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Vascular Disorders/ Peripheral Circulation Flashcards

1
Q

Name the 3 classifications of Vascular System disorders

A

Arterial, venous, and lymphatic

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2
Q

Arterial Disorders

A

Arteries may become DAMAGED of OBSTRUCTED as a result of atherosclerotic plaque, thromboemboli, chemical/mechanical trauma, infections, or congenital malformations

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3
Q

Sudden Arterial Disorders

A

result in irreversible tissue ischemia

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4
Q

Gradual Arterial Disease

A

less risk of tissue death due to collateral circulation, but overtime ischemia and tissue death may occur

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5
Q

Collateral Circulation

A

rerouting of blood vessels

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6
Q

Peripheral Arterial Disease (PAD)

A
  • any disease process that affects the arteries
  • results in ischemia
  • legs most affected
  • increased mortality, MI, and cerebrovascular disease
  • patients are initially asymptomatic
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7
Q

PAD Signs and Symptoms

A

hair loss, dry skin, skeletal muscle atrophy, skin pallor, diminished/absent pulses, cool extremities, paresthesia, numbness, tingling, edema, ulcers

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8
Q

PAD Pathophysiology

A

as the lumen narrows and blood flow decreases, ischemia occurs, progressing to infarction in the distal tissues

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9
Q

PAD Modifiable Risk Factors

A

diet, obesity, smoking, stress, lack of exercise

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10
Q

Non-modifiable Risk Factors

A

age, race, diseases such as hypertension and diabetes

Other:hyperhomocysteinema

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11
Q

PAD Critical Limb Ischemia (CLI)

A

chronic ischemic pain at rest, nonhealing ulcers, or gangrene
-infection can progress to amputation

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12
Q

Acute Limb Ischemia (ALI)

A

sudden decrease in limb perfusion either thrombosis or embolism that may threaten limb viability

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13
Q

Signs and symptoms of ALI

6 P’s

A
  1. Pain (severe stabbing, shooting, or burning)
  2. Pallor
  3. Pulselessness
  4. Poikilothermia (cool temperature to palpation)
  5. Paresthesia (numbness, tingling)
  6. Paralysis
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14
Q

What peripheral pulses should an RN check for PAD?

A

popliteal artery, dorsalis pedis artery, and posterior tibial artery

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15
Q

What diagnostics tests may be used for PAD?

A

doppler ultrasound flow studies, CTA, MRA, Angiography

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16
Q

Doppler Ultrasound Flow Studies

A

Evaluates arterial signals, BP measurement in the limbs, asses vessel size, presence of thrombus, and valve function

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17
Q

Computed Tomography Angiography (CTA)

A

Demonstrates cross sectional image of soft tissues

Diagnosis abdominal aneurysms, graft infections, occlusions, and hemorrhage

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18
Q

Magnetic Resonance Angiography (MRA)

A

Detection of changes, aneurysm, DVT

**useful in poor kidney function or contrast agent allergy

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19
Q

Angiography

A

Gold Standard
conformation of occlusive arterial disease when considering interventions
- watch for iodine allergies

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20
Q

What are the goals for PAD?

A
  • reduce the risk of life threatening complications of atherosclerosis
  • improve walking distance
  • salvage the limb
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21
Q

Raynaud’s Disease/ Phenomenon

A

vasospasm that occurs with cold or stress

  • unknown cause
  • Women 16-40+ years
  • Associated with immunologic disorders, scleroderma, and SLE
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22
Q

Signs and Symptoms of Raynaud’s Disease

A
  • skin becomes cyanotic due to vasospasm, then vasodilation causes redness
  • Numbness, tingling, and burning pain
  • Fingers and toes may be cool during attacks and may perspire excessively
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23
Q

What should patients do for Raynaud’s Disease?

