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Patho > Vascular disorders > Flashcards

Vascular disorders Flashcards

1
Q

Peripheral Artery Disease

A

Involves thickening of the artery walls and progressive narrowing of arteries of upper and lower extremeties

*usually sypmtomatic in ppl 60-80; but may appear earlier if you have diabetes

*higher prevelence in blacks

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2
Q

risks a/w PAD

A

literally all the other CVD

Higher risk of mortality –> strokes and HF

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3
Q

Etiology/Pathophysiology of PAD

A

-Atherosclerosis is leading cause in majority of cases (affects coronary, carotid, and lower extremeties)
-gradual thickening of the intima and media due to cholesterol and lipid deposits
-exact cause unknown; inflammation and endothelial injury play a major role

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4
Q

Risk factors that increase chances of getting PAD

A

tobacco
atherosclerosis
diabetes
htn
high cholesterol
older than 60

symptoms occur when arteries are 60-75% blocked

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5
Q

Potential arteries in lower extremeties that may be affected by PAD

A

iliac
femoral
ppopliteal
tibial
peroneal

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6
Q

Manifestations of PAD:

A

Claudication
Paresthesia
Reduced blood flow
Pain at rest
Critical limb ischemia

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7
Q

Lower extremety PAD manifestation: classic

A

Classic
-intermittent claudication
*ishemic muscle pain caused by constant level of exercise –> build up of lactic acid from anaerobic metabolism
*resolves w/in 10 mins or less with rest
*reproducible

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8
Q

Lower extremety PAD manifestation: paresthesia

A

Paresthesia
-numbness r tingling in toes or feet from nerve tissue ischemia
-neuropathy causes shooting or burning pain
-loss of pressure and deep pain sensations from low blood flow
-injuries often go unnoticed

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9
Q

LE PAD manifestations: Reduced blood flow to limb

A

-thin shiny and taut skin
-loss of hair on lower legs
-diminished or absent pedal, popliteal, or femoral pulses
-pallor of foot with leg elevation
-reactive hyperemia of foot with dependent position

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10
Q

LE PAD manifestation: pain at rest

A

-progressive disease
-occurs in feet or toes
-aggravated by limb elevation
-occurs from insufficient blood flow to distal tissues
-occurs more often at night
-pain relief by gravity

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11
Q

LE PAD manifestsation: Critical Limb Ischemia

A

characterized by:
-chronic ischemic rest pain lasting for 2+ weeks
-nonhealing arterial leg ulcers or gangrene
-more likely in diabetics or those w/ HF or stroke history

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12
Q

Complications of LE PAD

A

-atrophy of skin and underlying muscles
-delayed healing
-wound infection
-tissue necrosis
-arterial ulcers over bony prominences

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13
Q

Arterial ulcers

A

super serious if they don’t heal and develop gangrene
-collateral circulation may prevent gangrene
-might resulr in amputation if bloodflow isn’t restored and severe infection occurs
-amputation is indicated when there’s uncontrolled pain and spreading infection

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14
Q

Diagnostic studies for LE PAD

A

Doppler ultrasound
-segmental BP taken along leg when supine –> drop of 30+ = PAD

Duplex imaging
-bidirectional, color Doppler

Ankle brachial index (ABI)
-divide ankle SBP by higher brachial SBP
-old ppl and those w/ DM might have artifically elevated ones

Angiography and magnetic resonance angiography

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15
Q

Interprofesional care of IE PAD: Risk factor modification

A

REDUCE CVD RISKS

BP control
-reduce sodium; DASH diet

Tobacco cessation

Keep Hgb A1C < 7% if diabetic

Aggressive treatment of hyperlipidemia w/ diet and statins

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16
Q

Drug therapy for LE PAD

A

ACE inhibitors
Antiplatelet agents
Drugs for claudication

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17
Q

LE PAD drugs: ACE-i

A

Reduce PAD symptoms

e.g. Ramipril (Altace)
-decreases CV morbidity/mortality
-increases peripheral blood flow
-increases ABI
-increases walking distance

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18
Q

LE PAD drugs: antiplatelet agents

A

Aspirin and/or Clopidrogrel (plavix)
-reduce CVD risk

*don’t use anticoagulants

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19
Q

LE PAD drugs for claudication

A

Cilostazol (pletal)
-inhibits platelet aggregation
-increases vasodilation
-NOT FOR HF PATIENTS

