PAD PVD (EXAM 2) Flashcards
(98 cards)
1
Q
Normal Pulse
A
-Based on normal rate, Rhythm, and strength
-+2 is normal strength
2
Q
Bounding pulse
A
3+
3
Q
Absent pulse
A
0
4
Q
Doppler ultrasound flow studies
A
-Used for non-palpable pulses (If you think there is no pulse use this before you document)
-Ankle brachial index (Used to diagnose PAD)
-Used in combination to assess for arterial stenosis or occlusion
5
Q
Duplex Ultrasonography
A
-Assesses deep and superficial veins (Used to see DVT)
6
Q
CT scan
A
-Used to assess aorta and branches for aneurism, stenosis and obstruction
7
Q
Lymphoscintigraphy
A
Used to access lymphatic system
8
Q
Diagnosis criteria for PAD
A
Ankle brachial index (ABI) <.90
-If there is chronic life threatening ischemia (its advanced and obvious they have it), they can diagnose based on
-Pain at rest (claudication)
-Tissue loss
-Non-healing ulceration
-Gangrene
9
Q
Goals for pt with peripheral vascular disease
A
-Increase arterial blood supply
-Decrease in venous congestion
-Promote vasodilation and prevent vascular compression
-Pain relief
- Tissue integrity
-Self care, and prevention of complications
10
Q
S+S PAD
A
-Intermittent claudication
-Leg numbness or weakness
-Ulcers (Usually below ankle line) that dont heal
-Coolness to leg or foot (no bloodflow=cool)
-Changes in color texture or temp of legs, reddish blue color (No blood flow), dependent on position
-Skin is thin and brittle, and shiny
-Hair loss on legs*
-Slowed growth of toenails
-Pulselessness
-Hypertension
-Arterial bruit
Gangrene of digits
-Think your 5 p’s
11
Q
Intermittent claudication
A
-PAD, pain in legs when walking and is relieved by rest
12
Q
S+S PVD
A
-Swelling in feet, ankles and legs
-Spider or varicose veins
-Legs feel achy/ tired
-Burning numbness or tingling in thighs and calves
-Itchy dry skin on the legs
-Brownish color
13
Q
Peripheral arterial disease (PAD)
A
Obstruction or narrowing of the lumen or another great arterial vessel (Less blood flow to tissues), usually the lower extremities
-Cant meet blood flow demands during movement, causing buildup of waste which causes acidosis in the area, leading to pain
-Caused usually by atherosclerotic plaques, fatty cholesterol
-Prognosis depends on location and size of occlusion
14
Q
PAD causes, Start with A
A
-Atheromatous debris (Plaques)
-Atherosclerosis
-Aneurysms
-Aortic dissection
15
Q
PAD causes, Start with I
A
Indwelling arterial catheter
Immune arthritis
16
Q
PAD causes, Start with E
A
Embolism (A fib)
17
Q
PAD causes, Start with T
A
Thrombosis
Trauma
18
Q
PAD causes, Start with F
A
Fibromuscular disease
19
Q
PAD causes, Start with R
A
Raynaud disease
20
Q
Aneurysm
A
-Weak point in an artery that forms a sac, classified by shape and form
-Most are saccular and fusiform
21
Q
Pseudo aneurism
A
Lil bubble that occurs on the outermost payer of the artery, does not occlude blood flow, wall is in tact
-Can occur from trauma
22
Q
True aneurism
A
Lil out-patching in arterial wall that includes all the layers, on one side of the vessel
23
Q
Fusiform aneurism
A
-Out-patching of the vessel on both sides
24
Q
Saccular aneurism
A
Iil aorta zit, outpatching is formed into a sac, which only has a small opening to the bloodstream
25
Raynauds
-Intermittent arterial vascular constriction in feet and fingers
-Can be idiopathic or from a disease
-Manifestations is sudden vasoconstriction, and color changes, parasthesis and pain
-Usually triggered by cold or stress
26
Modify-able risk factors for PAD
Nicotine
-Diabetes
-Hypertension
-Hyper lip
-Diet
-Stress
-Sedentary lifestyle
-C-reactive protein (Biomarker)
-Hyperhomocysteinemia: Elevated homocysteine that irritates endothelium, altering colagulation
27
Hyperhomocysteinemia
Modifiable risk factor for PAD
-Elevated levels can irritate endothelium, promoting clotting factors
28
Nonmodifiable risk factors for PAD
Age
Family disposition/genetics
29
Complications of PAD
-Severe ischemia (leading to skin ulceration, and chronic pain)
-Skin ulceration (Leading to gangrene)
-Gangrene (Leading to tissue loss)
-Limb loss
30
Arterial ulcers
-Dry well defined borders, and deep
-Look punched out
-Heal terrible
31
Dependent rubor
PAD, legs turn red when dangling (this is actually good because it means some blood flow)
