Vascular Disorders Flashcards
What is the range for a normal Elevated Hypertension?
Systolic = 120-129 mmHg
Diastolic = < 80 mmHg
What range is Hypertension Stage 1?
Systolic = 130-139 mmHg
Diastolic = 80-89 mmHg
What range is Hypertension Stage 2?
Systolic = Greater than or equal to 140 mmHg
Diastolic = Greater than or equal to 90 mmHg
In order to stage hypertension, how many readings does there need to be?
2 or more elevated readings, on both arms, on 2 separate occasions
Are there Cultural or Gender differences with Hypertension?
Yes
What is the difference between Primary and Secondary Hypertension?
Primary has no cause
Secondary has a specific cause
Between men and women, which one has a greater risk of being Hypertensive from an earlier age?
Men
A person’s DBP will typically increase until what age?
55 Years Old
A person’s DBP will typically do what once they get 55 Years Old?
Start Declining
Between African Americans and White Americans, which one is more at risk of Hypertension?
African Americans
What is Prehypertension?
The stage between a Normal BP and Hypertension
What is considered to be the range for Prehypertension?
A SBP of 121 - 139 mmHg
A DBP of 81 - 89 mmHg
What are some of the older terms for Primary Hypertension?
Essential Hypertension + Essential Hypertension
Primary makes up what % of Hypertension cases of all Hypertension?
90 - 95%
Even though we don’t know the cause of Primary Hypertension, we do know the contributors, such as-
Increased Sodium Intake + Overweight + Diabetes mellitus + Excessive Alcohol
What are potential causes of Secondary Hypertension?
Pregnancy, Meds, Renal Disease, Estrogen Therapy, etc.
Risk factors for Primary Hypertension =
Age + Cigarette Smoking + Alcohol + Obesity + Excessive Sodium + Increased Triglycerides / Cholesterol + Sedentary Lifestyle + Stress + Diabetes mellitus + Family History + Ethnicity + Socioeconomic Status + Family History
What are the Clinical Manifestations of Hypertension?
Asymptomatic until Organ Damage (Due to the Heart’s increased workload)
Fatigue + Decreased Activity Tolerance + Dyspnea + Angina + Dizziness
What does Target Organ Damage (TOD) mean?
Damage to the body’s main organs (Heart, Brain, Kidneys, Eyes, etc.)
What are the symptoms of the TOD that occurs due to Hypertension?
Coronary Artery Disease (CAD) + Left Ventricular Hypertrophy (LVH) + Heart Failure + TIA’s & Strokes + Peripheral Vascular Disease (PVD) + Nepherosclerosis + Retinal Damage
What are the most common complications of Hypertension?
Target Organ Diseases
The exact mechanism of this disease is unknown, but it causes stiffened arterial walls with narrowed lumens. Leads to Angina and an MI =
Coronary Artery Disease
What is Left Ventricular Hypertrophy?
When an increased workload on the left ventricle causes it to become enlarged
This is what it’s called whenever the heart finally gives out. There’s decreased contractility, stroke volume, and CO =
Heart Failure
What is one thing that Atherosclerosis sped up by?
Hypertension
Atherosclerosis is the number 1 cause of-
Cerebrovascular Accident (CVA)
What’s a major risk of Atherosclerosis?
Hypertension
What’s the number 1 cause of a CVA occurring in Hypertensive pt’s?
Noncompliance to Meds
Why is a noncompliance with meds so common with Hypertension?
Hypertension can be asymptomatic until it’s a big issue, the meds for treatment do have side effects and are expensive
What’s a leading cause of End-Stage Kidney Disease?
Hypertension
What is Kidney Disease a direct result of?
Ischemia
How does Hypertension cause Ischemia?
By narrowing the Lumens of Arterioles
What does Kidney Disease result in?
Damaged Glomeruli and the death of Nephrons
What blood study results are a sign of Kidney Disease?
The presence of Microalbuminuria + Proteinuria + Elevated BUN/Creatine
This is commonly the first sign of Kidney Disease =
Nocturia
What’s the only place in the body that we can actually directly visualize the blood vessels?
The Retina
Damage here is a good indicator of damage in the vessels of the heart, etc. =
Retina
If Retinal damage has occurred, what symptoms may the pt have?
