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Care of Adult/Older Exam #3 (5701) > Vascular Disorders > Flashcards

Vascular Disorders Flashcards

1
Q

Peripheral Artery Disease (PAD) definition?

A

progressive narrowing and degeneration of arteries of the upper and lower extremities

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2
Q

What are the lower arteries commonly affect in PAD?

A
  • aortoiliac
  • femoral
  • popliteal
  • tibial
  • peroneal
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3
Q

PAD typically appears at what ages?

A

60s to 80s

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4
Q

What is the leading cause of PAD in a majority of cases?

A

Atherosclerosis

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5
Q

What are Risk factors for the development of PAD?

A
  • Cigarette smoking
  • Hyperlipidemia
  • Uncontrolled hypertension
  • Diabetes mellitus
  • Exposures to Agent Orange and herbicides (Vietnam War)
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6
Q

What are the classic symptoms of PAD?

A
  • 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)
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7
Q

PAD (pain at rest) is felt ______, is aggravated by ______, is caused by _______ and occurs most often _______?

A
  • 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
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8
Q

What are the symptoms of PAD (Paresthesia)?

A
  • Numbness or tingling in the toes or feet
  • Produces loss of pressure and deep pain sensations
  • Injuries often go unnoticed by patient
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9
Q

What is assessed during a PAD Neuro Nursing Assessment?

A

Mobility or sensation impairment in bilateral limbs

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10
Q

What will be seen during a PAD Nursing Assessment of the skin?

A
  • Thin, shiny, and taut skin

- Loss of hair on the lower legs

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11
Q

What will be seen during a PAD CV Nursing Assessment?

A
  • 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
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12
Q

Complications of PAD?

A
  • Atrophy of skin and underlying muscles
  • Delayed healing
  • Wound infection
  • Tissue necrosis
  • Arterial ulcers
  • Critical Limb
  • may need to Amputate
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13
Q

A condition characterized by:

  • Chronic ischemic rest pain > 2 week
  • Arterial leg ulcers
  • Gangrene
A

Critical Limb

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14
Q

Critical Limb is a condition characterized by?

A
  • Chronic ischemic rest pain > 2 week
  • Arterial leg ulcers
  • Gangrene
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15
Q

Critical Limb is A.K.A.?

A

ischemic limb

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16
Q

Treatment of Ischemic Limb?

A
  • Protect extremity
  • Decrease ischemic pain
  • Prevent/control infection
  • Maximize perfusion
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17
Q

Nursing Interventions

for Ischemic Limb?

A
  • Assess
  • Cleanse (DO NOT SOAK)
  • Lubricate
  • Frequent dressing change-keep CD&I
  • Protective footwear
  • Avoid cold/heat extremes
  • May need HBO treatment
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18
Q

Diagnostic Studies for PAD?

A
  • 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
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19
Q

Medications for PAD?

A
  • 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
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20
Q

Ramipril (Altace) category?

A
  • ACE inhibitors

- ↑ peripheral blood flow

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21
Q

Drugs prescribed for treatment of intermittent claudication?

A
  • Pentoxifylline (Trental)

- Cilostazol (Pletal)

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22
Q

Pentoxifylline (Trental)

A
  • prescribed for treatment of intermittent claudication

- ↓ blood viscosity

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23
Q

Cilostazol (Pletal)

A
  • prescribed for treatment of intermittent claudication

- ↑ vasodilation and walking distance

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24
Q

Vitamin E is contraindicated for?

A

patients on anticoagulants or NSAIDS

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25
Q

Interventions to reduce/prevent or treat PAD?

A
  • 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)
26
Q

Diet for PAD?

A
  • Dietary cholesterol <200 mg/day
  • Decreased intake of saturated fat
  • Sodium <2 g/day
27
Q

What is the most effective exercise for individuals with claudication?

A
  • Walking

- 30 to 45/60 minutes daily 3-5x per week

28
Q

Invasive Treatments for PAD?

A
  • Interventional Radiology
    • Percutaneous transluminal angioplasty (PTA)
    • Stents
    • Atherectomy
  • Surgical Treatment
    • By-pass surgery
    • Endarectomy
    • Patch graft angioplasty
    • Amputation
29
Q

Post PAD surgical procedure assessments?

A
  • Operative extremity q15 minutes
    • Compare to baseline, and opposite extremity
  • Pain management
  • Continue to assess for bleeding, hematoma, thrombosis, embolism
30
Q

Post PAD surgical procedure teaching?

A
  • 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
31
Q

What is Raynaud’s Phenomena/Disease?

A
  • Episodic vaso-spastic disorder of small cutaneous arteries, most often in fingers and toes
  • Etiology unknown
  • Known as the red, white and blue disease
32
Q

Risk Factors for Raynaud’s Phenomena?

