Vascular Disorders Flashcards
Peripheral Artery Disease (PAD) definition?
progressive narrowing and degeneration of arteries of the upper and lower extremities
What are the lower arteries commonly affect in PAD?
- aortoiliac
- femoral
- popliteal
- tibial
- peroneal
PAD typically appears at what ages?
60s to 80s
What is the leading cause of PAD in a majority of cases?
Atherosclerosis
What are Risk factors for the development of PAD?
- Cigarette smoking
- Hyperlipidemia
- Uncontrolled hypertension
- Diabetes mellitus
- Exposures to Agent Orange and herbicides (Vietnam War)
What are the classic symptoms of PAD?
- intermittent claudication
- Ischemic muscle ache or pain that is precipitated by a constant level of exercise
- Resolves within 10 minutes or less with rest
- Reproducible (with exercise)
PAD (pain at rest) is felt ______, is aggravated by ______, is caused by _______ and occurs most often _______?
- Occurs in the forefoot or toes
- Aggravated by limb elevation
- Occurs from insufficient blood flow
- Occurs more often at night because they are lying flat
What are the symptoms of PAD (Paresthesia)?
- Numbness or tingling in the toes or feet
- Produces loss of pressure and deep pain sensations
- Injuries often go unnoticed by patient
What is assessed during a PAD Neuro Nursing Assessment?
Mobility or sensation impairment in bilateral limbs
What will be seen during a PAD Nursing Assessment of the skin?
- Thin, shiny, and taut skin
- Loss of hair on the lower legs
What will be seen during a PAD CV Nursing Assessment?
- Diminished or absent radial (less common), pedal, popliteal, or femoral pulses
- Pallor of foot with leg elevation
- Reactive hyperemia (redness) of foot with dependent position
Complications of PAD?
- Atrophy of skin and underlying muscles
- Delayed healing
- Wound infection
- Tissue necrosis
- Arterial ulcers
- Critical Limb
- may need to Amputate
A condition characterized by:
- Chronic ischemic rest pain > 2 week
- Arterial leg ulcers
- Gangrene
Critical Limb
Critical Limb is a condition characterized by?
- Chronic ischemic rest pain > 2 week
- Arterial leg ulcers
- Gangrene
Critical Limb is A.K.A.?
ischemic limb
Treatment of Ischemic Limb?
- Protect extremity
- Decrease ischemic pain
- Prevent/control infection
- Maximize perfusion
Nursing Interventions
for Ischemic Limb?
- Assess
- Cleanse (DO NOT SOAK)
- Lubricate
- Frequent dressing change-keep CD&I
- Protective footwear
- Avoid cold/heat extremes
- May need HBO treatment
Diagnostic Studies for PAD?
- Doppler ultrasound
- Segmental blood pressures
- Duplex imaging
- Bidirectional, color Doppler
- Ankle-brachial index (ABI)
- Done using a hand-held Doppler
- Angiography
- Magnetic resonance angiography (MRA)- shows extent and location of PAD
Medications for PAD?
- Antiplatelet agents
- Aspirin 81-325mg/day
- Clopidogrel (Plavix) 75mg/day
- ACE inhibitors
- Ramipril (Altace)
- Drugs to treat intermittent claudication
- Pentoxifylline (Trental)
- ↓ blood viscosity
- Cilostazol (Pletal)
- ↑ vasodilation and walking distance
Ramipril (Altace) category?
- ACE inhibitors
- ↑ peripheral blood flow
Drugs prescribed for treatment of intermittent claudication?
- Pentoxifylline (Trental)
- Cilostazol (Pletal)
Pentoxifylline (Trental)
- prescribed for treatment of intermittent claudication
- ↓ blood viscosity
Cilostazol (Pletal)
- prescribed for treatment of intermittent claudication
- ↑ vasodilation and walking distance
Vitamin E is contraindicated for?
patients on anticoagulants or NSAIDS
Interventions to reduce/prevent or treat PAD?
- Smoking Cessation
- Exercise improves oxygen extraction in the legs and skeletal metabolism.
- Walking (30 to 60 minutes daily 3-5x per week)
- Diet
- BMI < 25 kg/m2
- Foot care (daily)
Diet for PAD?
- Dietary cholesterol <200 mg/day
- Decreased intake of saturated fat
- Sodium <2 g/day
What is the most effective exercise for individuals with claudication?
- Walking
- 30 to 45/60 minutes daily 3-5x per week
Invasive Treatments for PAD?
- Interventional Radiology
- Percutaneous transluminal angioplasty (PTA)
- Stents
- Atherectomy
- Surgical Treatment
- By-pass surgery
- Endarectomy
- Patch graft angioplasty
- Amputation
Post PAD surgical procedure assessments?
- Operative extremity q15 minutes
- Compare to baseline, and opposite extremity
- Pain management
- Continue to assess for bleeding, hematoma, thrombosis, embolism
Post PAD surgical procedure teaching?
- Reduce risk factors
- Medication teaching-long term antiplatelet
- Diet
- Exercise- walk 30-60 min 3-5 days/week
- Foot care-inspect, wash, socks, shoes, avoid temp extremes, pulses, CRT
- Positioning- do not cross legs, avoid long standing
- Wound care-as directed
- S/S of infection or complication
- Call if change in color, temperature, or increased pain
- Follow up
What is Raynaud’s Phenomena/Disease?
