Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

NURS 3512 - Class 1-6 > Week 4 - Peripheral Artery Disease, Acute Arterial Ischemia, Amputation > Flashcards

Week 4 - Peripheral Artery Disease, Acute Arterial Ischemia, Amputation Flashcards

1
Q

what is peripheral artery disease

A
  • thickening of the arterial walls that leads to progressive narrowing of the artery lumen
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what is the leading cause of PAD

A
  • atherosclerosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

where does PAD occur

A
  • in extremities
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what are the most significant risk factors for PAD (5)

A
  • tobacco use
  • hyperlipidemia
  • elevated CRP
  • DM
  • HTN
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what are other risk factors for PAD? (7)

A
  • FHx
  • hypertriglyceridemia
  • hyperuricemia
  • increasing age
  • obesity
  • stress
  • sedentary lifestyle
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what is the classic sign of PAD

A
  • intermittent claudification
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what is intermittent claudification

A
  • an ischemic muscle ache or pain that is precipitated by a consistent lvl of exercise
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

how long does intermittent claudification last

A
  • 10 min or less

- is reproducible

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what causes intermittent claudification

A
  • accumulation of end products of anaerobic cellular metabolism ex. lactic acid
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what causes intermittent claudification to go away

A
  • once the person stops exercising and the metabolites are cleared
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

PAD of the aortoiliac arteries produces pain where? (2)

A
  • buttocks

- thinghs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

PAD of the femoral or popliteal artery produces pain where? (1)

A
  • calf
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what is the best treatment for intermittent claudification (2)

A
  • walking for 30-60 min/day and 3-5 times/week

- meds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what 2 meds are used for intermittent claudification

A
  • pentoxifylline (trental)

- levocarnatine (cranitine)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what are the signs of PAD (9)

A
  • parasthesia of toes or feet
  • thin, shiny, hairless and taut skin
  • cool skin
  • diminished or absent pulses
  • intermittent claudification
  • neuropathies
  • brittle nails
  • prolonged cap refill
  • non healing ulcers & gangrene (later)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what color does the skin turn in PAD and what impacts this (2)

A
  • pallor if elevated

- red when dependent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

how does pain in PAD change w time

A
  • eventually will occur at rest too
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what causes rest pain

A
  • when there is insufficient blood flow to meet basic metabolic needs of distal tissues
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

when is rest pain more promininent during PAD? why?

A
  • at night

- bc cardiac output drops and limbs are at lvl of heart

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

what position can help relieve pain in PAD (2)

A
  • dangling legs over side of bed

- sleeping in chair

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

what are signs of critical limb ischemia (3)

A
  • chronic rest pain
  • gangrene
  • ulceration
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

what are complications of PAD (6)

A
  • delayed healing
  • wound infection
  • tissue necrosis
  • nonhealing arterial ulcers **
  • gangrene **
  • amputation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

what do arterial ulcers look like (2)

A
  • round, punched out looking

- minimal drainage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

where do arterial ulcers most commonly occur (4)

A

over bony prominences

  • toes
  • feet
  • lower leg
  • lateral malleolus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

describe what you would find on assessment of an arterial ulcer (3)

A
  • cool to touch
  • decreased/absent pedal pulses
  • cap refill >3 sec
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

what can be used to diagnose PAD (5)

A
  • doppler US
  • segmental BP at thigh, below knee, and at ankle
  • ankle brachial index
  • angiography
  • magnetic resonance angiography
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

when is a doppler US useful

A
  • if palpation of a peripheral pulse is difficult bc of severe PAD, it can determine the degree of blood flow
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

what is the ankle brachial index (2)

A
  • a comparative test of BP of the arm vs ankle to monitor blood flow
  • uses a handheld doppler
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

what are the categories of care for PAD (8)

A
  • risk factor modification
  • drug therapy
  • exercise therapy
  • nutritional therapy
  • care of the leg with critical limb ischemia
  • complementary and alternative therapy
  • interventional radiology catheter-based procedures
  • surgery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

what risk factor modifications are imp to reduce CVD risk factors (6)

A
  • healthy body weight
  • regular physical activity
  • smoking cessation
  • optimal BP control
  • optimal glycemic control
  • lower cholestrol (thru diet & meds)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

what diabetes increase the risk of for pts with PAD

A
  • amputation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

what type of meds are used for treatment of PAD (5)

