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Med-Surg > Vascular disorders chapter 26 > Flashcards

Vascular disorders chapter 26 Flashcards

1
Q

List arterial disorders?

A
  • Arteriosclerosis and atherosclerosis
  • Peripheral artery disease
  • Upper extremity arterial disease
  • Aortoiliac disease: Aortoiliac occlusive disease is a type of artery condition in the legs. It occurs when the iliac artery that brings blood to your legs becomes narrow or blocked by plaque.
  • Aneurysms (thoracic, abdominal, other)
  • Aortic dissection
  • Arterial embolism and arterial thrombosis
  • Raynaud’s phenomenon and other acrosyndromes
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2
Q

Arteriosclerosis? Think !!!! thickening

A
  • Hardening of the arteries
  • Diffuse process whereby the muscle fibers and the endothelial lining of the walls of small arteries and arterioles become thickened. Most of it has to do with aging.
    It happens because:
    1) There is calcium that sticks to the arterioles
    2) They become thick
    3)LDL particles build on your arteries.
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3
Q

Atherosclerosis? Atheromas = plaques (Not thick but hardening)

A

Different processes, affecting the intima of large and medium-sized arteries
Accumulation of lipids, calcium, blood components, carbohydrates, and fibrous tissue on the intimal layer of the artery
Atheromas or plaques.
A very slow process, It can start when you are a child as soon as 10 years of age.
-The problem here is not only the buildup of plaque but it is also the inflammation that narrows, even more, the walls of those arteries.

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4
Q

Risk Factors for Atherosclerosis and PAD (Peripheral artery disease)

A

Traditional Risks :
Nicotine use
Hyperlipidemia
Diet
Stress
Sedentary lifestyle
C-reactive protein (
High levels of CRP may mean you have a serious health condition that causes inflammation)
(Hyperhomocysteinemia)
Age

Non-Traditional Risks:

  • Socioeconomic status
  • Diabetes
  • Environmental pollution
  • Hypertension
  • Endothelial disease

Female specific-preeclampsia (a condition in pregnancy characterized by high blood pressure, sometimes with fluid retention and proteinuria.) & menopause

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5
Q

PAD Risk Modification:

A
  • Tobacco cessation
  • Hgb A1C <7.0% for diabetics and you want it under 7%. This is because if we just do a regular fasting blood check it might give us a false negative. Diabetes damages arteries especially the small ones.
  • Aggressive treatment of hyperlipidemia: Diet, weight loss, medications.
  • BP maintained <140/90.
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6
Q

PAD Description

A
  • Involves progressive narrowing and degeneration of arteries of upper and lower extremities
  • Atherosclerosis is the leading cause in the majority of cases.
  • Patients with PAD are more likely to have coronary artery disease and/or cerebral artery disease
  • Symptoms occur when vessels are 60-75% blocked
  • Typically appears at 60-80 years of age
  • Largely underdiagnosed
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7
Q

PAD Clinical Manifestations?

A

Pain at rest:
- As PAD progresses
- Occurs in feet or toes
- Aggravated by limb elevation
- Occurs from insufficient blood flow
- Occurs more often at night

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8
Q

Pharmacologic Therapy for PAD

A

1) Phosphodiesterase III inhibitor
- Cilostazol
2) Antiplatelet agents
- Aspirin
- Clopidogrel (Plavix)
- Coumadin (Warfarin)
3) Statins for cholesterol
4) Ace inhibitors
5) RAMIPRIL
6) For Intermittent claudication
- Cilostazol (Pletal)
- Pentooxifylline (Trental)

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9
Q

Exercise & Nutritional Therapy for PAD

A

Walking is most effective exercise for individuals with claudication
30-45 minutes daily, 3 times/week

Nutritional therapy -78% of vascular surgical patients can be classified as malnourished.
What we want are foods that take little energy to metabolize but are high in protein, and low in fat.
DASH diet: fruits, vegetables, nuts, and fiber, augmented by low sodium
Limit saturated fats to < 7% of total caloric intake but they can enjoy omega-3 fatty acids
Vitamin D can improve endothelial dysfunction

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10
Q

PAD Complications?

