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Flashcards in 10 minute topic vascular disease Deck (57):
1

Vascular diseases

PVD (peripheral vascular disease) and PAD (peripheral arterial disease)
both have interference of normal blood flow

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PAD (peripheral arterial disease)

results from atherosclerosis usually the lower extremities

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Atherosclerosis

gradual thickening of the intima and media of the arteries, ultimately resulting in the progressive narrowing of the vessel lumen

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Classifications of PAD

Inflow (distal aorta and iliac arteries)
Outflow – femoral, popliteal & tibial artery

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subtypes of PAD

Buerger’s, subclavian steal, thoracic outlet syndrome, Raynaud’s, popliteal entrapment

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PAD risk factors

HTN, hyperlipidemia, DM, Smoker, Obesity, sedentary lifestyle, familial predisposition, age

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PAD s/sx

Burning pain during exercise (intermittent claudication)
Pain while in bed
< cap refill
< distal pulse
Loss of hair on calf
Dry, scaly skin
thick toenails
muscle atrophy

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PAD diagnostic tests

Arteriography
Exercise tolerance test
Plethysmography

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PAD Arteriography

arterial injection of contrast medium, under fluoroscopy

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PAD Arteriography nursing actions

(same as with cardiac cath) Observe for bleeding and hemorrhage. Palpate pedal pulses to identify possible post-procedure occlusions

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PAD Exercise tolerance test

used to evaluate claudication during exercise

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PAD Plethysmography

used to determine the variations of blood passing through an artery, thus identifying abnormal arterial flow in the affected limb

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PAD nursing care

encourage exercise
avoid crossing legs
elevate the legs but not above the heart
promote vasodilation and reduce vasoconstriction

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Medications for PAD

ASA, clopidogrel (Plavix) Pentoxifylline (Trental)
give with meals
need several weeks to take effect
Antiplatelets

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Anti-platelet teaching

take with food
monitor for signs of bleeding
meds take weeks for effect

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PAD surgical interventions

Percutaneous transluminal angioplasty
Arterial revascularization

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Percutaneous transluminal angioplasty

balloon or stint them open
will be on anti-platelet therapy for 1-3 months

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Arterial revascularization

used for severe claudication and/or limb pain at rest
bypass graft around occlusion

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Arterial revascularization post procedure nursing actions

monitor BP, hypotension increases risk of clot or graft collapse
limit hip and knee bending
pain may be severe when reestablishing blood flow

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Arterial revascularization PT teaching

avoid crossing legs
loose clothing
no smoking or cold due to vasoconstriction
foot care

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Arterial revascularization complications

Graft occlusion
Compartment syndrome

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Compartment syndrome

Tissue pressure within a confined body space can restrict blood flow and the resulting ischemia can lead to irreversible tissue damage

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Examples of PVD's

venous thromboembolism (VTE)
venous insufficiency
varicose veins

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venous thromboembolism (VTE)

blood clot formed as a result of venous stasis, endothelial injury, or hypercoagulability (hypercoagulation)

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Thrombophlebitis

thrombus that is associated with inflammation

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Venous insufficiency

occurs secondary to incompetent valves in the deeper veins of the lower extremities

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Varicose veins

enlarged, twisted and superficial veins

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VTE risk factors

Hip surgery, total-knee replacement, open prostate surgery
Heart failure
Immobility
Pregnancy
Oral contraceptives

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Venus insufficiency risk factors

Sitting or standing in one position over a long time
Obesity
Pregnancy
Thrombophlebitis

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Varicose veins risk factors

A person over 30yrs with standing occupation
Pregnancy
Obesity
Systemic diseases
Family history

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VTE s/sx

Can be asymptomatic
Calf or groin pain – classic sign
Tenderness – classic sign
Sudden onset of swelling – classic sign
assess for SOB & chest pain (feeling of impending doom)

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Venus insufficiency s/sx

Pain
Stasis ulcers -typically found around ankles
Stasis dermatitis (brown discoloration around ankles that can extend up the calf relative to the level of insufficiency)
Edema

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Varicose veins s/sx

Aching pain (dull)
Distended superficial veins (visible just below the skin)
Tortuous in nature

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D-dimer diagnostic test

measures fibrin degradation products present in the blood produced from fibrinolysis.
indicates thrombus formation has possibly occurred

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Venous duplex ultrasonography diagnostic test

uses high-frequency sound waves to provide picture of the blood flow through a blood vessel.

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Impetus plesmography

determine the variations of blood passing through a vein, thus identifying abnormal venous flow in the affected limb

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Venogram

if other tests are negative but they still suspect a DVT
they put a contrast medium material into the vein and use x-ray and fluoroscopy to see it

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Trendelenburg test

used for varicose veins
If they fill proximally there are varicose veins
If they fill distally there are none (normal)

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DVT & thromblophlebitis nursing care

encourage rest
elevate extremity
no massage
warm compress
compression or antiembolism stockings

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Venous Insufficiency nursing care

Elevate legs several times a day for at least 15 to 30 min
Elevate feet at least 6 inches at night
Avoid crossing legs and constrictive clothing or stockings
TED hose – after the legs have been elevated and when swelling is at a minimum.

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Therapeutic procedures for varicose veins

sclerotherapy
Vein Stripping
Endovenous Laser Treatment
Radiofrequency Energy application

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sclerotherapy

chemical solution is injected into the varicose vein to produce localized inflammation which will, close the lumen of the vessel over time and it will collapse on itself

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Vein Stripping

moval of large varicose veins that cannot be treated with less-invasive procedures

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Vein Stripping post procedure

keep legs elevated
encourage ROM
need compression stockings

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Radiofrequency Energy application

electrode will scar the dilated vein causing it to close down on itself

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Endovenous Laser Treatment

heat from a laser is used to close the dilated vein.

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Aneurysms

weakness in a section of a dilated artery that causes widening or ballooning in the wall of the blood vessel

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Aneurysm forms

Saccular (only affecting one side of the artery)
Fusiform (involving the complete circumference of the artery)

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abdominal aortic aneurysms

account for 75% of aneurysms

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Aneurysm prevention

no smoking
decrease WT
healthy diet/exercise
control BP (#1)

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Aneurysm risk factors

Atherosclerosis
Age (arterial stiffening occurs)

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Aneurysm s/sx

none initially

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Abdominal aortic aneurysm (AAA) s/sx

Abdominal pain
pulsating abdominal mass (no not palpate)
> BP
Aortic dissections (likely fatal)

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Thoracic aortic aneurysm s/sx

Coolness or cyanosis below
Severe back pain
Hoarseness, cough, shortness of breath, and difficulty swallowing
Decrease in urinary output

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Aneurysm diagnosis

x-ray
CT and ultrasound to assess location and size

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Percutaneous aneurysm repair

Insertion of endothelial stent grafts
typically used for aortic aneurysms, but can be used to repair a thoracic aortic aneurysm

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Thoracic aortic repair

similar to open heart surgery