-pallor can also occur for them if their legs are elevated, gravity isnt helping out anymore
32
Should you apply direct heat PAD
No
33
Treatment PAD
-Smoking cessation
-Treat hypertension, diabetes, hyper lip
-Foot and leg care (Wounds)
-Weight control
-Low fat, low cholesterol, high fiber diet
-Weight reduction if needed
-Regular activity as directed by provider
-Exercise programs and activities
-Positioning strategties
34
Meds for PAD: Anvihypertenives
-Reduce BP, SVR, After load
35
Meds for PAD: Antiplatelets
-Prevent ischemic events
-Low dose aspirin, clopidogrel, ticlopidine
36
Meds for PAD: Plt aggregation inhibitors
Suppress plt aggregation and promote arterial vasodilation
-Cilostazol
37
Meds for PAD: Lipid lowering agents
-Any statin
-Controls dyslipidemia
38
Meds for PAD: Hypoglycemic agents
Promote optimal glucose control, insulin or any oral anti-diabetic gent
39
Surgeries for PAD
-Endovascular surgery: anything modifying the internal vasculature like a balloon or stent, can be used for aneurysm
-Open bypass surgery: Bypass the occlusion by taking a vein from another area
-Embolectomy: Remove thrombus with catheter
-Abdominal aortic aneurysm repair, removes aneurysm and puts in an artificial plaque
-Endarterectomy: Succ out fat deposits and put in patches
-Laser angioplasty: zap fatty plaques
-Lumbar sympathectomy: Cut nerve for pain control
-Amputation: gangrene
40
The nurse is teaching a patient diagnosed with peripheral arterial disease (PAD). What should be included in the teaching plan?
Elevate the lower extremities
Exercise is discouraged
Keep the lower extremities in a neutral or dependent position
PAD should not cause pain
Keep the lower extremities in a neutral or dependent position
Dangle em
Rationale: For patients with PAD, blood flow to the lower extremities needs to be enhanced; therefore, the nurse encourages keeping the lower extremities in a neutral or dependent position. In contrast, for patients with venous insufficiency, blood return to the heart needs to be enhanced, so the lower extremities are elevated. Exercise can be prescribed to aid in the development of collateral circulation. Some pain is associated with PAD.
41
Nursing intervention PAD
-Assess skin color integrity and temp
-Pulses, use doppler if you cant feel
-Document and notify if any changes occur
-Pain mgmt
-Foot and skin care, prevent injury
-Dont apply heat to affected extremity(?), dont elevate
-Give drugs
-Encourage independence, energy conservation
42
Post op care
-ABC, IV fluids as ordered, nutrition, bowels
-Surgical site for infection and bleeding. preform dressing changes and wound care
-5 P's
-Deep breathing, spirometry
-S+S hemorrhage
-Pain mgmt
-Early ambulation
43
Venous disease
Decreased venous blood flow resulting in stasis and back flow
-Causes coagulation, edema, tissue breakdown and increased risk of infection
-Major concerns
VTE
Chronic venous insufficiency, post thrombotic syndrome
Leg Ulcers
Varicose veins
44
Venous Thromboembolism
-Caused by Virchow triad
-Clot forms which can occlude blood flow or move and become an embolus, moving to another area (Lungs)
45
Virchow triad
-Endothelial dmg
-Venous stasis
-Altered coagulation
46
Virchow triad (Endothelial dmg)
-Central venous cath
-Dialysis Cath
-Local vein dmg
-Pacing wires
-Repetitive motion injury
-Surgery
-Trauma
47
Virchow triad (Venous stasis)
Age, 65+
-Bed rest
-HF (think right)
-Obesity
-History of varicosities
-SCI
-Polycythemia (Blood is too thic to move fast)
-Dehydration
48
Virchow triad (altered colagulation)
-Cancer
-Clotting factor elevation (2,8,9,11)
-Factor 5 leiden defect
-Hyperhomocysteinemia
-Preg
-Polycythemia
-Septicemia
-Oral contaceptives
49
VTE prevention
-Early ambulation and leg execises
-Graduated compression stockings
-Intermittent pneumatic compression devices
-SubQ heparin or LMWH
-Lifestyle changes (Weight loss, hydration and all that)
50
If ya suspect a clot do you massage the calf
NO
51
Complication of VTE
-PE
-Post thrombotic syndrome
-Venous ulcers
-Venous gangrene
-Chronic venous insufficiency
-varicosities
-more DVT in the future
52
History for VTE
-One or more risk factors
-Leg or arm pain
-Swelling and tenderness in the affected extremity
-Central venous cath or dialysis cath
-S+S of PE, (SOB, chest pain, resp distress)
53
VTE S+S
-May be asymptomatic
-Homans sign (not Evidence based)
