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Pathophysiology > Vascular Disorders > Flashcards

Vascular Disorders Flashcards

1
Q

Vascular Disorders - what are they?

A

Include disorders of arteries and veins

  • peripheral arterial disease (PAD)
  • peripheral venous disease (PVD)
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2
Q

Peripheral Arterial Disease

A
  • 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
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3
Q

Peripheral venous disease (PVD)

A
  • primarily effects lower extremities & categorized as venous thrombosis or chronic venous insufficiency
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4
Q

PAD of lower extremities: what arteries does it effect? and how is it diagnosed?

A
  • aortoiliac, femoral, popliteal, tibial or peroneal arteries or any combination
  • can be chronic
  • Diagnostics - ABPI index, doppler, S & S and CT
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5
Q

what determines the severity of the PAD?

A
  • site
  • extend of obstruction
  • amount of collateral circulation
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6
Q

Clinical manifestations of PAD

A
  • 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
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7
Q

Intermittent claudication

A
  • muscle ache or pain that is precipitated by consistent level of exercise
  • resolves within 10 min or less
  • reproducible
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8
Q

Skin changes in PAD

A
  • shiny, thin, taut
  • loss of hair
  • elevation pallor, reactive hyperemia
  • coolness of skin
  • poor wound healing - ulceration
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9
Q

Signs of decreased arterial circulation

A
  • decreased pulses
  • skin cool to touch
  • pallor
  • increased cap refill time
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10
Q

Advanced PAD

A

continuous pain at rest

gangrene

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11
Q

PAD Care: risk factor modification

A
  • healthy body weight, physical activity, smoking cessation, BP & glycemic control, treatment of hyperlipidemia (diet and statins)
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12
Q

Drug Therapy for PAD

A

antiplatelet (e.g., aspirin), statins, ACE inhibitors, meds to treat intermittent claudication

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13
Q

Exercise therapy for PAD

A
  • formal, supervised exercise training
  • walking is most effective, stop and rest with discomfort
  • do not exercise if: leg ulcers pain at rest, cellulitis, gangrene
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14
Q

nutritional therapy PAD

A

healthy body weight

diet high in fruits, veggies, and whole grains, low in cholesterol, saturated fat & salt

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15
Q

complementary and alternative therapies for PAD

A

consult HCP before taking if on antiplatelets, NSAIDs, or anticoagulants

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16
Q

Surgical Therapy

A

peripheral arterial bypass, endarterectomy, patch graft angioplasty, amputation

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17
Q

Critical limb ischemia

A
  • revascularization via surgery or endovascular procedure

- aggressive risk factor modification & antiplatelet therapy

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18
Q

Conservative Management of PAD

A

protect extremity from trauma
decrease ischemic pain
prevent & control infection
maximize perfusion

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19
Q

Acute Arterial Ischemic Disorders

A
  • 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
20
Q

Vascular disoders

A 
PAD (peripheral arterial disease)
- acute arterial ischemic disorder
PVD (peripheral venous disorder) 
- superficial vein thrombosis
- deep vein thrombosis
21
Q

what is PAD

A

reduced arterial blood flow to the extremities

22
Q

Why is PAD occuring?

A

atherosclerosis

23
Q

Where is PAD

A

arterial system, extending from aorta to tibial artery

24
Q

Complications of PAD

A
  • 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.
25
Q

Diagnostic Tests for PAD

A
  • ankle brachial pressure index (ABPI)
  • Ankle SBP/Brachail SBP
    (normal is 1-1.4)
  • doppler ultrasound
  • magnetic resonance angiography
26
Q

Interventions for PAD ( surgery)

A
  • femoral popliteal bypass
  • percutaneous transluminal angioplasty
  • endartectomy (removing plaque from vessel)
  • amputation as last resort
27
Q

Drug therapy PAD

A
  • antiplatelet
  • statin
  • ACE inhibitor (lowers HTN which is the #1 cause of atherosclerosis and PAD)
  • meds to treat intermittent claudication - pentoxifylline
  • NSAID (anti-inflammatory)
28
Q

Risk factor modification

A
  • control BP
  • weight control
  • smoking cessation
  • BG control
29
Q

Acute Arterial Ischemic Disorder

A
  • 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
30
Q

6 P’s of Acute arterial ischemic disorder

A

pain, pallor, pulselessness, paresthesia, paralysis, and perishingly cold

31
Q

Ineffective tissue perfusion interventions

A
  • walking program
  • compression stockings
  • avoid lifting feet above heart level
  • smoking cessation
  • avoid stress
  • relaxation exercise
  • do not cross legs
  • keep legs warm
32
Q

Impaired skin integrity interventions

A

prevent injury to extremities, soft foot wear, fleeced leg wraps, keep feet warm

33
Q

Acute pain interventions

A

elevate HOB, avoid standing in one position for too long, anything that is going to help circulation

34
Q

Activity intolerance interventions

A

activity program

35
Q

Ineffective therapeutic regimen management intervention

A

identify factor affecting their learning and teach them so they can adhere to their regimen

36
Q

Peripheral Venous Disorder (PVD)

A
  • venous thrombus - formation of blood clot
37
Q

why is blood clot forming? V

virchow’s triad (SHE)

A
  • 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
38
Q

Peripheral venous Disorder: superficial vein thrombosis:

  • where?
  • manifestations:
  • interventions:
A
  • 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
39
Q

Deep Vein Thrombosis (Venous thrombo-embolism): where?

A

blood clot forms in deep vein

40
Q

Clinical manifestations of DVT (may have no symptoms)

A
  • unilateral leg edema
  • extremity pain
  • sense of fullness in thigh or calf
  • warm skin, erythema or cyanosis
  • temp > 38
  • positive homans sign
41
Q

Complications of DVT

A
  • pulmonary embolism
  • chronic venous insufficiency (homoserine release)
  • phlegmasia cerulea dolens (one side of the limb turns blue)
  • venus leg ulcer
42
Q

Diagnostic Tests (DVT)

A
  • PTT, INR, platelet count
  • D-dimer - protein fragment when blood clot dissolves in body
  • Venous compression ultrasound
  • magnetic resonance venography
43
Q

Nursing Diagnosis DVT

A
  • 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
44
Q

Interventions for DVT

A
  • 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
45
Q

pharmacological treatment of DVT

A

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

46
Q

Hemosiderin release

A

PVD - brown leathery skin on extremity

Pathophysiology (8 decks)

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