vascular disorders Flashcards
describe arteries
- carry oxygenated blood away from the heart
- aorta to body
describe veins
- carry deoxygenated blood back to the heart
- returns via the inferior and superior vena cava
describe the lymphatic system
- fluid/waste removal
- absorption of fatty acids and fats to circulatory system
- produce immune cells (lymphocytes, monocytes, plasma cells)
- makes antibodies
what is peripheral vascular disease
disorder of natural flow of blood
name a couple and describe arterial disorders
raynauds and intermittent claudication
- if you have peripheral arterial disease most likely to concurrently have CAD
- same disease process: atherosclerosis
- same risk factors: smoking, DM, stress, HTN, hyperlipidemia
describe venous disorders
chronic venous insufficiency
whats a cause of intermittent claudication
atherosclerosis
what is happening with intermittent claudication
- narrowing of arteries feeding leg
- reduce blood flow to leg
- ischemia -> limb necrosis
how will a patient with intermittent claudication present?
- intermittent leg pain (increased with exercise or walking)
- erythema to legs/feet
- wounds are difficult to heal
- progressing to pain at rest
- cool skin
what labs are used for intermittent claudication
- CBC, BMP, D-dimer
- CT/MRI
- vascular ultrasound
- angiography (will show where decreased blood flow is)
what are some acute interventions for intermittent claudication
- rest legs (dependent position)
- warm compressions (vasodilate)
what are some surgical interventions for intermittent claudication
- angioplasty
- vascular surgery (bypass)
what are some complications of intermittent claudication
- limb ischemia
- pain at rest and walking
- hard to heal ulcers (DRY)
what are some nursing considerations for intermittent claudication
- frequent breaks
- dependent position
- warm compress
- inspect and protect legs/feet
- medication compliance
- control DM
- if in bed = sit upright and dangle
- same prevention as CAD
what are some causes of raynaud’s
- cold
- stress
- smoking
- idiopathetic
whats happening with raynaud’s
- smaller arteries to the skin (narrow)
- limits blood flow via vasospasm
how will a client with raynaud’s present?
- numbness and tingling in fingers/toes
- skin pale/blue/reddend
what meds may be used for raynaud’s
- calcium channel blockers (amlodipine)
- vasodilators (nitro)
what are some nursing considerations for raynaud’s
- gradual warming
- pain relievers/CCBs
- avoid cold temps
- quit smoking
- avoid emotional stress
- wounds are harder to heal
whats used for venous thromboembolism prophylaxis
- heparin SQ (5000units)
- enoxaprin SQ (weight based)
what are some causes of venous thromboembolism
- vichows triad: endothelial damage, venous stasis, altered coagulation
- immobility
- major surgery/injury
- pregnancy
whats happening with venous thromboembolism
- asymptomatic
- redness possible to calf
- tenderness/pain
- edema
what are some diagnostic tests for venous thromboembolism
- CBC, BMP
- D-dimer (increased indicates liklihood of clots)
- venous doppler ultrasound
what meds may be used for venous thromboembolism
anticoagulants (apaxiban, enoxaparin)
what are some acute interventions for venous thromboembolism
- TPA only if PE (life threatening)
- thrombectomy (vena cava filter)
what are some complications of venous thromboembolism
- pulmonary embolism (PE)
- CVA
- post thrombotic syndrome (PTS)
what are some nursing considerations for venous thromboembolism
- watchful waiting
- anticoagulants
- early ambulation
- SCD’s/ted/enoxaparin/heparin (VTE prophylaxis)
- stay active (lifestyle changes)
- discuss risks of birth control
- discuss HTN meds and treatment
- discuss symptoms of PE
- post thrombotic syndrome (PTS)
- follow up for ultrasound to monitor
what are some causes of chronic venous insufficiency
- varicose veins
- age
- extended sitting or standing
- reduced mobility
- PTS
- smoking
- trauma to leg
whats happening with chronic venous insufficiency
- venous valves incompetant
- stretching = improper closing of valves
- pooling of blood in veins
- increased pressure = increased stretch
- capillaries rupture (red/brown/purple skin)
- tissue swelling/inflammation
how will a client with CVI present?
- swelling to lower extremities
- aching/fatigue in legs
- varicose veins
- change in color of legs
- flaking/itchy skin
- venous stasis ulcers (WET)
what are some labs/diagnostics for CVI
- CBC, BMP
- D-dimer
- vascular US
- CT
- xray
what drugs may be used for CVI
antibiotics if theres an infection from ulcers
what are some complications of CVI
- cellulitis
- difficult to heal ulcers
describe nrusing care and considerations for CVI
- support hose; sit breaks
- avoid prolonged sitting/standing
- catch early
- surgical options
- elevate legs when sitting
- exercise
- good hygiene - take care of legs
- wound care
- quit smoking
- hyperbaric therapy (creates angiogenesis)
what are some causes of lymphedema
removal/damage of lymph node (typically occurs with cancer)
what is happening with lymphedema
- swelling (usually unilateral)
- lymph system blocked
- lack of drainage
- tissue swelling/edema
how will a client present with lymphedema
- mild - moderate - severe
- swelling in one or both arm/leg
- heaviness/tightness in affected limb
- decreased ROM
- aching
- infections
- fibrosis (late finding)
what labs/diagnostics are used for lymphedema
- CT scan
- doppler US
what meds mayy help for lymphedema
antibiotics (for infection)
what are some treatments of lymphedema
- compression
- decongestive therapy (push it to where it can drain, used in first two stages)
- surgery (as stages progress, not done a lot)
what are some complications of lymphedema
cellulitis
describe some nursing considerations for lymphedema
- protect from injury
- after CA treatment care
- avoid ice/heat
- elevate
- avoid tight fitting clothes
- good hygiene
- exercise
- compression dressing
- massage
- wound care dressing
what are some causes of cellulitis
- injury
- skin conditions
- lymphedema
- animal bites
- immunocompromised
whats happening with cellulitis
- infection in tissue
- spreading through blood/lymph
- can be life-threatening: sepsis
how will the client with cellulitis present
- continuous redness and swelling
- pain and tenderness
- warmth
- progress to S&S of infection
what labs/diagnostics for cellulitis
- CBC, BMP
- blood cultures
- outline with marker
- CT (to see depth)
what meds can help with cellulitis
antibiotics (vanc, penicillin, clindamycin)
clindamycin is primary for outpatient
try oral first, no response? go to IV
meds are dependent on severity
what are some complications of cellulitis
- sepsis
- lymphedema
- necrotizing fasciitis
what are some nursing considerations for cellulitis
- education!
- proper wound care
- protect skin
- DM special care
- treat skin infections
- if redness exceeds line -> ED
- elevate
- cool damp cloth
- take entire course of antibiotics
- analgesics
- protect area