-Palpable cord indicating thrombosed vein
-Unilateral calf edema
-Warmth, tenderness, redness
-Superficial venous dilation
-Pain and tenderness in thigh and calf
54
VTE diagnostics
Doppler ultrasound or compression ultrasonography
-Shows s presence of intraluminal thrombi
-Upper and lower extremities
CT angi of chest for PE
-Evaluates blood vessels, with contrast throughout the body
-Shows thrombi in lungs, abdomen or legs
Lung perfusion and vent scanning
-Nuclear
-Shows ration of vent and perfusion, showing decreased areas
55
Meds in VTE: First 10 days
-LMWH (enoxaparin sodium, dalteparin sodium), ends with parin
-Activated factor X inhibitors
-Unfractionated Heparin
-Factor Xa inhibitors
-Direct thrombin inhibitors (dabigatran)
56
Unfractionated heparin risk
Risk for HIT, hemolytic idopathic thrombocytopenia, need to monitor plt
57
Factor Xa inhibitors
Have XABAN in the name
Rivaroxaban or apixaban
58
Long term meds for VTE
10 day- 3mo
-Factor Xa inhibitors (XABAN)
-Direct thrombin inhibitors (dabigatran)
-Vitamin K antagonist, warfarin
-LMWH
-Activated factor X inhibitors, fondaparinuX sodium
59
Low molecular weight heparin (LMWH)
Ends in parin like HePARIN
60
Pt is unable to get anticoagulants or anti thrombolytics, VTE prevention
-Thrombectomy or catheter directed thrombolysis
-Ultrasound assisted thrombolysis
-Vena cava filter
61
Post thrombotic syndrome
-After Dvt occurs due to increased venous pressure
-Leading to decreased calf muscle perfusion and increased tissue permeability (fluid moves into interstitial)
-Persistent venous obstruction, valvular reflux due to valvular dmg from thrombus and inflammation (can still have clot), leading to fluid going into interstital
-Inflammation my delay thrombus resolution and induce vein wall fibrosis which promotes valvular reflux, (Further pooling)
62
S+S of post thrombotic syndrome
-S+S of PVD
-Leg pain, legs feel heavy/ fatigued, swelling
-Dusky red cyanosis for legs when in the dependent position
-New varicose veins, stasis, hyperpigmentation, Leg Ulcers
-lipodermatosclerosis: Thickening of skin and subq tissue
-Symptoms are persistent or intermittent , aggravated by movement and relieved with rest and elevation
63
Which patient is at highest risk for venous thromboembolism?
A 50-year-old postoperative patient
A 25-year-old patient with a central venous catheter in place to treat septicemia
A 71-year-old otherwise healthy older adult
A pregnant 30-year-old woman due in 2 weeks
A 25-year-old patient with a central venous catheter in place to treat septicemia
They got 2 risk factors, sepsis and cath, everyone only has one
Some risk factors for venous thromboembolism include but are not limited to age older than 65 years, patients undergoing surgery, central venous catheter placement, septicemia, and pregnancy. The client in this question with two risk factors is the 25-year-old with a central venous catheter in place to treat septicemia. All other patients only have one risk factor.
64
Pulmonary Embolism (PE)
-Clot that gets dislodged and travels to the pulmonary artery, or a branch of that artery
-Caused by VTE or DVT
-Can be asymptomatic by can also cause rapid heart death and Pulmonary infarction and HF
-The clot also causes the alveoli in the lungs to stop producing surfactant which leads to collapse and atelectasis
65
Causes of PE
-DVT
-Renal, pelvic or hepatic vein thrombosis
-fat embolism
-Air embolism
-Amniotic fluid
-Tumors
-Foreign body
-Right heart thrombus
-Valvular heart disease
66
Predisposing factors for PE
Cardiac arrhythmias
-Lung disorders
-Cardiac disorders
-Infection
-DM
-History of this
-Sickle cell
-Autoimmune hemolytic anemia
-Polycythemia
-Osteomyelitis
-Long bone fracture
-Manipulation or disconnection of central lines
67
Risk factors for PE: Venous stasis
-Immobility
-Obesity
-Over 40
-Burns
-recent childbirth
-Ortho cast
68
Risk factors for PE: Venous injury
-Surgery, especially the lower 1/2 body
-Legs or pelvic fractures or injuries
-IV drug use
-IV therapy
69
Risk factors for PE: Hyper coagulability
-Cancer
-Oral contraceptives
-Hypertension
-Cigarette smoking
70
S+S PE
-Tachypnea
-Tachycardia
-Restlessness
-Crackles
S3 and S4
-Low grade fever
-Weak and rapid pulse
-Hypotension
-Productive cough
-Calf warmth, pain tenderness or edema