A

Critical limb ischemia (CLI). Because if we are ischemic it’s going to turn into tissue necrosis. We can lose the limb.
**Characterized by rest pain lasting more than 2 weeks & or arterial leg ulcers or gangrene

-Atrophy of the skin and underlying muscles because they are not getting O2 and their toxins can’t get removed because the highway is closed.
-Delayed wound healing. No nutrients and oxygen
-Wound infection and then we get arterial ulcers. They look round.
-Tissue necrosis

Arterial ulcers:
**Arterial ulcers and gangrene are the most serious complications
**May result in amputation if adequate blood flow is not restored or if severe infection

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11
Q

PAD diagnostic studies : Ankle-brachial index (ABI) no need to memorize numbers.

A

NORMAL 0.9-1.3
ABI =ankle BP/highest arm BP

The ankle-brachial index, or ABI, is a simple test that compares the blood pressure in the upper and lower limbs. Health care providers calculate ABI by dividing the blood pressure in an artery of the ankle by the blood pressure in an artery of the arm.

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12
Q

PAD Diagnostic Studies?

A

-Doppler ultrasound (if you can’t feel the pulse)
-Angiography and MRI
Duplex imaging
Bidirectional, color -Doppler
-Ankle-brachial index (ABI)
NORMAL 0.9-1.3
ABI =ankle BP/highest arm BP

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13
Q

Continuous wave (CW) Doppler Ultrasound?

A

-Handheld ultrasound device that detects blood flow, combined with computation of ankle or arm pressures
-Signals are reflected by the moving blood cells
-Diagnostic technique helps characterize the nature of the peripheral vascular disease

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14
Q

PAD Interprofessional CareLeg with Critical Limb Ischemia?

A

-Revascularization via bypass surgery. By bypassing the obstruction.
-Percutaneous transluminal angioplasty (PTA) We insert a catheter and we dilate the vessel and put a stent to keep it open. (side note: it can cause DVT)
woooooooooooooooyayyyeyeyeyeyeyey
-IV prostanoids (iloprost [Ventavis])
-Spinal cord stimulation
-Angiogenesis

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15
Q

PAD Interprofessional CareLeg with Critical Limb Ischemia 2

A

Conservative Treatment:

-Protect from trauma: Because if they don’t have a good blood supply and they get an injury it’s gonna be hard for them to heal.
-Decrease ischemic pain: since the nerves are not getting O2 they die and that causes us to have pain.
-Prevent/control infection/ the same as with a wound not easy to heal because if the highway is closed our macrophages etc can’t come to rescue
-Improve arterial perfusion

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16
Q

PAD Interprofessional CareInterventional Radiology Procedures 3

A

Indications: We start doing radiology procedures when :

-Intermittent claudication symptoms become incapacitating. Meaning that they fuck your quality of life a lot.
-Pain at rest
-Ulceration or gangrene severe enough to threaten the viability f the limb

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17
Q

IR Procedures (Interventional radiology)

A

PTA: (Percutaneous Transluminal Angioplasty)
Involves insertion of a catheter through the femoral artery
Catheter contains a cylindrical balloon
Balloon is inflated dilating he vessel by compressing the atherosclerotic intimal lining
Stent is placed

Atherectomy: arthero=plaque
Removal of obstructing plaque
Performed using a cutting disc, laser, or rotating diamond tip

Cryoplasty:
Combines PTA and cold therapy (applying extreme cold to kill or dissolve something)
Liquid nitrous oxide to remove the plaque

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18
Q

IR Procedures 1 PTA para desbloquear

A

PTA: (Percutaneous Transluminal Angioplasty)

  • Involves insertion of a catheter through the femoral artery
  • Catheter contains a cyndrical balloon
  • Balloon is inflated dilating he vessel by compressing atherosclerotic intimal lining
  • Stent is placed
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19
Q

IR Procedures 2 Atherectomy. Remember athero= plaque

A
  • Removal of obstructing plaque
  • Performed using a cutting disc, laser, or rotating diamond tip
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20
Q

IR Procedures 3 Cryoplasty

A

Cryoplasty
- Combines PTA and cold therapy
- Liquid nitrous oxide
Cryoplasty is a minimally invasive treatment used for patients with peripheral vascular disease. It is an alternative to traditional angioplasty and stenting techniques.

