VD and Problems w/Peripheral Circulation Flashcards
Peripheral artery disease is a result of?
- atherosclerotic plaque
- thromboemboli
- trauma
- infections
- inflammation
- vasospastic disorders
- congenital
Peripheral artery disease is a manifestation of?
atherosclerosis
What is atherosclerosis?
a thickening/hardening of arteries
Atherosclerosis is a slow process that begins?
in early adulthood, most people do not know they have it
Assessment considerations for PAD?
- brain
- heart
- kidneys
- mesentery
- limbs
- frequently seen in DM and elderly patients
PAD causes:
- partial or totally obstruction
- lumen narrows
- infraction
- accusation of: lipid, calcium deposits, fibrous tissue, stenosis, thrombosis
Who is at risk for PAD?
- tabacco * big factor
- family
- age 70
- obesity
- HTN
- HLD
- DM
PAD asymptomatic/ symptomatic manifestations:
- pain in distal muscle groups: worse when walking
- ulcers
- numbness/tingling
- hairloss
- pallor
- cool to touch
- no pulse
- paralysis
PAD structural changes:
- hair loss distal to the occlusion
- thick opaque nails
- shiny dry skin
- skeletal muscle atrophy
PAD skin color changes:
- pallor with elevation
- dependent rubor
PAD pulse changes:
- diminished or absent blew area of stenosis/obstruction
- cool extremity distal to occlusion
PAD sensation changes:
- paresthesia: numbness/tingling
- ulcerations
- gangrene
With rubor the blood vessel cannot?
constrict they stay dilated.
Intermittent claudication is a hallmark symptom for PAD and is?
limping pain
What is it when the arterial occlusions develop gradually, and there is less risk of sudden death b/c this ______ ______ may develop.
collateral circulation
Over time with collateral circulation continued decreased perfusion results in?
ischemia and tissue death
DX of PAD:
- doppler
- ultrasonography
- magnetic resonance angiography (MRA)
- CT
An MRA is able to?
isolate blood vessels and vein in 3D
Treatment of PAD:
- thrombolysis
- percutaneous
- cilostazeol (aspirin)
- bypass graft
What is thrombolysis?
a thrombolytic agent injected directly into thrombosis to lyse the clot
What is percutaneous?
- angioplasty: balloon expanded stenosis
- stent placement: assess perfusion/pain
- bypass graft: rerouting blood flow
Nursing management of PAD:
- pain relief
- maintain tissue integrity
- tabacco cessation
- stress reduction
- avoid hot temperature
- avoid constrictive clothing
- avoid crossing legs
Six P’s for acute arterial occlusion:
- pain
- pallor
- pulselessness
- poiikilothermia (cool temp)
- paresthesia
- paralysis
_______ is vasospasm causing vasoconstriction, and occurs with cold or stress?
raynauds syndrome
_____ _____ is when blood vessel become inflamed, swell, and become blocked (thrombi).
buergers disease
Burgers disease puts you at risk for?
- infection
- gangrene
Abdominal aortic aneurysm (AAA) is a?
localized out pouching sac dilation formed on the arterial wall.
AAA is a result of?
- atherosclerotic plaque
- trauma
- disease
- congenital
Risk factors for AAA:
- genetic basis
- HTN
AAA grows an average of?
0.4 cm/year
Clinical manifestations of AAA:
- some people may not have any
- feeling there heart beat in their abdomen when lying down
- report feeling an abdominal mass or abdominal throbbing
- mottling of toes
- IMPENDING RUPTURE: severe pain pain or abdominal pain, persistent of intermittent, often midline
- Rupturing anerysm: constant, intense back pain, falling BP, decreasing hematocrit
- MOST IMPORTANT INDICATION: pulsating mass in the abdomen, also systolic bruit may be heard of mass
What is the MOST IMPORTANT indication for AAA:
pulsating mass in the abdomen.
DX of AAA:
- ultrasonography
- CT
Treatment of AAA:
- observation
- monitor BP
- education
- anti-hypertensives
- surgery
AAA can be confused with?
MI
For AAA ultrasound every 6 months and monitor BP is small but if larger than?
5.5 cm or significantly enlarging surgical intervention is required.
Nursing management for AAA:
- education r/t diet, smoking, meds
Postop considerations for AAA:
bleeding, circulation, neuro changes, pain management
Venous thrombosis is?
formation of blood clot in the venous system
People at risk for DVT:
- stasis of blood
- vessel wall injury
- hormone therapy
- smoking
- dehydration
- varicose veins
Manifestations of DVT:
- pain
- swelling/edema
- increase in tempature
- larger leg
- gray brown skin
DX of DVT:
- D dimer
- ultrasonography
- MRA
a d dimer that is positive:
clots when lyse
Treatment of DVT:
- heparin
- warfarin
- thrombotic therapy
- surgery
Goal for patients with DVT of warfarin:
- INR 2 to 3
- with heart valve INR 2.5 to 3.5
- check INR every month
heparin does not dissolve a clot that is?
already formed.
aPTT for heparin:
21 - 35 sec
Venous Ulceration complication:
cellulitis/dermatitis may complicate healing
Venus ulcers develop as a result of?
increased venous pressure or external trauma
Venous ulcerations cause the skin to be?
dry, cracked and pruritic
Treatment of venous ulceration?
- dressing for debridement
- hyperbaric oxygenation
- compression
With PAD venous ulceration develops as a result of
ischemia and may lead to gangrene
Treatment of ulceration
keep dry and usually not debriefed until revascularization procedures are performed.
