Vascular Dx Flashcards
Intermittent Claudication
begins during exercise and ends with rest
Not constant, resolve within 10 min
Dependent Rubuour
When foot is down it becomes more red
symptoms of PAD
Decreased circulation
Skin cool to touch, pallor, increase cap refill, loss of hair, taut and thin skin
Weak Pulse
Intermittent Claudication
Paresthesia
Elevating foot in PAD
Makes pain increase
Blood flow is even more difficult
PAD complications
Continued pain at rest (Pain with sleep bc decreased CO)
Gangrene: Essentially rotting flesh caused by an infection
What is the danger of Gangrene
If it is not removed it can spread to blood causing sepsis, and even death
Diagnostic for PAD
Ankle Brachial Pressure Index (ABPI)
Ankle SBP/Brachial SBP
Normal if 1-1.4
Doppler Ultrasound
Magnetic Resonance Angiography
Normal ankle brachial pressure index (ABPI)
And how it is calculated
BP at arm and ankle
Ankle BP DIVIDED by Brachial Reading
= ABPI
Normal is 1-1.4
Sx interventions for PAD
Femoral popliteal bypass (Usually use a vein from another part of body)
Percutaneous transluminal angioplasty (PTA) of the femoral arteries
Endarterectomy
Amputation as last resort
What to monitor after a bypass graft is done?
Monitor pulses to guage success
Watch for infection
Interventions (drugs) for PAD
Antiplatelet (e.g. aspirin)
Statins (Lower Cholersterol)
ACE inhibitors (Low BP)
Meds to treat intermittent claudication
Pentoxifylline/Trental
NSAID (Treats pain from inflammation)
Nutrition for PAD pts
Low cholesterol foods
High fiber
Most effective treatment
Exercise therapy (30-40 min 3-5 3-5QW)
Risk Factor Modification
Control BP, Weight control, Smoking cessation, Blood glucose control
Acute Arterial Ischemic Disorder
Occur suddenly, without warning
Caused by embolism, thrombus, or trauma
Clinical manifestations (“6 Ps”):
Pain, pallor, pulselessness, paresthesia, paralysis, and perishingly cold
Early treatment essential to keep limb viable
Anticoagulant therapy, tPA, surgery, amputation
6 Ps, clinical manifesstation of Acute Aterial ischemic Disorder
Pain, pallor, pulselessness, paresthesia, paralysis, and perishingly cold
What is TPA
A Clot buster
Ways to promote blood flow
Walking
Positioning
Smoking cessation
Avoiding tight socks/shoes
Prevent chilling (Promote warmth)
Impaired skin integ intervention
Check bath water temp
Roomy shoes
Activity intolerance prevention
Staggering exercise program
Ineffective therapeutic regimen mgmt intervention
Educate
PVD
Venous thrombus
- Formation of blood clot
- Why blood clot forms?
- Stasis
Hypercoagulability
Endothelial damage
- As thrombus can be enlarged - detaches - embolus
SVT
A type of PVD
Upper extremities (IV therapy)
Lower extremities (trauma to varicose veins)
Manifestation
- Palpable, firm, subcutaneous corlike vein with the surrounding
Which type of Peripheral disorder do we use compressing stockings
PVD
SVT intervention
Remote IV
Elevation of the affected limb
Warm & moist heat ( warm compress)
Compression stocking
Analgesics
NSAIDs
DVT
AKA Venous Thrombo-Embolism (VTE)
Where?
Blood clot form in deep vein
Clinical manifestation
May have no symptoms
Unilateral leg edema
Extremity pain
sense of fullness in thigh or calf
warm skin, erythema or cyanotic
temp > 38°C
Positive Homans sign (classic but very unreliable sign)
Complications of DVT
Pulmonary embolism
Chronic venous insufficiency (hemosiderin release)
Post thrombotic Syndrome
Phlegmasia cerulea dolens
Venous leg ulcer
DVT diagnositcs
PTT, INR, Platelet count
D-dimer (those with venous clots have higher levels)
Venus compression ultrasound
Magnetic resonance venography
Nursing diagnosis example for DVT
Acute pain related to impaired venous return and inflammation
Ineffective health maintenance
Risk for impaired skin integrity
Potential complication: Bleeding
Potential complication: Pulmonary embolism
Signs of PE
Bloody, frothy sputum
Occurring secondary to DVT
Trouble breathing
Impending doom anxiety
DVT Prevention
Early and aggressive mobilization –up 4-6 times/day
Bedrest patients – change positions, dorsiflex feet, rotate ankles q2-4h
Compression stockings – properly fitted
Sequential compression devices