A
  • antiplt
  • pentoxifylline (Trental)
  • cilostazol (pletal)
  • ACE-I
  • alternative med therapy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

why are antiplts imp for treatment of PAD (2)

A
  • reduce risks of CVD events

- and reduce risk of death in PAD pts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

what 2 antiplt meds are recommended for treatment of PAD

A
  • aspirin OR
  • clopidogrel (Plavix)

*combo therapy of the 2 are not recommended)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

what are not recommended for prevention of CVD events in pts with PAD

A
  • anticoagulants
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

what benefit do ACE-I have in treatment for PAD

A
  • decreased morbidity & mortality risks
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

what 3 drugs are used to treatment intermittent claudification

A
  • pentoxifylline (trental)
  • cilostazol (pletal)
  • levocarnatine (carnitor)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

what does cilostazol do? (3)

A

promotes effects of prostaglandin :

  • increased vasodilation
  • inhibits platelet aggregation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

what does trental do>

A
  • increases RBC flexibility

- decreases blood viscosity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

what are some examples of alternative med therapy that have been investigated in the treatment of intermittent claudifcation (4)

A
  • vitamins
  • minerals
  • dietary
  • herbal supplements
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

what should pts do prior to using alternative med therapy

A
  • consult with their HCP prior to taking any dietary or herbal supplements if on antiplt, NSAIDs, or anticoags d/t interactions and bleeding risks
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

describe exercise therapy for a pt with PAD (5)

A
  • walking
  • supervised rehab PAD progrsm is best
  • home exercise programs
  • at home, strive for 30-40 min/day 3-5x/week
  • the pt should walk to the point of discomfort, stop & rest, and then resume walking until it recurs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

what nutritional therapy should be implemented for a pt with PAD (6)

A
  • adjust their dietary intake so at a healthy weight
  • high fruits & veggies
  • high whole grains
  • low cholestrol
  • low sat fat
  • low sat
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

how much cholestrol should a pt with PAD have per day

A
  • less than 200 mg/day
45
Q

how much salt should a pt with PAD have per day

A
  • 2g/day
46
Q

what is critical limb ischemia

A
  • condition characterized by pain at rest or night and tissue loss such as gangrene or ulcers that attributed to PAD
47
Q

what is optimal therapy for critical limb ischemia (3)

A
  • revascularization via surgery or endovascular procedure
  • aggressive CVS risk factor modification
  • antiplt therapy to prevent CVD events
48
Q

describe conservative management for critical limb ischemia (8)

A
  • protect extremitiy from trauma
  • decrease ischemic pain
  • prevent and controll infection
  • maximize perfusion
  • avoid soaking feet to prevent skin maceration
  • cover ulcers w dry, sterile dressing
  • inspect, cleanse, and lubricate feet to prevent cracking and infection
  • keep feet free of pressure
49
Q

what teaching should be given to the pt regarding critical limb ischemia (2)

A
  • select soft, roomy, protective footwear

- healing is unlikely without increased blood flood

50
Q

what can be used to decrease pain r/t critical limb ischemia

A
  • opioid analgesics
51
Q

what bed position can decrease pain & increase perfusion to lower extremities r/t critical limb ischemia

A
  • reverse trendelenburg
52
Q

what 3 therapies could help prevent amputation in pts with critical limb ischemia

A
  • spinal cord stimulation
  • hyperbaric O2 therapy
  • angiogenesis
53
Q

what are interventional radiology catheter-based procedures

A
  • alternatives to open surgical approaches for treatment of lower extremities PAD
54
Q

describe ambulation after an interventional radiology catheter-based procedure

A
  • most can ambulate same day

- and return to normal activity 24-48 h after

55
Q

what do interventional radiology catheter-based procedures involve

A
  • insertion of a specialized catheter into the femoral artery
56
Q

what are 3 types of interventional radiology catheter-based procedures

A
  • percutaneous transluminal balloon angioplasty
  • atherectomy
  • cyroplasty
57
Q

what is the percutaneous transluminal balloon angioplasty procedure

A
  • procedure that uses a catheter that contains a cylindrical balloon at the tip
  • catheter is advanced to the narrowed (stenotic) area of the aerty
  • when in place, balloon is inflated to open the artery
58
Q

what is immeditaely deployed after balloon angioplasty? why?

