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NSG 2202 > Peripheral Arterial Disease of the Lower Extremities/Test 2 > Flashcards

Peripheral Arterial Disease of the Lower Extremities/Test 2 Flashcards

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1
Q

PAD (Peripheral Arterial Disease) is

A
  • Insufficient blood supply to periphery
  • Angina of the extremities
  • Plaque/atheroma process of extremities
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2
Q

Description of PAD-it may affect

A

*Femoral artery
*Aortoiliac artery
*Tibial artery
*Popliteal artery
*Peroneal artery
(FATPP)

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3
Q

Risk factors for PAD

A
  • increased cholesterol, lipids
  • Smoking
  • HTN
  • ETOH abuse
  • Obesity
  • Sedentary lifestyle
  • Diabetic
  • increased use of vasoconstrictors
  • Genetic predisposition
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4
Q

Clinical manifestations of PAD

A
  • Classic symptoms of PAD

- intermittent claudication

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5
Q

Intermittent Claudication

A
  • Pain when walking (ischemic muscle)
  • Resolves within 10 minutes or less with rest
  • Reproducible
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6
Q

Assessment for clinical manifestations of PAD

A
  • The 5 P’s
  • Pulseless, or diminished pulses <2
  • Pain
  • Pallor
  • Polar
  • Paresthesia
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7
Q

Clinical Manifestations of PAD

A

Associated signs

  • thin, shiny, and taut skin
  • loss of hair on the lower legs
  • most important assessment is quality of pulses
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8
Q

PAD is a

A

progressive disease-rest pain as disease progresses

  • occurs in the forefoot or toes and is aggravated by limb elevation
  • occurs from insufficient blood flow
  • occurs more often at night
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9
Q

Complications r/t decreased arterial blood with PAD

A
  • atrophy of the skin and underlying muscles
  • delayed healing
  • wound infection
  • tissue necrosis
  • arterial ulcers
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10
Q

Diagnostic Studies

A
  • Doppler ultrasound
  • sound waves reflect off RBC’s as they move through the legs
  • Ankle-brachial index (ABI)
  • done using a handheld doppler
  • sys ankle pressure/sys brachial pressure
  • normal ankle pressure same or higher than brachial or 1 or >
  • abnormal
  • duplex imaging
  • both audible and visual waveforms of blood flow
  • Angiogram
  • Magnetic Resonance Angiography (MRA)
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11
Q

For Diagnosis of PAD, include

A
  • Health and physical examination
  • include palpation of peripheral pulses (Most significant)
  • the other 5 p’s
  • risk factors
  • related diseases
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12
Q

Nursing Diagnoses for PAD

A
  • Ineffective tissue perfusion: periphery r/t narrowing of peripheral vessels Aeb:
  • Pain: legs r/t ischemia with lactic acid release, hypoxia to the leg muscles aeb:
  • Activity Intolerance r/t ischemia of the lower extremities aeb
  • Impaired skin/tissue integrity r/t ischemia of the extremities aeb
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13
Q

Collaborative Care/Risk factor modification for PAD

A
  • Smoking cessation
  • Aggressive treatment of hyperlipidemia
  • Hypertension and diabetes mellitus
  • BP maintained <7.0% for diabetes
  • Weight, habits controlled
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14
Q

Drug therapy for PAD

A
  • Antiplatelet agents
  • aspirin
  • ticlopidine (Ticlid)
  • clopidogrel (Plavix)
  • dipyridamole (Persantine)
  • cilostazol (Pletal)
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15
Q

Drugs prescribed for treatment of intermittent claudication

A
  • pentoxifylline (Trental)
  • takes 3-6 months to relieve pain
  • Heparin, lovenox
  • Coumadin
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16
Q

Exercise therapy

A
  • exercise improves oxygen extraction in the legs and skeltal metabolism
  • walking is the most effective exercise for individuals with claudication
  • 30 to 40 minutes/day
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17
Q

Nutritional Therapy

A
  • Dietary cholesterol less than 200 mg/day
  • Decrease intake of saturated fat
  • Soy products can be used in place of animal protein
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18
Q

Care of the leg with critical limb ischemia

A
  • Protect from trauma
  • keep warm
  • think diabetic limb/foot care
  • decrease vasospasm
  • prevent/control infection
  • maximize arterial perfusion
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19
Q

Disease progression

A

Indications

  • intermittent claudication symptoms become incapcitating
  • progresses to pain at rest
  • ulceration or gangrene severe enough to threaten viability of the limb
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20
Q

Interventional Radiologic Procedures

A
  • percutaneous transluminal balloon angioplasty

- balloon is inflated dilating the vessel by cracking the confining atherosclerotic intimal shell

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21
Q

Surgery for PAD

A

-Most common surgical approach
A peripheral arterial bypass operation with autogenous vein or synthetic graft material to bypass blood around the lesion

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22
Q

Collaborative care/surgical therapy

Study These Flashcards
A
  • Endarterectomy
  • Patch graft angioplasty
  • amputation
23
Q

