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Med Surg. 2 > Vascular disorders and peripheral circulation > Flashcards

Vascular disorders and peripheral circulation Flashcards

1
Q

what is tissue perfusion?

A

supply of blood with nutrients and oxygen going to the tissues to ensure proper functioning.

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2
Q

what are peripheral vessels?

A

they are vessels outside of the heart and brain! (meaning vessels in the neck and extremities)

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3
Q

PVD Peripheral Vascular Disease

A

reduction of blood flow through peripheral blood vessels

*interchangeable with PAD peripheral artery disease. (it is more severe,causes HYPOXIA-ANOXIA-NECROSIS)

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4
Q

WHAT DOES THE RIGHT DISE OF THE HEART DO?

A

COLLECTS RETURNING BLOOD->SENDING BLOOD TO THE LUNGS.

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5
Q

WHAT DOES THE LEFT SIDE OF THE HEART DO?

A

RESPONSIBLE FOR DISTRIBUTING BLOOD TO THE BODY

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6
Q

what is the patho: of arterial disease?

A

1st-intermittent claudication (cramping w/activity)
then the extremity becomes cool/pale (gets worse if pt. elevates ext.)
2nd-Rubor this appears when the limb is in dependent position. (rubor indicates severe artery damage)
Last- Cyanosis.

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7
Q

arterial disease patho: continued ..

A 
if patient has chronic deficit of nutritional supply it will lead to 
loss of hair
brittle nails 
dry/scaly skin 
atrophy and ulcers
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8
Q

what is gangrene?

A

necrosis due to severe prolonged ischemia

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9
Q

doppler ultrasound nursing interventions

A
  • pedal pulses very important!
  • patient SUPINE w/HOB elevated 20-30 degrees.
  • leg rotated externally (if possible) to asses medial malleolus
  • apply gel
  • avoid excessive pressure (occlude pulse)
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10
Q

exercise test indications

A

*used to assess progression of the disease
used to determine how far a patient can walk with no pain.
patient walks on a treadmill 10%incline for a max of 5 mins

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11
Q

duplex ultrasonography

A

non invasive no prep and its done at the bed side

-if abdominal study done patient must be NPO 6hrs prior used to dx-dvt

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12
Q

CT- computed tomography nursing interventions

A

cross section views of soft tissue (IMAGES)

check for allergies to contrast like iodine(shellfish)

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13
Q

CTA- computed tomography angiography nursing interventions

A
  • arteriogram w/radiopaque contrast
  • teach patient they will feel a warm flushing feeling with injection of the contrast
  • teach patient to notify nurse if feelings of DYSPNEA, CHEST PAIN, RASH/ITICHING occur
  • always check distal pulses before and after
  • CMTS(circulation,motion,temp,sensation)
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14
Q

arteriosclerosis

A

hardening of the arteries

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15
Q

atherosclerosis

A

accumulation of lipids (GRADUAL)

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16
Q

Modifiable risk factors for ARTERIO/ATHERO-SCLEROSIS

A

SMOKINGNICOTINE OF ANY KIND***
-FATTY DIET (LEADS TO BREAST CA)
-HTN
-DM
HYPERLIPIDEMIA
-STRESS
-SEDENTARY LIFESTYLE

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17
Q

Non-Modifiable risk factors for ARTERIO/ATHERO-SCLEROSIS

A
  • ***OLD AS FUCK ++60 **
  • FEMALES
  • FAMILY GENETICS
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18
Q

management of A&A-SCLEROSIS FOR PATIENT

A
  • *MODIFY RISK FACTORS THAT YOU CAN

* *SURGICAL INTERVETION TO IMPROVE BLOOD FLOW

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19
Q

management of A&A-SCLEROSIS FOR NURSE

A
  • QUIT SMOKING***TEACH
  • moderate activity
  • watch for chilling
  • relieve pain
  • adequate clothing
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20
Q

clinical manifestations of peripheral arterial occlusive disease

A
  1. HALLMARK SIGN-INTERMITTENT CLADICATION.
    * cramping pain (butt,hip,thigh,calf,arch)
    * onsetw/exercise
    * relieved by rest in dependent position
  2. Limbs cool/pale with elevation
  3. Limbs RUBOR in color
  4. Paresthesia (decreased sensation)
  5. Skin/hair changes
  6. Pulses diminished (when assessing start w/good ext. 1st)
  7. Pain/burning even at rest (severe disease progression)
  8. Impotence (guys)
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21
Q

diagnostic tests for PAD

A
  1. doppler US (assess progression)
  2. exercise test (how far pt walks b/f having pain)
  3. **ANGIOGRAPHY (INVASIVE)
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22
Q

