WEEK 4 : Vascular disorders Flashcards
true or false. the concept of perfusion is cells receiving adequate oxygen and nutrients
true
what is this describing : ability to pump and how well that blood can mov into blood vessels
perfusion : blood pressure
which area does altered perfusion affect ?
low blood flow to a specific area or generally
sensation changes is one of the signs and symptoms : what undergoes this
numbness or pins and needles
ishcemic pain does not have to be in peripherally or centrally it can be chest pain as well with altered perfusion?
yes this is true
these are the diagnostics tests for altered perfusion: vascular problem
- EKG
- Blood work (enzyme rise)
- Angiography
- Ultrasound (doppler)
- CT scan
explain
ischemia to the heart
lack of oxygen release enzymes
tropinin is released from a cardiac muscle – patency blocked areas
can be deployed to open up
extremities to palpate a pulse
blood flow to the area to the body - angiogram is much better
when it comes to arterial occlusion:
limb is affected
what does pulse indicate?
if we cannot palpate ( act quickly )
pain because of ischemia
pulse indicate blood flow
abrupt occlusion is something we can deal quickly
quick symptoms
notify dr as soon as possible
are those true ?
what can obstruction be ?
can be blood clot, or fibrin, or narrowin
Medication to promote increased blood flow
* vasodilators, antihypertensives, diuretics
why are diuretics used ?
to remove excess fluid because of venous dysfunction
what is this describing : the disease is undetected for years -impedded the blood flow
and accelerating the plaque in the artery walls
hypertension
what could be a caused of hypertensive crisis?
diagnosed in hypertension but stopped taking medications
what does patients develop when they have htn crisis ?
cerebral edema
hypertensive crisis: severe headache, blurred vision, dizzy, SOB, epistaxis, anxiety , recall these are the symptoms
why are they experiencing sob
and epitaxis?
pressure gets very high in the lungs
tiny blod vessles get burst and then nose bleeds- epitaxis
often feel anxious when these symptoms are occuring
affected in lowering blood pressure
should not be dropped too quickly when it comes to hypertensive crisis
with hypertensive crisis - cerebral edema , why is this happening , and what would out intervention be ?
because of leakage
to reduce this - position in semi fowlers , less blood is flowing through their brain
ensure oxy sat is 92 is above
assess head to toe ( neuro done frequently )
ensure is producing adequate amount of urine
what is causing the cad
coronary artery disease
the diseae is caused by atheroclesoris causing it to narrow
can have a clot formed on top of the plaque and continuum in coronary artery
stable angina to mi
where does the symptoms typically occurs with pts who have cad /
majority happen in centralize chest pain
( chest pain that may radiate )
recall that these : * nausea & vomiting
* diaphoresis
* dyspnea
* anxiety/fatigue
often indicates disease progression
start with stable angina and cannot control indicate progressing partial or full occlusion
Coronary Artery Disease
Analyze Cues- ACS
Diagnostic Testing
- ECG
- Cardiac enzymes (Troponin)
- Coronary angiogram*
define the description for the diagnostic testing for cad
* ECG
* Cardiac enzymes (Troponin)
* Coronary angiogram*
changes in st segment
st elevation is infraction
depression is associate with ischemia and st elevation is associated with infraction
not receiving oxygenated blood
cardiac enzymes - whenever its damage. releases troponin - this support the diagnoses of mi
coronary angio - catheter for femoral artery in the groin or the wrist , threaded dye in injected radiologist and look at the big screen can see blood flow through the heart
Coronary Artery Disease
Plan and Prioritize-ACS
what is the worst thing that can happen?
complete occlusion of a cornary artrey
Any patient who presents with chest pain: with complete occlusion of a coronary artery
what type of diagnostic test are we doing ?
- ECG
- Cardiac enzymes
big priority :
competed occluded part of the heart muscle not receiving oxygenated blood
chest pain understand the severity - do ekg and cardiac enzymes 0 recognize quickly
just read
exemplar : #2 coronary artery disease
take acion - acs
intervention for acs
give a brief description on cad
myocardium not receiving adequate oxygenated blood
oxygen
ecg/cardiac monioring
pain assesmetn and management
frequent s
iv access
meds ( nitro, asa, clop)
why is cardiac monitoring important ?
is when myocardial developing dysrthmias
pain assesment what are we utilizing ?
opqrstuv
and pain scale ( nitroglycerin ) if not controlling might change in iv route in continous hepful in doesnt help in original
morphine could also be used, this causes vasodiliation
why should frequent vital signs be utilized ?
establish a baseline
not lowering bp, too much
nitro and morphine - cause low bp
asa and clop decreases what ?
decrease amount of platelets aggression, could be causing blockage in coronary arteries
open blocked artery: what are the interventions
angioplasty
cabg ( open heart sx )
TPA ( far from hospital )
what is angioplasty?
gold standard injecting dye with balloon stent
cabg ( open heart sx )
may open up corporate vessel
tpa causes bleeding in the ____, therefore frequent assessments of what is needed ?
brain , frequent neuro checks
cabg could open what type of vessel?
