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NUR 201 Week 4 > Vascular Problems - Arterial/Venous > Flashcards

Vascular Problems - Arterial/Venous Flashcards

1
Q

Vascular system starts with the left heart that pumps oxygen-rich blood through arteries, arterioles, capillary system (where you have O2 and CO2 exchange with the cells of the body)

Venules and veins return the O2 poor, CO2 rich blood to the right side of the heart to the lungs

A
  • With peripheral circulation, we’re dealing with 2 groups of very different diseases - venous and arterial - that will exhibit with different symptoms and be treated differently
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2
Q

Peripheral Arterial Disease (PAD)

  • Affects ~12% of people in the US
  • Men are affected more commonly than women before menopause; then, women surpass men
A
  • 50-75% of clients with PAD have clinically significant coronary artery disease (CAD)
  • CAD may be silent because PAD prevents clients from exerting themselves enough to trigger angina
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3
Q

Pathophysiology of PAD

  • Insufficiency of the peripheral circulation
  • Atherosclerotic plaques narrow the arterial lumen impeding oxygenated blood flow to distal tissues
A
  • Stenosis (narrowing) and occlusion (blockage)
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4
Q

Risk Factors

  • # 1 > smoking (includes passive smoking)
  • Male gender
  • HTN
  • High LDL/low HDL cholesterol
  • Diabetes
A
  • Family h/o atherosclerosis
  • Obesity/sedentary lifestyle
  • High homocysteine and CRP levels
  • Stress
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5
Q

Homocysteine and C-reactive proteins increase __ formation and increase the propensity for __ formation; risk factor for atherosclerosis

A

thrombin

thrombus

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6
Q

Signs & Symptoms - What are the 6 P’s?

A
  • Pain
  • Pallor
  • Pulse
  • Paresthesia
  • Paralysis
  • Poikilothermia
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7
Q

?

Is the inability to maintain a constant core temperature independent of ambient temperature

A

Poikilothermia

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8
Q
  • 20% asymptomatic (b/c not active enough to induce symptoms)
  • Intermittent claudication/progress to pain at rest
  • Nocturnal pain/improved with dangling extremity
A
  • Delayed capillary refill
  • Waxy appearance of extremity
    > Extremity pallor when elevated
    > Extremity rubor when dependent
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9
Q
  • Diminished or absent peripheral pulses
  • Skin is thin, waxy, and with hair loss
  • Skin is cool to touch
A
  • Cyanosis (r/t decreased arterial flow to tissues) [extremity may even be diaphoretic r/t sympathetic overactivity]
  • Ulcers
  • Dry and wet gangrene [risk of cellulitis]
  • Painful
  • Progression to paresthesia and paralysis
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10
Q
  • Painful unless there is peripheral neuropathy from diabetes or alcoholism
A
  • Pulseless, cold, painful, paresthesia and paralysis may be indicative of acute embolic syndrome
  • PAD ulcers usually small, round, necrotic with minimal or no drainage
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11
Q

Diagnostics - Noninvasive

  • Doppler - segmented systolic BP measurements of the LE
  • (ABI) Ankle/Brachial Index
  • MRI
  • Exercise Tolerance
A

Diagnostics - Invasive

  • Arteriography
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12
Q

Doppler - segmented systolic BP’s of LE

  • Normally BP’s in LE are higher than UE
  • With PAD, UE BP’s are higher than LE
A
  • Mild disease - diff of 10-30 mmHg
  • Severe disease - diff of 40-50 mmHg
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13
Q

?

Is the ratio of systolic BP in the ankle to systolic BP in the arm

Derived by dividing the ankle systolic pressure with brachial systolic pressure

With increased stenosis, there’s a decrease in the systolic pressure distal to the stenosis/occlusion

A

ABI

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14
Q
  • Claudication 0.90-0.50
  • Rest pain 0.49 or less, severe ischemia and tissue loss 0.25 or less
A
  • > 1.3 indicates calcification of vessels from DM, CRF, hyperparathyroidism
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15
Q

Exercise Test

  • If there’s a drop in ankle pressure by 40-60 mmHg for 20-30 sec and a decrease in pulse volume waveform, this is indicative of PAD
  • Screen for CAD for surgical procedures
A

