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kol- Med Surg 320 Spring > PVD/PAD > Flashcards

PVD/PAD Flashcards

1
Q

define pvd

A

Reduced blood flow to OR away from the limbs (Typically) due to narrowing of vessels

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2
Q

what causes PAD

A

atherosclerosis

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3
Q

PAD patho

A
  • Result of atherosclerosis
  • –>Partial or complete occlusion of artery in peripheral circulation
  • –>Results in tissue death below area of occlusion
  • –>Increased risk of MI and Stroke
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4
Q

PAD is increase risk for

A

MI/ stroke

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5
Q

PAD risk factors

A
  • Hypertension
  • Hyperlipidemia
  • Diabetes mellitus
  • Smoking
  • Obesity
  • Hypercholesterolemia
  • Family history
  • Advanced age

(all same risk factors as HTN + addition of HTN)

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6
Q

define 4 stages of PAD

A

I Asymptomatic-reduced pulses
II Claudication- pain when walking
III Rest pain- pain at rest
IV necrosis/ gangrene- ulcers

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7
Q

inflow vs outflow PAD

A

Inflow = Aorta, common, internal and external iliac arteries are effected

Outflow = Femoral, popliteal, tibial arteries are effected

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8
Q

s/s of PAD

A
  • Pain > due to lack of O2
  • Diminished pulses - lack of blood flow
  • Pale - lack of blood flow
  • Hair loss - lack of nutrients
  • Dryness- lack of nutrients
  • Scaling- lack of nutrients
  • Ulcers - lack of O2
  • Thickened toenails
  • Dependent rubor- if someone has legs up then dangle the lower extremity will return red
  • Muscle atrophy - lack of nutrients/blood

—> all of these are coming from lack of blood/O2/nutrients

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9
Q

Inflow disease symptoms:

A

Experience discomfort in the back, buttocks, or thighs

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10
Q

Outflow disease symptoms:

A
  • Burning or cramping in the calves, ankles, feet and toes

- Obstruction below the popliteal associated with foot and instep pain

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11
Q

Diagnostics for PAD

A
  • MRA
  • CTA
  • Segmental systolic blood pressure- take BPs down the leg
  • **ABI
  • Doppler
  • Exercise tolerance testing
  • plethysmography
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12
Q

what is an ABI

A

ankle brachial index

take BP of ankle and of brachial and should be similar ratio of 1 but if blood flow is decreased then we would have ABI of

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13
Q

PAD vs PVD - leg positions

A

PAD (^) - legs pointing down

PVD ( v)- legs up

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14
Q

should you exercise with PAD?

A
  • Not for severe disease/ulcers -

- Exercise until pain. stop. start —> increase collateral circulation

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15
Q

heat or cold with PAD?

A
  • head (avoid cold)
  • No Heating pad due to loss of sensation- not aware that they are being burned
  • use warm socks with arterial disease
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16
Q

FLuids with PAD?

A

increase fluids

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17
Q

drugs for pad

A 
Antiplatelets
Hemorheologic
Phosphodiasterase inhibitors
Antihypertensives
Lipid Lowering medications
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18
Q

non surgical procedures for pad

A
  • Percutaneous vascular intervention - stint to keep it open

- Atherectomy- remove the plaque

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19
Q

surgical intervention for PAD

A

bypass

  • Autogenous (saphenous, cephalic, basilic veins) *preferred
  • Synthetic grafts

-Do not remove plaque/artery - blood just takes path of least resistance

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20
Q

special line for PAD Bypass surgery?

A

arterial line to monitor BP

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21
Q

preoperative care: arterial bypass

A
  • Infection prevention
  • One or more IV lines or a central line
  • Arterial line to monitor BP
  • Urinary catheter- monitor output
22
Q

How often to mark and assess pulses postop arterial bypass?

A

-Mark and assess pulses of affected extremity - every 15 min for an hour, every 30 for 4 hours, ever hour for 24 hours

23
Q

reperfusion pain =

A

throbbing

24
Q

2 PAD bypass surgery complications

A

graft occlusion

graft infection

25
Q

signs of graft occlusion and how do we treat?

A

Severe aching continuous pain with graft occlusion (versus throbbing from normal reperfusion)

-Often treated with thrombectomy or Thrombolytic agent

26
Q

What is an acute aterial occlusion?