Angiography pre and post op procedures for PAD

A

PRE- check for allergies to contrast iodine(shellfish)
liquid breakfast and give meds
check with md if you have to hold HEPARIN prior due to bleeding precautions
CONSENT
POST- V/S
ext. extended do not flex!
check pulses frequently and skin color
check for bleeding or bruising at site
force fluids IV to flush out dye to avoid renal failure

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23
Q

medication management for PAD

A

TRENTAL- increased flexibility of rbc
PERSANTINE- antiplatelet
ASPRIN- antiplatelet
LOPID

24
Q

medical management for PAD

A

QUIT SMOKING
WEIGHT LOSS
PTA- percutaneous transluminal angioplasty w/stent
*NO HOT BATHS/HEATING PADS

25
Q

surgical management for PAD

A
  1. excision and grafting (take out vessel and put a patch)
  2. endarterectomy ( roter rooter baby bottle scrubber)
  3. by-pass graft
26
Q

POST op care of surgical management of PAD

A
  • assess CMS (pulse, temp, color)
  • elevate legs, avoid prolonged dependency
  • AE hose in some pts do not compress graft
  • do not cross or flex limb
  • assess of S/S of infection
  • control BP
27
Q

What is an Aneurysm?

A

localized sac or dilation of artery due to a weak point.

  • most frequently caused by ATHEROSCLEROSIS
  • 10X’S more likely in men over 60yrs old
  • *most common type saccular and fusiform
28
Q

classification and location of an aneurysm (types)

A

saccular- 1 side of the vessel
fusiform- entire vessel circumference dilated
dissecting-bilateral hematoma that splits
thoracic-above diaphragm
abdominal-below diaphragm
other- popliteal, renal artery

29
Q

Clinical Manifestations of Thoracic Aneurysms

A
  • 85% caused by ATHEROSCLEROSIS
  • most are asymptomatic
  • pain is most prominent sign
  • Boring pain increased when lying down (supine)
  • dyspnea, dysphagia, brassy cough
  • diliated superficial veins of chest and neck and arms ( sup. vena cava syndrome)
30
Q

diagnostic test for Thoracic Aneurysms

A
  • chest xray
  • CTA w/contrast
  • fluoroscopy (xray guided w/device)
  • TEE
  • BRUIT-turbulent blood flow*
31
Q

management of thoracic aneurysms

A

surgical removal w/graft

  • strict CONTROL OF BP (hypertension will make it burst)
  • decrease force of cardiac contraction with BETA BLOCKERS
32
Q

Clinical Manifestations of Abdominal Aneurysms

A
  • most likely to rupture
  • mostly asymptomatic
  • patient complains of heart beating while lying down
  • patient will complain of abdominal pain persistent or intermittent
  • pain not relieved by position changes or pain meds
  • sometimes c/o pulse or throbbing or a mass in abdomen
33
Q

diagnostic evaluation of an Abdominal Aneurysms

A
  • *80% are palpated masses
  • auscultation of a bruit just above belly button
  • duplex US
  • CTA
34
Q

Medicational management of an abdominal aneurysm

A

anti HTN drugs to keep BP W/in normal limits

35
Q

surgical management for an abdominal aneurysm

A 
-surgical excision w/synthetic grafting (more than 2inches wide) 
Pre Op- assess for S/S of rupture 
-constant back pain or and. pain 
-shock, decreased BP, increased pulse  
-hematomas in the perineum, scrotum, penis 
-establish baseline data V/S 
Post Op- hemodynamic stability 
-BP 100/120 systolic 
-hydrated 
-good pulmonary hygiene 
-s/s of infections 
-assess for adequate UO
36
Q

causes of an Arterial Embolism

A
  • most commonly a thrombi in the heart
  • Atrial fib
  • MI
  • endocarditis
  • chronic CHF
37
Q

Most common sites of an arterial embolism

A 
***CVA-cerebral 
mesentric 
renal 
cornary MI 
large arteries of ext. femoral popliteal
38
Q

Clinical Manifestations of an Arterial Embolism 6 P’S

A
  1. Pain
  2. Pallor
  3. Pulselessness
  4. Paresthesia
  5. Paralysis
  6. Poikilothermic (cool ext.)
39
Q

Diagnostic test for Arterial Embolism

A
  • echocardiography
  • TEE
  • chest xray
  • EEG
  • doppler US
  • arteriography
40
Q

