vascular disorders - aorta Flashcards
aorta details
Largest artery in the body
Responsible for supplying oxygenated blood to essentially all viral organs
Branches include right and left common carotid, right and left subclavian, right and left coronary, brachiocephalic, celiac trunk, superior and inferior mesenteric, renal, gonadal, and common iliac
Most common vascular problems of aorta (3 of them)
Aneurysms
Aortoiliac occlusive disease
Aortic dissection
Aneurysms
Localized sac (outpouching) or dilation formed at a weak point in the wall of the artery
Aneurysms classified by (aneuysms shape ppl)
its shape or form
aneurysms increase with
age
AAA - where do they occur? And mostly below what arteries?
¾ occur in abdominal aorta
¼ occur in thoracic aorta
Most occur below renal arteries
The larger the aneurysm, the greater the risk
AAA patho (triple A is dilated)
Dilated aortic wall becomes lined with thrombi that can embolize
Leads to acute ischemic symptoms in distal branches
AAA causes (Triple a degrades from birth due to mechanics, trauma, inflammation or infection
Degenerative
Congenital
Mechanical
Penetrating or blunt trauma
Inflammatory
Infectious
AAA risk factors (triple A is male)
Age
Male gender
HTN
CAD
AAA clinical manifestations (opposite of what you think)
Often asymptomatic
Frequently detected during a routine physical exam or when patient is examined for an unrelated problem (KUB, abdominal CT scan)
AAA complications - rupture into retroperitoneal space
Bleeding may be tamponaded by surrounding structures, thus preventing exsanguination and death.
AAA xrays - chest (Triple A’s x-ray is wide)
Chest –demonstrate mediastinal silhouette and any abnormal widening of thoracic aorta
AAA ECG used to rule out what?
ECG to rule out MI
AAA echocardiography (triple A echoes in the valve)
Assists in diagnosis of aortic valve insufficiency
AAA ultrasonography monitors what? (ultra sound for baby’s size)
Useful in screening
Monitors size
AAA CT scan (Triple A needs a cutie for cross-section)
Most accurate to determine anterior-posterior length and cross-sectional diameter, presence of thrombus, type of surgery
AAA MRI (Mr, I need Triple A to locate the severity of the crash)
diagnose and assess location and severity
AAA angiography (Angie can provide valuable info to triple A)
Can provide accurate information about involvement of intestinal, renal or distal vessels
AAA If ruptured
emergent surgical intervention is required
90% mortality
AAA - pre op
Preop routines; bowel prep, NPO, shower. IV antibiotic (usually keflex) prior to incision
AAA Expectations after surgery - what meds? (Triple A before Beta B)
PACU, tubes, drains, ICU, beta blocker
AAA - Postoperative Nursing - how long in the ICU?
Postoperative Nursing
ICU monitoring 48 hours
AAA - Discharge teaching - what about ambulation?
Increase ambulation
No heavy lifting or staining
Teach about signs and symptoms of complications
Infection
Neurovascular changes
Venous thromboembolism (VTE) - where are they?
Venous thromboembolism (VTE) condition
Blood clots form in the deep veins of the leg,, groin or arm
Leg ulcers
Arterial
Venous
Mixed and other
varicose veins
valves give out, genetics and weight. painful.
venous disorders - Caused by Virchow’s triad (the end of virtue is hyper or stasis)
2/3 must be present
Endothelial injury
Venous Stasis
Hypercoagulability
venous stasis - causes (As you age with afib, HF, and obesity you become stasis)
Advanced age, a fib, chronic HF, obesity
endothelial damage - causes - what types of surgeries? (just stay around the abdomen)
Abdominal/pelvic surgery
hypercoagulability causes - what about thrombin?
Antithrombin II deficiency, smoking
DVT signs and symptoms (PEEW, it’s a DVT)
Erythema, edema, warmth
Pain
DVT complications
PE
Chronic venous insufficiency
Phlegmasia cerulea dolens (rare)
Swollen, blue, painful leg
labs for DVT (don’t forget on a dime)
Coags, platelets, H & H, d-dimer
tests for DVT (DVT tests are ultra Cuties, Mr)
ultrasound, CT Venography, MR Venography
DVT meds - anticoagulants (you know 2, and the 3rd?)
