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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
surgical management for PAD
1. excision and grafting (take out vessel and put a patch) 2. endarterectomy ( roter rooter baby bottle scrubber) 3. by-pass graft
26
POST op care of surgical management of PAD
* 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
What is an Aneurysm?
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
classification and location of an aneurysm (types)
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
Clinical Manifestations of Thoracic Aneurysms
- 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
diagnostic test for Thoracic Aneurysms
- chest xray - CTA w/contrast - fluoroscopy (xray guided w/device) - TEE * ****BRUIT-turbulent blood flow*****
31
management of thoracic aneurysms
surgical removal w/graft - strict CONTROL OF BP (hypertension will make it burst) - decrease force of cardiac contraction with BETA BLOCKERS
32
Clinical Manifestations of Abdominal Aneurysms
* 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
diagnostic evaluation of an Abdominal Aneurysms
* *80% are palpated masses - auscultation of a bruit just above belly button - duplex US - CTA
34
Medicational management of an abdominal aneurysm
anti HTN drugs to keep BP W/in normal limits
35
surgical management for an abdominal aneurysm
``` -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
causes of an Arterial Embolism
* **most commonly a thrombi in the heart** - Atrial fib - MI - endocarditis - chronic CHF
37
Most common sites of an arterial embolism
``` ***CVA-cerebral mesentric renal cornary MI large arteries of ext. femoral popliteal ```
38
Clinical Manifestations of an Arterial Embolism 6 P'S
1. Pain 2. Pallor 3. Pulselessness 4. Paresthesia 5. Paralysis 6. Poikilothermic (cool ext.)
39
Diagnostic test for Arterial Embolism
- echocardiography - TEE - chest xray - EEG - doppler US - arteriography
40
Surgical management for an Arterial Embolism Pre-Post Op
-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
medical management of Arterial Embolism
thrombolytic treatment if clot is small enough
42
what is Raynaud's disease?
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
Clinical Manifestations of Raynaud's disease
- 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
Management of Raynaud's diseases
1. avoid triggers- stress cold (holding cold beverages) 2. avoid smoking QUIT! 3. warm clothes
45
Mediation management of Raynaud's disease
*severe cases **VASODILIATERS CA+ CHANNEL BLOCKERS relax vascular smooth muscle and dilate blood vessels ==> lower BP. NIFEDIPINE AMLODIPINE DILTIAZEM VERAPAMIL PROCARDIA
46
NURSING EDUCATION OF PATIENTS WITH ARTERIAL DISEASE
* 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
Clinical Manifestation of DVT
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
Patients at high risk for DVT
- MI, CHF, Major surgery (hip, pelvic or CV) * note any pain * inspect for leg symmetry and circumference * warmth and erythema
49
diagnostic test for DVT
venography | doppler US
50
Prevention of DVT
*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
management of DVT
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
Nursing care with patients with DVT
``` BR with raised legs AE hose early ambulation no prolonged sitting bed exercise calf pumps kpad warm moist compression mild analgesics ```
53
lymphangitis
acute inflammation of the lymphatic channels caused by an infection (usually an ext)
54
lymphedema
increased quantity of lymph that results from obstruction of lymphatic vessels primary- congenital secondary- acquired
55
management of lymphatic disorders
``` 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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