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Nursing > Vascular Disorders/ Peripheral Circulation > Flashcards

Vascular Disorders/ Peripheral Circulation Flashcards

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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
Q

Saccular Aneurysm

A

projects from one side of the vessel only

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26
Q

Fusiform Aneurysm

A

the entire arterial segment becomes dilated

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27
Q

Abdominal Aortic Aneurysm (AAA)

A
  • Unknown cause, but atherosclerosis contributes
  • Most are asymptomatic and found on routine exam
  • can rupture leading to hemorrhage and death
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28
Q

Aneurysm Patho

A

The degradation of the medial elastin fibers and collagen leads to weakening and dilation of the aorta and the development of the aneurysm

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29
Q

At what rate does an aneurysm grow?

A

0.3-0.4 cm/ year

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30
Q

Risk Factors for Aneurysm

A 
Age (>50)
Male
Tobacco use
Family history
hypertension
Atherosclerotic disease
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31
Q

Aneurysm S/S

A
  • usually asymptomatic

- Patients may complain “I can feel my heart beating in my abdomen”

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32
Q

Impending Rupture

A
  • severe back or abdominal pain
  • falling blood pressure
  • decreased hematocrit
  • *Surgical repair is their ONLY chance to live
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33
Q

What are 2 signs to look for with a ruptured aneurysm?

A

Cullen Sign and Grey Turner Sign

34
Q

Cullen Sign

A

bluish to purplish periumbilical discoloration

35
Q

Grey Turner Sign

A

flank discoloration

36
Q

What are the most important indications of an AAA?

A
  • Pulsatile mass in the abdomen
  • a bruit may be heard over the mass
  • US/CT used to determine size, length, and location
37
Q

At what size does an AAA require surgery?

A

ANY AAA > 5.5 cm or one that is continuously growing

38
Q

Post Op care for AAA

A
  • frequent vitals
  • I&O
  • neurovascular assessment of lower extremities
  • bed rest
  • monitor for bleeding
  • maintain IV’s
  • assess all possible complications
39
Q

Venous Thrombosis (DVT)

A
  • 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
Q

Virchow Triad

A
  • Three factors considered to be the cause of DVT
    1. Stasis of blood
    2. Vessel wall injury
    3. Altered Coagulation
41
Q

What can cause stasis of blood?

A

immobility, obesity, paralysis, recent surgery, varicose veins

42
Q

What can cause Vessel Wall injury?

A

trauma, fractures, vascular devices, IV meds, cancer therapies

43
Q

What can cause Altered Coagulation?

A

estrogen-containing oral contraceptives, smoking, late pregnancy

44
Q

S/S of DVT

A
  • Phlegmasia cerulea dolens (massive iliofemoral venous thrombosis)
  • Edema of the extremity
  • Pain/ tenderness
45
Q

Phlegmasia Cerulea Dolens

Massive iliofemoral venous thrombosis

A

Entire extremity becomes massively swollen, painful, arterial ischemia (bluish color), and potential loss of distal pulses

46
Q

S/S and Nursing Care of Phlegmasia Cerulea Dolens

A
  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
Q

Preventions for Phlegmasia Cerulea Dolens

A
  • Elastic compression hose/ stockings
  • Body positioning
  • Exercise
  • Intermittent pneumatic compression hose
  • anticoagulant medication
48
Q

Objectives for DVT

A
  • prevent the thrombus from growing and fragmenting

- prevent recurrent thromboemboli

49
Q

Will anticoagulant therapy dissolve a clot that has already formed? (Heparin)

A

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
Q

Subcutaneous Heparin (LMWH)

A
  • 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
Q

IV Heparin

A
  • immediate anticoagulant effect
  • ALWAYS put on a pump
  • dosage is based on patient’s weight and possible bleeding tendencies
  • too much = hemorrhaging
52
Q

Coagulation Tests for Heparin

A
  • 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
Q

What is the NORMAL aPTT level?

