Week 7 - Vascular disorders and problems of circulation Flashcards

1
Q

What is the function of the vascular system?

A

To meet the circulatory needs of the tissues.

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2
Q

How does it work?

A

Blood flows from high pressure areas to low pressure.

From arterial to venous.

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3
Q

Peripheral flow rate is affected by:

A
  1. Haemodynamic resistance: blood viscosity, vessel diameter
  2. Regulation of peripheral vascular resistance: e.g. vasoconstriction
  3. Movement of fluid across the capillary wall: hydrostatic & osmotic force, metabolic needs.
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4
Q

Peripheral Arterial Disorders (PAD), clinical manifestations:

A
  • Intermittent claudication
  • Pulses diminished or absent
  • Oedema - none/minimal
  • Skin changes
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5
Q

Peripheral Venous Disorders (PVD), clinical manifestations:

A
  • Pain: aching to cramp like relieved by activity/elevation
  • Pulses usually present
  • Oedema - present/
  • Skin changes
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6
Q

Intermittent Claudication - Signs & symptoms

A

• Muscular/cramping (ischaemic) type pain

  • precipitated by exercise, resolves within 10 mins of rest.
  • Must be reproducible.
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7
Q

Intermittent Claudication - Causes

A
  • Lack of blood supply of O2/nutrients when increased demand

* Caused by arterial supply failure

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8
Q

Peripheral Arterial Disease (PAD) - Causes

A
  • Atherosclerosis (accumulation of plaque)

* Arteriosclerosis (hardening of arteries)

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9
Q

Peripheral Arterial Disease - nursing diagnoses

A
  • Altered peripheral tissue perfusion
  • Chronic pain
  • Risk for impaired skin integrity
  • Knowledge deficient
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10
Q

Nursing interventions for Altered Peripheral Tissue Perfusion

A
  • Protection of extremities and avoidance of trauma
  • Good hygiene - moisturisers
  • Reg. inspection of extremities
  • Podiatric care
  • Good nutrition
  • Weight reduction
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11
Q

What is an aneurysm?

A

An aneurysm is a localised sac or dilation formed at a weak point in the wall of the aorta (or any artery really).

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12
Q

Risk factors for Venous thromboembolism - DVT

A
  1. Venous stasis (HF, paralysis). 2. Venous endothelial damage (trauma).
  2. Hypercoagulability of the blood (smoking/the Pill). 4. Age. 5. Pregnancy.
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13
Q

DVT pathophysiology

A

RBCs/WBCs/platelets/fibrin clump together to form a thrombus.

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14
Q

Drug therapy for DVT

A

• Unfractionated heparin (sodium heparin) IV infusion
• LMW heparin (enoxaparin).
Minimise venipuncture (pressure 10 mins+ after injection)

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15
Q

Anticoagulant Drugs

A
  • heparin • dalteparin & enoxaparin (LMWHs)

* warfarin

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16
Q

What are the low-molecular-weight heparins (LMWHs)?

A

• dalteparin and enoxaparin (used in pregnancy)

These have fragments 1/3 the size of standard heparin. They have a range of 4000-6000 in molecular weight.

17
Q

Heparin mechanism of action

A

The anticoagulant affect is had by heparin combining with antithrombin III, a naturally occurring anti-clotting factor in the plasma. This complex is then able to act more rapidly at multiple sites, inactivating thrombin factor IIa, IXa, Xa, XIa and XIIa. Inactivation of Xa (intrinsic & extrinsic pathway) prevents the conversion of prothrombin to thrombin, so inhibiting the formation of fibrin from fibrinogen.

18
Q

Signs of heparin overdose

A

• Bruising, nosebleeds or excessive bleeding from minor cuts, brush of teeth or menstrual period.

19
Q

Blood flow rate?

A

Flow rate = ΔP/R (pressure difference ÷ resistance)

20
Q

What is the most important factor determining resistance in the vascular system?

A

• Vessel radius

21
Q

Vasodilators

A

• histamine • bradykinin • prostaglandin

22
Q

How to calculate the ankle-brachial index (ABI)

A

• Cuffs are placed on both arms and both legs above the malleolus
Using a doppler the highest systolic pressure from each arm is ÷ by the highest systolic pressure in both feet.
(systolic from the feet is via posterior tibial or dorsal is pedis)
Ankle systolic is usually higher in a healthy person.