Surgical management for an Arterial Embolism Pre-Post Op

A

-excision and clot removal (Embolectomy)
Pre Op-
*bed rest, limb level or depended NO ELEVATION
*keep warm, protect from injury, use bed cradles, keep linen off legs and a pillow between the legs.
continuous drip of IV Heparin to prevent clot extension or new clots.
Post Op-
*continued Heparin drip and oral anti coagulants
*Coumadin beginning 3-5 days before Heparin is titrated off
sign of Heparin overdose (HEMATURIA 1ST SIGN)**
lab PTT =theraputic range: 1.5 - 2.5
****HEPARIN ANTIDOTE: PROTAMINE SULFATE
*do not take ASA,Advil,Motrin while on Coumadin with out consulting MD
periodic lab PT
*COUMADIN ANTIDOTE: VITAMIN K
*encourage movement
* assess for s/s of infection or bleeding

41
Q

medical management of Arterial Embolism

A

thrombolytic treatment if clot is small enough

42
Q

what is Raynaud’s disease?

A

Arterial vasoconstriction that results in coldness, pain and pallor of the finger tips (causes unknown) patients with this disease tends to have immunological disorders such as Lupus and Scleroderma.

  • 80% ARE WOMAN
  • rarely leads to necrosis but could become permanent
43
Q

Clinical Manifestations of Raynaud’s disease

A
  • hands and feet
  • pallor (vasoconstriction), then bluish skin (vasospasm- blood pooling of deoxygenated blood)
  • can be asymptomatic
  • *aching, throbbing, burning, at the end of the spasm**
  • symptoms are bilateral and symmetrical*
44
Q

Management of Raynaud’s diseases

A
  1. avoid triggers- stress cold (holding cold beverages)
  2. avoid smoking QUIT!
  3. warm clothes
45
Q

Mediation management of Raynaud’s disease

A

*severe cases
**VASODILIATERS CA+ CHANNEL BLOCKERS relax vascular smooth muscle and dilate blood vessels ==> lower BP.
NIFEDIPINE
AMLODIPINE
DILTIAZEM
VERAPAMIL
PROCARDIA

46
Q

NURSING EDUCATION OF PATIENTS WITH ARTERIAL DISEASE

A
  • lower extremities below heart level if arterial
  • moderate walking for circulation
  • keep rooms and ext. warm no heating blankets cause burns
  • QUIT SMOKING (constricts vessels, impairs tissue circulation, and delays wound healing)
  • stress relief techniques
  • teach patient not to cross legs or cut corns thats fucking nasty!
  • EVERYTHING LIKE PTS WITH DM SHOES , FEET CARE HYGIENE NO SCRATCHING EX..
47
Q

Clinical Manifestation of DVT

A

1/3 are asymptomatic
* swelling and edema due to the restricted outflow of blood
*skin warm, pink, superficial veins may become prominent
*tenderness due to inflammation
*calf pain with dorsiflexion (HOMANS SIGN)
NEVER PLAPATATE OR MASSAGE

48
Q

Patients at high risk for DVT

A
  • MI, CHF, Major surgery (hip, pelvic or CV)
  • note any pain
  • inspect for leg symmetry and circumference
  • warmth and erythema
49
Q

diagnostic test for DVT

A

venography

doppler US

50
Q

Prevention of DVT

A

*correct fitting AE hose
apply when patient is recumbent
remove hose 20-30min q shift (to inspect the skin and let it air out)
*Elevate feet and lower legs to promote venous return, active and passive exercise like calf pumping

51
Q

management of DVT

A

anticoagulants (do not dissolve clot)
Heparin/ Coumadin
thrombolytic tx usually reserved for arterial occlusion
thrombectomy -only when pt can’t take anticoagulants
chronic dvt implantation of an umbrella filter in the IVC

52
Q

Nursing care with patients with DVT

A 
BR with raised legs 
AE hose 
early ambulation no prolonged sitting 
bed exercise calf pumps 
kpad warm moist compression 
mild analgesics
53
Q

lymphangitis

A

acute inflammation of the lymphatic channels caused by an infection (usually an ext)

54
Q

lymphedema

A

increased quantity of lymph that results from obstruction of lymphatic vessels
primary- congenital
secondary- acquired

55
Q

management of lymphatic disorders

A 
goal: reduce and control the amount of edema and prevent infection 
external compression devices 
custom fitting compression stockings 
manual drainage 
elevation diuretic therapy 
surgical removal of tissue

Med Surg. 2 (2 decks)

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