- Episodic vaso-spastic disorder of small cutaneous arteries, most often in fingers and toes
- Etiology unknown
- Known as the red, white and blue disease
Risk Factors for Raynaud’s Phenomena?
- Women 15-40 years
- Occupational related trauma
- Typists, pianists, hand-held vibrating equipment
- Lead exposures
- World War II and Korean War Veterans
- Exposure to extreme cold
- Secondary Raynaud’s
- Lupus, rheumatoid arthritis
Secondary Raynaud’s is associated with which disease(s)?
Lupus & rheumatoid arthritis
Manifestations of Raynaud’s Disease?
- color changes in fingers, toes, ears and nose
- Cold and numbness followed by throbbing, aching, and tingling
Teaching for Raynaud’s disease?
- loose warm clothes
- avoid extreme temperatures
- smoking cessation
- avoid caffeine
A) Tx for Raynauds
B) diagnostic test(s)
C) diagnosis criteria
A) Severe cases: Calcium channel blockers, amputation may be needed
B) NONE
C) Diagnosed by symptoms for at least 2 years
Most common disorder of the veins?
Venous Thrombosis
Causes of Venous Thrombosis?
- Stasis of venous flow,
- Damage of the endothelium
- Hypercoagulability of the blood
Classifications of Venous Thrombosis?
- SVT-Superficial Vein Thrombosis
- DVT- Deep Vein Thrombosis
- VTE- Venous Thromboembolism (DVT-PE)
S/S of Superficial Vein Thrombosis?
Venous inflammation, tender, red, and warm, may or may not have edema
Tx of Superficial Vein Thrombosis?
- Remove IV
- elevate
- warm compress,
- NSAIDS
- Common with varicose veins
S/S of Deep Vein Thrombosis?
- unilateral edema
- pain
- warmth
- erythema
- numbness
- fullness
Risk Factors for Deep Vein Thrombosis?
- History of thrombophlebitis
- Surgery
- Obesity
- HF, HTN, CVA
- Standing for long periods of time, immobility
- Pregnancy
- Advanced age
- Cigarette smoking
- IV Therapy
Diagnostic Tests for suspected clots?
- D-dimer (least expensive-only predictive)
- Venous Ultrasound (diagnostic)
- Blood studies
- INR, PTT, H/H, PLT
- Venogram
- CT or MRI
Abnormal Assessment Findings of a Venous Thrombosis?
- CV
- Unilateral edema, decreased perfusion, decreased/absent pulses, numbness/tingling
- Skin
- Increased warmth, redness
- Pain
- Initially may feel numbness/tingling or cramping
- Site tender to touch
- Psych/soc
- Fear, anxiety-potential
- Monitor for complications PE, MI, CVA
What to assess for if complications of a DVT is suspected?
- Embolus
- Cardiac: Signs of MI
- Neurological: Change in LOC or signs of CVA
- Neurovascular: Change in tissue perfusion or Venous insufficiency
- Respiratory
- Signs of PE, SOB, change in BS
Medication Therapy for DVT?
- Anticoagulants
- Heparin gtt-monitor PTT
- Lovenox or heparin injection
- Coumadin-Monitor PT/INR
- WATCH FOR BLEEDING
- Labs
- PTT, PT/INR, CBC, PLT
What lab do you monitor for a patient on a Heparin drip?
PTT
What lab do you monitor for a patient on a coumadin?
PT/INR
Teaching for DVT?
- DVT prevention
- Ambulation, (SCD’s for hospitalized patients), TED’s
- Medication side effects-bleeding
- Smoking cessation
- Increase activity
- Anticoagulation Therapy
- Lovenox injection administration
- Coumadin monitoring
Diet for patient on Coumadin?
consistent dietary intake of Vitamin K
Patients an anticoagulant therapy should avoid?
ASA, NSAIDS, fish oil, garlic, and ginkgo biloba
patient teaching - signs of bleeding?
- Black or bloody stools
- bloody urine
- coffee-ground or bloody vomit
- nose bleeds
- bleeding gums
What are physiological signs of bleeding?
- Hypotension
- tachycardia
- hematuria
- melana
- hematemesis
- petechiae
- ecchymosis
What is Venous Insufficiency?
- Caused by damaged valves in the veins resulting in pooling of blood in the legs
- Not life threatening
- Painful and debilitating
- Manifests as: Lower leg swelling, leathery appearance, stasis dermatitis, itching
manifestations of Venous Insufficiency?
- Lower leg swelling,
- leathery appearance
- stasis dermatitis
- itching
Nursing Interventions for Venous Insufficiency?
- Compression stockings
- Elevation
- Analgesics
- Wound Care if heavy drainage present
- Antibiotics for non-healing venous ulcers only (not routine)
- Culture wound
- Debridement
- Skin grafts
Arterial Disease: A) color B) edema C) nails D) pain
A) pale
B) little to none
C) thick and brittle
D) worse with elevation and exercise, sudden/severe, rest pain, claudication
Arterial Disease:
A) pulses
B) temp
C) ulcer
A) decreased, weak or absent
B) cool
C) dry/necrotic, toes most affected
Venous Disease: A) color B) edema C) nails D) pain
A) Ruddy, cyanotic if dependent B) Usually present C) Normal D) Better with elevation, Aching pain > through out the day
Venous Disease:
A) pulses
B) temp
C) ulcer
A) Normal
B) warm
C) moist, ankle/lower leg most affected
