Vascular Disorders Flashcards
Define arteriosclerosis
thicken + harden of arterial wall which causes stiffness
Types of arteriosclerosis
- Atherosclerosis
- Medial calcific sclerosis
- Arteriolar sclerosis
*Arteriosclerosis does NOT equal atherosclerosis
Atherosclerosis DOES equal arteriosclerosis
Atherosclerosis
Plaque buildup in arterial wall d/t LDL
Medial calcific sclerosis
Calcium deposition in arterial wall
Arteriolar sclerosis
Thickening of tiny arterioles
Distinguish between two types of HTN
- Primary: no exact cause
- Secondary: high BP d/t other disease (mostly renal dz)
HTN clinical manifestations
(chronically uncontrolled, primary)
- Headache
- Chest pain
- Vision changes
- SOB
- Renal dysfunction
- Dizziness
- Fatigue
- Nosebleeds
HTN (primary) complications
- Dilated cardiomyopathy
- Systolic dysfunction
- Renal failure
- Stroke
- Small vessel damage: sexual dysfunction & eyes
Hypertensive crisis
- Hypertensive urgency
- Hypertensive emergency
- Target organ damage (heart, brain, kidney, eyes)
Difference between hypertensive urgency & hypertensive emergency
Hypertensive urgency:
- DBP > 120mmHG WITHOUT TOD
Hypertensive emergency:
- DBP > 120mmHG WITH TOD (papilledema, aortic dissection, stroke, or HF)
HTN pt teaching
- *Monitor BP at home
- *Know SS and complications
- Med adherence
- Lifestyle change adherence
HTN nursing action
- Meds (diuretics, CCB, BB, ACEi)
- DASH diet: 1600mg of Na / day
What is Peripheral Artery Disease (PAD)
- Obstruction of blood flow to LEs (occlusion) –> depriving of O2
PAD clinical manifestations
- *Intermittent claudication (pain in calf muscle during exercise, alleviated thru rest)
- Weak/absent pulses (posterior tibial)
- Cool or cold d/t not getting arterial blood
- Prolonged capillary refill
- Loss of hair on calf, ankle foot
- *Ulcerations d/t loss of skin turgor
- *Thickened toenails
- *Muscle atrophy (super late sign)
- *Dry, scaly, and pale skin
PAD complications
- Critical limb ischemia
- Acute limb ischemia
Critical limb ischemia
Decreased arterial blood flow –> rest pain, etc., limb loss
Acute limb ischemia
Embolus causing complete occlusion
Six Ps of ischemia
- Pain
- Pallor
- Pulselessness
- Paresthesia (tingling)
- Paralysis (muscle atrophy)
- Poikilothermia (cold)
PAD nursing action
- Administer meds: antihypertensives, antiplatelets
- *Proper positioning: pt legs shud be dependent (eg. hang over bed) to facilitate blood flow
PAD pt teaching
- *Positioning
- *Inspect feet daily
- *Report chest discomfort
- LIfestyle change: DASH, no alcohol, no smoking, moderate exercise
Carotid disease
- Vessel wall thicken, plaque form, progressive narrowing
- Stenosis (narrowing) occur at carotid bifurcation
TIA/Stroke clinical manifestations (complication of carotid disease)
- Sudden weakness
- Dizziness
- Loss of coordination
- Difficulty talking
- Facial droop
- Sudden vision problems
- Sudden and severe headache
*BE FAST = balance, eyes, face, arm, speech, time
Carotid disease S&S
Asymptomatic bc plaque just builds up.
Full plaque obstruction will impact cerebral perfusion and manifest symptoms.
