Vascular Disorders Flashcards
Aortic Aneurysms
Outpouchings or dilations of the arterial wall
- men more often
- high incidence with age
- aortic arch, thoracic, abdominal
AA Causes
most common: atherosclerosis
- degenerative
- congenital
- trauma
- inflammatory
- infectious
Atherosclerotic plaques deposit RF
- male
- smoking
True Aneurysms
- wall of artery forms the aneurysm
- fusiform or saccular
False Aneurysm
- not an aneurysm
- leads to bleeding
- cause: trauma, infection, bypass surgery, arterial leakage
Thoracic Aorta Aneurysm
asymptomatic often
- deep, diffuse chest pain
- pain in interscapular
Ascending aorta/aortic arch
- produce angina & hoarseness
- distended neck veins
- edema of head/arms
AAA
- asymptomatic
- physical exam
- mimic abdominal/back disorders
- blue toe syndrome
AA Ruptures
Posterior -bleeding -severe pain -back/flank ecchymosis Anterior -massive hemorrhage -low survival
AA Diagnostics
- ultrasound
- CT
- MRI
- Angiography
- X ray
- ECG/echo
AA Care
- determine size/location
- small aneurysm: low BP
- 5.5 cm: repair
- young: surgery earlier
- old: endovascular repair
Endovascular Graft Procedure
- faster & safer
- comp: perigraft leak
- pericutaneous femoral access is better
PAD
- cause: atherosclerosis
- 60-80 yrs
- RF: smoking, hyperlipidemia, HTN, DM
- intermittent claudification
- shiny taut skin
PAD Symptoms
- intermittent claudication: pain with exercise
- resolves in 10 min
- paresthesia
- thin, shiny, taut skin
- pain at rest in foot, at night
PAD Complications
- atrophy of skin & muscles
- delayed healing
- wound infection
- tissue necrosis
- arterial ulcers
PAD Diagnostics
- doppler ultrasound
- ABI
- duplex imaging
- angiography
- MRA
PAD Care
- smoking cessation
- treatment of hyperlipidemia, HTN, DM
- BP < 130/80
- glycosylated Hg < 7.0%
PAD Care
- antiplatelet
- ACE inhibitors
- Pento & Cilo
- exercise
- cholesterol < 200
- radiation & PTBA
Thromboangitis Obliternas (Buerger’s Disease)
- affects small/med arteries/veins of extremities
- men < 40 who use tobacco
- intermittent claudication, color/temp changes of limbs
Thromboangitis Obliternas (Buerger’s Disease) Care
- cessation of tobacco
- IV iloprost
- sympathetomy
- amputation og fingers/toes
Raynaud’s
- arteries in fingers/toes
- in women 15-40 yrs
- white/blue/red color changes
Raynaud’s care
- protect hands/feet from cold
- stop all tobacco/caffeine
- calcium channel blockers
- sympathectomy
Superficial Vein Thrombosis
- arm/leg veins
- tenderness, redness, warmth
- D: physical exam
- C: removal of IV catheter, elevation, heat, drainage
Venous thromboembolism
- veins of arms/legs/pelvis
- tenderness
- embolism to lungs
SVT Drugs
- NSAIDs
- Low molecular weight heparin followed by unfractionated heparin then warfarin
DVT
- unilateral leg edema
- dull, aching to severe pain
- Homan’s: pain with dorsiflexion
- redness, warmth, tenderness
- temp > 100.4
DVT Diagnostics
- D-dimer
- doppler
- duplex scanning
- venogram
DVT Prevention
- TED/SCDs
- early moblization
- exercise
- avoid long sitting
- no smoking
- weight control
- LMW heparin
DVT Drugs
- IV heparin drip (unfractionated)
- SQ LMWH
- oral: warfarin
INR
normal: 0.75-1.25
therapeutic: 2-3
- used for monitor warfarin
PTT
normal: 24-36
therapeutic: 50-70
- monitor unfractionated heparin
Heparin
- inhibits fibrin & thrombus formation
- IV to treat existing DVT
- SQ to prevent DVT
Bleeding Precautions
- electric razor
- limit needle sticks/manual pressure at least 10 min
- no IM injections
- prevent constipation
- humidify o2
Heparin Antidote: Protamine sulfate
- heparin antagonist
- slow IVP over 10 min
- SE: HTN, brady, shock
Low molecular weight heparins:Lovenox, Fragmin, Normiflo
admin
- love handles
- don’t expel air bubble
- don’t aspirate/massage
- observe site
- monitor CBC
Oral Anticoagulant: Warfarin (Coumadin)
- prevents utilization of vitamin K
- starts while on on heparin
- 2-3 dys to alter PT/INR
Antidote for Warfarin Toxcity
Vitamin K (Aquamephyton)
Thrombolytic agents
- for: DVT, pulmonary embolus
- monitor for bleeding
- dissolves clot
Varicosities
dilated, tortuous subcutaneous veins
- primary: weakness
- secondary: VTE
- reticlar: smaller
- telangiectasis: spider
Varicose Vein M/D/C
- M: disfiguaration, heavy achy feeling or pain
- D: appearance RF: chronic cough, constipation
- C: Tx for symptomatic, limb elevation with graduated compression
Chronic Venous Insufficiency (Postphlebitic syndrome)
- advanced stage of venous disease
- S: skin changes, chronic edema, pain, pruritis, ulcers
CVI care
- compression
- wound care: moist dressings
Arterial Ulcers
- intermittent claudication
- no edema/pulse/drainage
- round smooth sores
- black eschar
- toes/feet
Venous Ulcers
- dull, achy pain
- lower leg edema
- pulse/drainage present
- sores with irregular borders
- yellow slough or ruddy skin
- ankles
