Cardiac - Unit 2 - Care of Patients with Vascular Problems

Question 1

Assessment - Arterial vs. Venous Problems

Answer 1

Arterial - smooth, shiny, loss of hair, thick nails, loss of sensation, pale, cyanotic, cool.

Venous - brown pigment around ankles, edematous, warm.

Question 2

Assessment of Peripheral Pulses - Arterial vs. Venous

Answer 2

Arterial - decreased or absent pedal pulses, ABI or = to 1

Venous = Normal pulses & ABI

Question 3

Assessment of pain - Arterial vs. Venous

Answer 3

Arterial = intermittent claudication, rest pain, loss of movement.

Venous = achy

Question 4

What are some diagnostics for arterial or venous problems?

Answer 4

Doppler Ultrasound, Arteriogram or Venogram

Question 5

Arteriosclerosis - def

Answer 5

thickening or hardening of arterial wall often associated with aging.

Question 6

Atherosclerosis - def

Answer 6

type of arteriosclerosis involving formation of plaque within the arterial wall.

Question 7

What are some lab assessments for atherosclerosis?

Answer 7

Lipid levels, HDL, LDL, homocysteine (high levels means you can be vulnerable to plaque buildup)

Question 8

What are some medical treatments for atherosclerosis?

Answer 8

Evaluate labs and life style changes, nutrition therapy, durg therapy (statins, fibrates [gemfibrozil - decrease triglycerides], cholesterol absorption inhibitors [ezetimibe], bile acid sequestrants, niacin)

Question 9

What are some surgical interventions for arterial problems?

Answer 9

PTA, endarterectomy, bypass graft, thrombectomy, embolectomy, amputation

Question 10

What are some surgical interventions for venous problems?

Answer 10

Vein ligation (they tie veins together to prevent pooling of blood), thrombectomy, debridement (removing dead tissue)

Question 11

What is angioplasty?

Answer 11

PTA (Percutaneous Transluminal Angioplasty with stent) - they go in and open up the blockage and stent it.

Question 12

What’s an endarterectomy?

Answer 12

They go in and basically strip the inside of the artery…

Question 13

Pre-op procedure - assessments?

Answer 13

Vitals & Pulses

Question 14

Post-op procedure - assessments?

Answer 14

Peripheral pulses, fluid status, coagulation status, pain, exercise & motion.

Question 15

What are some complications for arterial procedures?

Answer 15

Graft occlusion, compartment syndrome, acute arterial occlusion and ulcer formation.

Question 16

What are some complications for venous procedures?

Answer 16

Ulcer formation, pulmonary embolism.

Question 17

What are ulcers like for arterial problems?

Answer 17

Painful, tops of toes/heels/feet - grayish appearance, gangrene, mottled, dry, etc.

Question 18

What are ulcers like for venous patients?

Answer 18

Lightly to non-painful, bottom third of leg, uneven edges, ruddy, superficial/wet

Question 19

How do we position extremities for these patients (tell both)?

Answer 19

Arterial - gravity flow.

Venous - elevate the extremity.

Question 20

Thrombus - def

Answer 20

Formation of a blood clot within the vascular system.

Question 21

Embolus - def

Answer 21

clot or foreign substance traveling within the vascular system.

Question 22

Embolus originating in left side of heart may travel to the brain. T/F?

Answer 22

TRUE

Question 23

What are the signs and symptoms of sudden arterial occlusion? (6 P’s)

Answer 23

Pain - sudden & severe
Pallor - appearance is pale then white, cold and blotched - finally mottled & cyanotic.
Pulselessness - 
Paresthesia - (pens & needles)
Paralysis -
Polar or poikilothermia (temp varies)

Question 24

What is buerger’s disease?

Answer 24

Where you want Bravas all the time…

Just kidding - it’s an imflammatory & spasmotic occlusive vascular disease that happens more in Jewish men that are over the age of 40. A history of smoking is the biggest cause!

Question 25

What are symptoms of buerger's disease?

Answer 25

Pain (intermittent claudication), paresthesia, weak pulses, ulcerations, gangrene

Question 26

What is the treatment for buerger's disease?

Answer 26

Vasodilation, pain relief, stop smoking, buerger/allen exercises (improve circulation), dependant positioning, amputation

Question 27

What is Raynaud's disease?

Answer 27

Bilateral intermittent cold induced digital ischemia - it usually affects fingers and can progress to necrosis and loss of tissue and it usually happens in females and is affected by smoking.

Question 28

What is Raynaud's Phenomenon?

Answer 28

Raynaud's secondary to another disease such as Lupus, Scleroderma, Rheumatoid Arthritis

Question 29

What are symptom's of Raynaud's?

Answer 29

Bilateral, intermittent pallor, cyanosis, rubor (white, then blue, then red) Numbness, tingling, burning.

Question 30

What are the treatment options for Raynaud's?

Answer 30

Calcium channel blockers, nitro, resperine, biofeedback, protection from cold, no smoking, if severe = regional sympathectomy (cutting of a sympathetic nerve)

Question 31

What can also induce Raynaud's?

Answer 31

Coffee & Chocolate

Question 32

What are arterial aneurysms? The two types?

Answer 32

Abnormal dilation of an artery caused by deformity of its wall. True = involves all three layers. False = hematoma outside arterial wall. Predisposing factors include family history, atherosclerosis, syphilus, HTN

Question 33

What are some symptoms of an AAA?

Answer 33

Can be asymptomatic, but also can include pulsating abdominal mass w/ bruit, pain in back, abdomen or flank, blood stools, scrotal bruising, embolus, or sudden intense back pain/shock with a rupture!

Question 34

What are symptoms of a thoracic aortic aneurysm?

Answer 34

Back pain, SOB, hoarseness, difficult swallowing, mass may be visible above suprasternal notch, sudden excruciating back or chest pain (rupture)

Question 35

What are some diagnostic tests for a TAA or an AAA?

Answer 35

CT Scan, MRI, Ultrasound, CXR

Question 36

What are some post-op nursing care things for thoracic and abdominal aneurysm's?

Answer 36

TAA - monitor PAP pressure, chest tubes, assess LOC, assess upper extremity CSM. AAA - assess renal function, assess abdomen, assess spinal cord function and if there's graft occlusion.

Question 37

What is marfan's?

Answer 37

Genetic abnormality of connective tissue usually found in tall slender men with long extremities - can cause valve prolapse and treatment depends on symptoms.

Question 38

What is a VTE?

Answer 38

Venous Thromboembolism.

Question 39

What are some assessment findings with VTE?

Answer 39

Calf or groin pain or tenderness and sudden onset of unilateral leg swelling

Question 40

What are some treatment options for VTE?

Answer 40

anticoagulation therapy, bedrest, compression stockings, surgical management

Question 41

What are varicose veins?

Answer 41

Abnormally dilated, engorged, tortuous and superficial veins - symptoms include achy legs, itching, muscle cramps, local redness and tenderness

Question 42

What is schleroptherapy?

Answer 42

Used for small varicose veins - they insert a catheter, heat it up, the vein collapses and is then removed and BAM, you're golden!