Welsh's Study Guide Aneurysms/PVD

Question 1

What is PAD?

Answer 1

Peripheral Artery Disease. S/S Intermittent claudication. Pallor, no hair on lower extremeties, skin is shiny, sores that won’t heal and if it is bad enough you’ll have gangrenous tissue. Often the gangrenous tissue will be on the toes or between the toes.

Question 2

What are the risk factors for PAD?

Answer 2

High blood pressure, smoking, high cholesterol, hypertension, diabetes, family history of PAD and obesity

Question 3

What is atherosclerosis?

Answer 3

Hardening of the artieries. Happens when you get older. They are less flexible and have plaque build up.

Question 4

What are the s/s of PAD

Answer 4

1

Question 5

What is intermittent claudication? What relieves it?

Answer 5

Pain in the legs that is constant that happens when you do normal stuff. Remember, it is constant. It is NOT from working out hard. It is constant. IT IS RELIEVED BY REST.

Question 6

What are the severe s/s of PAD.

Answer 6

1

Question 7

What are the 6 P’s?

Answer 7

Pulse, pain, pallor, polikothermia, paralysis, parasthesia

Question 8

What is the nursing diagnosis for Intermittent claudication and what are the goals?

Answer 8

Decreased tissue perfusion. Goal: cappilary refill < x seconds. THEY DO NOT CROSS LEGS OR WEAR TIGHT CLOTHING.

Question 9

What are arterial ulcers? What are the s/s?

Answer 9

They are round with well defined borders. They are usually blue to black. They are painful. They are caused by arterial insufficiency. The tissue becomes necrotic.

Question 10

What is angiography? What are the complications? What do you assess for after the procedure?

Answer 10

A catheter that is stuck into an area where dye is injected to help them diagnose problems. Complications include allergic reaction to dye, emboli, perforation, hemorrhaging or hematoma. After the procedure you’ll assess for temp, color, pulses.

Question 11

What is the nonsurgical management for arterial ulcers?

Answer 11

Teach about positioning (do not cross legs, do not put feet up for long periods of time or keep them in one position), teach them to moderate exercise. Promote vasodilation. Talk to them about medication therapy. With arterial issues you want them to keep their feet BELOW THE HEART. (i.e. keep legs in a dependent position)

Question 12

What drugs are used to treat arterial ulcers?

Answer 12

Vasodilators.

Question 13

What is percutaneous transluminal angioplasty (PTA)?

Answer 13

It is when a baloon is used to try to open up an arterial occlusion. Sometimes they will try to use a stint to keep it open.

Question 14

What is the surgical management for percutaneous transluminal angioplasty?

Answer 14

Arterial revascularization (a graft).

Question 15

Where is outflow done? Complications?

Answer 15

Outflow is from below the femoral arteries. The grafts will be short grafts made from multiple vein segments. Complications include leaking,

Question 16

Where is inflow done? Complications?

Answer 16

Inflow is above the femoral arteries. Big, long veins are normally used. Mr. Welsh said there are usually not many complications.

Question 17

Post op care for PTA patients?

Answer 17

Deep Breething, Incentive Spirometer, Check pulse, temp, color, bp. If their bp drops suddenly it could be a bleeding issue. Teach patient to try not to move much. ALSO ASSESS SURGICAL SITE FOR INFECTION, BLEEDING, COMPARE THE LEGS FOR COLOR/TEMP, ETC., NOTIFY SURGEON IMMEDIATELY OF ANY BLEEDING AND ASSESS FOR PAIN! (WHAT KIND OF PAIN IT FEELS LIKE- SHARP RIPPING PAIN IS BAD. THROBBING MIGHT BE NORMAL)

Question 18

What is arterial occlusion? What is the treatment?

Answer 18

Blocked artery. Treated with anticoagulants and surgery. This is an emergency situation!!

Question 19

What is Buerger’s disease? S/S? Cure?

Answer 19

Inflammation of small arteries with thrombosis. Basically, the small arteries have a clot. Often occurs in smokers. S/S include: coolness, numbness, tingling. Usually found in men ages 20-35. It is exasterbated by cold, stress and nicotine. Diminished pulses in the affected areas. No cure- just treat symptoms.

Question 20

What is Raynaud’s? S/S? Treatment? Teaching?

Answer 20

Vasospasms to the upper arteries. Common in the hands. S/S: Coldness, pain, pallor, “patriotic color changes” (i.e. red, white, blue). Cold, nicotine and stress exasterbate it. Teach patient to stay warm, reduce stress and not to smoke. This will be on the test** (especially stress management as part of the teaching)

Question 21

What is PVD?

Answer 21

Peripheral Vascular Disease. Happens on the venous side.

Question 22

Risk factors for PVD?

Answer 22

Risk factors include: smoking, obesity, family history of PVD, high cholesterol, High BP and all the same things as PAD.

Question 23

What are varicose veins? Risk factors? S/S? Treatment?

Answer 23

These are dilated, tortuous(?) veins. Usually caused by a weakness in the valve or vein structure. Risk factors include: Obesity, Pregnant women, Folks who have long periods of standing. S/S include: dilated, purple, bulging veins. Treatment includes: prevention, surgical stripping (removal of valve or whole vein),

Question 24

What is thrombophlebitis? Causes? Treatment?

Answer 24

Inflammation in the vein (usually caused by an IV). The area becomes warm and reddened. Edema can occur. Treatment includes removing the IV, elevate the area, moist, warm compress.