Blurred Vision OR Loss of Vision + Retinal Hemorrhage
What lifestyle modifications can help treat Hypertension?
Weight Reduction + Decrease Sodium Intake + Lower Alcohol Intake + Regular Physical Activity + Avoid Tobacco + Stress Management
Dietary Approaches to Stop Hypertension (DASH) eating plan
Losing 22 lbs can lower your BP by how much?
5-20 mmHg
What foods make up the DASH Plan?
Fish, Lots of Water, Increased Fiber, Fruits / Veggies
Sodium intake should be lowered to less than how many mg a day for a normal healthy person?
Under 2,300 mg a day
Sodium intake should be lowered to less than how many mg a day for a person with Diabetes mellitus, Chronic Kidney Disease, or Hypertension?
Under 1,500 mg a day
Excessive Ethanol (ETOH) is strongly associated with -
Hypertension
Men should have no more than how many alcoholic drinks in a day?
2
Women should have no more than how many alcoholic drinks in a day?
1
This is the most common cause of Secondary Hypertension in America =
Cirrhosis
How much exercise should a person get in a day? How often?
30 mins of an Aerobic Physical Activity (like brisk walking) once a day at least 5 days a week
What is White Coat Syndrome?
It’s when someone gets Hypertension whenever in a clinical setting, but their BP is normal when out of a clinical setting
What should you tell a person with White Coat Syndrome to do?
Check their BP at home (If unable to do this, then do Ambulatory BP Monitoring instead)
When is your BP the highest?
The Early Morning
When does your BP decrease?
It decreases throughout the day
When is your BP at its lowest?
At Night
What is the goal BP range for a patient to be under for those without Diabetes or Kidney Disease?
Under 140/90 mmHg
What is the goal BP number for a patient to be under for those with Diabetes or Kidney Disease?
130/80 mmHg
What meds are used to treat Prehypertension?
Meds aren’t used to treat Prehypertension
Fish Oil Supplements and Herbal Therapy can-
Lower Hypertension
What’s one of the most common side effects of Anti-Hypertensive Meds?
Postural Hypotension
What is Postural Hypotension?
You may feel Dizzy, Weak, or Faint when first sitting up or when standing
How can you diagnose Postural Hypotension?
Obtain BP when Lying Down + Sitting + Standing
What indicators can show if a pt has Postural Hypotension?
Decreased SBP of 20 mmHg on Standing.
Decreased DBP of 10 mmHg on Standing.
Increased HR of 20 BPM from Supine to Standing.
Sexual Dysfunction (Decreased Libido + ED) can be caused by-
Hypertensive Meds
Most hypertensive pt’s will require how many Antihypertensive Meds?
More than 2
Are Forearm and Upper Arm BP’s interchangeable?
No (Site should be documented)
When taking a pt’s BP, don’t forget to take it on the same level as the-
Heart
If a pt is lying Supine, what should you do before taking the pt’s BP?
Raise and support their arm with a small pillow
When taking a hypertensive pt’s BP, which arm should you take their BP on at first? What next?
Both arms at first.
Whichever arm that has the highest reading should have at least 2 readings, each reading being 1 min apart.
If you can’t use a pt’s upper arm for a BP reading, what other site should you try as a secondary option?
Use the Forearm over the Radial Artery
What is Resistant Hypertension?
Stubborn HTN that refuses to lower after taking Hypertensive Meds
How is Resistant Hypertension treated?
A 3 Drug Regimen (Includes a Diuretic)
What are some causes of Resistant Hypertension?
Volume Retention + Drug Induced + Associated Conditions
What drugs can cause Resistant Hypertension =
NSAID’s + Corticosteroids + Decongestants
Associated conditions of Resistant Hypertension =
Obstructive Sleep Apnea + Primary Aldosterone + CKD
What is a Hypertensive Crisis?
An abrupt rise in SBP that’s greater than 180 mmHg
OR
An abrupt rise in DBP that’s greater than 120 mmHg
How high can a Hypertensive Crisis BP get up to?
220/140 mmHg
How is the severity of Hypertensive Crisis measured?
By the rate of the rise in BP
Most common cause of Hypertensive Crisis =
Noncompliance to meds
What is the goal in a pt with Hypertensive Crisis?
