Vascular disorders

Question 1

two classifications of vascular disorders

Answer 1

Peripheral artery disease

• occlusive
• aneurysm
• vasospastic

Venous disease

• Thrombosis
• chronic venal insufficiency

Question 2

PAD

Answer 2

Narrowing and degeneration of arteries of neck, abdomen, and extremities

Atherosclerosis

same risks as CAD

Question 3

PAD clinical manifestations

Answer 3

Intermittent claudication

• R/t occlusion
• Ischemic muscle ache, pain, or cramp after exercise
• Resolves w/in 10 min w/ rest
• reproducible

Paresthesia

• Numbness of toes and feet
• Gradually diminished perfusion
• Loss of pressure sensation
• Loss of deep pain sensations
• Injuries can go unnoticed by patients

Pallor on elevation
Dependent rubor
Diminished pulses
Pain at rest
Arterial ulcers

Question 4

Arterial vs venous ulcers

Answer 4

Arterial:

• Intermittent claudication/pain
• No edema
• No/weak pulse
• Smooth round sores
• Black eschar
• Feet and toes

Venous:

• Dull achy pain
• Lower leg edema
• Pulse and drainage present
• Sores w/ irregular borders
• Yellow slough, ruddy skin
• On ankles

Question 5

PAD diagnostics

Answer 5

Use doppler to detect flow
get BP thigh knee ankle

Duplex imaging for blood flow

Angiography

Question 6

PAD treatments

Answer 6

Aspirin, can be used w/ other antiplatelet

Ace inhibitors even if BP not elevated or LV problems
-Ramipril decreases CV morbidity, mortality, and increases blood flow, ankle brachial index, and walking distance

Question 7

PAD treatment for intermittent claudication

Answer 7

Pentoxifylline:

• Inc. erythrocyte flexibility
• Dec. blood viscosity

Cilostazol:
-Inc. vasodilation and walking distance

Question 8

PAD lifestyle and nutritional care

Answer 8

Walking helps

Dietary cholesterol under 200mg/day

Ginkgo biloba helps

Folate, b6, b12 lower homocysteine

Question 9

PAD complications

Answer 9

Prevent wounds (shoes and pads)
Prevent infection (no soaking)
Cover w./ sterile dressing

Watch for ischemia:

• Give tPA (tissue plasminogen activator) if clot
• Balloon angioplasty
• Synthetic graft
• Amputation

Question 10

Post op care for PAD

Answer 10

N/V assessment
Watch for bleeding, delayed wound healing

Teach about long term sitting, foot care

Question 11

Arterial disorders

Answer 11

Arterial ischemia

• 6ps
• Open blockage w/ anticoagulants or surgery

Raynauds:

• No tobacco
• Wear loose clothing
• cold bad

Question 12

Which type of aortic aneurysms are often asymptomatic

Answer 12

Thoracic

if thoracic has symptoms its deep chest pain, back pain w/ or without flank ecchymosis

Question 13

Ascending aorta aneurysms can cause

Answer 13

angina
Hoarseness (pressure on laryngeal nerve)
JVD
Head/arm edema

Question 14

How are ascending aortic aneurysms most often found

Answer 14

during routine physical exams finding pulsatile mass or getting abd x ray

Bruits auscultated

Bowel problems from compression

Blue toe syndrom (toes turn blue from plaque breaking off and blocking toes)

Question 15

Aneurysm diagnostics

Answer 15

X ray may show calcification of wall

ECG to rule out MI

Echocardiography to check fro aortic valve insufficiency r/t aortic dilation

Ultrasound for size

CT Scan MOST ACCURATE for size/presence of thrombi

MRI for size and location

Angiography not reliable to determine diameter or length

Question 16

Threshold for aneurysm repair

Answer 16

5.5cm
for women with AAA 5cm

Will repair under 5.5 if symptomatic (back pain, gray turner’s), hypotension

Question 17

Aortic dissection preoperative

Answer 17

Semi-fowler's
Anxiety and pain management
continuous IV admin of antihypertensives
Continuous ECG and intraarterial pressure
Peripheral pulse montioring
vitals

Question 18

Venous insufficiency

Answer 18

Damaged valves, backflow pools
Often post DVT
Swelling of lower extremities

Leads to venous leg ulcers

skin breakdown

Question 19

Venous insufficiency care

Answer 19

Ulceration increased r/t infection

Compression measures need to be taken indefinitely

Lose weight

Make sure vitamin A, C and zinc is good

Question 20

DVT

Answer 20

Remember virchow triad

• Venous stasis
• Damaged endothelium
• Blood hypercoagulability