Vascular disorders Flashcards
two classifications of vascular disorders
Peripheral artery disease
- occlusive
- aneurysm
- vasospastic
Venous disease
- Thrombosis
- chronic venal insufficiency
PAD
Narrowing and degeneration of arteries of neck, abdomen, and extremities
Atherosclerosis
same risks as CAD
PAD clinical manifestations
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
Arterial vs venous ulcers
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
PAD diagnostics
Use doppler to detect flow
get BP thigh knee ankle
Duplex imaging for blood flow
Angiography
PAD treatments
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
PAD treatment for intermittent claudication
Pentoxifylline:
- Inc. erythrocyte flexibility
- Dec. blood viscosity
Cilostazol:
-Inc. vasodilation and walking distance
PAD lifestyle and nutritional care
Walking helps
Dietary cholesterol under 200mg/day
Ginkgo biloba helps
Folate, b6, b12 lower homocysteine
PAD complications
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
Post op care for PAD
N/V assessment
Watch for bleeding, delayed wound healing
Teach about long term sitting, foot care
Arterial disorders
Arterial ischemia
- 6ps
- Open blockage w/ anticoagulants or surgery
Raynauds:
- No tobacco
- Wear loose clothing
- cold bad
Which type of aortic aneurysms are often asymptomatic
Thoracic
if thoracic has symptoms its deep chest pain, back pain w/ or without flank ecchymosis
Ascending aorta aneurysms can cause
angina
Hoarseness (pressure on laryngeal nerve)
JVD
Head/arm edema
How are ascending aortic aneurysms most often found
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)
Aneurysm diagnostics
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
Threshold for aneurysm repair
5.5cm
for women with AAA 5cm
Will repair under 5.5 if symptomatic (back pain, gray turner’s), hypotension
Aortic dissection preoperative
Semi-fowler's Anxiety and pain management continuous IV admin of antihypertensives Continuous ECG and intraarterial pressure Peripheral pulse montioring vitals
Venous insufficiency
Damaged valves, backflow pools
Often post DVT
Swelling of lower extremities
Leads to venous leg ulcers
skin breakdown
Venous insufficiency care
Ulceration increased r/t infection
Compression measures need to be taken indefinitely
Lose weight
Make sure vitamin A, C and zinc is good
DVT
Remember virchow triad
- Venous stasis
- Damaged endothelium
- Blood hypercoagulability
