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NUR205 BUDER > week 7 > Flashcards

week 7 Flashcards

1
Q

Vascular System:
Comprised of:
Depends upon:

A 
Comprised of:
Arteries and arterioles
Capillaries
Veins and venules
Lymphatic vessels
Depends upon:
Cardiovascular system
Systemic blood vessels
Circulating blood (volume/viscosity)
Nervous & endocrine system activity
Metabolic tissues needs
… lymphatic system
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2
Q

Vascular System:
Function
How?

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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3
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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4
Q

Pathophysiology of Vascular Disorder:
Characterised by reduced blood flow
Effect depends on imbalance of demand/supply
Inadequate supply = ischemia

A
  1. Heart failure
    Left
    Pulmonary congestion & reduced cardiac output
    Poor arterial blood supply
    Right
    Venous congestion & ? reduced cardiac output
2. Alteration in vessel supply
Lymph/arterial/venous
Intact 
Rupture – aneurysm/trauma
Patent 
Atherosclerosis/thrombus/valve issues
Responsive 
Vasospasm/arteriosclerosis/aging changes

The ability to develop collateral supply can greatly decrease the ischaemic damage

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5
Q

Peripheral Arterial Disorders

PAD

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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6
Q

Peripheral Venous Disorders

PVD

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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7
Q

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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8
Q

Assessing peripheral pulses

A

Diagnostic:
Doppler studies
Exercise testing ( with ankle systolic blood pressure)
Duplex ultrasound/CT or MRI (with/without angiogram)
Angiogram
Venous studies
Lymphatic studies

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9
Q

Ankle Brachial Index FYI (with hand-held doppler)

A

Measures degree of PAD

Quantifies stenosis
Systolic BP both arms
Use highest reading
Systolic BP both ankles

Divide ankle systolic/
brachial systolic pressure

Normal ~ 0.90 – 1.30
Mild-mod. – 0.50 – 0.95
Mod-severe – 0 – 0.50

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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

Risk Factors for PAD: Modifiable

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

Risk Factors for PAD: Non Modifiable

A

Age
Gender
Familial predisposition/genetics

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13
Q

Nursing Process: The care of the patient with PAD — assessment

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

Nursing process: The care of the patient with PAD — diagnoses

A

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

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15
Q

Nursing process: Altered peripheral tissue perfusion — planning

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

Nursing process: Altered peripheral tissue perfusion — implementation

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)

17
Q

Peripheral Arterial Disease (PAD)

Complications

A

Atrophy of skin/nerves /muscles

Delayed healing/wound necrosis/infection/gangrene

18
Q

PAD – Medical treatment

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

Arterial Aneurysms

A

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

21
Q

Aortic Aneurysm: Classified

A 
Classified:-
Type 
True – wall of artery forms the aneurysm
False – disruption of all artery layers (trauma/infection)
Shape
Position (thoracic 85%)
22
Q

Aortic Aneurysm: Risk factors: (exact pathophysiology unknown)

A 
Atherosclerosis in most cases
Genetic link/congenital vessel wall weakness
Trauma/disease/inflammation
After formation 		tends to enlarge
Smoking/hypertension
23
Q

Aortic Aneurysm: Clinical manifestations

A

Clinical manifestations (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

24
Q

Aortic Aneurysm: Diagnosis

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

25
Q

Medical Management - 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

26
Q

Open Repair of an Ascending Aortic Aneurysm- Postop Nursing Care

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

27
Q

Thromboembolism(VTE) Prevention & Care

A

“Deep vein thrombosis (DVT) is one of the most common, preventable complications of surgery

28
Q

DVT - Prevention/prophylaxis

A

often medically prescribed - though not always
nothing stopping us from initiating interventions (Dr have you considered …)
Prevention is better than cure!
Early mobility/ambulation/SOOB
Bed exercises/deep breathing & coughing/alter position

Compression stockings/(good for distal DVT but what about proximal)? –
Fit correctly!!!!
(some contra-indications – see the readings)
Pneumatic compression devices - SCDs/ICDs
(some contra-indications – see the readings)
Drugs
Anticoagulants - Heparin(LMWH)/enoxaparin/warfarin (phasing out)/others

29
Q

DVT treatment

A

Treatment (of diagnosed DVT)
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

NUR205 BUDER (13 decks)

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