Vascular Disorders Flashcards
Form of atherosclerosis which decreases the blood flow to peripheral tissues. Occurs more frequently in the arms or legs.
Peripheral Arterial disease
What are some of the causes of PAD
Tobacco use; hyperlipidemia; HTN; DM; Family History
Signs and symptoms of PAD
Pain; Paresthesia; Pallor; Diminished Pulse
Ischemic muscle pain resulting from exercise that resolves within ten minutes of rest.
Intermittent Claudication
What is intermittent claudication caused by
The release of lactic acid
What are some signs of progressing PAD?
Rest pain - burning/aching in toes or forefoot; during sleep
What can make PAD pain better?
Dangling legs over the bed
What are some consequences of worsening PAD
Ulceration, gangrene, critical limb ischemia, tissue death
6 P’s of Acute Arterial Ischemia
- Pain. 2. Pallor. 3. Pulselessness. 4. Parasthesia.
5. Poikilothermia. 6. Paralysis
Complications of PAD
Wound infections; Tissue Necrosis; Arterial Ulcers; Gangrene
What is the cause of complications of PAD
Poor Perfusion
Diagnostic Studies for PAD
Doppler Ultrasound; Ankle-Brachial Index (ABI); Angiography; Magnetic Resonance Angiography
Collaborative Care for PAD:
Modify risk factors; Proper Exercise; Proper Nutrition; Take Care of Feet; Drug Therapy; Percutaneous Transluminal Balloon Angioplasty; Surgical Therapy
What is important for people with PAD to avoid?
Exposure to cold; Constrictive Clothing; Stress; Crossed Legs
When taking segmental blood pressures, what finding is suggestive of PAD?
Drop in BP of > 30 mmHg
What are some things to check for if your patient is going to have a magnetic resonance angiography?
Check allergies and renal function (dye is hard on kidneys)
Encourage PO fluids to help flush the dye.
How do you measure the ankle-brachial index?
Divide ankle SBP by the higher of left v. Right SBP
How should patient take care of their feet?
Proper fitting shoes; daily inspection; clean & moisturize feet; proper toenail trimming; keep heels up
What is the nursing interventions for percutaneous transluminal balloon angioplasty?
Vascular & Vital signs check every 15 min for first hr;
Watch for bleeding;
Supine 6 hours after; loss of plus in extremity = call MD
What is the most effective exercise for PAD patients?
Walking
What kind of diet should someone with PAD go by?
Low saturated fat, cholesterol & salt
What are the goals of care for PAD
Control disease progression;
Pain Control;
Prevent Complications
What is the most common surgical therapy for PAD?
Femoral-Popliteal Bypass (Fem-Pop)
Top Nursing Interventions for Post Fem-Pop surgery
Vascular checks;
Proper positioning;
Monitor for signs of infection;
Notify the doctor if pulse is lost
How often should nurse perform vascular checks after fem-pop?
Every 15 minutes for the first hour;
Then, hourly
When positioning patient after fem-pop, what position should patient avoid? When should patient begin to ambulate?
Avoid: knee-flexed position
Discourage prolonged sitting w/ leg dependency to avoid swelling and clots;
Ambulate on post op day 1
Nursing Diagnoses for PAD
Ineffective Tissue Perfusion;
Risk for Impaired Skin integrity;
Acute Pain;
Activity intolerance
Risk Factors for Abdominal Aortic Aneurysms
Athlerosclerosis;
CAD;
HTN;
Genetics
S/S Abdominal Aortic Aneurysm
Often Asymptomatic
- Pulsating mass in mid/upper abd
- Bruit over aneurysm
- Pain (constant or intermittent/mid abd or back)
Complications of AAA
Rupture
Embolus
Signs of AAA Rupture
Grey Turner Sign - flank ecchymosis
Diagnostic Studies for AAA
Abd X-Ray Ultrasound CT scan MRI Angiography
Results when arteries in the lower extremities are occluded. Blood collects and forms clots which shower through the body.
Blue Toe Syndrome
Aortic dissection s/s
Chest pain, SOA, high mortality rate, medical emergency
Result: hypovolemic shock (increased HR, Decreased BP, pale, clammy, decreased level of consciousness, decreased urine output)
Immediate Surgery Required
AAA Rupture in thoracic or abdominal cavity
Nursing Care AAA
Gather good History and Physical
Bed rest; Calm environment
Continuous cardiac monitoring
Check UOP hourly; Meds
When is surgery normally done for an abdominal aortic aneurysm
Aneurysm is greater than 5 cm or expanding rapidly
2 Types of AAA surgery
- Open AAA Repair
2. Endovascular Graft procedure
Big thing for nurses to watch if procedure requires aorta to be cross clamped?
Watch UOP and peripheral pulses
Nursing care after Open AAA Repair
ICU 24-48 hours after;
Monitor BP;
Check peripheral pulses and UOP hourly;
Monitor patient’s LOC
Nursing Care for Raynaud’s
Provide Education (loose,warm clothing when cold; gloves when handling cold items; avoid temp extremes; smoking cessation; avoid caffeine); Calcium Channel Blockers if severe
Clot in superficial vein
Superficial Vein Thrombosis
Venous Thromboembolisms
DVTs and Pulmonary embolism
Causes of DVT
Venous Stasis; Vessel Wall Injury; Blood hypercoagulability
Complication of DVT
Pulmonary Embolism
S/S Pulmonary embolism
SOA; Decreased oxygen saturation; chest pain; anxiety; sudden onset
Collaborative care for DVT
- Prevention
- Treatment for Actual DVT
- Surgery
How to prevent DVT
Change position and ROM exercise q2h;
Ambulate 4-6x daily;
Ted hose/scds;
Pharmacological prophylaxis
Two meds given for VTE Prophylaxis
Heparin
Enoxaparin
Treatment for actual DVT
Bed rest w/ limb elevation;
Monitor for PE; Anticoagulant therapy
Surgical interventions for DVT
Venous thrombectomy;
Inferior Vena Cava Filter (Greenfield Filter)
What is a complication of greenfield filter
Patient can develop pneumothorax
S/S of Chronic Venous Insufficiency
Leathery appearance; Edema; Stasis Dermatitis;
Venous Ulcers; Pain
Collaborative Care for Chronic Venous Insufficiency
- Compression; 2. Nutrition; 3. Watch for infection
- Daily moisturizing; 5. Education: avoid standing/sitting for long periods; elevate legs above heart; avoid crossing legs; start walking