Question 25

What is a venous thrombosis?

Answer 25

Blood clot in the vein.

Question 26

What are the risk factors for venous thrombosis?

Answer 26

People on bed rest, people older than 40 who have had surgery (especially folks who have had immobilization surgery like having a cast, having a knee replacement, femur fracture, etc)

Question 27

S/S of deep vein thrombosis? S/S of superficial vein?

Answer 27

Deep: Edema, warmth/tenderness at site, positive Homan’s sign. Superficial: Pain, redness, warmth/tenderness.

Question 28

How are deep vein/superficial vein diagnosed?

Answer 28

Ultrasound of legs, chest x-ray, possibly a CT scan.

Question 29

Treatment for Deep vein/superficial vein thrombosis?

Answer 29

Anticoagulants, Elevate, bed rest, activity as tolerated (if they don’t become active they could get another one).

Question 30

DVT S/S? Prevention? Complication?

Answer 30

Positive Homan’s Sign, unilateral leg edema, pain, redness, warmth, fever (and, if it’s in the lower extremity they could have calf tenderness). Prevention: Early immobilization, TED hose or SCD’s. The biggest complication would be a PE.

Question 31

Nonsurgical Treatment for DVT?

Answer 31

Anticoagulants, antithrombolytics, elevate leg, encourage ambulation when tolerated.

Question 32

Surgical Treatment for DVT?

Answer 32

Thrombectomy. IVC filters

Question 33

What is a PE? S/S?

Answer 33

Pulmonary Embolism (a clot has broken loose, usually from a DVT but sometimes it can be a fat or air embolus). S/S include: Dyspnea, impending sense of doom, 02 sats low

Question 34

What are the complications of a massive PE?

Answer 34

1

Question 35

Priority Care for a PE?

Answer 35

Airway! Raise the head of the bed, put oxygen on them. Get them to where they can breathe?

Question 36

What is the treatment for PE?

Answer 36

Prevention (if they have DVT’s they’ll probably get a filter), anticoagulants, bed rest, elevate head, monitor vitals and assess respiratory system. Anticoagulants will be given.

Question 37

How does Heparin therapy help? What labs need to be monitored?

Answer 37

Heparin thins the blood BUT REMEMBER ANTICOAGULANTS DO NOT BUST UP THE CLOTS. They just stop them from getting bigger. Labs: PTT

Question 38

What are the complications?

Answer 38

Hemorrhage, bleeding.

Question 39

What is the antidote to Heparin?

Answer 39

Protamine Sulfate. This will be on the test.

Question 40

What is Lovenox? How is it given? Air bubble?

Answer 40

LMWH. It is a low molecular weight heparin that is given subcutaneously. (Heparin is given subcu or IV). You push any air bubbles. You do not get rid of them. This ensures they get ALL of the medicine. He said to remember this.

Question 41

What is Coumadin?

Answer 41

Warfarin. Blood thinner. Also used as rat poison. It is theraputic 3-4 days. Heparin and Coumadin can be given together until it becomes therapeutic (then you’ll stop the heparin) Coumadin inhibits clotting factors.

Question 42

Complications from Coumadin?

Answer 42

Bruising and hematomas come easy. Wounds take longer to clot. You’ll monitor PTINR. Keep an eye on H&H. People on coumadin are at a higher risk for bleeding.

Question 43

Teaching for Coumadin?

Answer 43

Wear a medical alert bracelet. LIMIT VITAMIN K FOODS, Monitor for bleeding.

Question 44

What is the antidote for Coumadin?

Answer 44

Vitamin K

Question 45

What is a CVI?

Answer 45

Chronic venous insufficiency. Caused by destruction of the valves.

Question 46

S/S of CVI?

Answer 46

Edema (usually in lower legs), increased pain, STATUS DERMATITIS (brown pigmentation), Redness, Venous ulcerations.

Question 47

Complications of CVI?

Answer 47

Cellulitis and infection

Question 48

What are venous ulcerations? S/S? Treatment? **this answer is not complete. Add to it.

Answer 48

Ulcerations caused by venous insufficiency. S/S: irregular border, superficial, pink wound bed.

Question 49

What is an AAA? When is it treated surgically?

Answer 49

Abdominal Aortic Aneurysm. It is a weakness in the aortic wall (it pooches out). It is not treated surgically until it is about 5-6 cm.

Question 50

S/S of an AAA? Complications?

Answer 50

S/S: PULSATING MASS, sudden severe pain. Complications: rupture. S/S of a rupture, pallor, tachycardia, low bp. Treatment: Graft.

Question 51

What is an aortic dissection? Complications?

Answer 51

It is when the aorta splits open. Complications: Instant death.

Question 52

Post op care/assessment for AAA repair?

Answer 52

Watch for hemorrhage, vitals, watch for infection, loc, temp, wbc count, wound care, keep everything clean!

Question 53

D/C teaching for AAA repair?

Answer 53

Avoid heavy lifting for 4-6 weeks, gradually increase activities, have them watch for infection and fever, have them inspect wound site, have them watch color. They will be tired, have decreased appetite and irregular bowel habits. Teach them that the repair can cause sexual dysfunction.

Question 54

Study specifically

Answer 54

3, 5, 8, 9, 10, 18, 20, 30, 33, 37, 38, 39, 40, 41, 42, 43, 45, 46, 48, 52. Study the difference between venous and arterial! He stressed this several times.