A
  • avoid stimuli that causes vasoconstriction
  • dress warmly, wear gloves or mittens
  • avoid tobacco
  • educate on the use of calcium-channel blockers
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24
Q

Aneurysm

A

a localized outpouching, sac, or dilation formed at a weak point in the arterial wall

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25
Saccular Aneurysm
projects from one side of the vessel only
26
Fusiform Aneurysm
the entire arterial segment becomes dilated
27
Abdominal Aortic Aneurysm (AAA)
- Unknown cause, but atherosclerosis contributes - Most are asymptomatic and found on routine exam - can rupture leading to hemorrhage and death
28
Aneurysm Patho
The degradation of the medial elastin fibers and collagen leads to weakening and dilation of the aorta and the development of the aneurysm
29
At what rate does an aneurysm grow?
0.3-0.4 cm/ year
30
Risk Factors for Aneurysm
``` Age (>50) Male Tobacco use Family history hypertension Atherosclerotic disease ```
31
Aneurysm S/S
- usually asymptomatic | - Patients may complain "I can feel my heart beating in my abdomen"
32
Impending Rupture
- severe back or abdominal pain - falling blood pressure - decreased hematocrit * *Surgical repair is their ONLY chance to live
33
What are 2 signs to look for with a ruptured aneurysm?
Cullen Sign and Grey Turner Sign
34
Cullen Sign
bluish to purplish periumbilical discoloration
35
Grey Turner Sign
flank discoloration
36
What are the most important indications of an AAA?
- Pulsatile mass in the abdomen - a bruit may be heard over the mass - US/CT used to determine size, length, and location
37
At what size does an AAA require surgery?
ANY AAA > 5.5 cm or one that is continuously growing
38
Post Op care for AAA
- frequent vitals - I&O - neurovascular assessment of lower extremities - bed rest - monitor for bleeding - maintain IV's - assess all possible complications
39
Venous Thrombosis (DVT)
- often the source of a pulmonary embolism - can occur spontaneously or with an elevated venous pressure (person stands suddenly or engages in activity after prolonged inactivity)
40
Virchow Triad
* Three factors considered to be the cause of DVT 1. Stasis of blood 2. Vessel wall injury 3. Altered Coagulation
41
What can cause stasis of blood?
immobility, obesity, paralysis, recent surgery, varicose veins
42
What can cause Vessel Wall injury?
trauma, fractures, vascular devices, IV meds, cancer therapies
43
What can cause Altered Coagulation?
estrogen-containing oral contraceptives, smoking, late pregnancy
44
S/S of DVT
- Phlegmasia cerulea dolens (massive iliofemoral venous thrombosis) - Edema of the extremity - Pain/ tenderness
45
Phlegmasia Cerulea Dolens | Massive iliofemoral venous thrombosis
Entire extremity becomes massively swollen, painful, arterial ischemia (bluish color), and potential loss of distal pulses
46
S/S and Nursing Care of Phlegmasia Cerulea Dolens
1. Edema- check leg circumference bilaterally ankle to thigh 2. Tenderness- gently palpate area 3. Positive Homan's Sign- pain in calf after foot is sharply dorsiflexed 4. Pain/ tenderness- elevate extremity, bedrest, analgesics 5. Fever- assess for increasing temp
47
Preventions for Phlegmasia Cerulea Dolens
- Elastic compression hose/ stockings - Body positioning - Exercise - Intermittent pneumatic compression hose - anticoagulant medication
48
Objectives for DVT
- prevent the thrombus from growing and fragmenting | - prevent recurrent thromboemboli
49
Will anticoagulant therapy dissolve a clot that has already formed? (Heparin)
No, is will not dissolve a clot already formed - it is effective prophylaxis - It will prevent the extension of a thrombus and the development of new thrombi
50
Subcutaneous Heparin (LMWH)
- lower half life so given 1-2 sq inj/day - fewer bleeding complications - decreased risk for HIT - used cautiously in patients with renal impairment - safe to give pregnant women
51
IV Heparin
- immediate anticoagulant effect - ALWAYS put on a pump - dosage is based on patient's weight and possible bleeding tendencies - too much = hemorrhaging
52
Coagulation Tests for Heparin
- effective/therapeutic range when activated partial thromboplastin time (aPTT) is 1.5-2.5 times the baseline control - if PTT is < 100 seconds the risk for hemorrhage is SIGNIFICANT - measure 6 hours after therapy has started
