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NURS 347 EXAM 3 > Peripheral Artery Disease ; Vascular Disease > Flashcards

Peripheral Artery Disease ; Vascular Disease Flashcards

1
Q

Peripheral artery disease is?

A

Involves thickening of the artery walls & progressive narrowing of arteries of upper & lower extremities

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2
Q

Symptomatic age of peripheral artery disease is ?
And can increase when patients have?

A

60 to 80
Diabetes

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3
Q

Over how many people have PAD? And it’s mainly found in which type of people?

A

8.5 million
Black people

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4
Q

Peripheral artery disease is strongly related to what?

A

Other cardiovascular disease & risk factors

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5
Q

Peripheral artery disease patients have a higher risk of ? (4)

A

CVD Mortality
major coronary events
Mortality
Stroke

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6
Q

What is the main leading cause of PAD, peripheral artery disease?

A

Atherosclerosis

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7
Q

What is atherosclerosis?
When does it occur?

A

Thickening or harden of the aterties

Occurs when plaque builds up in the inner lining of the artery

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8
Q

Atherosclerosis plaque is made up of?
And this plaque can what? (2)

A

Fats, cholesterol, other substances
Narrow the arteries & block blood flow

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9
Q

Etiology & pathophysiology
Risk factors are?
Multiple risk factors increase risk (3)
Often effects the? (3)
Symptoms occur when? %
Usually at what age ^

A

Same hypertension & heart failure
High cholesterol, hypertension, smoking
Coronary, carotid, lower extremity arteries
60-75% arteries are blocked
50

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10
Q

PAD of lower extremities may effect which artery’s? (5)

A

Femoral artery
Iliac artery
Peroneal artery
Popliteal artery
Tibial artery

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11
Q

What are the 6 p’s of limb ischemia?

A

Pain
Perishing cold
Pallor
Paresthesia
Pulselessness
Paralysis

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12
Q

Symptoms of PAD
What are the 4 symptoms of PAD?

A

Intermittent claudication
Paresthesia
Decreased blood flow to limb
Pain at rest

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13
Q

What is intermittent claudication?
And caused by?

A

Ischemic muscle pain that
Constant level of exercise

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14
Q

Intermittent claudication is the build up of ?
Resolved within?
Is it reproducible?

A

Build up of lactic acid from anaerobic metabolism
Resolves within 10min or less with rest
It is Reproducible

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15
Q

What does claudication mean?

A

Condition in which cramping pain in the leg is endured by exercise, like walking, typically caused by obstruction of the arteries

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16
Q

What Under anaerobic conditions mean?

A

Glucose is converted into lactic acid in order to produce energy for the cells

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17
Q

Once the patient stops exercising what happens to the lactic acid and pain?

A

Lactic acids clean
And pain subsides

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18
Q

What is Paresthesia?
From what?

A

Numbness or tingling in the toes, feet from nerve tissue ischemia

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19
Q

Paresthesia
Neuropathy causes what?

A

Severe shooting or burning pain

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20
Q

Paresthesia can produce what?
patients will typically not noticed what?

A

Loss of pressure and deep pain sensation from reduced blood flow

Injury

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21
Q

Decreased blood flow to limb may result in what symptoms? (5)
T, L, D, P, R

A

Thin, shiny, taut skin
Loss hair on legs
Dinisined or absent pulses
Pale foot with leg elevation
Reactive hyperemia of foot ( redness of foot ) Dependent rubor/position

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22
Q

What’s an anagram that can help me remember the results of decreased blood flow to limb (5)

A

Thin
Loss
Dimiy
Pale
Reacts

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23
Q

We always want to check what when we noticed a patient has decreased blood flow to the limb for PAD?

A

Check pulses!!!

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24
Q

Symptoms of PAD
Pain at rest
It’s what type of disease?
Occurs where?
Aggravated during?
Occurs from?
Occurs more often ?
How is pain relief?
( example of this ^ )

A

Progressive disease
Occurs in feet and toes
Aggravated limb elevation
Occurs from insufficient blood flow to distal tissues
Occurs more often at night
Pain relief by gravity
( dangle their leg over the side )

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25
Q

What is critical limb ischemia?
Where does this occur?
( this is a very serious form of PAD )

A

Severe blockage in the arteries of the lower extremities

This blockage significantly reduces blood from to the hands, legs, feet.

This is a serious form of PAD

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26
Q

Critical limb ischemia is characterized by? (2)

A

Chronic ischemic rest pain lasting more than 2 weeks

No healing arterial leg ulcers or gangrene

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27
Q

People who have these 3 history’s are at a high increase risk of getting critical limb ischemia ( CLI )

A

Diabetes
Heart failure
History of stroke

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28
Q

Prolonged ischemia leads to
Complications
What are they?(5)

A

Atrophy of skin & underlying muscles
Arterial ulcers over honey prominences
Delayed healing
Tissue necrosis
Wound infection

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29
Q

Arterial ulcers over honey prominences, non healing ulcers will develop into what? And often results in?

