Vascular Disorders Flashcards
peripheral vascular disease
alters natural flow of blood through arteries and veins of peripheral circulations
what are the two types of peripheral vascular disease
peripheral arterial disease and peripheral venous disease
peripheral artery disease
involves thickening of the artery walls and progressive narrowing of arteries of upper and lower extremities; strongly r/t other cardiovascular diseases and risk factors; higher risk of mortality, CVD mortality, major coronary events, and stroke
etiology of peripheral vascular disease
atherosclerosis is leading cause in majority of cases; exact cause is unknown; inflammation and endothelial injury plays a major role
pathophysiology of peripheral vascular disease
gradual thickening of the intima and media due to cholesterol and lipid deposits
risk factors for peripheral vascular disease
tobacco use, atherosclerosis, diabetes, HTN, high cholesterol, being over 60; multiple risk factors increase risk of PAD; atherosclerosis often affects coronary carotids and lower extremity arteries; symptoms occur when arteries are 60-75% compromised
what does PVD of lower extremities affect
iliac artery, femoral artery, popliteal artery, tibial artery, and peroneal artery
clinical manifestations of PVD
intermittent claudication; parasethesia; reduced blood flow to limb; pain at rest
what’s special about pain at rest
chronic ischemic rest pain lasting more than 2 weeks; nonhealing arterial leg ulcers or gangrene; increased risk if pt has diabetes, heart failure, history of stroke
complications of PVD
prolonged ischemia leads to: atrophy of skin and underlying muscles; delayed healing wound infection; tissue necrosis; arterial ulcers over bony prominences
what is the most serious complication of PVD
nonhealing arterial ulcers and gangrene; may result in amputation
diagnostic studies of PVD
doppler ultrasound; angiography and magnetic resonance angiography; arteriography; nursing actions
ankle-brachial index
done with hand held doppler
how to measure ABI
patient placed in supine position, the brachial and ankle systolic pressure measurements are obtained
how to calculate ABI
R ABI= highest pressure in R foot/highest pressure in both arms
what’s the normal range for ABI
0.9-1.3
what does ABI indicate if it is lower than normal
ischemia and PAD
nursing care for PVD
walking (3045 minutes daily, 3x/week); consult with dr for dietary/herbal supplments (no NSAIDs or anticoagulants
nutritional therapy for PVD
3-5% weight loss yields reduced triglycerides, glucose, A1c, and decreased risk of type II diabetes
what are some interventional radiology procedures for PVD?
percutaneous transluminal angioplasty, atherectomy
percutaneous transluminal angioplasty
catheter has a balloon at the tup; balloon is inflated dilating the vessel by compressing atherosclerotic intimal lining; stent is placed to hold artery open
atherectomy
removal of obstructing plague; performed using a cutting disc laser, or rotating diamond tip
post op nursing care after arterial revascularization (surgery)
deep breathing Q1-2 hrs; maintain circulation- pedal pulses; assess pulse, color, and temp Q15 min, then hourly; maintain pain, BP, monitor graft occlusion- symptoms and actions; monitor wound infection- symptoms and actions; client education
health promotion (management)
identification of at risk patients; diet modification; proper care of feet; avoidance of injuries
post surgery/radiologic interventions
monitor: skin color and temp, capillary refill, presence of peripheral pulses distal to the operative sit (notify HCP with changes), and sensation and movement of extremity
acute care (after leaving recovery) (implementation)
continued circulatory assessment; monitor for potential complications (report increased pain, loss of pulses, pallor/cyanosis, numbness/tingling); avoid knee-flexed positions; turn and position frequently, OOB, ambulate (avoid prolonged sitting); graduated compression socks
ambulatory care/client education
smoking cessation; long-term antiplatelet/ASA therapy; importance of meticulous foot care; comfortable shoes with rounded toes and soft insoles (lightly laced); show how to check skin temp, capillary refill, and palpate pulses