53
What is the NORMAL aPTT level?
21-35 seconds
54
Warfarin (Coumadin)
- oral anticoagulant - administered at the same time as heparin - takes 3-5 days to achieve therapeutic effect - International Normalizing Ratio (INR) must be measured (levels b/t 2-3)
55
Target INR
depends on why the person is being anticoagulated
56
Normal INR
approximately 1
57
Thrombolytic Therapy
"Clot Busters" - lyses and dissolves thrombi - increase in bleeding complications - reserved for patients w/ life threatening limb ischemia - if bleeding occurs DISCONTINUE
58
When can a patient NOT receive thrombolytic therapy?
- if they are bleeding - had a stroke - pregnant - GI ulcer - Surgery in the last 2 weeks - hypertension
59
What are early signs of spontaneous bleeding in the body?
bruises, nosebleeds, bleeding gums, hematuria
60
What is often the first sign of excessive dosage of an anticoagulant?
bleeding from the kidneys
61
What would a nurse use as an antidote for heparin? What are some risks?
Protamine Sulfate | -bradycardia and hypotension (minimized by slow administration)
62
What would a nurse use as an antidote for warfarin (coumadin)?
- Vitamin K - Infusion of fresh frozen plasma - Prothrombin concentrate
63
Heparin Induced Thrombocytopenia (HIT)
sudden decrease in the platelet count by at least 30% of baseline levels in patients receiving heparin
64
Normal Platelet Count
150,000-400,000
65
A patient with a platelet count of less than 20,000 could be experiencing what?
spontaneous bleeding
66
A platelet count of less than 10,000 may result in what?
intracranial hemorrhage
67
Varicose Veins
abnormally dilated, tortuous, superficial veins caused by incompetent venous valves -most likely to occur in lower extremities
68
What are risk factors for Varicose Veins?
- more common in women - occupations that require long periods of standing - hereditary - pregnancy
69
S/S of Varicose veins (if present)
- dull aches - muscle cramps - increased muscle fatigue - ankle edema - feeling of heaviness in legs - pigmentation changes - ulcers
70
Varicose Veins Prevention
- avoid activities that increase venous hypertension (crossing legs, standing long periods) - change positions frequently; elevate legs - encourage walking daily - weight reduction diet in overweight patients
71
What are treatment options for Varicose Veins?
- Ligation/ Stripping - Ablation - Sclerotherapy
72
Ligation and Stripping
- veins must be patent and functional - the saphenous vein is ligated and divided - pressure and elevation minimize bleeding during surgery * *Less common
73
Ablation
-nonsurgical approach using thermal energy to close the vein
74
Sclerotherapy
injection of an irritating chemical into a vein to produce localized phlebitis and fibrosis, thereby obliterating the lumen in the vein
75
Post Procedure Care for Varicose Veins
- encourage ambulation - TED hose may be worn - Leg exercises - AVOID jogging and hard impact exercises - Analgesics
76
Lymphedema and Elephantiasis
tissue swelling occurs in the extremities b/c of an increased quantity of lymph that results from obstruction of lymphatic vessels
77
What happens with edema during Lymphedema/ Elephantiasis?
Initially edema is soft and pitting, but as the condition progresses it becomes firm, nonpitting, and less responsive to treatment
78
What can happen with chronic swelling with a patient who has Lymphedema/ Elephantiasis?
- frequent bouts of acute infection | - can lead to chronic fibrosis, thickening of sub q tissues, and hypertrophy of the skin
79
Elephantiasis
the condition in which chronic swelling of the extremity recedes only slightly with elevation
80
What is the treatment plan for Lymphedema/ Elephantiasis?
- focus on reducing edema and preventing increasing edema, infections, and tissue damage - comprehensive decongestive therapy - avoid breaks in skin - antibiotics - patient education
81
What should the nurse include in the education of a patient with lymphedema/ elephantiasis?
- keep skin clean and dry - wear compression support garments - AVOID BP cuffs, needle sticks, injections in affected limb - AVOID tight clothing - AVOID trauma (pet scratches, rashes, cracks in skin) - clean cuts and insect bites - ELEVATE AFFECTED LIMB as much as possible

Nursing (21 decks)

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