Nursing Interventions

  • Meticulous foot care
  • Monitor and treat pain (no cold or warm packs r/t ischemia and increased trauma)
  • Legs in the dependent position
  • Monitor for the development of ulcers
  • Wound care as ordered
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16
Q
  • Antibiotics as ordered for cellulitis
  • Encourage moderate amount graded ambulation once initial infection resolved and healing begins
  • Encourage adequate PO fluids (fluids to decrease viscosity of blood)
  • Surgical interventions: aorta-femoral bypass, embolectomy
A
  • Avoid the cold
  • Diet of protein, vitamin A, C, zinc
  • Avoid leg crossing
  • CMS checks
    > Palpate dorsal pedis, posterior tibialis, popliteal and femoral pulses > doppler
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17
Q
  • NPO and IV for angiogram or surgical intervention
  • ___ (cilostazol), ___ (pentoxifylline), ___ (clopidogrel), aspirin
  • Review of antihypertensives
A

Pletal, Trental, Plavix

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18
Q

Pletal (antiplatelet/vasodilator)

  • HA, diarrhea, abnormal stools, palpitations, tachycardia
A

Trental (hematological agent)

  • Xanthine
  • May potentiate antihypertensives and anticoagulants (! know bleeding precautions)
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19
Q

Plavix (clopidogrel) and asa (antiplatelets)

  • Clopidogrel also is good for reducing MI and stroke
A
  • Antihypertensives may decrease flow to LE and cause worsening symptoms, i.e., beta blockers, no vasoconstrictors
20
Q
  • Avoid tobacco
  • Avoid caffeine
  • Vasodilators
A

Other Arterial Diseases

  • Aneurysm
    > Thoracic, aortic
  • Buerger’s Disease
  • Raynaud’s disease
    > Raynaud’s phenomenon
21
Q

?

  • Cause unknown
  • Chronic inflammatory disease
  • Most common in men, ages 20-35
  • Occurs in many areas of the world
  • Smoking and chewing tobacco is causative and aggravating factor
A

Buerger’s Disease

22
Q

Buerger’s Disease

  • thromboangiitis obliterans
  • Inflammation and scarring of small and medium arteries and veins of extremities
  • Pulseless pedal, radial, ulnar
  • But positive pulses in the femoral and popliteal areas
A
  • Leads to clot formation and ulcers; gangrene in distal arteries, bilateral and symmetrical
  • Color: rubor, pale, or cyanotic limb
23
Q

Prevention/Treatment

  • Smoke cessation
  • Avoid cold
  • Treat pain
  • Vasodilators - calcium channel blockers
  • Wound care - amputation
A
24
Q

Raynaud’s ?

  • Unilateral
  • 30 years of age
  • Either gender
A

phenomenon

25
Q

Raynaud’s ?

  • Bilateral
  • 17-50 years
  • Mostly women
A

disease

26
Q

Raynaud’s assessment - S/S

  • Skin pallor, then becomes cyanotic, and eventually turning red
  • Numbness and tingling
  • Burning pain as the skin color changes
  • Possible ulcers
A

Treatment

  • Avoid cold, caffeine, nicotine
  • Stress management/biofeedback
  • Vasodilating agents
  • Preventive practices
    > Avoid known vasoconstrictors
27
Q

Venous Disease

  • Deep venous thrombosis [clot]/embolus [travels to lung]
  • Post thrombotic syndrome
  • Varicose veins
  • Venous stasis ulcers
A
28
Q

?

Is permanent valve and vessel damage from DVT which makes the extremity at risk for future DVT’s, emboli, varicosities, and ulcers

A

Post thrombotic syndrome (PTS)

29
Q

?

Is a clot or thrombus formation in the veins

A

DVT

30
Q

DVT - S/S

  • Warm, red skin
  • Visible surface veins
  • Calf, leg, or groin pain, tenderness, fatigue
  • Sudden swelling of unilateral limb
  • Induration
A
31
Q

PE - S/S

  • SOB
  • Rapid pulse
  • Diaphoresis
  • Sharp chest pain
  • Bloody sputum, fainting
A
32
Q

What is Virchow’s triad?