Pentoxifylline (Trental)
-improves flexibility of RBCs and WBCs
-decreases fibrinogen concentration, platelet adhesiveness, and blood viscosity

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20
Q

LE PAD Exercise therapy

A

most effective for intermittent claudication
-30-45 mins 3x a week
-more important in women bc they decline faster
-increases survival rate

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21
Q

LE PAD nutritional care

A

keep BMI <25 (BUT ALSO FUCK THAT)

Waist circumference under 40 in men and 35 in women

3-5% weight loss yields reduced triglycerides, glucose, A1C, and decreased risk of DMII

Recommend reduced calories and salt for obese or overweight persons

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22
Q

LE PAD alternative/complementary therapie

A

Consult with HCP before taking dietary or herbal supplements esp if taking NSAIDs or anticoagulants

Interactions pose bleeding risk

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23
Q

How to treat leg with CLI: drugs and procedures

A

Revascularization via bypass surgery using autogenous vein

Percutaneous transluminal angioplasty

IV prostanoids (not FDA approved though)

Decrease CVD risk w/ statins, antiplatelet ACE-i, and B-blockers

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24
Q

How to treat LE PAD patient with CLI: conservative treatment

A

-protect from trauma
-decrease ischemic pain
-prevent/control infection
-improve arterial perfusion

*spinal cord stimulation can help with pain

*growth factors and gene therapy can help promote angiogenesis

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25
Q

Catheter based procedures for LE PAD

A

(similar to angiography)
-insert catheter into femoral artery for all of them
-done in cath lab, not OR
-antiplatelets given postprocedure to prevent restenosis

Includes
PTA
Atherectomy
Cryoplasty

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26
Q

Percutaneous transluminal angioplasty

A

-catheter has balloon tip
-balloon is inflated dilating the vessel by compressing atherosclerotic intimal lining
-stent is placed to hold artery open

*stent coated with drug to limit growth of new tisue in treated area

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27
Q

Atherectomy

A

removal of plaque
-performed using a cutting dic, laser, or rotating diamond tip

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28
Q

Cryoplasty

A

combo of PTA and cold therapy
-balloon filled with liquid NO that changes to gas
-gas expands and cools to 14 F
-limits restenosis by reducing smooth muscle cell activity

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29
Q

Peripheral artery bypass surgery

A

Use umbilical vein or composite sequential bypass graft

PTA with stenting can also be used along with bypass

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30
Q

Other surgical options for LE PAD

A

Endarterectomy = open artery and remove plaque

Patch graft angioplasty = open artery, remove plaque, sew patch to widen lumen

Amputation
-if necrosis, gangrene, or osteomyelitis

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31
Q

nursing diagnoses for LE PAD

A

ineffective tissue perfusion

activity intolerance

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32
Q

Overall goals for PAD

A

adequate tissue perforation
relief of pain
exercise tolerance
intact, healthy skin
increased knowledge

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33
Q

Acute care in recovery after surgery or radiologic intervention

A

Frequently monitor
-skin color and temp
-capillary refill
-peripheral pulses!!! NOTIFY HCP OF CHANGES
-sensation/movement of extremety

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34
Q

Acute care after leaving recovery for surgery

A

continued circulatory assessment
-monitor for potential complications (increased pain, loss of pulse, pallor/cyanosis, numbness/tingling)
-avoid knee-flexed positions
-turn and position frequently; oob, ambulate; avoid prolonged sitting
-compression stockings

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35
Q

Ambulatory care

A

-don’t smoke
-long term antiplatelet/ASA therapy
-supervised exercise after revascularization
-meticulous foot care

36
Q

Foot care

A

daily inspection of feet
comfy shoes w/ rounded toes, soft insoles, and lightly laced
Check skin temp, cap refill, and pulses

37
Q

Acute arterial ischemic disorders: definition and causes

A

-sudden interuption in arterial blood supply that can result in necrosis

-Caused by trauma or clots

-usually due to embolization of thrombus from heart r/t IE, mitral valve disease, Afib, cardiomyopathies, and prosthetic heart valves

Noncardiac causes: aneurysms, ulverated atherosclerotic plaque, endovacular procedures, venous thrombi