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21
Q

Surgical Therapy PAD. Peripheral artery bypass (most common surgical approach)

A
  • Surgery with autogenous (arising from within or from a thing itself.
    ) vein or synthetic graft to bypass blood around the lesion
  • PTA with stenting may also be used in combination with bypass surgery
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22
Q

Surgical Therapy PAD Endarterectomy

A

Opening artery and removing obstructing plaque

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23
Q

Surgical Therapy PAD. Patch graft angioplasty

A

Opening artery, removing plaque, and sewing a patch to the opening to widen the lumen

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24
Q

Surgical Therapy PAD Amputation

A

Required if tissue necrosis is extensive, gangrene, or osteomyelitis develop, or all major arteries in limb are blocked

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25
Q

PAD Nursing Management. Post-procedure monitor: IT CAN BE bypass, amputation etc…

A

Post procedure monitor:
- VS: because you are going to maintain thier BP. There is gonna be bleeding here.
- Operative site
- CSM checks (Circulation, Sensation, Motion). You don’t want to flex anything.
- Pain management
- Avoid knee flexed position (to allow blood circulation)
- Encourage ambulation like after any other surgery.

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26
Q

Disorders of the Aorta?

A
  • Largest artery in the body
  • Responsible for supplying oxygenated blood to essentially all vital 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
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27
Q

Disorders of the Aorta 2?

A

Most common vascular problems of the aorta:

  • Aneurysms (aneurysms and dissections are hard to survive)
  • Aortoiliac occlusive disease
  • Aortic dissection
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28
Q

Aneurysms definition?

A
  • Localized sac (outpouching) or dilation formed at a weak point in the wall of the artery. The bigger the blood the bigger amount of blood that is gonna be sequestered and the worse the severity.
  • Classified by its shape or form
  • Incidence increases with age. Because of the wear and tear of the arteries. It makes sense.
  • Most common forms of aneurysms are saccular and fusiform:
    ***Saccular aneurysm projects from only one side of the vessel

***When an entire arterial segment becomes dilated, a fusiform aneurysm develops. Both sides and it looks like a balloon.

***Pseudoaneurysm is a disruption of all layers of the arterial wall resulting in bleeding contained by surrounding structures

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29
Q

AAA (abdominal aortic aneurysm) Causes?

A

Degenerative
Congenital
Mechanical
Penetrating or blunt trauma
Inflammatory
Infectious

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30
Q

AAA (abdominal aortic aneurysm) Risk factors?

A

Age
Male gender
HTN
CAD
Family history
High cholesterol
Lower extremity PAD
Carotid artery disease
Previous stroke
Tobacco use
Being overweight or obese

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31
Q

AAA Clinical Manifestations?

A

-Often asymptomatic
-Frequently detected during a routine physical exam or when the patient is examined for an unrelated problem (KUB, abdominal CT scan)
-May mimic the pain associated with abdominal or back disorders
-May cause back pain, epigastric discomfort, altered bowel elimination, intermittent claudication
-May spontaneously embolize plaque causing “blue toe syndrome”

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32
Q

AAA Complications?

A

1) Rupture into retroperitoneal (situated or occurring behind the peritoneum) space:
- Bleeding may be tamponaded (stopped) by surrounding structures, thus preventing exsanguination and death.
- Severe back pain
- May/may not have back/flank ecchymosis (Bruise)(Grey Turner’s sign)

2) Rupture into the thoracic or abdominal cavity
- Massive hemorrhage
- Most do not survive long enough to get to the hospital

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33
Q

AAADiagnostics

A

Check slide 38

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34
Q

AAA Interprofessional Care?

A
  • If ruptured, emergent surgical intervention is required
    90% mortality
  • Preoperative Nursing
  • Brief expiation of disease process
  • Planned surgical procedure
  • Preop routines; bowel prep, NPO, shower
  • IV antibiotic prior to incision
  • Expectations after surgery
    **PACU, tubes, drains, ICU, beta blocker
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35
Q

AAA Interprofessional Care. Postoperative Nursing

A

1) ICU monitoring 48 hours
Neuro, cardia, resp function, Renal GI
FEN
Pain control
Monitor graft patency
Infection
Increase ambulation

2) Discharge teaching
Increase ambulation
No heavy lifting or staining
Teach about signs and symptoms of complications
Infection
Neurovascular changes

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36
Q

Venous Disorders?

A

1) Venous thromboembolism: There are usually deep and superficial ones. We are worried about the deep ones. Leg mainly but also in the groin or arm.
(VTE) condition:
- Blood clots form in the deep veins of the leg, groin, or arm.
- DVT and PE
- SVT (superficial vein thrombosis
2) Chronic venous insufficiency/post-thrombotic syndrome
3) Leg ulcers
-Arterial
-Venous
-Mixed and other
4) Varicose veins from standing for a long time.

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37
Q

Venous Disorders. What conditions must be present.