Avoid Target Organ Damage
What are the clinical manifestations of a Hypertensive Crisis?
Hypertensive Encephalopathy + Severe Headache + N/V + Seizures + Confusion + Coma + Cerebral Edema + Papilledema
What are the clinical manifestations of a Hypertensive Crisis if it persists?
Renal Failure + Retinal Damage + Heart Failure + Pulmonary Edema + Aortic Dissection + Unstable Angina (Leading to MI)
What can be expected with a pt who is in hypertensive crisis, but has a long history of hypertension?
They can tolerate the high BP better than those who don’t have a history of it
What is Hypertensive Encephalopathy?
General Brain Dysfunction (Due to significantly high BP)
What is Papilledema?
Edema of the Optic Discs in your Eyes
What is Aortic Dissection?
This is a serious condition that occurs whenever the inner layer of the Aorta tears
How do you classify a Hypertensive Crisis?
By how fast it developed + How slowly we need to lower the BP + Amount of Target Organ Damage
The association of the elevated BP to organ damage determines the seriousness of hypertensive crisis, not the actual BP itself.
True or False?
True
What are the two classifications of Hypertensive Crisis called?
Hypertensive Urgency
Hypertensive Emergency
How long does Hypertensive Urgency take to develop?
Hours to Days
What’s the difference between Hypertensive Urgency and Hypertensive Emergency?
Hypertensive Urgency has no current signs of Target Organ Damage.
Hypertensive Emergency has evidence of Target Organ Damage involved.
How high is Hypertensive Urgency usually?
180/120 mmHg
How is Hypertensive Urgency treated?
Outpatient Treatment:
PO Meds + Frequent Follow Up + Oral Hypertensive Drugs
How is Hypertensive Emergency treated?
Hospitalization / ICU:
IV Antihypertensives (To SLOWLY lower BP) + IV Vasodilators
Monitoring for Target Organ Damage + Monitor MAP for better evaluation
How do you figure out a pt’s MAP?
(SBP + 2DBP) / 3
If a BP is lowered too quickly in a body that’s already adjusted to a high BP, what can it cause?
Stroke + MI + Visual Changes
A pt with a Hypertensive Crisis will have an Arterial Line inserted in order to continually monitor-
BP + Continuous EKG + Hourly Urine Output Monitoring + Frequent Neuro Checks + Be on complete bed rest
Why might a Stroke pt have an Elevated BP?
It could be the body’s way of compensating (To try to get blood to the Ischemic Brain Tissue)
Progressive narrowing of Arterial Lumen of Upper and Lower Extremities =
Peripheral Arterial Disease (PAD)
Most common cause of PAD =
Atherosclerosis
PAD is a marker that can be used to indicate-
Coronary Artery Disease
What are the 4 major risk factors of PAD?
Tobacco Use + Uncontrolled HTN + Hyperlipidemia + Diabetes
What are the non-major risk factors of PAD?
Elevated CRP + Obesity + Elevated Triglycerides + Sedentary Lifestyle + Family History + Family History + Stress + Getting Older + Low Socioeconomic Status + Women + African Americans
When do start experiencing the clinical manifestations of PAD?
At 60-75% Occlusion
What are the commonly involved arteries with PAD?
Coronary + Carotids + Aortic Bifurcation + Iliac + Femoral + Politeal
With PAD, there will be stretches of good arteries and then stretches of bad arteries.
True or false?
True
How are Peripheral Arterial Disease and Peripheral Vascular Disease different?
They’re the same thing
PAD doesn’t increase with age.
True or false?
False
When does PAD start to appear normally?
After 60 years old (But can be present earlier in Diabetics)
If you have PAD, you are at a great risk for-
Major Cardiac Event (MI, Stroke)
What are the severity of the symptoms of PAD dependent on?
Site + Collateral Circulation
What are the symptoms of PAD (Lower Extremities)?
Intermittent Claudication (Hallmark) + Paresthesia + Thin, Shiny, Hairless Skin + Thickened Toenails + Diminished / Absent Peripheral Pulses (Pedal, Popliteal, Femoral) + Elevation Pallor & Dependent Rubor + Rest Pain (Rest Ischemia) + Arterial Ulcers + Critical Limb Ischemia
What are Arterial Ulcers?
