vascular disorders - PAD Flashcards
Assessment of the Patient with Peripheral Vascular Problems (arms and legs)
Health history
Medications
Risk factors
Signs and symptoms of arterial insufficiency
Claudication and rest pain
Color changes
Weak or absent pulses
Skin changes and skin breakdown (pale or ruddy, shiny)
arterial sclerosis
arterial sclerosis = generic term for thickening of artery walls, usually associated with aging.
risk factors (the usual SOD for PAD)
diabetes (A1C), obesity (BMI), smoking or any vasoconstriction. stressors in life, activity,
clottication advances to
pain at rest, can they keep going or does it make them stop?
use a skin pen
to mark where a pulse is if it’s hard to find
grade the
pulse - 0 -4 0 = absent, 3+ is very strong, 4+ is bounding
Major goals include: (think venous and artery)
Increased arterial blood supply
Decrease in venous congestion
Promotion of vasodilatation and prevention of vascular compression
Relief of pain
Attainment/maintenance of tissue integrity
Adherence to the self-care program
if no venous congestion and it’s an arterial problem, you want to
lower the extremity. if it’s venous, elevate.
how to improve peripheral arterial circulation - position - below what?
body part below the heart
how to improve peripheral arterial circulation - exercise (can’t exercise on PADs)
walking, graded isometric exercises - consult doc before exercising
how to improve peripheral arterial circulation - temp
effects of heat and cold
how to improve peripheral arterial circulation - nicotine
discourage nicotine use
how to improve peripheral arterial circulation - stress
reduction
Aneurysms
thoracic, abdominal, other (don’t need to memorize all of them)
Arteriosclerosis
Hardening of the arteries
Diffuse process whereby the muscle fibers and the endothelial lining of the walls of small arteries and arterioles become thickened
Risk Factors for Atherosclerosis and PAD - traditional (nicotine diabetes, hyper and hyper, diet, stress, and the weird ones)
nicotine, diabetes, hypertension, hyperlipidemia, diet, stress, sedendtary, c-reative protein, hyperhomctyeinemia, age
Risk Factors for Atherosclerosis and PAD - non - traditional (SEE, PADs are non-traditional)
socioeconomic, environmental pollution, endothelial disease
PAD - how to reduce risk - the obvious one and blood sugar? (PADS should eat less than 7 sugars a day)
quit smoking, hgb A1C < 7.0% for diabetics,
PAD description (PADs keeping more and more narrow)
Involves progressive narrowing and degeneration of arteries of upper and lower extremities. it’s all of the arteries.
leading cause of PAD (athena causes pads)
Atherosclerosis is leading cause in majority cases
Patients with PAD are more likely to have what diseases? (CAD CAD and PAD are best friends)
coronary artery disease and/or cerebral artery disease
Symptoms of PAD occur when what % of vessels are blocked?
vessels are 60-75% blocked, usually not symptomatic until then.
PAD Typically appears at what age? (wear PADs from 60 - 80)
Typically appears at 60-80 years of age, getting younger and younger though.
is PAD easily diagnosed?
Largely underdiagnosed
Hallmark symptom of PAD is (wear PADs with your clauds)
intermittent claudication described as aching, cramping, or inducing fatigue or weakness
PAD symptoms
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
Ischemic rest pain is usually worse
at night and often wakes the patient
PAD symptoms
Thin, shiny and taut skin, Loss of hair on the lower legs, Diminished or absent pedal (need to use a doplar), popliteal, or femoral pulses, Pallor of foot with leg elevation, Reactive hyperemia of foot with dependent position
arterial - feet will look
pale when elevated and red when down
PAD clinical manifestations
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
meds for PAD (don’t really need to memorize these)
Phosphodiesterase III inhibitor
Cilostazol
Antiplatelet agents
Aspirin
Clopidogrel
Coumadin
Statins
Ace inhibitors
RAMIPRIL
Intermittent claudication:
Cilostazol (Pletal)
Pentooxifylline (Trental)
exercise PAD - and how often and minutes? (PADs keep me walkin)
Walking is most effective exercise for individuals with claudication - 30-45 minutes daily, 3 times/week
nutrition for PAD - and how low should fat be? (PAD fat before 7)
Nutritional therapy -78% of vascular surgical patients can be classified as malnourished
Low energy to metabolize, high protein, low in fat
DASH _fruits, vegetables, nuts and fiber, augmented by low sodium
Limit saturated fats to < 7% of total caloric intake, enjoy omega-3 fatty acids
Vitamin D can improve endothelial dysfunction
PAD complications - Critical limb ischemia (CLI) (PADS are critical if you need more than 2 weeks)
Characterized by rest pain lasting more than 2 weeks & or arterial leg ulcers or gangrene
PAD complications - atrophy
of the skin and underlying muscles
PAD complications - wounds
delayed wound healing, wound infection, tissue necrosis
PAD complications - arterial ulcers
Arterial ulcers and gangrene are most serious complications
May result in amputation if adequate blood flow is not restored or if severe infection
PAD diagnosis (need a PAD for my ankle bracelet)
doppler
angiography and MRI
duplex imaging - bidirectional color doppler
ankle-brachial index (ABI) = ABI - ankle BP/highest arm BP
PAD diagnosis
doppler
angiography and MRI
duplex imaging - bidirectional color doppler
ankle-brachial index (ABI) = ABI - ankle BP/highest arm BP
Continuous wave (CW) Doppler Ultrasound (continuous doppler is moving)
Handheld ultrasound device that detects blood flow, combined with ankle or arm pressures. Signals are reflected by the moving blood cells.
