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Chapter 26 Clinical Flashcards

Vascular Peripheral Circulation - Disorders (65 cards)

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1
Q

Pump failure means:

A

inefficient pump/ contractile force

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2
Q

HFrEF/ systolic HF

A

HF with left ventricular ejection fraction

Causes blood accumulation in lungs
Reduction in forward flow/ CO

= inadequate arterial flow to tissues

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3
Q

HFpEF, diastolic HF

A

HF with preserved left ventricular ejection fraction

Systemic venous congestion
Reduction in forward flow

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4
Q

Blood vessels must be:

A

intact, patent, and responsive

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5
Q

Arterial Occlusion/ Arteries become damaged or obstructed
(6 factors):

A

Atherosclerotic plaque
Thromboembolus
Chemical or mechanical trauma
Infections or inflammation
Vasospastic disorders
Congenital malformations

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6
Q

Arterial Occlusion (Sudden)

A

profound and irreversible tissue ischemia and tissue death

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7
Q

Arterial Occlusion (Gradual)

A

less risk for tissue death, able to form collateral circulation (opp. to adapt to gradual blood flow decrease)

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8
Q

Venous Occlusion, causes:

A

Thromboembolus, incompetent venous valves, reduced pumping action

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9
Q

Edema, formation:

A

dec. venous blood flow – inc. venous pressure – fluid out of capillaries into interstitial space

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10
Q

Edematous tissue is prone to:

A

breakdown, injury, infection
due to inadequate nutrition = cell death

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11
Q

Peripheral Vascular Disease, type and severity depend on:

A

type, stage, extent of disease process, progression speed

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12
Q

Peripheral Vascular Disease, prognosis:

A

Ischemia (most)

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13
Q

Peripheral Vascular Disease, similar symptoms:

A

pain, skin changes, diminished pulses, possible edema

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14
Q

Characteristics of Arterial Insufficiency

A

Pain: intermittent claudication to sharp, unrelenting, constant

Pulses: diminished, absent

Skin: dependent rubor, elevation pallor

Edema: dry, shiny skin; cool to cold temp; loss of hair (toes, dorsum), thickened and ridged nails

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15
Q

Characteristics of Venous Insufficiency

A

Pain: aching, throbbing, cramping

Pulses: present but difficult to palpate thru edema

Skin: pigmentation in gaiter area (medial and lateral malleolus), thick and tough skin, may be reddish-blue, often with dermatitis

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16
Q

Ulcers, Arterial Insufficiency:

A

Location: tip of toes, web spaces, heel, or other pressure points (if immobile)

Pain: very painful

Depth: deep, with joint space involved

Shape: circular

Ulcer base: pale to black, wet to dry gangrene

Leg edema: minimal unless leg kept in dependent position constantly to relieve pain

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17
Q

Ulcers, Venous Insufficiency:

A

Location: malleolus (medial, lateral) or anterior tibial area

Pain: minimal to very painful

Depth: superficial

Shape: irregular borders

Ulcer base: granulation tissue (beefy red to yellow fibrinous in chronic, long-term ulcer)

Leg edema: moderate to severe

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18
Q

Assessment (Health History)

A

ask pain and precipitating factors

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19
Q

Intermittent Claudication, definition:

A

Indicates peripheral arterial insufficiency (50 – 75% of lumen/ cross-section area obstructed)

muscular, cramp-type pain, discomfort, fatigue in extremities consistently reproduced with the same degree of activity or exercise and relieved by rest

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20
Q

Intermittent Claudication, nursing intervention:

A

monitor progression by documentation of amount of exercise or distance walked (blocks, feet, or meters) before onset of pain

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21
Q

Rest Pain, definition:

A

Persistent pain in anterior portion of foot (forefoot) even at rest, worse at night and may interfere with sleep

Indicates severe arterial insufficiency and a critical state of ischemia

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22
Q

Rest Pain, nursing intervention:

A

requires extremity to be lowered to a dependent position to improve perfusion to distal tissues

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23
Q

Assessment (Physical Assessment)

A

patient’s skin color and temperature, character or quality of peripheral pulses

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24
Q

Rubor, definition:

A

reddish-blue discoloration of the extremities

observed within 20s to 2 minutes in dependent position

suggests severe peripheral arterial damage where BVs cannot constrict and remain dilated