A

21-35 seconds

54
Q

Warfarin (Coumadin)

A
  • 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
Q

Target INR

A

depends on why the person is being anticoagulated

56
Q

Normal INR

A

approximately 1

57
Q

Thrombolytic Therapy

A

“Clot Busters”

  • lyses and dissolves thrombi
  • increase in bleeding complications
  • reserved for patients w/ life threatening limb ischemia
  • if bleeding occurs DISCONTINUE
58
Q

When can a patient NOT receive thrombolytic therapy?

A
  • if they are bleeding
  • had a stroke
  • pregnant
  • GI ulcer
  • Surgery in the last 2 weeks
  • hypertension
59
Q

What are early signs of spontaneous bleeding in the body?

A

bruises, nosebleeds, bleeding gums, hematuria

60
Q

What is often the first sign of excessive dosage of an anticoagulant?

A

bleeding from the kidneys

61
Q

What would a nurse use as an antidote for heparin? What are some risks?

A

Protamine Sulfate

-bradycardia and hypotension (minimized by slow administration)

62
Q

What would a nurse use as an antidote for warfarin (coumadin)?

A
  • Vitamin K
  • Infusion of fresh frozen plasma
  • Prothrombin concentrate
63
Q

Heparin Induced Thrombocytopenia (HIT)

A

sudden decrease in the platelet count by at least 30% of baseline levels in patients receiving heparin

64
Q

Normal Platelet Count

A

150,000-400,000

65
Q

A patient with a platelet count of less than 20,000 could be experiencing what?

A

spontaneous bleeding

66
Q

A platelet count of less than 10,000 may result in what?

A

intracranial hemorrhage

67
Q

Varicose Veins

A

abnormally dilated, tortuous, superficial veins caused by incompetent venous valves
-most likely to occur in lower extremities

68
Q

What are risk factors for Varicose Veins?

A
  • more common in women
  • occupations that require long periods of standing
  • hereditary
  • pregnancy
69
Q

S/S of Varicose veins (if present)

A
  • dull aches
  • muscle cramps
  • increased muscle fatigue
  • ankle edema
  • feeling of heaviness in legs
  • pigmentation changes
  • ulcers
70
Q

Varicose Veins Prevention

A
  • 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
Q

What are treatment options for Varicose Veins?

A
  • Ligation/ Stripping
  • Ablation
  • Sclerotherapy
72
Q

Ligation and Stripping

A
  • veins must be patent and functional
  • the saphenous vein is ligated and divided
  • pressure and elevation minimize bleeding during surgery
  • *Less common
73
Q

Ablation

A

-nonsurgical approach using thermal energy to close the vein

74
Q

Sclerotherapy

A

injection of an irritating chemical into a vein to produce localized phlebitis and fibrosis, thereby obliterating the lumen in the vein

75
Q

Post Procedure Care for Varicose Veins

A
  • encourage ambulation
  • TED hose may be worn
  • Leg exercises
  • AVOID jogging and hard impact exercises
  • Analgesics
76
Q

Lymphedema and Elephantiasis

A

tissue swelling occurs in the extremities b/c of an increased quantity of lymph that results from obstruction of lymphatic vessels

77
Q

What happens with edema during Lymphedema/ Elephantiasis?

A

Initially edema is soft and pitting, but as the condition progresses it becomes firm, nonpitting, and less responsive to treatment

78
Q

What can happen with chronic swelling with a patient who has Lymphedema/ Elephantiasis?

A
  • frequent bouts of acute infection

- can lead to chronic fibrosis, thickening of sub q tissues, and hypertrophy of the skin

79
Q

Elephantiasis

A

the condition in which chronic swelling of the extremity recedes only slightly with elevation

80
Q

What is the treatment plan for Lymphedema/ Elephantiasis?

A
  • focus on reducing edema and preventing increasing edema, infections, and tissue damage
  • comprehensive decongestive therapy
  • avoid breaks in skin
  • antibiotics
  • patient education
81
Q

What should the nurse include in the education of a patient with lymphedema/ elephantiasis?

A
  • 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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