A

Caused by Virchow’s triad
2/3 must be present:
- Endothelial injury
- Venous Stasis: It can be from dehydration. Obstruction of blood flow
- Hypercoagulability from cancer, pregnancy etc …

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38
Q

Venous stasis?

A

Advanced age, a fib, chronic HF, obesity, ortho surgery, pregnancy/postpartum, prolonged immobility, stroke, varicose veins

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39
Q

Endothelial damage?

A

Abdominal/pelvic surgery, caustic IV meds, pelvic, hip leg fracturs, history of previous VTE, PICC or central line, IVDU, trauma

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40
Q

Hypercoagulability?

A

Antithrombin II deficiency, smoking, dehydration, malnutrition, increased factor VIII or lipoprotein, high altitude, malignancies, oral contraceptives, sepsis, severe anemia

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41
Q

Venous Thromboembolism

A

Pathophysiology
Risk factors
Endothelial damage
Venous stasis
Altered coagulation
Manifestations
Deep veins
Superficial veins

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42
Q

DVTManifestationsS/Sx & Complications

A
  • S/Sx
    Erythema (means redness), edema, warmth
    Pain
  • +Homans sign
  • Complications
    PE
    Chronic venous insufficiency
    Phlegmasia cerulea dolens (very rare)
    Swollen, blue, painful leg
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43
Q

DVT Diagnostics

A

Labs
Coags (google), platelets, H & H, d-dimer
Ultrasound
CT Venography
MR Venography

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44
Q

DVT Treatment?

A

1) Anticoagulation
Heparin bolus or drip gtt, enoxaparin (Lovenox), Coumadin

2)Surgical treatment
Venous thrombectomy
Inferior vena cava (VC) filter
Filters clots
Complications can include:
Air embolism, improper placement, filter migration, perforation of vena cava

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45
Q

DVT Preventive Measures

A
  • Early ambulation and leg exercises
  • Graduated compression stockings
  • Intermittent pneumatic compression devices
  • Subcutaneous heparin (unfractionated) (LMWH: low molecular weight heparin)
    Fondaparinux
  • Lifestyle changes
    Weight loss
    Smoking cessation
    Regular exercise
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46
Q

DVT Nursing Management

A

Considerations: Be alert for:

  • Pregnancy
  • Obesity
  • Central lines , PICC, PIV ()
  • No mechanical prophylaxis for those with skin breakdown or limb ischemia due to PVD
    Contraindications for pharmacological DVT prophylaxis :
    **Actie or recent bleeding
    **    Coagulopathy (INR > 1.5
    **Planned surgical procedure in next 6-12 hours
    **    Thrombocytopenia (<50,000, sometimes < 100,000)
    ***Bleeding disorders
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47
Q

Chronic Venous Insufficiency Etiology

A

Damaged valves of the veins that stop the blood from backing up)
Deep vein obstruction (deep in the middle of the tube that is the leg as opposed to superficial veins)
Congenital venous malformation
AV fistula (AV) fistula is an irregular connection between an artery and a vein.)

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48
Q

Chronic Venous Insufficiency Etiology

A

Damaged valves
Deep vein obstruction (vs superficial)
Congenital venous malformation
AV fistula (artery attaches to vein)

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49
Q

Chronic Venous Insufficiency Complications

A

Ulcers

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50
Q

Chronic Venous Insufficiency Manifestations

A
  • Brownish, leathery, itchy skin
  • Ulcers usually above the ankle it makes sense because if the blood can’t go back to the heart ut causes it to back up in the feet due to gravity daaaaa then the pressure of all that fluid pushes against the skin and causes an ulcer.
  • Ulcers are painful when swollen or infected
51
Q

Chronic Venous Insufficiency Nursing Management

A

1) Education
2) Prevention
- Avoid standing for prolonged periods
- Use of compression stocking or TED hose
(a type of socks)
- Ambulation/Exercise
- Good skin care –inspection and moisturizer
- Avoid trauma (to avoid infection)
3) Diet
- Increase protein intake/ high-calorie (if medically safe)
- Vitamin A & C
- Zinc

52
Q

Assessment of the Patient with Leg Ulcers can be due to PAD Or PVD (venous not vessel because vessel applies to both )

A
  • History of the condition
  • Assess pain, peripheral pulses, edema
  • Treatment depends on the type of ulcer
  • Assess for presence of infection
  • Assess nutrition
53
Q

Assessment of the Patient with Leg Ulcers

A
  • History of the condition
  • Assess pain, peripheral pulses, edema
  • Treatment depends on the type of ulcer
  • Assess for presence of infection
  • Assess nutrition
54
Q
A
55
Q
A
56
Q