A

Gangrene
Amputation

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30
Q

Arterial leg ulcers (4)
Vs
Venous leg ulcers (4)

A

Punched out appearance
Well defined borders
Pain at night
Very little discharge

Irregular shape
Shallow
Superficial
Pus discharge

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31
Q

Arterial ulcers tend to be more what ?
Venous ulcers may cause a what throughout the leg?

A

Painful in affected area
Dull ache throughout leg

32
Q

Arterial vs venous
Which has intermittent claudication pain?
Which has edema?
Which has no pulse/weak pulse?
Which has drainage?
Which has round smooth sores?
Which has black eschar?
Which has dull achy pain?
Which has sores with irregular borders?
Which has yellow slough rough skin?
Which is on toes & feet?
Which is on ankles?
Which gets better to dangle legs?
Which feels cold to the touch?

A

A
V
A
V
A
A
V
V
V
A
V
A
A

33
Q

What are the diagnostic studies for PAD?(4)

A

Doppler ultrasound &Duplex imaging
Segmental blood pressure
Angiography&Magenitic reasonance angiography
Ankle brachial index

34
Q

How does the Doppler ultrasound and duplex imaging help diagnose PAD?

A

Sound waves to create procured of the arteries & locate blockages

35
Q

What is the segmental blood pressure diagnosis for PAD?

How do you do it?

What’s the percentage of drop of Seg BP that confirms PAD?

A

A noninvasive vascular test that measures blood flow in the upper and lower extremities

Blood pressure cuffs and ultrasound to detect difference in blood pressure at specific locations in different limbs

30

36
Q

What’s the angiography & Magnetic resonance angiography (MRI) that helps us diagnose PAD?

And what do we use?

A

MRI scan to look at blockages in the arteries

Use a iodine dye to see the blood vessels

37
Q

What’s an ankle brachial index to help diagnosis PAD? How do you do it?

What’s the number that indicated PAD from ABI?

The lower the number the more?

A

Calculate the ABI for each leg by diving the ankle systolic over the highest brachial systolic

Ankle systolic / brachial systolic

0.9

More severe the disease

38
Q

Calcified and stiff arteries in patients who are older or have diabetes often show what?

A

Falsely elevated ABI

39
Q

Interprofessional care
Risk factor modification for PAD
What’s the goal?
We want what type of control?
We want to reduce and follow what?
We want what cessation?
What do want for diabetics?
What type of medication?

A

Reduce cardiovascular disease factors
Blood pressure control
Reduce sodium
Follow dash diet
Tobacco
Hemoglobin less than 7.0
hyperlipidemia
( statins & diet )

40
Q

What are some good low sodium foods?

A

Dry peas
Fruit
Yogurt
Unsalted nuts & seeds
Vegetables
Anicent grains
Herbs & spices

41
Q

What does DASH stand for
And what is it rich in?(4)

A

Dietary approaches to stop hypertension

Fruits,vegetables, whole grains, low fat dairy foods

42
Q

What is low cholesterol diet? (3)

A

Vegetables
Fruits
Lean meats

43
Q

What type of drug therapy are we going to give our PAD patients? (3)

A

Ace inhibitors
Antiplatelet
Intermittent claudication meds

44
Q

Ace inhibitors function how?
And helps how? 2D 1I (3)

A

Prevent an enzyme in the body from making angiotension 2 that narrows blood vessels

Decreases cardiovascular morbidity
Decreases mortality
Increase Peripheral blood flow

45
Q

What does Antiplatelet agents do?
Medication examples? (2)
It’s effectiveness becomes reduced when also taking what?

A

Blood thinner
Aspirin
Clopidigrel (Plavix )
Omeprazole

46
Q

What are the two medications we can give to help treat intermittent claudication?

A

Cilostazol (Pletal)
pentoxifylline (Trental)

47
Q

What does Cilostazol (Pletal) do? (2)

A

Inhibits platelet aggregation
Increase vasodilation

48
Q

What does Pentoxifylline ( Trental ) do?(2)

A

Improves flexibility of RBC & WBC
Decrease Fibrinogen concentration, platelet adheresivness, blood viscosity

49
Q

What’s the 2 interprofessional care for overall PAD?

A

Walking
Weight/nutrition

50
Q

Walking is the most effective ?
Give Time as well
And who it helps most^

Women vs Men

Increased what?

