week 4 Flashcards
peripheral artery disease
NARROWING of lower extremity arteries for atherosclerosis = inadequate blood flow
peripheral artery disease manifestations
pain at rest (aka intermittent clausication)
parethesia
bruit of femoral & aortic arteries
pallor
dependent rubor
cool extremities
nonpalpable peripheral pulses
calf muscle atrophy
shiny skin w hair loss & thick toenails
6P’s manifestations of acute occlusion from thrombosis
Pain
Pallor
Paralysis
Parethesia
Pulselessness
Poikilothermia (cant regulate temp)
lab values indicating risk for peripheral arterial disease
elevated:
*c-reactive protein
*homocysteine level
* lipids— hyperlipidemia
PAD manifestations commonly occur
**aggravated by limb elevation
occurs @ night
@ rest
diagnostic studies for PAD
- Ankle-Brachial Index <0.9
- 6min walk test
- doppler ultrasound
- Segmental systolic BP measurements
- Peripheral vascular angiography
meds for intermittent claudication
**pain @ rest w PAD
- Cilostazol
- Pentoxifylline
- Statins
med to increase blood flow
*PAD = ramipril
*risk for hyperkalemia –muscle weakness, paralysis, abdominal cramps
PAD complications
- ulcers
- wounds
- compartment syndrome
- infection
- amputation
Buerger’s disease
*THROMBOANGIITIS OBLITERANS
recurring inflammation of the arteries & veins resulting in THROMBOSIS w OCCLUSION
** men 20 - 35yrs old **
Buerger’s disease risk factors
genetics
smoking
tobacco
men: 20 to 35yrs old
Buerger’s manifestations
painful open sores
ulcers w gangrene
claudication
cold sensitivity
nursing care for buerger’s
- smoking cessation
- avoid cold & constrictive clothing
- pain meds
- antibiotics
Raynaud’s Syndrome
EPISODIC vasospastic disorder of arteries/arterioles cold & stress
manifestations of Raynaud’s Syndrome
2 phases
- Vasoconstrictive phase = cold/white extremities w pain
- Hyperemic phase = blood flow to extremities (red & swelling)
nursing care for Raynaud’s
- avoid cold & keep warm
- stop smoking
- limit caffeine
- manage stress
Virchow’s triad
presence of 3 factors predisposes a person to develop vascular thrombosis
(1) hypercoagulability
(2) venous stasis
(3) endothelial damage
Risk factors for venous thromboembolisms
surgery / immobility
oral contraceptives
65+
pregnancy
obesity
catheters
clinical manifestations of venous thromboembolisms
asymptomatic
calf/groin tenderness
warm, erythematous skin
change in circumference of extremity
diagnostic studies for VTE
D-dimer
ultrasound
CT / MRI
CT pulmonary angiography
V/Q scan
antidote for heparin
protamine sulfate
white clot syndrome
antibody development to a heparin-platelet membrane complex
*arterial thrombi
enoxaparin
SubQ low-molecular weight heparin
1mg/kg of body weight not to exceeed 90mg BID
antidote for warfarin
Vitamin K
3 IV thrombolytics & monitoring for…
Reteplase
tenecteplase
activase (tPA)
*neuro status
bleeding
anaphylaxis
Intracranial bleeding
Dabigatran
PO direct thrombin inhibitor
antidote= idarucizumab
venous vs arterial ulcer
- location (A) =
anemia manifestations
increased HR
orthostatic hypotension
fatigue
decreased O2
SOB / dyspnea
cold sensitivity
irony deficiency anemia manifestations
glossitis (beefy red tongue)
chelitis (swollen lips)
asymptomatic
decreased iron
increased total iron binding capacity
Thalassemia manifestations
**inherited blood disorder– abnormal hgb resulting in RBC destruction
facial bone deformities
growth failure
jaundice
Thalassemia collaborative care
blood transfusion
folic acid
bone marrow transplant
splenectomy
B12 deficiency anemia manifestations
parethesia
ataxia
glossitis
jaundice
tests for vitamin B12 deficiency anemia
labs
Shilling test *swallowing radio-labeled tablet
Aplastic Anemia
result of bone marrow suppression
INCREASED
iron
total iron binding capacity
DECREASED
hgb
wbc
platelets
reticulocytes
risk factors for hemolytic anemia
trauma
lead poisoning
infection
transfusion reaction
clinical manifestations of hemolytic anemia
chills
jaundice
hepato/spleno-megaly
dark urine
medication for patient with anemia AND kidney disease
epoetin alfa
sickle cell anemia
abnormal hgb = sickled red cells that clump together *african-american or Mediterranean origin
sickle cell anemia manifestations
*hypoxia
fever
jaundice
swelling
pain
hematuria
priapism
med for sickle cell anemia
hydroxyurea & O2 therapy
pain = morphine or hydromorphone
thrombocytopenia manifestations
petechiae
purpura
ecchymoses
if bleeding
increased HR
decreased BP
LOC change
abdominal pain
dizziness
weakness
meds for heparin induced thrombocytopenia
protamine sulfate
alternative anticoagulant (warfarin or argatroban)
pulse pressure in PAD
is lower in the thigh, calf, & ankle than in upper extremities
ankle brachial index range
0.9 to 1.3
*less than 0.9 = PAD
PAD is treated w/ (2)
(1) = antiplatelets : aspirin, clopidogel, pentoxifylline
(2) = statins : simvastatin, atorvastatin
a nurse should expect to see a client with PAD
have pallor on elevation of limbs & rubor when limbs are dependent
sleep with both legs in dependent position
test to determine PVD
d-dimer test
teaching to client w PVD
apply stockings in the morning upon awakening & before getting out of bed
keep legs elevated for at least 20 min 4 to 5x a day
folate diet
spinach
lentils
bananas
iron dextran
parenteral iron
Z-track methos
*SEVERE anemia only
Vitamin C w/ anemia
increases oral iron absorption
total iron binding capacity test
diagnoses anemia
is an indirect measurement of transferring (indicates total iron stores)
medication for client with DIC
heparin– decreases microclots
aPTT range
30 to 40 sec
*measures clotting factors
*1.5 to 2x baseline range when taking heparin
pTT range
*how long it takes blood to clot
60 to 70 seconds
fibrinogen range
200 to 400 mg/dL
prothrombin time range
11.0 to 12.5 seconds
3 anticoagulants with direct thrombin inhibitor
- argatroban
- lepirudin
- bivalrudin
disseminated intravascular coagulation
clotting and anti-clotting mechanisms occur at the same time
*internal and external bleeding
immune thrombocytopenic purpura (ITP)
autoimmune disorder that results in the body producing antibodies that decreases platelet lifespan with normal platelet production
females 20 - 50
epoetin alfa considerations
increases erythrocytes (rbc’s)
treats anemia
monitor hgb & Hct 2x a week (increased = effective)
monitor iron levels
DO NOT SHAKE VIAL
adv effects = HEADACHE &
HYPERTENSION
iron dextran
IM & IV form of iron for iron deficiency anemia
adverse effect of vitamin b12 meds
hypertension
hypokalemia
erythema
s/s of hypokalemia
muscle weakness
nausea
palpitations
paresthesia
Alteplase
thrombolytic drug that can dissolve thrombi
*taken within 3 hours
adverse effects of alteplase
*thrombolytic drug that dissolves thrombi
intracranial bleeding
headache
bronchospasm
bleeding
hypotension
antidote for alteplase
alteplase= thrombolytic drug that dissolves thrombi
***AMINOCAPROIC ACID = coagulator