corporate vessel
interventions for post angioplasty
monitor for :
bleeding from insertion site
acute closure of vessel ( CP, increase st )
contrast dye reaction
vital signs ( low bp , dysrhythmias )
band is over the incision wrist
that band is inflated with air ( we take a syringe to inject air ) little punch to apply a bit of pressure
in over time to deflate and remove of air and no signs take off the band
bandage insertion site - job is look for any signs of bleeding, blood pouring out or it might be a lot of swelling under the ski ( internal bleeding )
put pressure to stop bleeding
reocclude- back to where they started , chest pain, st elevation and go right back to intervention ( ekg, vs, adequate oxy, nitro, notfiy dr)
reaction to the dye - pt may have develop rash and give antihistamine
anaphylaxis- immediate intervention
vital signs - regular intervention, look for blood pressure ( closely )
increase chance of dyes. because heart is manipulated ( causing dizzy=- not adequate co )
notify dr
just reead ( interventions for post angio )
exemplar #2 coronary artery disease
take action - acs
in manitoba, all cardiac surgery is done at st boniface hospital
icu initial care :
initially
intubated, large chest tubes, pacemaker wires
icu initial care : watch out for
anginal pain
bleeding
decreased loc/dysrhythmias
electrolyte + fluid imbalance
hypothermia/hypertension/hypotension
is this true or false. this is initially come out in the cardiac ICU lot of tubes and intubated and chest tube against their lungs and tubes draining from sites.
true
true or false. pacemaker wires from heart muscles is seen. What is this in risk for ?
dysrhythmias
OR is very cold and what can this caused ?
this can caused hypothermic, and blood loss in the surgery ( nurses will use warming blanket )
interventions for patients on the cardiac surgery ward : cabg
recall is
deep breathing and coughing
discharge teaching
cardaic rehab refferal
monitor for complications
supervised ambulation
explain
db and coughing to avoid atelectasis in the lungs
supervisd ambulation to avoid dvt
discharge teaching such as not driving, or how much weight and activities ( take a while to heal )
cardiab rehab referall - after a cabg , refit or wellness ( physio or nurses to get exercise or walk around, monitor health )
just read : supplmeent oxyegn for awhile to improve that situation
if there is alot of pain the sternum ( breast bone )
avoid taking deep breaths ( the patient ) not getting good exchange and decrease oxygen sat
incision site and graft sites ( chest or leg )
any tubes coming out of he body ( infection )
neuro status is something we will monitor ( anaesthetic ) or clot has dislodged ( rate complication ) but monitor
what is this describing in terms of the complications of cad: loss of cardaic output as nurses say crashing bp is low, unrespoinsive not getting to the brain, and shutting down organs
this is emerg
cardiogenic shock
true or false. cardiogenic shock is a large mi
true
what is pad ?
partial or total occlusion, usually in the legs
what is claudification?
intermittent ( ishcemic muscle ache, resolve with rest, triggered with exercise )
what is this describing : did not get enough blood supply, extreme part of the body ( end of the toes and the feet )
necrosis/gangrene
what is an ankle brachial index?
ankle pressure is compared to arm- if its lower than 1 - low blood flow to the foot
what are the two major complications ? what is our priorities
ulcer location and appearance
sudden peripheral artery occlusion
furthest from the heart - hardest to supply blood flow
is what location?
end/between on the toes
pale and round edges is due to what
due to lack of bloodflow
true or false. clot that makes it way down the artery and blocks off bloodflow can occur
yes this is true, often from mi or AFIB ( sudden peripheral artery occlusion )
true or false. sometimes clot from coronary artery - goes peripheral
this is true
PAD
take action
promote blood vessel health : risk factor modification and exercise
what is it
walking to increase collateral circulation
walk until discomfort, rest, resume
what is the goal for promoting blood vessel health
increase the amount of the pt can walk before experiencing clotication
what should the position be for pad
keep limbs below heart ( anything above the heart - harder to perfuse )
if pain at night dangle from bef
what is the drug theraphy for pad
antiplatelets, antihypertensive, pentoxifylline
what does pentoxifylline do ?
increase blood flow, by reducing viscosity, and enhancing ( rbc flexibility )
what is the intervention to promote vasodillation?for apd
keep feet warm ( socks ( not too tight ) insulated shoes
what are the two non surgical interventions to increase blood flow
balloon angioplasty with stent insertion
atherectomy
true or false. thrombus can form immediately after and stop bloodflow - look for changes to the feet (the p’s)
true
true or false. pad has the same complications as coronary angioplasty?
true
atherectomy : what happens ?
dislodges plaque and gets rid of it - often on blood thinners for a while to avoid clot formation
what is surgical intervention to increase blood flow for pad
femoral popliteal bypass graft around an occluded femoral artery
what should we look for when it comes to cwcm after post op care
look for htn - bad for graft and cause it to fail
hypotension- can indicate blood loss and bleeding
atlectasis or pneumonia
comapartment syndrome
think of 6 p’s
this is alot of swelling in a fixed area - affects circulation
ambulation as soon as possble when it comes to femoral politeal bypass graft
yes but supervised first