A
  • 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
33
Q

Secondary Raynaud’s is associated with which disease(s)?

A

Lupus & rheumatoid arthritis

34
Q

Manifestations of Raynaud’s Disease?

A
  • color changes in fingers, toes, ears and nose

- Cold and numbness followed by throbbing, aching, and tingling

35
Q

Teaching for Raynaud’s disease?

A
  • loose warm clothes
  • avoid extreme temperatures
  • smoking cessation
  • avoid caffeine
36
Q

A) Tx for Raynauds
B) diagnostic test(s)
C) diagnosis criteria

A

A) Severe cases: Calcium channel blockers, amputation may be needed
B) NONE
C) Diagnosed by symptoms for at least 2 years

37
Q

Most common disorder of the veins?

A

Venous Thrombosis

38
Q

Causes of Venous Thrombosis?

A
  • Stasis of venous flow,
  • Damage of the endothelium
  • Hypercoagulability of the blood
39
Q

Classifications of Venous Thrombosis?

A
  • SVT-Superficial Vein Thrombosis
  • DVT- Deep Vein Thrombosis
  • VTE- Venous Thromboembolism (DVT-PE)
40
Q

S/S of Superficial Vein Thrombosis?

A

Venous inflammation, tender, red, and warm, may or may not have edema

41
Q

Tx of Superficial Vein Thrombosis?

A
  • Remove IV
  • elevate
  • warm compress,
  • NSAIDS
  • Common with varicose veins
42
Q

S/S of Deep Vein Thrombosis?

A
  • unilateral edema
  • pain
  • warmth
  • erythema
  • numbness
  • fullness
43
Q

Risk Factors for Deep Vein Thrombosis?

A
  • History of thrombophlebitis
  • Surgery
  • Obesity
  • HF, HTN, CVA
  • Standing for long periods of time, immobility
  • Pregnancy
  • Advanced age
  • Cigarette smoking
  • IV Therapy
44
Q

Diagnostic Tests for suspected clots?

A
  • D-dimer (least expensive-only predictive)
  • Venous Ultrasound (diagnostic)
  • Blood studies
    • INR, PTT, H/H, PLT
  • Venogram
  • CT or MRI
45
Q

Abnormal Assessment Findings of a Venous Thrombosis?

A
  • 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
46
Q

What to assess for if complications of a DVT is suspected?

A
  • 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
47
Q

Medication Therapy for DVT?

A
  • Anticoagulants
    • Heparin gtt-monitor PTT
    • Lovenox or heparin injection
    • Coumadin-Monitor PT/INR
  • WATCH FOR BLEEDING
  • Labs
    • PTT, PT/INR, CBC, PLT
48
Q

What lab do you monitor for a patient on a Heparin drip?

A

PTT

49
Q

What lab do you monitor for a patient on a coumadin?

A

PT/INR

50
Q

Teaching for DVT?

A
  • 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
51
Q

Diet for patient on Coumadin?

A

consistent dietary intake of Vitamin K

52
Q

Patients an anticoagulant therapy should avoid?

A

ASA, NSAIDS, fish oil, garlic, and ginkgo biloba

53
Q

patient teaching - signs of bleeding?

A
  • Black or bloody stools
  • bloody urine
  • coffee-ground or bloody vomit
  • nose bleeds
  • bleeding gums
54
Q

What are physiological signs of bleeding?

A
  • Hypotension
  • tachycardia
  • hematuria
  • melana
  • hematemesis
  • petechiae
  • ecchymosis
55
Q

What is Venous Insufficiency?

A
  • 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
56
Q

manifestations of Venous Insufficiency?

A
  • Lower leg swelling,
  • leathery appearance
  • stasis dermatitis
  • itching
57
Q

Nursing Interventions for Venous Insufficiency?

A
  • Compression stockings
  • Elevation
  • Analgesics
  • Wound Care if heavy drainage present
  • Antibiotics for non-healing venous ulcers only (not routine)
  • Culture wound
  • Debridement
  • Skin grafts
58
Q 
Arterial Disease:
A) color
B) edema
C) nails
D) pain
A

A) pale
B) little to none
C) thick and brittle
D) worse with elevation and exercise, sudden/severe, rest pain, claudication

59
Q

Arterial Disease:
A) pulses
B) temp
C) ulcer

A

A) decreased, weak or absent
B) cool
C) dry/necrotic, toes most affected

60
Q 
Venous Disease:
A) color
B) edema
C) nails
D) pain
A 
A) Ruddy, cyanotic if dependent
B) Usually present
C) Normal
D) Better with elevation, 
Aching pain > through    
out the day
61
Q

Venous Disease:
A) pulses
B) temp
C) ulcer

A

A) Normal
B) warm
C) moist, ankle/lower leg most affected

Care of Adult/Older Exam #3 (5701) (8 decks)

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