-Wheezing
71
PE diagnostics
-CT of the chest, shows DVT
-Pulmonary angiography, shows pulmonary vessle filling defect or an abrupt vessel ending
-Reveals the location and extent of the PE
72
PE mgmt
-O2 therapy, mechanical vent
-Anticoagulants
-Oral rivaroxaban (Xa inhibitor)
-Thrombolytics
-Antibio (Sepsis)
-Vena cava filter
-Cath directed procedure for removal of clot
-Pulmonary embolectomy
73
Monitoring and interventions post PE
-Vitals, pulse ox, temp
-Fluid balance and I+O
-Cardiopulmonary status : heart and lungs sounds and cardiac rate and rhythem
-ABG
-PTT + PT/INR
-Plt level
-Dont massage legs
-Monitor for S+S of bleeding (urine, stool IV sites gums)
-Have antidote for heparin and warfarin
74
Antidote for Heparin
Protamine sulfate
75
Antidote for warfarin
Vitamin K
76
Venous ulcer
-Above ankle below knee usually (Gaiter)
-Irregular shape, granular wound , Mild to moderate exudate
-Wet looking
-Not as deep as arterial
-Lipodermasclerosis (Thickening of skin)
-Firm edema
-Can be sloughy
77
Causes of venous ulcers
-Diabetes
-Preg
-Age
-Deep vein thrombosis
-CHF
-Malnutrition
-Obesity
-Immobility
78
Wet Gangrene
Open and putrid smelling, Draining exudate
-Gas gangrene is included in this
79
Dry Gangrene
Eschar like appearance across the wound bed, no drainage
80
Medical mgmt of patient leg ulcers
-Antibiotics
-Compression therapy
-Debridement (Slough)
-Dressings
-Hyperbaric chamber
81
Complications of leg ulcer
Gangrene/Infection
82
Nursing interventions with leg ulcers
-Restoring skin integrity, wound care
Cleaning wound, avoiding trauma, AVOIDING heat
-Improve mobility
Promoting nutrition
83
Cellulitis
Infection of skin, subq tissue , causing inflammation
-Characterized by redness, edema, warmth and pain
-May be caused by dmg to skin by wound/bite
-Good prognosis if you dont let it fester
84
Risk factors cellulitis
Venous and lymphatic compromise
-PAD
-Edema
-DM
-Underlying skin lesion
-Prior trauma
-Burns
-Immune suppression
-Advanced age
85
Complications of Cellulitis
-Sepsis
-DVT
-Local abscesses
-Thrombophlebitis
-Super infection
-Necrotizing fasciitis
86
S+S cellulitis
-Tenderness and warmth of an area
-Pain at the site and surrounding area
-Redness with distinct margins
-Visible red streaking in skin around infection
-Blisters, skin compromise
-Skin breakdown
-Fever, malise, skin dimpling, edema
87
Treatment cellulitis
-Antibiotics
-Elevation of extremity
-Warm moist packs every 2-4 hours
-CBC, blood culture
-Hydration, nutrition, DVT prophylaxis
-Wound care
-Surgery for wound debridement
88
Prevention of varicose veins
-Avoid activities that cause venous stasis
-Elevate legs 3-6 inches above heart
-Walk 30 min a day if not contraindicated
-Wear compression socks
-Weight reduction
89
Lymphangitis
Infection of lymph system
90
Lymphadenitis
Inflammation or infection of the lymph nodes
91
Lymphedema
Swelling related to obstruction of lymph flow, water moving into interstitial space
-Chronic obstruction causes this to become fibrotic impairing vascular flow and o2 to tissues
-Can occur in upper and lower extremities at the same time
-Primary is congenital, secondary is acquired
-Requires compression
92
Causes of lymphedema
-Surgery
-Radiation, cancer
-Infection
-Trauma
-CHF
-Portal hypertension
-Lipectomy
-Burns
-Insect bites
93
Complications of lymphedema
-Abscess formation
-Recurrent cellulitis
-Amputation (lymphangiosarcoma)
-Sepsis
-DVT
-Severe quality of like issues*
94
S+S lymphedema
-Edema, nonpitting in extremity
-Fissuring/ulcerations, skin breakdown with clear or yellow fluid
-Thickened skin in the affected area along with redness
-Stemmer sign is positive
95
Stemmer sign
Cannot lift thickened skin between the first and second digit when pinched, skin too thick to pinch away from fat
96
Lymphedema mgmt
-Skin care, and debridement
-Compression stockings(compression in general)
-Elevation when able
-Manual drainage of lymph
-Low level laser therapy
97
Lymphedema meds
-Retinoid like agents ( Acitretin)
-Anthelmintic agents (Albendazole)
-anti bio
98
Which of the following is an effective strat to promote lymph drainage and prevent edema in clients with lymphedema
-Antibiotics for 14 days
-Constant elevation of the affected extremity
-Heat therapy 2x per day
-Daily exposure to the sun
-Constant elevation of the extremity
