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XIO > vascular disorders - PAD > Flashcards

vascular disorders - PAD Flashcards

1
Q

Assessment of the Patient with Peripheral Vascular Problems (arms and legs)

A

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)

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2
Q

arterial sclerosis

A

arterial sclerosis = generic term for thickening of artery walls, usually associated with aging.

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3
Q

risk factors (the usual SOD for PAD)

A

diabetes (A1C), obesity (BMI), smoking or any vasoconstriction. stressors in life, activity,

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4
Q

clottication advances to

A

pain at rest, can they keep going or does it make them stop?

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5
Q

use a skin pen

A

to mark where a pulse is if it’s hard to find

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6
Q

grade the

A

pulse - 0 -4 0 = absent, 3+ is very strong, 4+ is bounding

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7
Q

Major goals include: (think venous and artery)

A

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

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8
Q

if no venous congestion and it’s an arterial problem, you want to

A

lower the extremity. if it’s venous, elevate.

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9
Q

how to improve peripheral arterial circulation - position - below what?

A

body part below the heart

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10
Q

how to improve peripheral arterial circulation - exercise (can’t exercise on PADs)

A

walking, graded isometric exercises - consult doc before exercising

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11
Q

how to improve peripheral arterial circulation - temp

A

effects of heat and cold

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12
Q

how to improve peripheral arterial circulation - nicotine

A

discourage nicotine use

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13
Q

how to improve peripheral arterial circulation - stress

A

reduction

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14
Q

Aneurysms

A

thoracic, abdominal, other (don’t need to memorize all of them)

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15
Q

Arteriosclerosis

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

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16
Q

Risk Factors for Atherosclerosis and PAD - traditional (nicotine diabetes, hyper and hyper, diet, stress, and the weird ones)

A

nicotine, diabetes, hypertension, hyperlipidemia, diet, stress, sedendtary, c-reative protein, hyperhomctyeinemia, age

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17
Q

Risk Factors for Atherosclerosis and PAD - non - traditional (SEE, PADs are non-traditional)

A

socioeconomic, environmental pollution, endothelial disease

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18
Q

PAD - how to reduce risk - the obvious one and blood sugar? (PADS should eat less than 7 sugars a day)

A

quit smoking, hgb A1C < 7.0% for diabetics,

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19
Q

PAD description (PADs keeping more and more narrow)

A

Involves progressive narrowing and degeneration of arteries of upper and lower extremities. it’s all of the arteries.

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20
Q

leading cause of PAD (athena causes pads)

A

Atherosclerosis is leading cause in majority cases

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21
Q

Patients with PAD are more likely to have what diseases? (CAD CAD and PAD are best friends)

A

coronary artery disease and/or cerebral artery disease

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22
Q

Symptoms of PAD occur when what % of vessels are blocked?

A

vessels are 60-75% blocked, usually not symptomatic until then.

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23
Q

PAD Typically appears at what age? (wear PADs from 60 - 80)

A

Typically appears at 60-80 years of age, getting younger and younger though.

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24
Q

is PAD easily diagnosed?

A

Largely underdiagnosed

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25
Q

Hallmark symptom of PAD is (wear PADs with your clauds)

A

intermittent claudication described as aching, cramping, or inducing fatigue or weakness

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26
Q

PAD symptoms

A

Occurs with some degree of exercise or activity. Relieved with rest (usually 10 minutes or less) & is reproducible.

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27
Q

Pain is associated with

A

critical ischemia of the distal extremity

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28
Q

Ischemic rest pain is usually worse

A

at night and often wakes the patient

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29
Q

PAD symptoms

A

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

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30
Q

arterial - feet will look

A

pale when elevated and red when down

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31
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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32
Q

meds for PAD (don’t really need to memorize these)

A

Phosphodiesterase III inhibitor
Cilostazol
Antiplatelet agents
Aspirin
Clopidogrel
Coumadin
Statins
Ace inhibitors
RAMIPRIL

Intermittent claudication:
Cilostazol (Pletal)
Pentooxifylline (Trental)

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33
Q

exercise PAD - and how often and minutes? (PADs keep me walkin)

A

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

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34
Q

nutrition for PAD - and how low should fat be? (PAD fat before 7)

A

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

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35
Q

PAD complications - Critical limb ischemia (CLI) (PADS are critical if you need more than 2 weeks)

A

Characterized by rest pain lasting more than 2 weeks & or arterial leg ulcers or gangrene

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36
Q

PAD complications - atrophy

A

of the skin and underlying muscles

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37
Q

PAD complications - wounds

A

delayed wound healing, wound infection, tissue necrosis

38
Q

PAD complications - arterial ulcers

A

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

39
Q

PAD diagnosis (need a PAD for my ankle bracelet)

A

doppler
angiography and MRI
duplex imaging - bidirectional color doppler
ankle-brachial index (ABI) = ABI - ankle BP/highest arm BP

39
Q

PAD diagnosis

A

doppler
angiography and MRI
duplex imaging - bidirectional color doppler
ankle-brachial index (ABI) = ABI - ankle BP/highest arm BP

40
Q

Continuous wave (CW) Doppler Ultrasound (continuous doppler is moving)

A

Handheld ultrasound device that detects blood flow, combined with ankle or arm pressures. Signals are reflected by the moving blood cells.

