Vascular Disorders

Question 1

peripheral vascular disease

Answer 1

alters natural flow of blood through arteries and veins of peripheral circulations

Question 2

what are the two types of peripheral vascular disease

Answer 2

peripheral arterial disease and peripheral venous disease

Question 3

peripheral artery disease

Answer 3

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

Question 4

etiology of peripheral vascular disease

Answer 4

atherosclerosis is leading cause in majority of cases; exact cause is unknown; inflammation and endothelial injury plays a major role

Question 5

pathophysiology of peripheral vascular disease

Answer 5

gradual thickening of the intima and media due to cholesterol and lipid deposits

Question 6

risk factors for peripheral vascular disease

Answer 6

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

Question 7

what does PVD of lower extremities affect

Answer 7

iliac artery, femoral artery, popliteal artery, tibial artery, and peroneal artery

Question 8

clinical manifestations of PVD

Answer 8

intermittent claudication; parasethesia; reduced blood flow to limb; pain at rest

Question 9

what’s special about pain at rest

Answer 9

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

Question 10

complications of PVD

Answer 10

prolonged ischemia leads to: atrophy of skin and underlying muscles; delayed healing wound infection; tissue necrosis; arterial ulcers over bony prominences

Question 11

what is the most serious complication of PVD

Answer 11

nonhealing arterial ulcers and gangrene; may result in amputation

Question 12

diagnostic studies of PVD

Answer 12

doppler ultrasound; angiography and magnetic resonance angiography; arteriography; nursing actions

Question 13

ankle-brachial index

Answer 13

done with hand held doppler

Question 14

how to measure ABI

Answer 14

patient placed in supine position, the brachial and ankle systolic pressure measurements are obtained

Question 15

how to calculate ABI

Answer 15

R ABI= highest pressure in R foot/highest pressure in both arms

Question 16

what’s the normal range for ABI

Answer 16

0.9-1.3

Question 17

what does ABI indicate if it is lower than normal

Answer 17

ischemia and PAD

Question 18

nursing care for PVD

Answer 18

walking (3045 minutes daily, 3x/week); consult with dr for dietary/herbal supplments (no NSAIDs or anticoagulants

Question 19

nutritional therapy for PVD

Answer 19

3-5% weight loss yields reduced triglycerides, glucose, A1c, and decreased risk of type II diabetes

Question 20

what are some interventional radiology procedures for PVD?

Answer 20

percutaneous transluminal angioplasty, atherectomy

Question 21

percutaneous transluminal angioplasty

Answer 21

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

Question 22

atherectomy

Answer 22

removal of obstructing plague; performed using a cutting disc laser, or rotating diamond tip

Question 23

post op nursing care after arterial revascularization (surgery)

Answer 23

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

Question 24

health promotion (management)

Answer 24

identification of at risk patients; diet modification; proper care of feet; avoidance of injuries

Question 25

post surgery/radiologic interventions

Answer 25

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

Question 26

acute care (after leaving recovery) (implementation)

Answer 26

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

Question 27

ambulatory care/client education

Answer 27

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