rest, cellulitis, gangrene
nutritional therapy PAD
healthy body weight
diet high in fruits, veggies, and whole grains, low in cholesterol, saturated fat & salt
complementary and alternative therapies for PAD
consult HCP before taking if on antiplatelets, NSAIDs, or anticoagulants
Surgical Therapy
peripheral arterial bypass, endarterectomy, patch graft angioplasty, amputation
Critical limb ischemia
- revascularization via surgery or endovascular procedure
- aggressive risk factor modification & antiplatelet therapy
Conservative Management of PAD
protect extremity from trauma
decrease ischemic pain
prevent & control infection
maximize perfusion
Acute Arterial Ischemic Disorders
- occur suddenly, without warning
- caused by embolism, thrombosis of already narrowed artery, or trauma
- clinical manifestations - pain, allow, pulselessness, parestheisa, paralysis, and poikilothermic (cold)
- early treatment is essential to keep limb viable - anticoagulant therapy, tpA, surgery, amputation
Vascular disoders
PAD (peripheral arterial disease) - acute arterial ischemic disorder PVD (peripheral venous disorder) - superficial vein thrombosis - deep vein thrombosis
what is PAD
reduced arterial blood flow to the extremities
Why is PAD occuring?
atherosclerosis
Where is PAD
arterial system, extending from aorta to tibial artery
Complications of PAD
- continuous pain at rest
- gangrene - skin turns green or brown
- limb threatening disease - damage to surface of tissue of limb and it will never return to normal. amputation.
Diagnostic Tests for PAD
- ankle brachial pressure index (ABPI)
- Ankle SBP/Brachail SBP
(normal is 1-1.4) - doppler ultrasound
- magnetic resonance angiography
Interventions for PAD ( surgery)
- femoral popliteal bypass
- percutaneous transluminal angioplasty
- endartectomy (removing plaque from vessel)
- amputation as last resort
Drug therapy PAD
- antiplatelet
- statin
- ACE inhibitor (lowers HTN which is the #1 cause of atherosclerosis and PAD)
- meds to treat intermittent claudication - pentoxifylline
- NSAID (anti-inflammatory)
Risk factor modification
- control BP
- weight control
- smoking cessation
- BG control
Acute Arterial Ischemic Disorder
- like a heart attack to a limb
- occurs suddenly without warning
- caused by embolism, thrombus, or trauma
- early treatment is essential to keep limb viable - anticoagulant therapy, TPA, surgery
6 P’s of Acute arterial ischemic disorder
pain, pallor, pulselessness, paresthesia, paralysis, and perishingly cold
Ineffective tissue perfusion interventions
- walking program
- compression stockings
- avoid lifting feet above heart level
- smoking cessation
- avoid stress
- relaxation exercise
- do not cross legs
- keep legs warm
Impaired skin integrity interventions
prevent injury to extremities, soft foot wear, fleeced leg wraps, keep feet warm
Acute pain interventions
elevate HOB, avoid standing in one position for too long, anything that is going to help circulation
Activity intolerance interventions
activity program
Ineffective therapeutic regimen management intervention
identify factor affecting their learning and teach them so they can adhere to their regimen
Peripheral Venous Disorder (PVD)
- venous thrombus - formation of blood clot
why is blood clot forming? V
virchow’s triad (SHE)
- stasis - blood doesnt flow. valve dysfunction, obesity, inactivity, pregnancy
- hypercoagulability - increase in clotting factor, smoking, malnutrition, dehydration, cancer
- endothelial damage - surgery, trauma, fracture, burn, cancer, diabetes
Peripheral venous Disorder: superficial vein thrombosis:
- where?
- manifestations:
- interventions:
- upper extremities (IV therapy)
- lower extremities (trauma to varicose veins)
- palpable, firm, subcutaneous cordlike vein with the surrounding area tender
- remove IV, elevation of affected limb, warm and moist heat, compression stocking, analgesics, NSAIDs
Deep Vein Thrombosis (Venous thrombo-embolism): where?
blood clot forms in deep vein
Clinical manifestations of DVT (may have no symptoms)
- unilateral leg edema
- extremity pain
- sense of fullness in thigh or calf
- warm skin, erythema or cyanosis
- temp > 38
- positive homans sign
Complications of DVT
- pulmonary embolism
- chronic venous insufficiency (homoserine release)
- phlegmasia cerulea dolens (one side of the limb turns blue)
- venus leg ulcer
Diagnostic Tests (DVT)
- PTT, INR, platelet count
- D-dimer - protein fragment when blood clot dissolves in body
- Venous compression ultrasound
- magnetic resonance venography
Nursing Diagnosis DVT
- acute pain related to impaired venous return and inflammation
- ineffective health maintenance
- risk for impaired skin integrity
- potential complication: bleeding b/c of anticoagulant
- potential complication: pulmonary embolism
Interventions for DVT
- early and aggressive ambulation. up 4-6 times/day
- bedrest patients - change positions, dorsiflex feet, rotate ankles q2-4 hr
- compression stockings
- sequential compression devices
pharmacological treatment of DVT
Vit K antagonist:
- warfarin
- 48-72 hr to work
INR - check to dose the warfarin
- Thrombin inhibitor(indirect) (heparin - monitor PPT, can have Heparin Induced Thombocytopenia (rapid decrease in platelet count) - LMWH - low molecular weight hepain which has less side effects. Dalteparin/enoxaparin)
- thrombin inhibitor (direct) - hiruin. Directly inhibit thrombin enzyme
Hemosiderin release
PVD - brown leathery skin on extremity