41
Q

Interprofessional Care
 Leg with Critical Limb Ischemia (critical needs, by the stint, meds, or spinal cord)

A

Revascularization via bypass surgery, Percutaneous transluminal angioplasty (PTA) (putting a stint in), IV prostanoids (iloprost [Ventavis]), spinal cord stimulation, angiogenesis

42
Q

Conservative Treatment for Care
Leg with Critical Limb Ischemia

A

Protect form trauma
Decrease ischemic pain
Prevent/control infection
Improve arterial perfusion

43
Q

Radiology Procedures - when is it necessary? (radiate my pain at rest)

A

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

44
Q

intra-radial PTA - inserted where? (fem at the PTA)

A

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

45
Q

intra-radial - Atherectomy (athens is cutting edge)

A

Removal of obstructing plaque
Performed using a cutting disc, laser, or rotating diamond tip

46
Q

intra-radial - Cryoplasty

A

Combines PTA and cold therapy
Liquid nitrous oxide

47
Q

peripheral artery bipass (most common) (just a regular bypass) and what can be used with it?

A

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

48
Q

endarectomy (the end is removal)

A

Opening artery and removing obstructing plaque

49
Q

patch graft angioplasty - self explanatory

A

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

50
Q

amputation

A

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

51
Q

nursing management - Post procedure monitor (PADs don’t flex)

A

high risk for bleeding
VS
Operative site
CSM checks
Pain management
Avoid knee flexed position
Encourage ambulation

52
Q

pain with arterial stuff?

A

Intermittent claudication to sharp, unrelenting, constant

53
Q

type of pain you feel with venous (ACT with venous pain)

A

Aching, throbbing, cramping

54
Q

pulses with with arterial stuff?

A

Diminished or absent

55
Q

pulses with venous stuff?

A

Present, but may be difficult to palpate through edema

56
Q

arterial ulcers - pain?

A

very painful

57
Q

veinous ulcers - pain?

A

minimal to very painful

58
Q

arterial ulcers - shape?

A

circular

59
Q

veinous ulcers - shape?

A

irregular borders

60
Q

ulcer colors - arterial (art has a black heart)

A

arterial - pale to black, wet and dry.

61
Q

abdominal or iliac reduced flow - where would you feel pain? (where the iliac is…)

A

hip or buttocks

62
Q

ankle-brachial index (ABI) - when to do it? (older pts get ankle bracelets)

A

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.

63
Q

CT scan (soft tissue is a cutie)

A

soft tissue, good for abdominal aorta. uses dye so watch the kidneys.

64
Q

Arterial disorders cause what?

A

ischemia and tissue necrosis

65
Q

Atherosclerotic lesions are of two types (Athens has fat and plaque)

A

fatty streaks and fibrous plaque

66
Q

how to increase arterial supply

A

walking, stopping the constriction, dehydrated, oxygenated, and surgery

67
Q

how to decrease venous congestion

A

elevate extremity and arteral blood supply can be increased

68
Q

how to Promote of vasodilatation and prevention of vascular compression (tight will dilate)

A

no tight pants, ted hose

69
Q

how to Attainment/maintenance of tissue integrity - just shower and lotion

A

shower and use lotion w/out a lot of water

70
Q

ankle-brachial index (ABI) = how to do it?

A

highest ankle divided by highest arm

71
Q

ABI - if doing walk test, systolic will drop if

A

pt has claudication.

72
Q

how is PAD pain described? (aching all the time, I need a PAD)

A

as persistent, aching, or boring (rest pain)

73
Q

how to reduce PAD - BP goal and what about cholesterol? (I need to get down to 140 PADs)

A

aggressive treatment for hyperlipidemia, bp < 140/90

74
Q

continuous wave doppler does what?

A

helps characterize the nature of peripheral vascular disease

75
Q

ulcer colors - venous

A

Granulation tissue—beefy red to yellow

76
Q

arterial sclerosis - causes (art has plaque)

A

causes - calcified sclerosis, arterial - small arterioles get thick, LDL build up.

77
Q

athlosclerosis

A

means to harden, LDL build up in arteriole wall

78
Q

is athloslerosis a short or long process?

A

very slow process, usually starts in childhood.

79
Q

Computed tomography angiography (CTA) provides what image? (computed the cross sectional)

A

cross-sectional image

80
Q

after arterial vascular bypass graft, the nurse should monitor the pulse how often?

A

Peripheral pulses every 15 minutes after surgery

81
Q

edema, brown pigmentation is venous or artery?

A

venous

82
Q

elevational pallor is artery or vein?

A

artery

83
Q

dissection of the aorta - what sensation? (rip van winkle the dissection)

A

ripping in the chest

84
Q

BP goal for ppl with diabetes (diabetes have your fav number)

A

130/80

85
Q

ventricular gallop is a sign of what?

A

heart failure

86
Q

140 bpm on the monitor - monitor for what?

A

myocardial ischemia

87
Q

ST-segment elevation requires what intervention?

A

cardiac catheterization

88
Q

abrupt onset, abrupt cessation, and a QRS of normal duration

A

Paroxysmal atrial tachycardia

89
Q

ventricular bigeminy cardiac rhythm

A

The rhythm has a normal beat, then a premature beat pattern

90
Q

F waves represent what? (F for flutter)

A

The F waves are flutter waves representing atrial activity

91
Q

frequent episodes of ventricular fibrillation - do what?

A

internal cardioverter defibrillator insertion

XIO (372 decks)

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