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25
Cyanosis, definition:
bluish tint of the skin, amount of oxygenated hemoglobin is reduced (darker red in color)
26
Chronically-reduced nutrient supply
loss of hair, brittle nails, dry or scaling skin, atrophy, ulcerations (from cell and tissue death)
27
Edema, affected area:
bilateral or unilateral
28
Gangrene occurs with:
prolonged, severe ischemia represent tissue necrosis
29
What are arterial ulcers?
blood is unable to flow into the lower extremities, like the legs and feet. When skin and underlying tissue are deprived of oxygen, the tissue starts to die off and form an open wound.
30
Venous ulcers
develop in areas where blood collects and pools, as swelling there interferes with the movement of oxygen and nutrients through tissues
31
Vascular ulcers, negative impacts (5):
increased risk of infection, sepsis, gangrene, and pain and limited movement
32
Absence of Pulse
indicates site of stenosis (narrowing or constriction) or occlusion is proximal to level occlusive arterial disease
33
Pulses, assessment:
compared bilaterally and simultaneously compare both sides for symmetry in: rate (60 – 100 bpm) rhythm (regular, irregular) quality (0 – 4+) 0 no palpable pulse 1+ faint pulse 2+ slightly diminished pulse 3+ normal pulse 4+ bounding pulse
34
CW Doppler Ultrasound (continuous wave)
when pulses can’t be reliably palpated can detect blood flow in advance arterial disease states, esp. if collateral circulation has developed
35
ABI (Ankle-Brachial Index)
ratio of ankle SBP/ brachial SBP objective indicator of arterial disease that allows examiner to quantify degree of stenosis inc. stenosis/arterial narrowing = progressive decrease in SBP distal to involved sites notify provider on absence of signal in areas previously detected
36
Why do we avoid excessive pressure?
severely diseased arteries can collapse even with minimal pressure
37
Obtaining ABI:
Client in supine position for 5 mins approx. ABI: posterior tibial SBP/ brachial SBP, both left and right ABI = 1.0 – 1.40 (no arterial insufficiency); ankle SBP of healthy person is same or slightly higher than brachial SBP
38
Ankle, ABI:
approp. size cuff on client’s ankle above malleolus check pulse of posterior tibial and dorsalis pedis on both legs SBP obtained while listening to Doppler (doppler can’t measure DBP)
39
Arm, ABI:
both evaluated bec. px may have asymptomatic stenosis in subclavian artery which causes BP on affected side to be 15 – 20 mmHg (or more) lower than systemic pressure if abnormally low, do not use for assessment
40
Indications for ABI/ perform baseline ABI on any patient:
With decreased pulses Change in clinical status: sudden cold or painful limb Above 65 years old History of diabetes and/ or nicotine use Underwent arterial intervention or surgery
41
ABI, Instruct patient to:
Avoid nicotine/ products use Drinking caffeinated beverages at least 2 hours prior Expect some discomfort when cuffs are inflated
42
Exercise Testing, use:
Used to determine how long a patient can walk, measure ankle SBP in response to walking (true vascular claudication)
43
Exercise Testing, how:
Px’s brachial SBP obtained on each arm prior to treadmill walking, or modified to a set distance in a hallway Treadmill at 1.5 mph with a 12% incline for a max of 5 mins, or walks with gradual rise in speed and incline to the point of claudication
44
Exercise Testing, nursing interventions:
no running, but walking on a slight incline cycling – eval client’s ability to walk
45
Exercise Testing, results:
Normal response: little to no drop in ankle SBP True vascular claudication: ankle SBP drops
46
Unable to complete exercise test if:
significant arterial insufficiency severe cardiac, pulmonary, or orthopedic problems physical disability
47
Duplex Ultrasound, use:
standard for diagnosing lower extremity venous thrombosis determine the level and extent venous disease, and chronicity
48
Duplex Ultrasound, nursing interventions:
noninvasive and usually requires no patient preparation abdominal vascular duplex ultrasound – NPO status for at least 6 hrs prior
49
CT Scan, abdomen:
useful in assessing characteristics and monitoring changes within the aorta (such as an increasing aortic diameter indicating aneurysmal formation)
50
Angiography, for:
confirm the diagnosis of occlusive arterial disease locate a vascular obstruction or an aneurysm and collateral circulation
51
Aneurysm
abnormal dilation of a blood vessel
52
Radiopaque contrast agent with Iodine: Allergic reaction manifestations
dyspnea, nausea & vomiting, sweating, tachycardia, numbness of extremities
53
Radiopaque contrast agent with Iodine: Allergic reaction treatment
administer epinephrine, antihistamines, corticosteroids
54
Arterial Disorders, cause:
Chronic progressive pathologic changes to the arterial vasculature (atherosclerotic changes) Acute loss of blood flow to tissues (aneurysm rupture)
55
Arteriosclerosis
Most common disease of arteries, thickened walls of arteries or arterioles
56
Atherosclerosis
Generalized arterial disease: when present in extremities, also present elsewhere in body Atheromas or plaques
57
Atheromas/ Plaques
accumulation of lipids, calcium, blood components, carbohydrates, and fibrous tissue on the intimal layer of the artery
58
Atherosclerosis, direct:
o stenosis (narrowing) of the lumen o obstruction by thrombosis o aneurysm o ulceration o rupture
59
Atherosclerosis, indirect:
o malnutrition o subsequent fibrosis of the organs that the sclerotic arteries supply with blood
60
What is ischemic necrosis?
death of cells due to deficient blood flow
61
What happens when there is severe and permanent reduction of nutrient supply?
Ischemic necrosis and replacement by fibrous tissues (which require much less blood flow)
62
Atherosclerotic Lesions, Fatty Streaks:
 yellow and smooth  protrude slightly into the lumen of the artery  composed of lipids and elongated smooth muscle cells  have been found in the arteries of people of all ages, including infants  Do not usually cause clinical symptoms, prognosis to formation of plaques unclear
63
Atherosclerotic Lesions, Fibrous Plaques:
 white to white-yellow  protrude to various degrees into the arterial lumen, sometimes completely obstructing it  composed of smooth muscle cells, collagen fibers, plasma components, and lipids  found predominantly in the abdominal aorta and the coronary, popliteal, and internal carotid arteries  believed to be progressive lesions
64
Risk Factors for Atherosclerosis (Modifiable)
use of nicotine products (dec. BF to extremities, inc. clot formation, CO lowers O2, lowers HDL) diabetes (2-4x) - earlier onset, faster progression HTN Hyperlipidemia, diet Stress Sedentary lifestyle elevated serum CRP = inc. vascular damage Hyperhomocyteinemia
65
Risk Factors for Atherosclerosis (Non -Modifiable)
increasing age family history/ genetics

CC2 (2 decks)

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