Types of bypass grafting surgery

Study These Flashcards
A
  • Femoral-popliteal
  • fem-fem
  • popliteal-tibial
  • axillo-femoral
  • amputation
24
Q

Nursing post op interventions

Study These Flashcards
A
  • Assessment of graft pulses
  • mark pulses
  • -compare pulse quality
  • Assess skin color temperature cap refill
  • Report changes in the 5 P’s
25
Bypass grafting collaborative care
* IV fluid-low molecular weight dextrose - plasmanate - ntg possible - heparin IV-check PTT - rationale- keep patent - serious danger of reocclusion
26
Post op care
* Pain mangement * Positioning- never crimp or occlude a graft * bed cradle * oxygen * nutrition * telemetry
27
Evaluation after surgery
* Check the 5 p's * Improve perfusion * Improve activity * Less pain
28
Discharge teaching
* Control risks * Begin progressive ambulation * Avoid crossing extremeties * Get rid of cigarettes * Control BP
29
Sudden acute occlusion/embolism
* Sudden ischemic pain-maybe an embolism * May occur with injury to already compromised vessel * May occur after vascular procedure - or from an injury to a limb - or from plaque progression to total occlusion
30
Symptoms of excruciating pain
* MI of the leg * Cold * Mottled to dusky * Pulseless * Compare both sides * Compare to prior assessment
31
Embolism in toe/Acute intervention
* Reperfuse - thrombolytics-tPA * Prevent extension of clot - heparin * PTCA * Surgery-Embolectomy * Possible bypass grafting
32
Collaborative Care/Embolism in toe
*Treat as post op graft patient
33
Untreated or untratable PAD List outcomes
* Raynaud's Syndrome * Arterial Ulcers * Venous disorders * DVT * Thromophlebitis
34
Raynaud's Syndrome
* small arteries/arterioles constrict * more common in women * more common in upper extremities * associated with autoimmune disorders
35
Raynaud's is aggravated by
*stress, cold, exacerbations of chronic diease
36
Treatment for Raynaud's
* Control underlying conditions * Stay warm, protect extremities * Stop smoking, caffeine and associated risks * Calcium channel blockers-reduce spasm * Antiplatelet meds
37
Arterial Ulcers
* Cause: ischemia-decreased blood flow * Location: between toes, tip of toes, heels, ankles * Depth- deep, well defined edges * Appearance-pale grey base, decreased blood necrotic * Painful
38
Nursing diagnoses for Arterial Ulcers
* Ineffective tissue perfussion * Pain * infection * PC: sepsis
39
Outcomes and interventions for arterial ulcers
* Maximize perfussion * free from gangrene, sepsis, loss of limb * pain reduced to 4 * healing of site without infection
40
Treatment/Wound care for arterial ulcer
* Dressing changes * Gauze-to debride * Saline, elase or chemical wound debridement * Pain management * Oxygen * antibiotics * eventually bypass grafting
41
Evaluation of arterial ulcer
* Free from necrosis | * Consider bypass graft and skin graft
42
Venous disorders
* Varicose veins * Venous insufficiency - risks of gentics, multiple pregnancies, standing or sitting professions - valves weaken-backflow - symptoms of swelling, tired, heavy legs - relieved by elevation - antiembolic hose comforting * Thrombophlebitis-DVT
43
Thrombophlebitis/DVT
- inflammation of the wall of the vein, clot formation * *Risks-surgery, injury, increased clotting factors from inflammatory diseases ie CA, inactivity, obesity, venous insufficiency
44
Nursing diagnoses/Outcomes for DVT
* Ineffective perfusion: impaired venous return * Pain: inflammation * PC: PE
45
Symptoms PAD vs. DVT
* + Homan's sign * Pain in calf of affected side * Redness * Swelling * Warmth
46
Diagnostics for DVT
* Venous duplex scanning * Doppler ultrasound * D-Dimer * VQ scan
47
Collaborative Care for DVT:
* Bedrest * Moist heat * Anticoagulation - conservative lovenox SQ at home - advantage-slow continuous release * Acute care * Heparin therapy PTT 1 1/2- 2 1/2 xs control * Possible coumadin- INR- 2.0-3.0
48
Prevention of DVT
* Ambulation best * Exercise * Dorsi/plantar flexion * Rotation of ankles
49
Prevention of DVT's
* promote venous return - position - antiembolic stockings/SCDs - reduce risks - early recongmition of s/s
50
Evaluation for DVT
* Decrease pain, redness, swelling * Negative scans * Knowledgeable about prevention
51
Venous ulcers:
* Cause venous congestion * Sites-ankles, medial common * Depth-more superficial * Appearance- uneven edges, pink or dark red base d/t venous congestion * discomfort but NOT pain of arterial * Compare to arterial
52
Collaborative care for Venous Ulcers
* Antibiotics * Wet-dry dressing changes * Gauze * Vicodin * elevate limb * no debridement usually needed, no grafting, should heal
53
Evaluation of Venous ulcer
* healing of ulcer * understanding of prevention * control risks

NSG 2202 (22 decks)

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