Medical Management of the Patient with Leg Ulcers

A
  • Anti-infective therapy depends on the infecting agent
    ***Oral antibiotics are usually prescribed (BECAUSE it is an opening and an opening can be a port of entry)
  • Compression therapy
  • Debridement of wound
  • Dressings
  • Other
57
Q

Nursing Interventions for the Patient with Leg Ulcers

A
  • Restoring skin integrity
    **Cleansing wound; positioning; avoiding trauma; avoid heat sources
  • Improving physical mobility
    **Physical activity initially restricted to promote healing; gradual progression of activity
    **Activity to promote blood flow; encourage the patient to move about in bed and exercise upper extremities
    **Diversional activities
    **Analgesic agents before scheduled activities (walking or dressing changes) at least 30 min before.
  • Promoting adequate nutrition
    **Protein; Vitamins C and A; Iron; Zinc
58
Q

Buerger disease? It almost only happens in younger men that smoke!!!

A

Rare, progressiveCharacterized by inflammation and thrombus that block blood flow in the upper & lower extremities arms, feetSymptoms include claudication, Raynaud’s pain (often mistaken for joint/muscle pain) (If you have Raynaud’s phenomenon, your hands may change colour in cold weather and there may be pain, tingling and numbness. These attacks often only last a few minutes, but they can last two to three hours. You may find that moving into a warmer environment often stops the attack.)

59
Q

Varicose Veins Prevention (From standing too much)

A
  • 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 the 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
60
Q

Lymphatic Disorders

A
  • Lymphangitis: inflammation or infection of the lymphatic channels
  • Lymphadenitis: inflammation or infection of the lymph nodes (endodentist abcess highland)
  • Lymphedema: tissue swelling related to obstruction of lymphatic flow
    **Primary: congenital
    **Secondary: acquired obstruction
61
Q

Cellulitis?

A
  • S&S: localized swelling or redness, fever, chills, sweating, pain
  • Treat with oral or IV antibiotics based on severity
  • Nursing:
    **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 (can help to reduce swelling and speed healing.)
    **Warm, moist packs to site every 2 to 4 hours
    **Educate regarding prevention of recurrence
    **Reinforce education about skin and foot care
62
Q

Raynaud’s Phenomenon

A

1) Intermittent arterial vasoocclusion, usually of the fingertips or toes
**Raynaud’s disease: primary or idiopathic
**Raynaud’s syndrome: associated with other underlying disease such as scleroderma

2) Manifestations: sudden vasoconstriction results in color changes, numbness, tingling, and burning pain
3) Episodes brought on by a trigger such as cold or stress
4) Occurs most frequently in young women
5) Protect from cold and other triggers.
Avoid injury to hands and fingers

63
Q

why does PAD cause pain?

A

The pain is caused by too little blood flow to the legs or arms. Claudication is usually a symptom of peripheral artery disease, in which the arteries that supply blood to the arms or legs, usually the legs, are narrowed. The narrowing is usually due to a buildup of fatty deposits (plaques) on the artery walls.

64
Q

Statins PAD

A

Statins are a group of medicines that can help lower the level of low-density lipoprotein (LDL) cholesterol in the blood. LDL cholesterol is often referred to as “bad cholesterol”, and statins reduce the production of it inside the liver.

65
Q

What does a Doppler ultrasound do?

A

A Doppler ultrasound is a noninvasive test that can be used to estimate the blood flow through your blood vessels by bouncing high-frequency sound waves (ultrasound) off circulating red blood cells. A regular ultrasound uses sound waves to produce images, but can’t show blood flow.

66
Q

What is a PTA? Percutaneous transluminal angioplasty (PTA)

A

What is a PTA? Percutaneous transluminal angioplasty (PTA) is a procedure that can open up a blocked blood vessel using a small, flexible plastic tube, or catheter, with a “balloon” at the end of it

67
Q

A stent ?

A

A stent is a short, wire mesh tube that acts like a scaffold to help keep your artery open

68
Q

Warfarin (brand names Coumadin and Jantoven)

A

Warfarin (brand names Coumadin and Jantoven) is a prescription medication used to prevent harmful blood clots from forming or growing larger. Beneficial blood clots prevent or stop bleeding, but harmful blood clots can cause a stroke, heart attack, deep vein thrombosis, or pulmonary embolism.

69
Q

A pulmonary embolism?