A

Most effective exercise with unsocial with claudication
30-45mins 3 times a week

Women have faster decline and mobility loss than men

Survival rates

51
Q

Weight and nutrition
BMI of what?
Waist for men & women
% of weight loss yields improvement

A

Less than 25
40 men 35 women
3-5%

52
Q

Interprofessional care
Complementary & alternative therapies
Patients should always consult with HCP before taking what 2 things if they take
What two medications (2)
Because of the potential risk? (2)

A

Dietary or herbal supplments

NSAIDS and anticoagulants

Potential interactions & bleeding

53
Q

Nurses must always asses what? And where?

A

Bleeding!!
Stool, hemopytsis

54
Q

How are nurses going to monitor anti coagulates, which tests ?
Means what?

A

PTT/INR

PT- long to form blood clot
INR - type of calculation from PT

55
Q

Interprofessional care
Leg with critical limb ischemia
We are going to what type of treatment ?
(5)
PRESIDENT!! PROTECT!! FOOT!!

A

Conservative treatment

Protect from trauma
Decrease ischemic pain
Prevent/control infection
Improve arterial perfusion
Foot care lotion
( no soaking & between toes )

56
Q

What’s An anagram to help me remember care for critical limb ischemia?

A

Conservative
Protects
Decreasing
President
Important
Foot

57
Q

Why are avoiding lubrication between toes and soaking the patients feet? To prevent what?

A

Skin maceration ( breakdown )

58
Q

We can also do a PTA, which stands for and what’s the procedure?

Stent helps hold it in place but the stent is coded in which drug? To limited growth of ?

A

Percutaneous transluminal Angioplasty

Catheter has ballon
Inflate ballon
Increase vasodsiltion

Paclitaxel
New tissue in treated area

59
Q

What are the two catheter procedure?

A

Arthrectomy
Cryoplasty

60
Q

What is an arthrectomy?
Performed how?

A

Removal of obstructing plaque

Performed using a cutting disc, laser or rotating diamond tip

Cuts right through Atheromas

61
Q

What is cryoplasty?

Balloons fills up with what and goes down to What F*
Limits restenosis by reducing what?

A

Combines Percutaneous transluminal angioplasty & cold therapy

Balloon filled with liquid nitrous oxide that changes to gas

The gas expands and cools to 14F

Smooth muscle cell activity

62
Q

Surgical therapy
Interprofessional care
What is peripheral artery bypass surgery with?

What’s the two main things used for graft?

Can PTA be used with this too?

A

Auto genius vein or synthetic graft to bypass blood around lesion

Umbilical vein
composites sequential

Yes

63
Q

What are 3 other surgical options for PAD?

A

Endarterectomy
Patch graft angioplasty
Amputation

64
Q

What’s an endarterectomy?

A

Open artery and remove plaque

65
Q

What’s a patch graft angioplasty?

A

Open artery remove plaque
Sew patch to widen the lumen

66
Q

What’s amuptation and consider if what?

A

Complete Removal

Necrosis
Gangrene
Osteromyelitis

67
Q

Nursing assessment
Subjective vs Obective

A

Health history
Functional health patterns ( Health perception, nutritional, activity )

Skin, heart, brain, diagnostic findings

68
Q

Nursing management for PAD
Nursing diagnosis (2)
Ineffective what??

Nursing goals (5)
Want to promote what?

A

Ineffective tissue perfusion
Activity intolerance

Tissue perfusion
Relief of pain
Increased exercise
Intact skin
Knowledge of disease

69
Q

Nursing implementation
What are we as nurses going to do to help promote health? (5)

We are going to want identify what?
What with food?
What with feet?
Avoid what type of stuff?
And come again?

A

Identify risk patients
Diet
Proper feet care!!
Avoid injury
Regular follow up

70
Q

Nursing implementation
Acute care
What are the 5 main things to check

At the hospital what are we touching physical on patient

A

Skin color
Temperature
Capillary refill
Peripheral pulses distal to operative site
Sensation & movement

71
Q

The nurse should always report what? (5)

A

Increased pain
Loss of pulse
Pallor
Cyanosis
Numbness or tingling

72
Q

We should always recommend the usage of what?

A

Graduated compression stockings!!!

73
Q

The nurses should avoid and do what?

A

Avoid knee flexed position

Turn and position frequently
Ambulating!!

74
Q

What is ambulatory care for PAD? (7) What are the 7 things we as nurses will want our patient to do
SC, LA, SE, MFC, DIF, CS, ST

A

Smoking cessation!
Usage of long term Antiplatelet
Supervised exercise
Meticulous foot care
Daily insecption of feet
Comfortable shoes
Skin temperature/capillary refill/palpate pulses

75
Q

What are the 4 nursing managements of PAD?

A

Adequate peripheral tissue perfusion
Increased activity tolerance
Effective pain management
Knowledge of disease & treatment plan

NURS 347 EXAM 3 (9 decks)

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