A
  1. stasis of blood flow
  2. endothelial injury
  3. states of hypercoagulability
33
Q

Risk Factors - Virchow’s Triad

  • Previous DVT/Fhx DVT
  • Immobility, recent injury, long distance travel
  • Hormone therapy, oral contraceptives, pregnancy, post-partum
A
  • Previous or current cancer
  • Limb trauma, orthopedic procedures
  • Coagulation abnormalities
  • Obesity
  • Varicose veins
  • HF/MI
  • Older than 40
34
Q

Prevention

  • Smoke cessation (smoking > increased platelet aggregation)
  • ROM exercises when in bed
  • Ambulate ASAP >surgery
  • Change position q2h
  • Pneumatic devices
  • Elastic graduated compression stockings
  • Anticoagulants
A
  • Elevate your feet when sitting
  • Avoid tight-fitting clothing
  • Do not cross your legs
35
Q
  • SCDs (from the ankle to the thigh assisting blood return to the heart)
  • TEDs
A
  • Elastic graduated compression stockings
36
Q
  • Wear gradient compression socks or stockings everyday
  • Use rubber gloves to get a better grip on the fabric
  • If you can’t tolerate wearing them all day, wear for a few hrs at a time and increase amt of time daily
  • Put on 1st thing in the morning
  • If skin is moist, apply cornstarch or grease-free talcum
  • Keep legs and feet warm to promote circulation
  • Stockings last about 3-6 mos
A
  • Pay attention to washing instructions
  • Don’t allow wrinkles in the stockings
  • Don’t cut or alter
  • Don’t fold or roll down
  • Remove if prolonged numbness or tingling occur or if you see bluish discoloration
37
Q

Diagnostics

  • D-dimer
  • Duplex venous ultrasonography
  • Venography
  • MRI
A

Treatment/Goals

  • Prevent thrombus
  • Prevent growth of existing thrombus
  • Prevent growth of new thrombi
  • Prevent pulmonary embolus
    > Anticoagulants do not dissolve existing thrombus but prevent new clots from forming
    > Vena cava filter
38
Q
  • Heparin, Lovenox (enoxaparin) prevent new clots

What is the antidote for heparin and what coagulation factor are we looking at?

! Know HIT (drop in platelets)

A

protamine sulfate

PTT

39
Q

What is the antidote for coumadin (warfarin) and what coagulation factor are we looking at?

A

Vitamin K

PT/INR

40
Q
  • Prevent post-thrombotic syndrome
    > Catheter-directed thrombolysis
    > Thrombolytic delivered directly to existing thrombus and dissolves it
A

What are some thrombolytics?

  • Urokinase, tPA, Retavase, TNKase, Activase, streptokinase - dissolves existing clots
41
Q

What is the antidote for thrombolytics?

A

Amicar

42
Q

?

Are incompetent valves that lack surrounding muscle support; painful, tortuous bluish veins

A

Varicose veins

43
Q

Varicose Veins Risk Factors

  • Familial tendency
  • Thrombophlebitis
  • Obesity (only in women)
  • Prolonged standing
  • Pregnancy (2 or more greater risk)
A

Prevention/Treatment

  • Avoid prolonged standing
  • Promote weight loss
  • Exercise, TEDS
  • Chemical sclerosing
  • Surgical vein ligation and stripping
44
Q

?

A condition caused by chronic venous insufficiency

Edema, pain at site and discoloration can be noted here

A

Venous stasis ulcer(s)

45
Q

Treatment

  • Wound care and assessment
    > Unna boot
    > Debridement
    > Elevation
  • Antibiotics for cellulitis
  • Treat pain
A
  • Provide adequate nutrition for wound healing (protein, vitamin A, C, zinc)
  • Hyperbaric oxygenation
46
Q

Nursing Diagnoses

  • Ineffective peripheral tissue perfusion r/t compromised circulation
  • Chronic pain r/t impaired ability of peripheral vessels to supply O2 to tissues
A
  • Impaired skin integrity r/t vascular insufficiency
  • Alteration in mobility r/t vascular insufficiency

NUR 201 Week 4 (3 decks)

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