Bony prominences of Toes, Feet, and Lower Leg
What is Dependent Rubor?
When the skin becomes red or husky when below the level of the heart
What is Elevation Pallor?
The skin becomes pale when elevated (Sign of poor blood flow)
What is Parasthesia?
Secondary to Nerve Tissue Ischemia, Numbness or Tingling in the Toes or Feet
What is Intermittent Claudication?
Cramping or Aching in the Calves, Thighs, and Buttocks that occurs with a predictable level of activity
(Pain during exercise that’s resolved with rest)
What should always be advised against for patients (with issues like Parasthesia) when a lack of feeling is an issue?
Heating Pads always should be avoided whenever there’s a lack of feeling
Do veins have pulses and control skin temperature?
No, only Arteries control skin temp and have a pulse
Which artery is the most commonly affected in pt’s with PAD who aren’t Diabetic?
Femoral Popliteal
By the time Intermittent Claudication occurs, the vessel is often already how occluded?
70% Occluded
Diminished or Absent Petal, Popliteal, or Femoral Pulses are all indicators of-
PAD
What is Rest Ischemia most often described as?
A burning sensation in the lower legs
When does Rest Ischemia occur the most?
At Night
What can PAD progress to? What must you do if this begins to happen?
Ulcers or Gangrene.
Must Revascularize the area, usually done with Surgery.
What is Critical Limb Ischemia?
Chronic Ischemia that lasts longer than 2 weeks, Arterial Leg Ulcers, or Gangrene
What pt’s are at an increased risk for Critical Limb Ischemia?
Pt’s with Diabetes mellitus, Heart Failure, or Stroke
How can PAD be diagnosed?
Doppler Ultrasound
Ankle Bracelet Index
Due to decreased arterial blood flow, even tiny minor trauma to the feet like shoes that don’t fit or stubbing toes can lead to-
Amputation (Because of infection)
How do you determine someone’s ABI?
Using a Doppler, take Ankle and Brachial BP. Divide the Ankle SBP by the Brachial SBP
What’s the normal ABI range?
1.0 - 1.3
What ABI range is a sign of Mild PVD?
0.71 - 0.9
What ABI range is a sign of Moderate PVD?
0.41 - 0.7
What ABI range is a sign of Severe PVD?
Less than 0.4
Meds for PAD =
Simvastatin (For Cholesterol)
Anti-platelet Agents (ASA, Ticlid, Plavix, Clopidogrel)
Thiazides & ACE Inhibitors (For BP Control)
Pletal, Cilostazol & Pentoxifylline (For the Intermittent Claudication)
How much exercise therapy should someone with PAD have?
30-45 mins / day for 3 days a week, slowly build 30-60 days.
(Walk, then rest, then walk, then rest again)
What should nutrition look like for a person with PAD?
Fruits + Vegetables, Whole Grain + Low Cholesterol, Sodium, Saturated Fat
Goal BMI for a pt with PAD?
Under 25
Goal waist circumference for people with PAD =
Men = 40 or under
Women = 35 or under
Goal Cholesterol intake for a PAD pt?
Less than 200 mg per day
Goal intake of Sodium for a PAD pt =
2 g
What is the goal Glycosylated Hemoglobin (A1C) if not diabetic?
Under 7
What is the goal Glycosylated Hemoglobin (A1C) if not diabetic?
Under 6
PAD can leave you at a high risk of-
MI, Ischemic Stroke, Cardiovascular Related Death
A pt with PAD should avoid doing what things with their legs?
Avoid crossing them, putting pillows underneath their knees, putting heating pads on them, exposing them to cold
For a pt with PAD, how often should Peripheral Pulses, Pain, Color, Temp, and Cap Refill be assessed?
Q4h
What things should be used to keep the legs of a pt with PAD warm?
Foot Cradle + Lightweight Blankets + Socks + Slippers
What device should be used for pulses that are not palpable on a pt with PAD?
A Doppler Device
What are some Cath Lab procedures that can be used to treat PAD?
Percutaneous Transluminal Balloon Angioplasty (PTA) + Stent Placement + Atherectomy + Cryoplasty
This is the removal of plaque from an artery =
Atherectomy
This is when you use gases to cool an area =
Cryoplasty
What meds are needed post-procedure for a Cath Lab?