A
  • When an embolus travels and lodges in an artery
  • On rarer occasion, caused by a local thrombus
  • Usually travels from the heart due to A-fib (blood pooling in Atria and clots form) or MI
27
Q

what are the 6 p’s of ischemia

A 
Pain
Pallor
Pulselessness
Parasthesia
Paralysis
poikilothermy- coolness
28
Q

Acute arterial occlusions: Interventions

A
  • Arteriotomy
  • Catheter guided intra-arterial thrombolytic therapy
    • done in IR , thread sheath in, guide wire/catheter is threaded in, put in TPA to break down clot
    • can leave sheath in for a couple of days while clot is slowly broken down
29
Q

3 types of Peripheral Venous disease

A
  1. Venous insufficiency
  2. Venous thromboembolism
  3. Varicose veins
30
Q

who gets stasis ulcers? PAD or PVD

A

PVD

31
Q

What is stasis dermatitis?

A

breakdown of iron –> discoloration blue/red/purplish + thickening of skin

32
Q

Venous insufficiency assessment (3)

A
  • Stasis dermatitis = breakdown of iron –> discoloration blue/red/purplish + thickening of skin
  • Edema
  • Stasis ulcers
33
Q

Venous insufficiency: Interventions

A
  • Prevent stasis and wound formation
  • promote wound healing
  • Prevent infection - cellulitis risk + ulcer infection
  • Compression stockings/SCD
  • Elevations of legs for 20 minutes, 4-5 times per day (for venous insufficiency) (V)
  • Elevate legs above the level of the heart
  • Use of pump devices
34
Q

PAD vs PVD ulcers

A

Peripheral Arterial Disease (PAD)

  • Painful
  • Often develop on toes first
  • Eventually become gangrenous
  • Difficult to manage
  • Round and small/ well defined
  • Cool
  • Absent arterial pulses

Vascular Insufficiency (Venous Ulcer)

  • Often develop over inner ankle area
  • Irregular borders
  • Chronic and difficult healing, exudate
  • warm
  • pulses present or variable
35
Q

Venous thromboembolism =

Where likely to occur

A

=Blood clot (thrombus or embolus) in the vein

-most likely to occur in deep veins in lower extremities but can occur in upper extremities

36
Q

Deep vein thromboembolism =

A

=deep vein thrombophlebitis or DVT

37
Q

What is the most important risk of a dvt?

A

PE

38
Q

Who is at risk of developing DVT?

A
  • Hip or knee surgery
  • Open prostate surgery
  • Ulcerative colitis
  • Heart failure
  • Cancer
  • Oral contraceptives
  • Immobility
  • Phlebitis
  • Most hospitalized people due to immobility and other conditions
39
Q

Virchows Triad

A

determines risk of developing DVT

  1. Hypercoagulability of blood
  2. Vascular damage to the vessel
  3. Circulatory stasis
40
Q

Dvt assessment

A
  • Calf or groin tenderness
  • Sudden onset of Pain and
  • *Unilateral swelling of the leg
  • Positive homan’s sign (unreliable) - dorsiflex foot and feel pain in calf
  • Redness
  • Warmth
41
Q

DVT Diagnosis

A
  • *Venous duplex ultrasonography - most helpful
  • Doppler flow tests
  • Impedance plethysmography
  • MRI
  • D-Dimer- looks at breakdown of firbinogen, all it tells us is that there is a clot somewhere
42
Q

D Dimer looks at what and tells us what?

A

looks at breakdown of firbinogen, all it tells us is that there is a clot somewhere

43
Q

Top 3 goals with DVT interventions

A
  1. *Preventing complications —> Clot Traveling to lung
    • assess respiratory status!
  2. Preventing clot from getting bigger - anticoagulant
  3. Preventing more clots from forming - anticoagulant
44
Q

Do you massage area where DVT is?

A

heck no

45
Q

Venous thrombosis surgery

A
  • In general, surgery is rare for venous thrombi =Thrombectomy
  • Inferior vena cava filtration is more common
    • use for people who cannot be anticoagulated for some reason
    • prevents DVT from travling past inferior vena cava preventing PE
46
Q

varicose veins =

A

Distended, protruding veins that become darkened and tortuous

*most common in >30 yr

47
Q

varicose veins caused by and associated with

A

-Caused by: Prolonged standing or heavy lifting
-Associated with
Obesity
Estrogen
Family history

48
Q

varicose veins assessment

A
  • Itching
  • Edema
  • Feeling of fullness in legs
  • Signs and symptoms of venous insufficiency
49
Q

Varicose Veins diagnosis

A
  • Ultrasonography

- Duplex ultrasonography

50
Q

Varicose veins: Interventions

A
  • Elevate
  • Elastic Compression stockings
  • Exercise
51
Q

Varicose veins: surgery (3)

A
  • Vein ligation or removal - tie the ends of the varicose vein and they collapse b/c no blood going through
  • Sclerotherapy- injection of substance into vein causing sclerosis and blood moves somewhere else
  • Endovenous ablation- runs catheter into vein, ablates it, vein goes away and blood uses healthier vein

kol- Med Surg 320 Spring (43 decks)

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