A
  • stent

- which acts as a scaffold to keep the artery open

59
Q

what is an athrectomy

A
  • removal of the obstructing plaque
60
Q

what are the 2 types of atherectomy

A
  • direct

- laser

61
Q

what is direct atherectomy (2)

A
  • catheter is inserted into femoral artery to break up plaque by cutting or rotation
  • a cutting disc or rotational tip attached to end of catheter that pulverizes plaque to smaller than a RBC
62
Q

what is a laser atherectomy

A
  • same as direct

- but uses ultraviolet energy to break up the plaque

63
Q

what is cyroplasty

A
  • combines 2 procedures: balloon angioplasty and cold therapy
64
Q

how does cyroplasty work (3)

A
  • catheter inserted via femoral artery to narrowed area
  • balloon is inflated w nitrous oxide that changes from liquid to gas as it enters the baloon
  • expansion of the gas causes cooling to -10* which minimizes re-stenosis
65
Q

what is required after interventional radiology catheter-based procedures

A
  • antiplatelet meds to decrease risk of restenosis –> long term, low dose asa recommended
66
Q

when is surgery indicated for PAD treatment (2)

A
  • for long areas of stenosis

- or severely calcified arteries

67
Q

what is the most common surgical therapy uses to improve blood flow beyond a stenotic or occluded artery

A
  • peripheral artery bypass operation
68
Q

what is a periperal artery bypass

A
  • use of an autologous or artificial vein to bypass the diseased portion of the artery
69
Q

what are typically used for peripheral artery bypass

A
  • synthetic grafts
70
Q

what are 2 other surgical options for PAD

A
  • endarectomy

- patch graft angioplasty

71
Q

what is an endarectomy

A
  • opening of the artery & removing the plaque
72
Q

what is a patch graft angioplasty

A
  • opening of the artery, removing the plaque, and sewing a patch to the opening to widen the lumen
73
Q

what is the least desired surgical option for PAD

A
  • amputation
74
Q

what should you teach a pt with PAD (8)

A
  • how to reduce risk factors
  • diet modification to reduce cholestrol, salt, sat fat
  • proper care of feet
  • infection control
  • avoidance of injury to extremities
  • tobacco use contraindicated
  • physical activity imp
  • instruct to inspect legs daily for mottling, changes in color, skin texture, amt of subcut fat, reduction in hair growth, skin temp, cap refill, pedal pulses
  • report any changes to legs to HCP
  • keep follow up appts
  • monitor for worsening symptoms (rest pain)

imp to inspect daily bc they may have peripheral neuropathy = cant feel if something is wrong

75
Q

describe post-op/post-procedure care for a pt with PAD (9)

A
  • check operative extremity q15 min then q1h
  • VS
  • monitor for complications
  • avoid placing pt in a knee flexed position (besides exercise)
  • turn and position pt frequently w pillows to support incision
  • encourage ambulation asap
  • discourage long hours of sitting w legs dependent
  • postop wound assessment
  • pain management
76
Q

what should you assess regarding the operative extremity (7)

A
  • color
  • temp
  • cap refill
  • peripheral pulses
  • sensation
  • movement
  • pain
77
Q

what complications should you monitor for post-op for PAD (6)

A
  • bleedings
  • hematoma
  • compartment syndrome
  • thrombosis
  • embolization
  • occlusion of stent
78
Q

what are signs of occlusion of the stent or graft (6)

A
  • dramatic increase in pain
  • loss of previously palpable pulses
  • extremitity pallor or cyanosis
  • decreased ABIs
  • numbness/tingling
  • cold extremity
79
Q

why should a post-op pt with PAD avoid prolonged sitting w leg dependency (4)

A
  • pain
  • edema
  • increases risk of venous thrombosis
  • places stress on suture line
80
Q

what should you do if the pt experiences edema post-op (3)

A
  • position pt supine
  • and elevate edematous leg above heart
  • may use compression sock
81
Q

how can pts protect their extremities from trauma (7)

A
  • protective roomy footwear
  • clean cotton socks
  • non restrictive clothing
  • avoid heat & cold
  • avoid pressure
  • change position frequently
  • avoid leg crossing
82
Q

what should we teach pts regarding infection control w PAD (3)