Antiplatelets
What surgeries can treat PAD?
Endarterectomy + Peripheral Artery Bypass + Femoral Popliteal (Femoropopliteal) Bypass Surgery + Amputation
How does a Femoropopliteal Bipass Surgery treat PAD?
Treats severe blockage caused by plaque in the Femoral Artery
Is a PTA an invasive or minimally invasive procedure?
Minimally Invasive
What arteries does a PTA work best on?
Iliac and Femoral Arteries
How does a bypass graft work on arteries?
You take a piece of the pt’s own vein or use a synthetic vein, and use that to carry blood around a lesion
How does an Endarterectomy help treat PAD?
You open up the artery and remove the obstructing plaque
How does Cryoplasty treat PAD?
Uses a balloon to insert cooling gases a Stenosed area to limit Restenosis by reducing muscle cell activity
If an artery is Stenosed, it is-
Filled with Plaque
Most common Peripheral Artery Bypass Surgery?
Femoral Popliteal Bypass
Things to report for a pt who just had Peripheral Artery Bypass Surgery? Why?
Pain Increase + Loss of previously palpable pulses + Extremity pallor or cyanosis + Numbness or tingling + Cold extremities
Graft or Stent may have Occluded
What should a pt who just had Peripheral Artery Bypass Surgery avoid?
Prolonged Sitting + Flexing the Knees
When should a pt who just had Peripheral Artery Bypass Surgery leave their bed to walk?
Leave bed by day 1 post-operatively
When teaching a patient with PAD, which statement by the patient indicates a need for further teaching?
A.) “I think I can quit smoking with the use of short-term nicotine replacement and support groups.”
B.) “I should not walk if they cause pain in my legs.”
C.) “I should not use heating pads to warm my feet.”
D.) “I will examine my feet every day for any sores or red areas.”
B
Where do Arterial Ulcers form?
Bony prominences of feet and lower leg
Symptoms of Arterial Ulcer?
Absent Pulse with no Edema or Dermatitis / Pruritus + Elevation Pallor + Dependent Rubor + Cool temp gradient down the leg
What should the edges of an Arterial Ulcer look like?
Rounded / Smooth
What Thromboangitis Obliterans also called?
Buerger’s Disease
This is a Non-Atherosclerotic Occlusive Vascular Disease where small and midsize Peripheral Arteries become Inflamed and Spastic, causing the formation of blood clots to occur =
Buerger’s Disease
This is the single most significant cause of Buerger’s Disease =
Smoking
Clinical manifestations of Buerger’s Disease?
Pain in Affected Extremity + Claudication / Cramping Pain in Calves or Feet, Forearms, & Hands + Paresthesia
What will a pt’s involved digits/extremities will be like if they have Buerger’s Disease?
Pale + Cyanotic or Ruddy / Red + Cold or Cool to touch + Distal Pulses difficult to palpate or are absent
Does Buerger’s Disease affect upper extremities or lower extremities?
Both
What’s the main risk group for Burger’s Disease?
Men younger than 45 with a long history of tobacco / marijuana use + Chronic Peridontal Infection with no other risk factors for heart disease
What is Burger’s Disease marked by?
Dramatic Exacerbations + Marked Remissions
How long might Buerger’s Disease remain dormant for?
Weeks, Months, or Years
Prolonged periods of Tissue Hypoxia increase the risk of -
Tissue Ulceration + Gangrene
Buerger’s Disease can make it impossible to assess a pt’s distal pulses, even when using a Doppler.
True or false?
True
What can be used to diagnose Buerger’s Disease?
History & Physical Exam
What needs to happen for pt’s with Buerger’s Disease?
Complete cessation of any tobacco or marijuana use + Keep extremities warm + Manage stress + Keep affected extremities in dependent position + Prevent injury to affected tissues + Regular exercise + ATB to treat ulcers + Pain management
What pain med can be used for pain caused by Buerger’s Disease?
IV Iloprost
Single most important component to managing Buerger’s Disease =
Complete Smoking Cessation
Can a pt with Buerger’s Disease use a Nicotine Patch or other Nicotine Replacement Products as they try to stop smoking?
No
How much exercise does someone with Buerger’s Disease need?
20 mins or more of walking several times a day
What is Raynard’s Phenomenon Disease?
Episodes of Vasospasms of small arteries of fingers, toes, ears, and nose
What will your color be like for Raynaud’s Phenomenon?
Color changes from White to Blue to Red
What are Raynaud’s Phenomenon precipitated by?
Emotional Upsets + Exposure to Cold + Tobaccos use + Caffeine use
How can Raynaud’s Phenomenon be treated?
Put hands in warm water (NOT HOT) + stress management + avoid caffeine & vasoconstrictive meds, statins, nifedipine
What’s Raynaud’s Phenomenon caused by?
Abnormalities in the Vascular, Intravascular, and Neuronal Mechanisms that cause an imbalance between Vasodilation & Vasoconstriction
In what people does Raynaud’s Phenomenon usually occur in?
Women aged 15-40
What are the types of Raynaud’s Phenomenon?
Primary Raynaud’s Phenomenon
Secondary Raynaud’s Phenomenon
What’s the difference between Primary and Secondary Raynaud’s Phenomenon?
Primary has no known cause, Secondary does
Secondary Raynaud’s Disease often occurs in association with-
Autoimmune Diseases (Lupus, Rheumatoid Arthritis)
People with Raynaud’s Phenomenon will have an exaggerated response to-
Sympathetic Nervous System Stimulation
Is there any kind of specific diagnostic test for Raynaud’s Phenomenon?
No (Diagnosis is based on persistent signs/symptoms for at least 2 years)
Can a person with Raynaud’s Phenomenon use gloves?
No
If a pt is not responding to conservative treatment of Raynaud’s Phenomenon, what meds can be used to help?
Calcium Channel Blockers + Nifedipine + Diltiazem
If a pt is not responding to conservative treatment of Raynaud’s Phenomenon, what meds should be avoided?
Pseudoephedrine & Other Vasoconstrictors + Amphetamines + Cocaine + Ergotamine
What is Phlebitis?
Inflammation of walls of small veins of hands or arms that have IV catheter
Clinical manifestation of Phlebitis =
Redness, pain or tenderness, warmth, edema and palpable cord
Risk factors of Phlebitis =
Mechanical irritation from the catheter, infusion of irritating meds and catheter location
Phlebitis treatment =
Remove IV + Apply warm, moist heat + Elevate extremity if edema + Oral or topical NSAIDS
Does Phlebitis usually resolve quickly after the IV has been removed?
Yes
If a pt has Edema caused by Phlebitis, what should be done?
Elevate the extremity in order to promote the reabsorption of fluid into the vascular system
What is Veinous Thrombosis?
Thrombus (clot) due to inflammation of vein
What are the types of Venous Thrombosis?
Superficial vein thrombosis (SVT)
Venous thromboembolism (VTE)
deep vein thrombosis (DVT)
What is Venous Thrombosis a risk for?
Detachment-Embolus + Pulmonary Embolism
What is a Superficial Thrombophlebitis?
Formation of a clot in a Superficial Vein
What is a Venous Thromboembolism or Deep Vein Thrombosis?
Blood clot in deep vein (Most often Iliac or Femoral Veins)
What factors make up the Virchow’s Triad?
Venous Stasis + Endothelial Damage to Vein + Hypercoagulability of Blood
What is the Virchow’s Triad?
The 3 broad categories that are thought to contribute to thrombosis
Dysfunctional Valves and/or Inadequate Muscle Action =
Venous Stasis
What’s responsible for Venous Blood Movement?
Competent Valves + Action of Surrounding Muscles
Risks for Venous Stasis?
Obesity + Pregnant and postpartum women + Immobile for long periods (surgery, illness) + Long trips + Heart failure or atrial fib
When does Endothelial Damage occur?
When receiving IV Agents that may be Irritating
What IV Agents can be Irritating?
Antibiotics, K+, Chemo, Hypertonic Fluids, Contrast Media
Endothelial Damage can occur if an IV Catheter is left inserted for -
Over 72 Hours
What disease process can cause Endothelial Damage?
Diabetes mellitus
What things can predispose you to Endothelial Inflammation and Damage?
Direct Damage like damage to the inner lining of the vein (Trauma + External Pressure + Venipuncture)
Indirect Damage (Diabetes mellitus + Chemo + Venous Stasis + Blood Clot)
Hypertonic Fluids, such as Total Parenteral Nutrition, can cause what issue to occur?
Endothelial Damage
What disorders can cause Hypercoagulability to occur?
Hematological Disorders (Cancer, Anemia, Malignancies)
Risk factors for Hypercoagulability?
Dehydration + Malnutrition + Hematological Disorders + Smoking + Oral contraceptives + Menopausal women using HRT + Sepsis
What things double the risk Hypercoagulability?
Smoking + Oral Contraceptives
Manifestations of SVT?
Tenderness + Redness, warmth, pain, and induration + Palpable cordlike vein + May or may not have edema + Possible Itchiness
How is SVT diagnosed?
Physical exam + Venous duplex ultrasound
How is SVT treated?
Low molecular weight Heparin or Fondaparinux + Oral or topical NSAIDS + Elastic compression stockings (TED hose) + Walking
How can you tell which diagnosis technique to use on SVT?
Physical Exam if checking Upper Extremities
Venous Doppler Ultrasound if Lower Extremities
For SVT, what meds should be used for Inflammation?
Ibuprofen or Diclofenac
Risk factors of SVT =
Getting Older + Obesity + Pregnancy + Estrogen Therapy + History of SVT or DVT
Low Molecular Weight Heparin is often used for SVT that’s in which extremities?
Lower Extremities
When is Symptomatic Treatment used for SVT?
Used for SVT of the Short Vein Segment (<5 cm)
Symptoms of Deep Vein Thrombosis (DVT) or Venous Thromboembolism on Extremities?
May be asymptomatic
Tenderness or pain on palpation + Warm skin + Sense of fullness in thigh or calf + Unilateral leg edema + Dilated superficial veins + Paresthesias + Erythema + Oral temperature greater than 100.4 degrees F
What complications can occur because of Deep Vein Thrombosis (DVT) or Venous Thromboembolism?
Pulmonary Embolism + Chronic Venous Insufficiency
DVT can occur in what places?
Deep veins of Pelvis & Lower Extremities most common
Can also occur in the Axilla, Subclavian, and the Inferior/Superior Vena Cava
If the Inferior Vena Cava is involved in a case of DVT, what are some indicators?
Symptoms in the lower extremities with Edema and Cyanosis
If the Superior Vena Cava is involved in a case of DVT, what are some indicators?
Symptoms in the upper extremities, neck, back, and face
This is a really unreliable sign for DVT that has a lot of false positives =
Homan’s Sign
Most common symptom of Vein Thrombosis (DVT) or Venous Thromboembolism =
Calf Pain
What occurs during a Pulmonary Embolism? Is it Life-Threatening?
Yes. An Embolus advances through the venous system, into the heart, and into the Pulmonary Circulation
What is Chronic Venous Insufficiency?
Damage to the Valves in Veins. This allows for retrograde blood flow + edema + increased pigment + varicosities + ulcerations
How long would it take for Chronic Venous Insufficiency to occur after a DVT?
Several Years
How is a Venous Thromboembolism diagnosed?
Venous Doppler (ultrasound) + Duplex Doppler Scan + Venogram + D-Dimer
How does a Duplex Doppler Scan diagnose a Venous Thromboembolism?
It combines ultrasound and color doppler graphical images
Most widely used test to diagnose DVT =
Duplex Doppler Scan
What’s a D-Dimer?
A type of blood test that detects Fragments of Fibrin Degradation and Clot Breakdown.
Elevation is suggestive of DVT.
When does a D-Dimer produce Elevated Results?
When there’s a clot in the body as a result of the body’s attempt to break it down
What is the reason to use TEDS or SCUDS?
Prevention and Prophylaxis
What are some nursing interventions for pt’s wearing SCUDS or TEDS?
Early and aggressive ambulation + If bedrest, change position q 2 hrs + Teach pt to flex and extend feet, knees, and hips q2-4 hrs + Up in chair for meals + Ambulate 4-6 times per day as tolerated + Elastic compression stockings (TED hose) + Sequential Compression Devices (SCDs) + Preventative anticoagulation
For pt’s wearing TEDS or SCUDS, what things should be avoided?