38
Q

Acute arterial ischemic disorders:
-Left sided thrombi
-atherosclerotic plaque

A

may dislodge and travel anywhere systemically –> most block leg artery

Sudden loval thrombosis can occur at site of atherosclerotic plaque
-predisposing factors: hypovolemia, hyperviscosity, hypercoagulability

39
Q

acute ischemic disorder:
-trauma
-procedure-related

A

Trauma injury to extremety can cause blockage

arterial dissection of carotid artery or aorta can happen

40
Q

Manifestations of Acute Arterial ischemic disorder

A

6 P’s
-Pain
-Pallor
-Pulselessness
-Paresthesia
-Paralysis (late sign)
-Poikilothermia (adaptation of limb to enviro-temp)

**need immediate intervention

41
Q

How to treat acute arterial ischemic disorder

A

IV heparin

Restore bloodflow - remove thrombus
-thrombectomy
-percutaneous catheter-directed thrombolytic therapy
-percutaneous mechanical thrombectomy w/ or w/o thrombolytic therapy
-surgical bypass

42
Q

Percutaneous catheter-directed thrombolytic therapy

A

-catheter has alteplase or urokinase if ischemia is less than 14 days old
-dissolves clot over 24-48 hrs
-need close monitoring to avoid catheter movement or bleeding

43
Q

When to use surgical revascularization, amputation, and long term anticoagulants when dealing with acute arterial ischemic disorder

A

Surgical revascularization
-trauma or arterial blockage

Amputation
-ischemic rest pain and tissue loss

Long-term anticoagulation
-if risk of further embolization exists

44
Q

Thromboangitis Obliterans/ Buerger’s disease
-what is it?
-who’s affected?

A

Nonatherosclerotic, segmental, recurrent inflammatory disorder of the small and medium arteries and veins in arms and legs

Men under 45 who smoke anything and DONT have other CVD risks

45
Q

Acute vs chronic phase of thromboangitis obliterans

A

Acute
-inflammatory thrombus blocks vessel

Chronic
-thrombosis and fibrosis cause ischemia

46
Q

Symptoms of Thromboangiitis obliterans

A

intermittent claudication
rest pain
ischemic ulcerations
changes in color and temp
paresthesia
superficial vein thrombosis
cold sensitivity

47
Q

Diagnosis of thromboangiitis obliterans

A

no specific tests
based on history, symptoms, and ruling out other stuff

48
Q

Treatment of Thromboangiitis Obliterans

A

-stop smoking everything

Conservative
-avoid cold
-take walks
-antibiotics for ulcers
-analgesia for pain
-avoid trauma

Drugs
-IV iloprost promotes vasodilation

Surgery
-lumbar sympathectomy
-spinal cord stimulator
-microsurgical flap and omental transfer
-bypass
-amputatio

Stem cell therapy

49
Q

Raynaud’s Phenomenon
-what is it?
-who gets it?

A

Episodic vsospastic disorder of small cutaneous arteries in fingers and toes

-more common in women aged 15-40

50
Q

Raynaud’s pathogenesis

A

abnormalities in vasculature, intravasculature, and neuronal mechanisms that cause vasodilation

51
Q

Contributing factors to Raynauds

A

-use of vibrating machinery
-work in cold enviro
-exposure to heavy metals
-high homocysteine levels

52
Q

Symptoms of Raynauds
(diagnosis?)

A

Symptoms
-fingers, toes, ears, and nose turn red, white, blue
-coldness/numbness followed by throbbing, aching pain, tingling, and swelling
-long or often attacks cause thick skin, brittle nails, punctate lesions, and gangrenous ulcers
-Triggers = cold, emotions, tobacco, caffeine

Diagnosed if persistant symptoms for 2 yrs

53
Q

Nursing care of Raynaud’s

A

Prevention!
-avoid temp extremes
-wear appropriate clothing
-no tobacco
-no caffeine
-no vasoconstricting drugs

54
Q

Drug therapy for Raynauds

A

-sustained release CCBs to decrease vasoplasm
-vasodilators

55
Q

Raynaud’s: Digital Ulceration or critical ischemia

A

Requires
-prostacyclin infusion, antibiotics, analgesia
-surgical debridement
-botox and statins
-sympathectomy (in severe cases)

56
Q

Aortic Aneurysms
-what is it?
-who does it affect?