A
  • keep feet clean
  • keep well lubricated (but not between toes)
  • cover ulcers w sterile dressing
83
Q

what is acute arterial ischemia

A
  • sudden interruption in the arterial blood supply to a tissue, organ, or extremity
84
Q

what can acute arterial ischemia lead to

A
  • tissue death & gangrene if left untreated & after just a few hours
85
Q

what can cause acute arterial ischemia (9)

A
  • embolism (ex. from heart)
  • thrombosis of athersclerotic artery
  • trauma
  • IE
  • MI
  • afib
  • hypovolemia
  • hyperviscosity
  • hypercoaguability
86
Q

what are the 6 P’s of acute arterial ischemia

A
  • Pain
  • Pallor
  • Paralysis
  • Pulselessness
  • Paresthesia
  • Poikilothermia
87
Q

what is Poikilothermia

A
  • adaptation of the limb to the environmental temp, most often cool
88
Q

what is imp for acute arteril ischemia

A
  • early treatment and intervention to keep the affected limb viable
89
Q

what is the first step in treatment for acute arterial ishcemia (2)

A
  • call physician

- keep client at rest

90
Q

what type of meds are used for treatment of acute arterial ischemia

A
  • anticoagulant (unfractured heparin, warfarin)
91
Q

why are anticoagulants used for acute arterial ischemia

A
  • prevent thrombus enlargement

- inhibit further embolization

92
Q

if a pt is undergoing embolectomy, what should the pt be on after for long-term?

A
  • long-term anticoag with warfarin
93
Q

what is done to restore blood flow in acute arterial ischemia

A
  • remove/dissolve clot
94
Q

what are options for clot removal/dissolving

A
  • percutaneous catheter-directed thrombolytic therapy
  • percutaneous mechanical thromboectomy
  • surgical thrombectomy
  • surgical bypass
95
Q

describe what percutaneous catheter-directed thrombolytic therapy is

A
  • where a percutaneous catheter is inserted into the femoral artery, threaded to the site, and the thrombolytic drug is infused to break up the thrombus
96
Q

how long does it take for thrombolytics to dissolve the clot

A
  • 24-48 hr
97
Q

the catheter may also act as…. in treatment of acute arterial ischemia

A
  • mechanical thrombectomy device (can remove or fragment the thrombus)
98
Q

when is surgical intervention indicated in acute arterial ischemia

A
  • if have ischemia for more then 14 days when catheter-based interventions are not possible
99
Q

what are surgical options for acute arterial ischemia

A
  • direct arteriotomy
  • surgical revascularization
  • open artery, remove clot or bypass it*
100
Q

when is amputation considered in acute arterial ischemia

A
  • pts with ischemic rest pain & tissue loss

- and limb salave is not possible

101
Q

what is the goal of amputation

A
  • preserve extremity length and function while removing all infected, pathologically compromise, or ishemic tissue
102
Q

describe what happens during amputationq

A
  • skin and muscle layers cut
  • major blood vessels clamped and severed
  • bone is cute w special saw
  • muscle stitched over bone
  • skin closed over wound
103
Q

describe preop management for a pt undergoing amputation (3)

A
  • instruct on upper extremitity exercises to promote arm strength for crutch walking and gait training
  • general post op care discussed
  • educate on phantom limb sensation & phantom limb pain
104
Q

describe post-op care after amputation (8)

A
  • monitor for PTSD
  • monitor VS
  • monitor dressings
  • prevent contractures
  • keep clean
  • monitor for infection
  • pain control
  • exercise regimen and crutch walking
105
Q

describe how we should monitor for infection post amputaion

A
  • inspect residual limb daily for irritation, excoriation, infection
106
Q

what should you do if excoriation develops and the pt is using a prosthetic

A
  • d/c use
107
Q

describe how to keep the residual limb clean (3)

A
  • wash every night
  • no alcohol, powders, or oil to residual limb
  • change limb sock daily
108
Q

describe how to prevent contractures post-amputation (4)

A
  • perform ROM daily
  • do not elevate limb on pillow
  • lay prone w hip in extension for 30 min, 3x/day
  • avoid sitting in change for more than 1 hr with hip flexed
109
Q

what can be used to treat pain post-amputation (3)

A
  • opioids
  • analgesics
  • mirror therapy

NURS 3512 - Class 1-6 (47 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions