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NUR205 > Week 7 > Flashcards

Week 7 Flashcards

1
Q

The vascular system is comprised of

A

Arteries and arterioles
Capillaries
Veins and venules
Lymphatic vessels

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2
Q

The vascular system depends on

A 
Cardiovascular system
Systemic blood vessels
Circulating blood (volume/viscosity)
Nervous & endocrine system activity
Metabolic tissues needs
Lymphatic system
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3
Q

Vascular system

A

Function:
To meet the circulatory needs of the tissues
Constantly changing according to metabolic requirements
When supply doesn’t meet demand = ischaemia

How?
Blood flow (from high pressure to low pressure)
(from arterial [~100mmHg] venous [~4mmHg])
Flow rate = ΔP/R (pressure difference ÷ resistance)
Capillary Fluid exchange
Hydrostatic (blood pressure)/osmotic pressures (proteins)
Any extra between arterial supply & venous reabsorption lymph

Imbalance = oedema

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4
Q

Peripheral blood flow

A

Flow rate = ΔP/R! Affected by:-
Hemodynamic resistance
Blood viscosity
Vessel diameter
Regulation of peripheral vascular resistance
CNS (sympathetic = vasoconstriction)
Hormonal (noradrenaline/adrenaline/angiotensin)
Chemicals/proteins/hypoxia/pH
Movement of fluid across the capillary wall:
To meet metabolic needs
Hydrostatic & osmotic force

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5
Q

Pathophysiology heart failure

A

Left:
Pulmonary congestion & reduced cardiac output
Poor arterial blood supply
Right:
Venous congestion & ? reduced cardiac output

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6
Q

Pathophysiology alteration in vessel supply

A 
Lymph/arterial/venous
Intact 
Rupture – aneurysm/trauma
Patent 
Atherosclerosis/thrombus/valve issues
Responsive 
Vasospasm/arteriosclerosis/aging changes
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7
Q

Clinical manifestations of peripheral arterial disorders

A

Intermittent claudication
Pulses diminished or absent
Oedema – None/minimal
Skin changes: Trophic – cold/dry/shiny/hairless/thick opaque toe nails
Pallor when elevated
Red when dangling (dependent rubor)
Ulcers – tips of extremities/ painful/deep/circular/pale to black base or dry gangrene

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8
Q

Clinical manifestations of peripheral venous disorders

A

Pain: aching to cramp like, relieved by activity/elevation
Pulses usually present
Oedema – present/increases at the end of day
Skin changes: warm/thick/ tough/darkened/? dermatitis
Ulcers – medial malleolus/ pain variable/ superficial/irregular border/granulation base

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9
Q

Assessment of intermittent claudication

A 
Muscular/cramping (ischaemic) type pain
Precipitated by exercise
Resolves within 10 mins of rest
Reproducible
Area depend on which vessel affected
Lack of blood supply of oxygen/nutrients when increase in demand
Caused by arterial supply failure
Anaerobic cellular metabolism
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10
Q

Common sites of Atherosclerotic Obstruction

A 
Coronary arteries
Carotid arteries
Aortic bifurcation
Iliac and common femoral arteries
Distal popliteal artery
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11
Q

Modifiable risk factors for peripheral arterial disease

A 
Smoking
Diet
Hypertension
Hyperlipidaemia
Diabetes
Obesity 
Stress
Sedentary lifestyle
C-reactive protein (inflammation)
Hyperhomocysteinemia (clotting factor)
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12
Q

Non-modifiable risk factors for peripheral arterial disease

A

Age
Gender
Familial predisposition/genetics

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13
Q

Nursing assessment of PAD

A 
Health history 
Medications 
Risk factors
Clinical manifestations of arterial insufficiency
Claudication and rest pain
Colour changes
Weak or absent pulses
Skin changes and skin breakdown
Arterial/venous/lymphatic (medical) diagnosis made
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14
Q

Diagnosis of PAD

A

Altered peripheral tissue perfusion
Chronic pain
Risk for impaired skin integrity
Knowledge deficient

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15
Q

Planning of PAD

A 
Major goals include:
Increased arterial blood supply 
Promotion of vasodilatation
Prevention of vascular compression
Relief of pain
Attainment or maintenance of tissue integrity
Adherence to self-care programme
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16
Q

Implementation of PAD

A

Exercises and activities:
Walking (stop with pain – gradually increase tolerance)
Graded isometric exercises.
Promote circulation & development of collateral circulation
Specialist advice before commencement
Contraindications include leg ulcers/cellulitis/thrombotic occlusions
Positioning strategies
Temperature
Effects of heat (vasodilation) & cold (avoid)
Stop smoking
Stress reduction (counselling)
Due to poor nutrition & oxygen supply the extremities are susceptible to injury/infection/poor healing
Protection of extremities and avoidance of trauma
Good hygiene/gentle soap/moisturisers
Regular inspection of extremities (infection/inflammation)
Podiatric care (foot wear/nail care)
No constricting clothing
Good nutrition/stop smoking
Weight reduction as necessary
Nurse - Patient education essential