Heparin gtt, enoxaparin (Lovenox), Coumadin
DVT surgical treatment (DVTs can be removed or filtered)
Venous thrombectomy
Inferior vena cava (VC) filter
Filters clots
how to prevent DVT
early ambulation, leg exercises, graduated compression stockings, intermittent pneumatic compression devices, Subcutaneous heparin (unfractionated) LMWH
Fondaparinux, Lifestyle changes
Weight loss
Smoking cessation
Regular exercise
DVT nursing management
Pregnancy
Obesity
Central lines , PICC, PIV
highest risk for DVT
A 25-year-old patient with a central venous catheter in place to treat septicemia - it’s the sepsis
chronic veinous insufficiency - causes (chronic bad veins are from Valves, veins, birth or fists)
Damaged valves
Deep vein obstruction
Congenital venous malformation
AV fistula
chronic veinous insufficiency complications - just one, you know it.
ulcers
chronic veinous insufficiency - appearance (veins are itchy leather) Think of the patient
Brownish, leathery, itchy skin
chronic veinous insufficiency prevention (same as the others)
Avoid standing for prolonged periods
Use of compression stocking or TED hose
Ambulation/Exercise
Good skin care –inspection and moisturizer
Avoid trauma
chronic veinous insufficiency diet - think infection
Diet
Increase protein intake (if medically safe)
Vitamin A & C
Zinc
albumin is ok
chronic veinous insufficiency education - and what about extremities?
keep skin hydrated, don’t bump into anything, avoid standing for long periods, elevate the extremity, use compression if possible,
assessment of pt with leg ulcers
History of the condition
Assess pain, peripheral pulses, edema
Treatment depends on the type of ulcer
Assess for presence of infection
Assess nutrition
neurovascular assessment - 5 Ps
pain, pulse, pallor, paresthesia, paralysis
leg ulcer medical management - compression?
Anti-infective therapy depends on the infecting agent
Oral antibiotics are usually prescribed
Compression therapy
Debridement of wound
Dressings
Other
leg ulcer nursing interventions - avoid what?
Restoring skin integrity
Cleansing wound; positioning; avoiding trauma; avoid heat sources
leg ulcer nursing interventions - Improving physical mobility - can you walk?
Improving physical mobility
Physical activity initially restricted to promote healing; gradual progression of activity
Activity to promote blood flow; encourage patient to move about in bed and exercise upper extremities
Diversional activities
Analgesic agents before scheduled activities
leg ulcer nursing intervetions diet
Promoting adequate nutrition
Protein; Vitamins C and A; Iron; Zinc
buerger’s disease (burger smokes)
rare, progressive, inflammation and thrombus, almost only young men who smoke, toes and fingers turn blue symptoms include claudication, Raynaud’s , pain (often mistaken for joint/muscle pain
varicose vein prevention - how often to walk and elevate leg and compression stockings?
Avoid activities that cause venous stasis (wearing socks that are too tight at the top or that leave marks on the skin, crossing the legs at the thighs, and sitting or standing for long periods)
Elevate the legs 3 to 6 inches higher than heart level
Encourage to walk 30 minutes each day if there are no contraindications
Wear graduated compression stockings
Overweight patients should be encouraged to begin weight reduction plans
Lymphangitis - what causes it? (my gitis is obese)
inflammation or infection of the lymphatic channels - from surgery or obstruction, obese. painful. lymph fluid itself can get infected.