Interprofessional Care Leg with Critical Limb Ischemia (critical needs, by the stint, meds, or spinal cord)
Revascularization via bypass surgery, Percutaneous transluminal angioplasty (PTA) (putting a stint in), IV prostanoids (iloprost [Ventavis]), spinal cord stimulation, angiogenesis
Conservative Treatment for Care Leg with Critical Limb Ischemia
Protect form trauma
Decrease ischemic pain
Prevent/control infection
Improve arterial perfusion
Radiology Procedures - when is it necessary? (radiate my pain at rest)
Indications
Intermittent claudication symptoms become incapacitating
Pain at rest - this is when you do radiology procedures
Ulceration or gangrene severe enough to threaten viability of the limb
intra-radial PTA - inserted where? (fem at the PTA)
Involves insertion of a catheter through the femoral artery
Catheter contains a cyndrical balloon
Balloon is inflated dilating the vessel by compressing atherosclerotic intimal lining
Stent is placed
intra-radial - Atherectomy (athens is cutting edge)
Removal of obstructing plaque
Performed using a cutting disc, laser, or rotating diamond tip
intra-radial - Cryoplasty
Combines PTA and cold therapy
Liquid nitrous oxide
peripheral artery bipass (most common) (just a regular bypass) and what can be used with it?
Surgery with autogenous vein or synthetic graft to bypass blood around the lesion
PTA with stenting may also be used in combination with bypass surgery
endarectomy (the end is removal)
Opening artery and removing obstructing plaque
patch graft angioplasty - self explanatory
Opening artery, removing plaque, and sewing a patch to the opening to widen the lumen
amputation
Required if tissue necrosis is extensive, gangrene, or osteomyelitis develop, or all major arteries in limb are blocked
nursing management - Post procedure monitor (PADs don’t flex)
high risk for bleeding
VS
Operative site
CSM checks
Pain management
Avoid knee flexed position
Encourage ambulation
pain with arterial stuff?
Intermittent claudication to sharp, unrelenting, constant
type of pain you feel with venous (ACT with venous pain)
Aching, throbbing, cramping
pulses with with arterial stuff?
Diminished or absent
pulses with venous stuff?
Present, but may be difficult to palpate through edema
arterial ulcers - pain?
very painful
veinous ulcers - pain?
minimal to very painful
arterial ulcers - shape?
circular
veinous ulcers - shape?
irregular borders
ulcer colors - arterial (art has a black heart)
arterial - pale to black, wet and dry.
abdominal or iliac reduced flow - where would you feel pain? (where the iliac is…)
hip or buttocks
ankle-brachial index (ABI) - when to do it? (older pts get ankle bracelets)
systolic blood pressure in the ankle to the systolic blood pressure in the arm. do ABI if pt is 65 or older or decreased pulse.
CT scan (soft tissue is a cutie)
soft tissue, good for abdominal aorta. uses dye so watch the kidneys.
Arterial disorders cause what?
ischemia and tissue necrosis
Atherosclerotic lesions are of two types (Athens has fat and plaque)
fatty streaks and fibrous plaque
how to increase arterial supply
walking, stopping the constriction, dehydrated, oxygenated, and surgery
how to decrease venous congestion
elevate extremity and arteral blood supply can be increased
how to Promote of vasodilatation and prevention of vascular compression (tight will dilate)
no tight pants, ted hose
how to Attainment/maintenance of tissue integrity - just shower and lotion
shower and use lotion w/out a lot of water
ankle-brachial index (ABI) = how to do it?
highest ankle divided by highest arm
ABI - if doing walk test, systolic will drop if
pt has claudication.
how is PAD pain described? (aching all the time, I need a PAD)
as persistent, aching, or boring (rest pain)
how to reduce PAD - BP goal and what about cholesterol? (I need to get down to 140 PADs)
aggressive treatment for hyperlipidemia, bp < 140/90
continuous wave doppler does what?
helps characterize the nature of peripheral vascular disease
ulcer colors - venous
Granulation tissue—beefy red to yellow
arterial sclerosis - causes (art has plaque)
causes - calcified sclerosis, arterial - small arterioles get thick, LDL build up.
athlosclerosis
means to harden, LDL build up in arteriole wall
is athloslerosis a short or long process?
very slow process, usually starts in childhood.
Computed tomography angiography (CTA) provides what image? (computed the cross sectional)
cross-sectional image
after arterial vascular bypass graft, the nurse should monitor the pulse how often?
Peripheral pulses every 15 minutes after surgery
edema, brown pigmentation is venous or artery?
venous
elevational pallor is artery or vein?
artery
dissection of the aorta - what sensation? (rip van winkle the dissection)
ripping in the chest
BP goal for ppl with diabetes (diabetes have your fav number)
130/80
ventricular gallop is a sign of what?
heart failure
140 bpm on the monitor - monitor for what?
myocardial ischemia
ST-segment elevation requires what intervention?
cardiac catheterization
abrupt onset, abrupt cessation, and a QRS of normal duration
Paroxysmal atrial tachycardia
ventricular bigeminy cardiac rhythm
The rhythm has a normal beat, then a premature beat pattern
F waves represent what? (F for flutter)
The F waves are flutter waves representing atrial activity
frequent episodes of ventricular fibrillation - do what?
internal cardioverter defibrillator insertion