A

Permanent, localized outpouching or dilation of wall of aorta
-can happen at more than one spot

-more in men, whites, and older ppl

57
Q

Abdominal aortic aneurysm

A

-3/4 of aortic aneurysms (the rest are thoracic)
-usually below renal arteries
-the bigger the aneurysm, the greater the risk of rupture

58
Q

Causes of aortic aneurysms

A

-can be degenerative, congenital, mechanical (trauma), inflammatory, or infectious

59
Q

Aortic Aneurysm risk factors

A

age
male
htn
CAD
fam history
tobacco
high cholesterol
LE PAD
CAD
previous stroke
obesity

60
Q

Aortic aneurysm genetic link

A

Familial tendency r/t congenital abnormalities
-bicuspid aortic valve
-coarctation of aorta
-Turner’s syndrome
-Autosomal dominant PKD
-Ehlers-Danlos syndrome
-Loeys-Dietz syndrome
-Marfan’s syndrome

61
Q

Two types of aortic aneurysms

A

true
-wall of artery forms aneurysm
-at least one vessel layer still in tact
-“fusiform” = circumferential, relatively uniform shape
-“saccular” = pouchlike with narrow neck connecting bulge to one side of arterial wall

False/pseudo
-not an aneurysm
-disruption of all layers in arterial wall
-results in bleeding contained by surroundig structures
-from trauma, infection, peripheral artery bypass graft surgery, or arterial leakage after removal of cannulae

62
Q

Thoracic aortic aneurysm

A

usually asymptomatic

Manifests as:
-deep diffuse chest pain
-pain may extend to intercapsular area

63
Q

Manifestation of aneurysm in ascending aorta/ aortic arch

A

-angina
-transient ischemic attacks
-coughing, SOB, hoarseness and/or dysphagia

If pressess of SVC
-decreased venous return
-distended neck veins
-edema of face and arms

64
Q

AAA manifestations

A

-usually asymptomatic
-Detected during routine physical or when getting images for another issue
-pulsatile mass in periumbilical area slightly left of midline
-bruit over aneurysm

-back pain, epigastric discomfort, altered pooping, intermittent claudication

might spontaneously embolize plaque (blue toe syndrome)

65
Q

Aortic aneurysm complications

A

RUPTURE

into retroperitoneal space
-bleeding may be tamponaded by surrounding structures preventing exsanguination and death
-SEVERE back pain
-may/may not have back/flank ecchymosis (Grey Turner’s syndrome)

into thoracic or abdominal cavity
-massive hemorrhage causes hypovolemic shock
-most do not survive long enough to get to hospital
- if they survive, need simultaneous resuscitation and immediate surgery (53% mortality)

66
Q

Aortic aneurysm diagnostic studies

A

Xrays
-chest: demonstrate mediastinal silhouette and any abnormal widening of thoracic aorta
-abdomen: may show calcification w/in wall of AAA

ECG
-to rule out MI

Echo
-assesses aortic valve function

Ultrasonography
-screening for aneurysms
-monitors aneurysm size

CT or MRI
-diagnose and assess location and severity

Angiography
-anatomic mapping of aortic system using contrast

67
Q

How to care for a small aneurysm

A

(<5.4 cm)

Risk factor modification
-decrease blood pressure; stop tobacco; decrease lipids; increase activity

If 4-5.4 cm
-ultrasound and CT scan monitoring every 6-12 months

If <4cm
-ultrasound every 3 yrs

68
Q

How to care for big aneurysm

A

5.5 cm+

Surgical repair

Surgery also appropriate in ppl w/ smaller aneurysms if
-genetic disorder
-rapidly expanding aneurysm
-symptomatic
-high rupture risk

may be necessary to correct other carotid or coronary artery blockages before surgery

69
Q

Surgery preop

A

hydration
-stabilize electrolytes, coagulation, and hematocrit

If it ruptures, emergency surgery –> 90% mortality w/ ruptured AAAs

70
Q

Open aneurysm repair

A

-incises diseased segment of aorta
-removes thrombus or plaque
-inserts synthetic graft to aorta proximal and distal to aneurysm
-structures native aortic wall around graft (acts as protective cover)

71
Q

EVAR (endovascular graft procedure)

A

-alternative to OAR (minimally invasive)