Sitting with legs crossed for long periods + Smoking + Abnormal weight + Sitting or Standing for long periods + Estrogen Containing Contraceptives + Dehydration
For pt’s wearing TEDS or SCUDS, what preventative med may or may not be ordered, according to the pt’s risk for VTE?
Anticoagulants
In regards to VTE Assessment, how often should peripheral pulses, skin integrity, capillary refill times and color of extremities be assessed?
Every 8 hrs
When are SCD’s not recommended?
If already receiving an active VTE
How long should a TED hose or SCD stocking be removed during daily bath?
30-60 min
How long can a SCD or TED Hose be?
Knee High or Thigh High
A TED Hose or SCD can impede venous return if-
Put on too tightly
What classification is Heparin?
An Anti-Coagulant
What’s the antidote to Heparin?
Protamine Sulfate
What is the normal aPTT lab value range?
30-40 Seconds
What lab value is used to assess the blood’s coagulation properties?
aPTT
When are Anticoagulants required?
When the pt’s aPTT value is 1.5 - 2.5 times the normal value
What is Heparin Induced Thrombocytopenia?
Heparin Induced Low Platelets
What are Direct Thrombin Inhibitors (DTI’s)?
Anticoagulants that do not cause Heparin Induced Thrombocytopenia
What are the 3 DTI’s that have been approved by the FDA Administration?
Lepirudin + Argatroban + Bivalirudin
What is Enoxaparin?
Low Molecular Weight Heparin
How should Low Molecular Weight Heparin be Administered?
SUBQ, Anterolateral Abdomen
What shouldn’t be done when administering Low Molecular Weight Heparin?
Routine coagulation tests are unrequired
Aspirate, injecting IM, massage site, don’t expel air bubble
What class is Warfarin?
Anticoagulant
Warfarin Antidote?
Vitamin K
Should take Warfarin if-
Pregnant
Normal lab value range for the blood test called INR?
0.75-1.25
For a heart valve replacement, the INR should be kept at a range of-
2.5-3.5
For most cardiac related surgeries, the INR should be kept at a range of-
2-3
When is the INR not supposed to be used?
During the initiation of Coumadin therapy
What’s recommended if Anticoagulant therapy is contraindicated due to risk of bleeding?
Vena Cava Interruption Devices
What do Vena Cava Interruption Devices do?
Filter clots but don’t interfere with blood flow
What complications may occur after the insertion of a Vena Cava Interruption Device?
Air embolism, improper placement, migration of filter and perforation of vena cava with retroperitoneal bleeding
Describe Chronic Venous Insufficiency =
Incompetent venous valves
Retrograde venous blood flow
Increased hydrostatic pressure
Fluid/RBCs leak into tissue and are broken down
Skin & tissue of ankle becomes thick, hard, and fibrous
Chronic Venous Insufficiency can lead to-
Venous Leg Ulcers
Manifestations of Chronic Venous Insufficiency?
Itching
Leathery skin on lower leg
Brown or brawny color
Edema-especially if leg dependent
C/O heavy feeling in leg/dull ache
Eczema/stasis dermatitis
Skin warm in area
Venous ulcers (old term- ‘stasis ulcer’)
Where can Venous Ulcers typically be found?
Around or above medial malleolus
Cellulitis and Secondary Lymphedema can be caused by-
Venous Ulcers
What can result in Osteomyelitis or Malignant Changes?
Venous Ulcers
What does a Venous Ulcer look like?
Irregularly Shaped Edges + Ruddy Color + Deepens if left untreated
When a Venous Ulcer is left untreated, the pain may be more painful whenever the leg is in what position?
Dependent Position
Compression is an essential treatment for-
Venous Ulcers
What are all of the treatments for Veinous Ulcers?
Compression + Moist dressings (Hydrogels) + Paste bandage called Unna boot + Nutrition (Protein, Vitamin A & C, Zinc) + Antibiotics only if infected + Herbal therapy (horse chestnut seed extract) + Teach self-care measures
Side effects of Horse Chestnut Seed Extract?
Dizziness + GI Complaints + Headache + Pruritis