- Audible bruit d/t turbulent blood flow past obstruction at coronary artery bifurcation (listened by stethoscope)
Carotid disease assessment
- Vital signs
- Carotid bruit
- Neuro assess
- Stroke history/signs of stroke
- Doppler ultrasound: looks at blood flow
Carotid disease surgical treatments
- Carotid endarterectomy: take out plaque, patch it back up
- Carotid artery stenting
Post CEA nursing action
*Control and assess BP
- Hypotensive: lie flat and anticipate vasoactive drips & fluids
- Hypertensive: maintain head of bed 30 degrees
- Head in neutral position to alleviate stress on incision and artery
Post CAS nursing action
*Control and assess BP
- Hypotensive: lie flat and anticipate vasoactive drips & fluids
- Hypertensive: maintain head of bed 30 degrees
- Encourage fluid intake, maintain IV fluids to aid in flushing IV dye thru kidneys
Carotid artery pt teaching
- Clinical manifestations of stroke
- Lifestyle changes
AAA
- Permanent dilation of artery causing bulge
- Weakened middle layer stretches inner and outer layer
- Artery widens & arterial wall tension increases
AAA complications
- Aortic dissection: tear in inner layer, blood rushes thru tear and splits inner and middle layer
- Aortic rupture: complete tear thru all layers of aorta
AAA S&S
Asymptomatic until AAA complication –> usually found when incident happens
Aortic dissection/rupture clinical manifestations
- *Chest pain
- *Back pain
- *Flank pain
- Palpable pusatile mass in abdomen
- Pain occur spontaneously
- Pain not related to any activity
AAA risk population
Males
Would you palpate pt abdomen w suspected AAA?
No
AAA risk on pt history
- Smoking
- HTN
- High cholesterol
- CAD
- Atherosclerosis
Signs of possible leaking/bursting AAA:
- Hypotension
- Decreased O2 sat
- Severe pain in abd/back
Thoracic AAA assess
- Pain
- Dyspnea/cough
- Hoarseness & dysphagia
Abd AAA assess
- Pain (back and abd)
- Pulsatile mass near umbilicus
- Cyanosis, numbness, tingling
AAA nursing action
- Administer meds
- Bowel regimen to reduce strain
- NO abd palpation
AAA pt teaching
- S&S of aneurysm dissection/rupture
- Medication adherence
- Screening w congenital problems
- Smoking cessation
- Healthy diet
Define DVT
Blood clot that usually occurs in lower limbs and blocks blood flow
Virchow’s triad
Factors that contribute to venous thrombosis
- Decreased flow rate of blood OR stasis of blood flow
- Endothelial injury (damage to BV wall)
- Hypercoagulability (increased tendency of blood to clot)
DVT clinical manifestations
Asymptomatic or symptomatic (depends on clot itself)
- *Pain
- Swelling
- Tenderness
- Color changes
- *Redness
- *Warmth
DVT meds
- Heparin
- Lovenox
- Eliquis (Apixaban): factor XA inhibitor (oral but irreversible)
- Warfarin/Coumadin
DVT nursing action
Prevention:
- Low DVT risk: ambulation
- High DVT risk, low bleed risk: Lovenox or Heparin
- High DVT/bleed risk: compression stockings, SCDs
*Avoid SCD in leg WITH DVT
DVT pt teaching
Prevention:
- Hydration, early ambulation, leg exercises
Treatment:
- S&S of bleeding
- Lab monitoring compliance
- Safety precautions on anticoags
DVT assess
- *Vital signs, oxygen sat
- *Sign of bleeding: bruising, petechiae
- Extremity assess: swell, pain, red, warmth
- Bilateral calf circumference
- Lab values: d-dimer, pt/ptt/INR
DVT complications
- Pulmonary embolism: clot that dislodges to R heart then to lungs and occludes pulmonary artery
- Post-thrombotic syndrome
PE S&S
- SOB
- Decreased O2 sat
- Tachycardia
- Hypotension
- Sweating d/t activation of SNS
- Sharp chest pain esp during deep breathing
- Hemoptysis (bloody sputum)
PTS S&S
- Minor leg swell & discomfort
- Severe leg pain
- *Leg ulceration
- *Skin changes