17
Q

Complications of PAD

A

Atrophy of skin/nerves /muscles

Delayed healing/wound necrosis/infection/gangrene

18
Q

Medical treatment for PAD

A

Medical (relieve symptoms/improve arterial supply)
Risk factor modification (smoking/diet/exercise)
Drugs (aspirin …/prostaglandin)
Management of diabetes/hypertension/obesity
Refer to podiatrist/physio/rehab. speciallist

Surgical (relieve symptoms/improve arterial supply)
PTBA (balloon angioplasty/stent)
Peripheral arterial bypass graft (femoral-popliteal)
Endarterectomy/patch graft
Amputation (last resort)

19
Q

Nursing Management – Peripheral arterial bypass graft

A 
Vital signs/neurovascular observations (pulses)
Graft patency obs (doppler)
Ankle brachial index (8hrly)
IDC 1hrly measures
Complex invasive line care
Wound care (bleeding/haematoma)
Elevate extremity/gently exercise
Graduated compression stockings(?)
Analgesia
Discharge advice/patient education
Care of co-morbidities
20
Q

Aortic aneurysm

A

An aneurysm is a localised sac or dilation formed at a weak point in the wall of the aorta.

Type: 
True – wall of artery forms the aneurysm
False – disruption of all artery layers (trauma/infection)
Shape
Position (thoracic 85%)
21
Q

Risk factors for aortic aneurysm

A 
Atherosclerosis in most cases
Genetic link/congenital vessel wall weakness
Trauma/disease/inflammation
After formation - tends to enlarge
Smoking/hypertension
22
Q

Clinical manifestations of aortic aneurysm

A

(often asymptomatic/varied)
Pain/throbbing/”beating”
Ascending – voice hoarseness/dysphagia/venous return interruption (distended neck vessels/oedema)
Thoracic – deep spreading chest pain
Abdominal –back pain/bowel pressure/bruit/palpable
From thrombosis of smaller vessels

23
Q

Diagnosis of aortic aneurysm

A

Routine examination
Pulsatile mass in 80% cases/bruit
Chest x-ray – calcification/widening of aorta
ECG to rule out MI
Echocardiology – aortic insufficiency
Ultrasound/ CT scan/MRI scan
Angiography – useful to assess other vessel involvement

24
Q

Medical management for aortic aneurysm

A

Depends on symptoms/prognosis/position/ patient co-morbidities
High rate of surgical death/complications
Prevent rupture/early detection essential
Conservative (small aneurysm/poor surgical risk)
Risk factor/behaviour modification (hypertension/smoking/sedentary lifestyle)
Manage co-morbidities & other atherosclerosis

Operative
Surgical - graft or primary closure
Endovascular – femoral/iliac artery catheter accessed
minimally invasive/strict criteria

25
Q

Post op nursing care for an ascending aortic aneurysm

A

Complex major surgery/surgical ICU/HDU area
Patient may have complex co-morbidities
Vital signs/neurovascular – frequent/regular
Monitoring for signs of occlusion/thrombosis/emboli
Monitor all systems (respiratory/renal – IDC 1 hrly)
Monitor T° 4 hrly (graft rejection)
Assess site/wound – haematoma/ooze/inflammation
Often first or second day post op walking
Surgeon/facility dependent

26
Q

Risk factors for deep vein thrombosis

A 
over 35 years
smoker
family history
oral contraceptive 
obesity
27
Q

Clinical manifestations of DVT

A

Maybe nil or non specific
Unilateral pain/warm/erythema
Systemic T°/tender/Homan’s sign

28
Q

DVT prevention/prophylaxis

A

Early mobility/ambulation/SOOB
Bed exercises/deep breathing & coughing/alter position
Compression stockings/(good for distal DVT but what about proximal)? – Fit correctly!!!!
Pneumatic compression devices - SCDs/ICDs
Drugs
Anticoagulants - Heparin(LMWH)/enoxaparin/warfarin (phasing out)/others

No prophylaxis – 26% patients developed DVT
Stockings alone – 13% patients developed DVTs (50% )
Stockings and anticoagulants – only 4% patients developed DVTs

29
Q

DVT treatment

A

Prevent further growth & fragmentation (into PE)
Bed rest with limb elevation
Anticoagulants (prevent further thrombi)
Thrombi resolves naturally (not through anticoags)
Then mobilise with quality stockings (not the cheapies)
Drug Therapy
Heparin – IV infusion/SCI/Warfarin/more modern types
Thrombolytics
Previously (with DVTs) only for limb threatening situations
Now being trialled to ascertain treatment as more routine

Surgery (uncommon):
Vena cava filter
Open thrombolectomy

30
Q

Contraindications of Pneumatic Compression Devices/stockings

A

The obese (can’t fit them correctly/tourniquet the limb!)
Heart failure
Assess your patient/history
Certain conditions/diseases of the lower limbs
Diabetic neuropathy
Severe oedema of the lower limb

31
Q

Adverse events of pneumatic compression devices

A 
Nerve palsies
Common peroneal nerve palsy
Paraesthesia of legs/feet
Compartment syndrome
Pressure ulcers
Slipping while walking (wear shoes/slippers!)

NUR205 (11 decks)

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