A

A pulmonary embolism occurs when a clump of material, most often a blood clot, gets stuck in an artery in the lungs, blocking the flow of blood
When a pulmonary embolism happens, a blockage in any of the arteries leads to a decrease in blood flow to lung tissue downstream.

The majority of the time, this blockage is caused by a broken off piece of a blood clot commonly associated with deep vein thrombosis.

A deep vein thrombosis most commonly develops in the lower legs, below the knee, although a blood clot can form in both superficial and deep veins and also in other parts of the body as well.

70
Q

Venous Stasis?

A

It’s also known as chronic venous stasis. Chronic venous insufficiency, or CVI, is a condition in which veins have problems moving blood back to the heart.

71
Q

Hypercoagulability?

A

Hypercoagulability can be defined as the tendency to have thrombosis as a result of certain inherited and/or acquired molecular defects. Clinical manifestations of hypercoagulability can be devastating and even lethal.

72
Q

Erythema?

A

superficial reddening of the skin

73
Q

+Homans sign? 3ndou les tires chabin

A

Homans’s sign is often used in the diagnosis of deep venous thrombosis of the leg. A positive Homans’s sign (calf pain at dorsiflexion of the foot) is thought to be associated with the presence of thrombosis

74
Q

anticoagulant vs antiplatelet?

A

There are different types of blood thinners: Anticoagulants, such as heparin or warfarin (also called Coumadin), slow down your body’s process of the blood cells sticking to themselves and therefore prevent clots. Antiplatelets, such as aspirin and clopidogrel, prevent blood cells called platelets (usually come together when there is injury but inflammation due to HBP/artherosclerosis etc.. or anything else can mimic this)from clumping together to form a clot.

75
Q

why do Chronic Venous Insufficiency cause ulcers?

A

Blood then pools in your lower legs, causing your legs to swell. Since the blood can’t flow well in your legs, the swelling may be extreme. This extreme swelling can put so much pressure on your skin that venous ulcers form. Una herida desde fuera hacia dentro por la presion que el edema ejerce en las venas.

76
Q

What is paresthesia?

A

sthesia= sensacion !! Paresthesia refers to a burning or prickling sensation that is usually felt in the hands, arms, legs, or feet, but can also occur in other parts of the body

77
Q

Intermittent claudication? indicates?

A

Arterial

78
Q

No edema

A

arterial

79
Q

no pulse weak pulse no drainage

A

arterial

80
Q

Round smooth sores

A

arterial

81
Q

black eschar

A

arterial

82
Q

Location of sores feet and toes

A

arterial

83
Q

Antiplatles plavix (clodiprogrel)

A

arterial

84
Q

dull achy pain ?

A

venous

85
Q

lower leg edema

A

venous

86
Q

pulse present drainage

A

venous

87
Q

sores with irregular borders

A

venous

88
Q

Yellow slough or ruddy skin

A

venous

89
Q

Location of sores ankles

A

venous

90
Q

Cool foot touch

A

arterial

91
Q

Cellulitis definition ?

A

is a common bacterial skin infection that causes redness, swelling, and pain in the infected area of the skin.

92
Q

why does varicose increase in pregnancy?

A

Varicose veins aren’t exclusive to pregnancy, but pregnancy can signal their arrival — or make them worse. The reason: during pregnancy, the blood volume in the body increases by as much as 20 percent, while the number of veins remains the same, meaning more work for the body’s vascular system.

93
Q

A tourniquet?

A

A tourniquet’s primary purpose is to stop life-threatening external bleeding,

94
Q

What is the most common cause of venous ulcers?

A

The cause of venous ulcers is high pressure in the veins of the lower leg. The veins have one-way valves that keep blood flowing up toward your heart. When these valves become weak or the veins become scarred and blocked, blood can flow backward and pool in your legs. This is called venous insufficiency.

A venous leg ulcer is the most common type of leg ulcer, accounting for more than 60% of all cases. Venous leg ulcers can develop after a minor injury, if persistently high pressure in the veins of the legs has weakened the skin.

95
Q

Lymphangitis definition? not Octavia’s

A

Lymphangitis is an acute inflammation of the lymphatic channels caused by an infectious process.Antibiotics are always a component of treatment
Lymphangitis is inflammation of lymphatic channels due to infectious or noninfectious causes. Potential pathogens include bacteria, mycobacteria, viruses, fungi, and parasites.

96
Q

Lymphadenitis? piensa diente

A

Lymphadenitis is the medical term for enlargement in one or more lymph nodes, usually due to infection.

97
Q

Lymphedema?

A

Lymphedema: tissue swelling related to obstruction of lymphatic flow
Primary: congenital
Secondary: acquired obstruction

98
Q

Assessment of the Patient with Peripheral Vascular Problems History:

A

-We want to know how they have been feeling
-What is their diet like?

99
Q

Assessment of the Patient with Peripheral Vascular where do we focus?

A

Arms and legs.

100
Q

Assessment of the Patient with Peripheral Vascular problems assessment.

A
  • Health history
  • Medications: Are they medications for hypertension, is it working? Is it available to them? How does it make them feel? Are they gonna be adherent to something that makes them feel terrible?
  • Risk factors: Diabetes, obesity, smoking, and anything that is going to cause vasoconstriction.
  • Signs and symptoms of arterial insufficiency: decreased pulses, changing colors
  • Claudication and rest pain
  • Color changes
  • Weak or absent pulses at extremities. We use a doppler if we can’t hear it. Grade the pulse from 0 to 4. A normal pulse being +2.
  • Skin changes and skin breakdown
101
Q

How can we help someone with a vascular disorder? I mean what are the planning and Goals for the Patient with Peripheral Vascular Problems?

A

Major goals include:
- Increased arterial blood supply: This can be done by walking, medical management, and being hydrated and well-oxygenated.
- Decrease in venous congestion because it doesn’t go back to the heart it will affect the arterial blood supply.
- Promotion of vasodilatation and prevention of vascular compression, so nothing like tight pants, etc… Bending an extremity at a certain angle.
- Relief of pain: We usually use narcotics, and non-steroidal anti-inflammatories because this is an inflammatory process as well (Remember).
- Attainment/maintenance of tissue integrity
- Adherence to the self-care program: whatever program they have.

102
Q

Peripheral Artery Disease (PAD)

A
  • The hallmark symptom is intermittent claudication (pain) described as aching, cramping, or inducing fatigue or weakness
  • Occurs with some degree of exercise or activity
  • Relieved with rest (usually 10 minutes or less) & is reproducible
  • Pain is associated with critical ischemia of the distal extremity and is described as persistent, aching, or boring (rest pain). Basically, it starts as a pain that only happens when you do some activities and then it progresses to resting pain. meaning that even if you are resting it’s gonna hurt you.
  • Ischemic rest pain is usually worse at night and often wakes the patient. This is because the pt is horizontal instead of hanging down. So there is no help from gravity to perfuse those distal areas. So they have to wake up and walk around to relive the pain.
103
Q

Why is there pain with PAD?

A

Because there is no O2 and nerve endings are dying.

104
Q

PAD Clinical Manifestations 2.0

A
  • Thin, shiny(With PAD, your blood circulation is impaired. The oxygen-rich blood from your heart must pass through narrowed arteries, making the flow of blood slow and inefficient. Shiny skin is known as a “trophic change” and is a form of atrophy or a sign of skin deterioration due to lack of blood flow.), and taut skin (Taut is an adjective that describes skin that is stretched tight, without wrinkles or sagging. Taut skin is not the same as tight skin, as the words “tight skin” imply a dry, uncomfortable tightness.)
  • Loss of hair on the lower legs
  • Diminished or absent pedal (You need a doppler to confirm this), popliteal, or femoral pulses
  • Pallor of the foot with leg elevation
  • Reactive hyperemia of the foot with dependent position
105
Q

How does diabetes cause people PETER to lose a limb when they get an injury?

A

Excess blood sugar decreases the elasticity of blood vessels and causes them to narrow, impeding blood flow. This can lead to a reduced supply of blood and oxygen, increasing the risk of high blood pressure and damage to large and small blood vessels.
So basically if you get a wound on your foot and it’s not getting blood supply with nutrients macrophages etc to heal. It’s going to become necrotic and you might get an amputation.

106
Q

Abdominal Aortic Aneurysms(AAA)

A

¾ occur in the abdominal aorta
¼ occur in the thoracic aorta
Most occur below renal arteries. Which is good news.
The larger the aneurysm, the greater the risk
Etiology and Pathophysiology:

The dilated aortic wall becomes lined with thrombi (clots) that can embolize because of the turbulence and change in blood flow. These clots that form can rupture and go to the distal arteries and this leads to acute ischemic symptoms in the distal branches because they stop blood flow.

107
Q

Deep vs superficial thrombosis?

A

Superficial vein thrombosis (SVT) refers to a blood clot in a vein near the surface, deep vein thrombosis (DVT) is a clot in a deep vein in the body, usually in the leg. Superficial vein thrombosis can present as pain and inflammation while deep clots can travel to the lungs and cause a pulmonary embolism.
Deep vein thrombosis (DVT) is a condition in which a blood clot develops in the deep veins, most commonly in the lower extremities. A pulmonary embolism occurs when a part of the clot breaks off and travels to the lungs, a potential life threat. Venous thromboembolism (VTE) refers to DVT, PE, or both.

108
Q

Why and how does a catheter (or central venous catheter) cause a DVT?

A

Intravenous catheters cause endothelial trauma and inflammation and are often placed in patients who are hypercoagulable, leading to venous thrombosis. The majority (70 to 80 percent) of thrombotic events occurring in the superficial and deep veins of the upper extremity are due to intravenous catheters.
DVT occurs in the deeper veins of the arm, typically above the elbow, and in the large internal jugular vein in the neck. Any time a needle or catheter is put into a vein, the vein wall may become irritated or inflamed, which may lead to the development of small blood clots.

109
Q

Why does venous insufficiency cause ulcers?

A

Blood then pools in your lower legs, causing your legs to swell. Since the blood can’t flow well in your legs, the swelling may be extreme. This extreme swelling can put so much pressure on your skin that venous ulcers form.

110
Q

PVD also PAD but don’t confuse with PVD

A

1 Peripheral vascular disease (could be any vassel)
2 Peripheral artery disease
3 Peripheral venous disease

111
Q

Every-time a word or a test has the word ultrasound in it ?

A

It’s like CPMC. It’s a non invasive procedure to visualize something inside the body.

112
Q

TRanslumina
Percutaneous

A

trans ——luminal
Per——–cutaneous

113
Q

The reason you dont feel your feet with ischemia ?

A

The arteries supplying the legs are the most commonly affected vessels in peripheral vascular disease. When less blood gets to the muscle tissue in the legs, the tissue receives less oxygen and becomes ischemic. Ischemic cells release adenosine, a type of signaling molecule, which is thought to affect nerves in these areas; this is felt as pain. This pain in the legs is often referred to as claudication.

114
Q

Lymphatic system of tubes and nodes

A

Lymph nodes filter substances that travel through the lymphatic fluid, and they contain lymphocytes (white blood cells) that help the body fight infection and disease. There are hundreds of lymph nodes found throughout the body. They are connected to one another by lymph vessels.

115
Q
A

cellulitis is a deeper bacterial skin infection involving the deeper dermis and subcutaneous tissues by normal bacteria that lives in our skin that is not supposed to be there. Risk factors that can allow these bacteria to invade the skin include having previous damage due to insect bites, minor trauma, abrasions, or skin conditions like eczema, as well as previous skin infections like impetigo or a history of cellulitis.

116
Q

Scleroderma?

A

Scleroderma is a connective tissue disease characterized by chronic inflammation, sclerosis, and fibrosis of the skin, blood vessels, and internal organs. T

117
Q

Plasty?

A

act or process of forming

118
Q

catheter?

A

Tube fih neboula

119
Q

blood with o2 in the arteries looks more red than blood without o2 in the veins

A

this is what causes the blue color in cyanosis or any other decoloration of blood

120
Q

why pallor ?

A

When a person appears pale, it may be because there is not enough oxygen-rich hemoglobin near the skin’s surface.

121
Q

Why is dvt and svt more common after surgury? I mean 70 to 80 % of them happen in a hospital after the insertion of a catheter (or central venous catheter)

A

Because if you get something inserted in your vein it hurts the walls of the vessel and the rest is history inflammation clot etc

Any time a needle or catheter is put into a vein, the vein wall may become irritated or inflamed, which may lead to the development of small blood clots.

122
Q

Spinal cord stimulation used in PAD? why?

A

When you turn the SCS on, it SCS stimulates the nerves in the area where you feel your pain. This stimulation provides PAD treatment by reducing the pain. The electrical pulses mask and modify the pain signal. It keeps the pain signals from reaching your brain

123
Q

Raynauds phenomenon?

A

Raynaud’s phenomenon is a form of intermittent arteriolar vasoconstriction resulting in inadequate tissue perfusion. This results in coldness, pain, and pallor of the fingertips or toes. Pain is typically intermittent and acute, not chronic, and skin integrity is rarely at risk. In most cases, the patient is not at high risk for injury.

Med-Surg (7 decks)

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