Lymphadenitis (the dentist inflames me)
inflammation or infection of the lymph nodes
Lymphedema - primary and secondary
tissue swelling related to obstruction of lymphatic flow
Primary: congenital
Secondary: acquired obstruction
promote lymphatic drainage by (nymphs fly high)
Constant elevation of the affected extremity
cellulitis
S&S: localized swelling or redness, fever, chills, sweating, pain
Treat with oral or IV antibiotics based on severity
cellulitis nursing management - leg position and warm packs? (cellulitis elevated me)
Mark the cellulitis with a skin pen and date and time, then take a photo as per your agency’s policy
Elevate affected area 3 to 6 inches above heart level
Warm, moist packs to site every 2 to 4 hours
Educate regarding prevention of recurrence
Reinforce education about skin and foot care
raynaud’s phenonmenon
Intermittent arterial vasoocclusion, usually of the fingertips or toes
AAA risk factors (Grandma, butter and pads are risky)
Family history
High cholesterol
Lower extremity PAD
AAA risk factors (Triple A in my carotid stroking me out)
Carotid artery disease
Previous stroke
Tobacco use
Being overweight or obese
AAA - May mimic pain associated with…
abdominal or back disorders
AAA - symptoms (Claud works for Triple A)
May cause back pain, epigastric discomfort, altered bowel elimination, intermittent claudication
AAA - blue toe syndrome (Triple A makes me blue, spontaeously blue)
May spontaneously embolize plaque causing “blue toe syndrome”
AAA rupture - symptoms
Severe back pain
May/may not have back/flank ecchymosis (Grey Turner’s sign)
AAA Rupture into thoracic or abdominal cavity
Massive hemorrhage
Most do not survive long enough to get to the hospital
AAA xrays - abdomen (Triple A has calcium on the xray)
Abdomen (KUB) =may show calcification within wall of AAA
AAA post op - what to monitor? (the usual)
Neuro, cardia, resp function, Renal GI
FEN (fluid electrolytes nutrition)
AAA post op - monitor graft for…
Pain control
Monitor graft patency
Infection
check LOC
types of venousthromboembolisms (the veins in my embolus are DVT, SVT, and PE)
DVT and PE
SVT (superficial vein)
causes of venousthromboembolisms (think venous, smoking and what else) cancers?
smoking, cancer, birth control, cancer in abdomen, ascities, liver disease
endothelial damage - IVs?
caustic IV meds
endothelial damage - fractures? (endothelial is down low)
pelvic, hip leg fractures
endothelial damage - history of…(the end of you)
history of previous VTE, PICC or central line, IVDU, trauma
hypercoaguability - (think thick blood)
dehydration, malnutrition, increased factor VIII or lipoprotein
hypercoagulability - HMOSS is hyper (Moss on a mountain)
high altitude, malignancies, oral contraceptives, sepsis, severe anemia
complications of DVT surgery (Davit has air when he migrates)
Air embolism, improper placement, filter migration , perforation of vena cava
DVT nursing management - No mechanical prophylaxis for…
those with skin breakdown or limb ischemia due to PVD
Contraindications for pharmacological DVT prophylaxis (think bleeding, that’s it)
Active or recent bleeding
Coagulopathy (INR > 1.5
Planned surgical procedure in next 6-12 hours
Thrombocytopenia (<50,000, sometimes < 100,000)
Bleeding disorders
varicose veins - use stockings?
yes
raynaud’s disease vs. raynaud’s syndrome (the disease is idiopathic)
Raynaud’s disease: primary or idiopathic
Raynaud’s syndrome: associated with other underlying disease such as scleroderma
raynaud’s symptoms - don’t forget tingling
Manifestations: sudden vasoconstriction results in color changes, numbness, tingling, and burning pain
raynaud’s brought on by what?
Episodes brought on by a trigger such as cold or stress
Occurs most frequently in young women
Protect from cold and other triggers. Avoid injury to hands and fingers
AAA - ambulate or not after surgery?
Increase ambulation, don’t strain or lift
venous stasis causes (this pregnancy and surgery are giving me static)
ortho surgery, pregnancy/postpartum, prolong immobility
venous stasis causes (Static when I stroke my hair with varicose veins)
stroke, varicose veins
chronic veinous insufficiency - where are ulcers located? Are they painful?
Ulcers usually above ankle
Ulcers are painful when swollen or infected