Criteria: iliofemoral vessels are safe for graft insertion and vessels are adequate length and width to support a graft

Involves placement of sutureless aortic graft into abdominal aorta inside aneurysm

Graft is made from Dacron cylinder and its surface is supported with rings of flexible wire –> its delivered thru a sheath to the predetermined point via femoral artery catheter w/ balloon –> anchored wo vessel with small hooks

Need to do post procedure angiography to check for leaks and confirm patency

72
Q

Potential complications of EVAR

A

Endoleak = common –> seepage of blood into old aneurysm

-aneurysm growth
-aneurysm rupture
-aortic dissection
-bleeding

Renal artery occlusion due to
-stent migration
-graft thrombosis
-incisional site hematoma
-site infection

73
Q

Intraabdominal hypertension (IAH)

A

-potentially lethal compmlication in emergency repain of AAA
-intraabdominal pressure measured with catheter and transducer

Associated with abdominal compartment syndrome
-reduces blood flow to viscera
-end-organ perfusion impaired results in multisystem organ failure

74
Q

Treatment of IAH

A

open surgical decompression
percutaneous drainage
percutaneous drainage w/ thrombolytic infusion

75
Q

Why is it important to get baseline measurements?

A

so you can compare them after the procedure

76
Q

Signs of aneurysm rupture

A

-diaphoresis
-pallor
-weakness
-tachycardia
-hypotension
-abdominal, back, groin, or periumbilical pain
-changes in LOC
-pulsating abdominal mass

77
Q

What to assess when looking for aortic aneurysms

A

Peripheral pulses
renal and neuro status
skin lesions on lower extremeties

78
Q

Preop for aortic aneurysms

A

teach ab disease, treatment plans, and postop
-emotional support

Preop routines
-bowel prep
-NPO
-shower
-IV antibiotics right before incision

79
Q

Post-op ICU monitoring

A

24-48 hrs

Devices
-arterial line
-CVP or PA catheter
-ET tube and mech ventilation
-peripheral IVs
-urinary cath
-NG tube
-MAYBE chest tube and lumbar drain

Needs continuous ECG monitor
Pulsox
Pain meds

80
Q

Postop: maintaining graft patency

A

ensure
-normal BP
-IV fluids and blood components for adequate blood flow
-CVP or PA pressure monitoring
-Urinary output monitoring –> hourly
-Avoid severe hypertension –> might need drugs for that

81
Q

Postop CV status

A

-continuous ECG
-electrolyte monitoring
-ABG monitoring
-give O2
-antidysrhythmic and antihypertensive meds
-pain control
-resume heart meds

82
Q

Postop: infection

A

-antibiotic administration
-assess temp
-monitor WBC
-adequate nutrition
-look at wound site
-Hand hygiene and aseptic technique for all invasive catheters
-Perineal care to decrease risk of UTI

83
Q

Postop GI status

A

-monitor for paralytic ileus –> bowel sounds
-passing of flatus
-record amt and character of NG tube output
-while NPO –> provide oral care
-abdominal assessment
-assess for bowel ischemia: no bowel sounds, feverm abdominal distention, diarrhea, bloody stools

84
Q

Postop neuro status

A

LOC

ascending aorta
-pupil size and response to light
-facial symmetry
-speech
-ability to move upper extremeties
-quality of hand grasps

descending aorta
- neurovascular check to lower extremeties

85
Q

Postop: peripheral perfusion status –> pulse assessment

A

frequent pulse assessment
-use doppler if needed
-mark pulse locations with felt-tip pen

ascending aorta and aortic arch
-carotid, radial, and temporal

descending aorta
-femoral, popliteal, posterior tibial, and dorsalis pedis

86
Q

Post op: peripheral perfusion status

A

extremity assessment
-temp, color, capillary refill time, sensation, and movement of extremeties

vasospasm and hypothermia can cause absence of lower extremety pulses

absent pulses and cool/pale/mottled/painful extremety means embolization or graft occlusion –> REPORT IMMEDIATELY

87
Q

Postop: renal perfusion status

A

-hourly urinary output (at first)
-accurate I and O
-daily weight
-CVP pressure
-blood urea nitrogen/creatine
-decrease in renal perfusion may occur with embolization of plaque to renal arteries, hypotension, prolonged aortic clamping or blood loss

Patho (44 decks)

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