Peipheral arterial diease and venous insufficiency

Question 1

risk factors for atherosclerosis and PAD

Answer 1

nicotine
diabetes
diet
HTN
obesity
stress
sedentary lifestyle
high cholesterol
age > 60
gender
familial predisposition

Question 2

intermittent claudication

Answer 2

pain with walking

Question 3

pain in arterial insufficiency

Answer 3

intermittent claudication to sharp, unrelenting constant

Question 4

pain in venous insufficiency

Answer 4

aching, throbbing, cramping

Question 5

pulses in arterial insufficiency

Answer 5

absent or diminished

Question 6

pulses in venous insufficiency

Answer 6

present, but may be difficult to palpate through edem

Question 7

skin in arterial insufficiency

Answer 7

dependent rubor; elevation pallor of foot; shiny skin; cool/cold temperature; loss of hair over toes and foot; nails thickened

Question 8

skin in venous insufficiency

Answer 8

pigmentation in gaiter area; skin thickened and tough; may be reddish blue (dermatitis)

Question 9

location of ulcer in arterial insufficiency

Answer 9

tips of toes, toe webs, heel or other pressure areas if confined to bed

Question 10

location of ulcer in venous insufficiency

Answer 10

medial malleolus, lateral malleolus, or anterior tibial area

Question 11

pain of ulcer in arterial insufficiency

Answer 11

very painful

Question 12

pain of ulcer in venous insufficiency

Answer 12

minimal pain if superficial or may be very painful

Question 13

depth of ulcer in arterial insufficiency

Answer 13

deep, often involving joint space

Question 14

depth of ulcer in venous insufficiency

Answer 14

superficial

Question 15

shape of ulcer in arterial insufficiency

Answer 15

circular

Question 16

shape of ulcer in venous insufficiency

Answer 16

irregular border

Question 17

ulcer base in arterial insufficiency

Answer 17

pale to black and dry gangrene

Question 18

ulcer base in venous insufficiency

Answer 18

beefy red to yellow fibrinous in chronic long-term ulcer

Question 19

leg edema in arterial insufficiency

Answer 19

minimal unless extremity kept in dependent position constantly to relieve pain

Question 20

leg edema in venous insufficiency

Answer 20

moderate to severe

Question 21

ankle-brachial index

Answer 21

taking BP in two places and getting a ratio; in PAD there’s a large decrease in BP

Question 22

nicotine causes

Answer 22

vasoconstriction and potential endothelial damage

Question 23

ways to prevent PAD

Answer 23

smoking cessation
diet, weight management, and exercise
lipid modification and statin therapy
prevention and management of diabetes
prevention and management of HTN
antiplatelet therapy

Question 24

clinical manifestations of PAD

Answer 24

intermittent claudication
changes in peripheral pulses
signs and symptoms of perfusion and atrophy
bruit
wounds

Question 25

signs and symptoms of perfusion and atrophy

Answer 25

``` temperature intolerance (cold) color changes skin, hair, and nail changes ```

Question 26

consequences of PAD

Answer 26

limb ischemia - can lead to wounds and amputations

Question 27

pharm goals of PAD

Answer 27

symptom management and risk reduction

Question 28

symptom management of PAD

Answer 28

vasodilator/antiplatelet (cilostazol) -- for intermittent claudication antiplatelets (aspirin, clopidogrel) HMG-COA reductase inhibitors (statin)

Question 29

angioplasty and stents

Answer 29

tube goes into femoral artery (opposite) monitor perfusion lower than stent make sure there's no hematoma

Question 30

bypass surgery

Answer 30

``` if stent doesn't work monitor BP (low BP can collapse graft) ```

Question 31

nursing management for PAD

Answer 31

``` increased arterial blood supply promotion of vasodilation prevention of vascular compression relief of pain maintenance of tissue integrity adherence to self-care ```

Question 32

assessment and monitoring of PAD

Answer 32

round shape, dry, necrotic, uniform rubor (blood starting to flow with gravity); pt will be sitting with feet up because there's a lot of burning pain with feet down (want them in a dependent position)

Question 33

maintaining tissue integrity in PAD

Answer 33

prevention - wear sturdy shoes, don't wear compression stockings limit cause of vasoconstriction (cold, caffeine, chocolate) don't put feet directly on heating pad regular inspection of extremities and f/u good nutrition, low-fat diet weight reduction

Question 34

encourage activity in PAD

Answer 34

supervised exercise program (walking) offered to people with intermittent claudication; 2 hours of supervised exercise a week for 3 months; encourage exercise to point of pain

Question 35

exercise increases ________ ________

Answer 35

collateral circulation

Question 36

chronic venous insufficiency is a result of

Answer 36

incompetent valves or venous obstruction

Question 37

venous insufficiency leads to

Answer 37

edema, tissue congestion, tissue impairment

Question 38

goal of venous stasis wounds

Answer 38

get the fluid out of the legs

Question 39

risk factors of venous insufficiency

Answer 39

``` DVT varicose veins obesity pregnancy smoking extended periods of sitting or standing female age > 50 ```

Question 40

clinical manifestations of venous insufficiency

Answer 40

``` edema (bilateral) pain, aching hyperpigmentation skin atrophy stasis dermatitis (brown thickness) venous ulcers ```

Question 41

management of venous insufficiency

Answer 41

``` avoid long periods of sitting/standing regular exercise (walking) maintain BMI position legs (elevation) compression therapy practice skin hygiene improved diet for wound healing ```

Question 42

restoring skin integrity in venous insufficiency

Answer 42

``` cleansing wound compression therapy avoiding trauma and injury positioning wounds are not uniform, draining, macerated ```

Question 43

improving physical mobility

Answer 43

activity is usually restricted to promote healing gradual progression of activity activity to promote blood flow in bed and exercise upper extremities diversional activities pain med before activities

Question 44

promoting adequate nutrition

Answer 44

``` protein vit C and A iron zinc iron intake for anemic patients ```

Question 45

improving peripheral arterial circulation

Answer 45

``` exercises (walking), isometric positioning - feet down during day temp - cold feet stop smoking stress reduction limit caffeine rubor, wound is round and uniform need aspirin to prevent blood clots most likely to see gangrene ```

Question 46

improving peripheral vascular circulation

Answer 46

``` compression stockings elevate dependent limbs weight loss nutrition dermatitis stasis - brown coloring pulses should be present risks for DVT ```

Question 47

risks for DVT

Answer 47

``` post-op women overweight any type of stasis DVT can travel to lungs (pulmonary embolism) ```