Peripheral Vascular Disease Flashcards
(150 cards)
1
Q
Where does the left side of the heart pump blood?
A
to body tissues through systemic circulation
2
Q
What degree of ABI indicates arterial disease?
A
< 1
3
Q
True claudication will show what in exercise testing?
A
A drop in ankle pressures
4
Q
What does reduced ejection fraction HF cause?
A
accumulation of blood in the lungs, reduced CO, and inadequate arterial blood flow to tissues
5
Q
What are the procedural risks of an angiography?
A
acute arterial occlusion, bleeding, contrast nephropathy
6
Q
lymph nodes are enlarged, tender, and red
A
acute lymphadenitis
7
Q
Types of emboli that can be impacted
A
air, fat, amniotic fluid, and septic
8
Q
localized sac or dilation formed at a weak point in the wall of the artery
A
aneurysm
9
Q
involves injecting radiopaque contrast agent directly into arterial system to visualize the vessels; confirms obstruction or aneurysm
A
angiography
10
Q
What are the different endovascular therapies?
A
angioplasty, atherectomy, stent/stent graft placement
11
Q
balloon-tipped catheter maneuvered over area of stenosis to improve blood flow by overstretching vessel or “cracking” and flattening plaque
A
angioplasty/percutaneous transluminal angioplasty (PTA)
12
Q
Types of Peripheral Arterial Disease
A
aneurysms, aortic dissection, embolism and thrombosis, and Raynaud’s Phenomenon
13
Q
sudden onset of symptoms
severe and persistant chest pain; can extend into shoulder, epigastric region, or abdomen
MAY BE MISTAKEN FOR AN MI
pale, diaphoresis, tachychardia
A
aortic dissection
14
Q
How can vasodilation be promoted?
A
applying warmth, avoiding cold, avoiding smoking, reducing stress, wearing unrestrictive clothes, avoiding crossing legs
15
Q
hardening of the arteries
A
arteriosclerosis
16
Q
antiplatelet agent; prevents formation of thromboemboli; treatment for symptomatic patients; reduces risk of cardiac events; contraindicated in pts with GI problems
A
Aspirin or Clopidogrel (Plavix)
17
Q
Nursing management of DVTs
A
asses/monitor anticoagulant therapy, monitor/manage potential complications, pain management, position body and encourage exercise
18
Q
Describe the nursing actions for a MRA
A
assess for presence of incompatible devices
19
Q
When do patients often report rest pain being worst?
A
at night
20
Q
reduces the plaque buildup using a cutting device or laser
A
atherectomy
21
Q
accumulation of lipids, calcium, etc. on the artery; “plaques”
A
atherosclerosis
22
Q
What is the most common cause of an AAA?
A
atherosclerosis
23
Q
What can cause arterial alterations in blood vessels?
A
atherosclerotic plaque, thromboembolus, infection or inflammatory processes
24
Q
How can one maintain tissue integrity?
A
avoid trauma to area
25
Lab studies for DVT diagnosis
baseline CBC, prothombin time (PT), activated partial thromboplastin time (aPTT), international normalized ration (INR)
26
What is the most common site for formation of an aortic aneurysm?
below the renal arteries
27
BP control meds for a thoracic aortic aneurysm
beta-blockers, ARBs, hydralazine, and nitroprusside
28
symptoms of Raynaud's are always…
bilateral and symmetrical
29
Aneurysm treatment and management varies on severity and other factors, but what are the possible options?
BP control
IV fluid and/or blood administration
surgical repair or endovascular repair
CSF drainage to increase spinal perfusion
30
femoral-popliteal the most common; greater or lesser saphenous vein or combination of one of saphenous veins and upper extremity vein such as cephalic vein are used to provide length
bypass grafting
31
What drug is effective in treating Raynaud's? Why?
calcium-channel blockers because they are vasodilators
32
occurs when microbe enters through broken skin and release their toxins in the SQ tissues
cellulitis
33
Thoracic aortic aneurysm patients can be asymptomatic, but what are common clinical manifestations that are seen when they are?
chest or upper back pain (often feels more severe when supine)
34
results from obstruction of the venous valves in the legs or a reflux of blood through the valves
chronic venous insufficiency/postthrombotic syndrome
35
vasodilator that inhibits platelet aggregation; treatment for claudication; contraindicated in pts with HF
cilostazol (Pletal)
36
fluid in a space that cannot be expanded
compartment syndrome
37
Types of compression therapy
compression stocking, external compression devices and bandages, intermittent pneumatic compression devices
38
cross-sectional images of soft tissues, bones, and blood vessels
Computed Tomography Study (CT)
39
Characteristics of an AAA rupture
constant, intense back pain
falling BP
decreased hematocrit
40
injection of radiopaque contrast agent into venous system
contrast phlebography
41
What is the point of managing BP in a patient with an aneurysm?
controlled BP reduces the risk of rupture
42
What are the physical signs of PAD upon inspection of the skin?
cool to touch, pale, pallor, rubor and cyanosis (depending on severity)
43
thrombus formation in the deep veins in the thigh, calf, and sometimes arms (mainly patients with PICC lines)
deep vein thrombosis
44
What is the purpose of anticoagulant therapy for DVTs?
delays clotting time, prevents thrombus formation in post-op patients, forestalls extension of thrombus after formation
45
What is the most common cause of PEs?
dislodgement or fragemented DVT
46
What are the possible complications of stent placement?
distal embolization, dissection, and dislodgment
47
BP control meds for an abdominal aortic aneurysm
diuretics, beta-blockers, ACE inhibitors, ARBs, and calcium-channel blockers
48
What are the nursing actions for Ankle-Brachial Index?
don't use abnormally low blood pressures in assessment
49
stents with antiplatelet meds on them
drug-eluting stents
50
Symptoms of varicose veins
dull aches, muscle cramps, increased muscle fatigue in lower legs, ankle edema, heaviness in legs, nocturnal cramps
51
assess blood flow and locate disease (stenosis vs occlusion)
Duplex Ultrasonography
52
Two types of VTEs
DVT and PE
53
What are the most common symptoms of PEs?
dyspnea, tachypnea, and chest pain
54
Signs/Symptoms of Chronic Venous Insufficiency
edema, altered pigmentation, pain, stasis edema
55
What is the main concern of edematous tissues?
edematous tissues are more prone to breakdown and infection
56
Ways to increase venous blood flow
elevating legs, avoiding prolonged sitting and standing in one position, avoiding cross legs, avoid constricting garments, use of graduated compression stocking
57
Virchow's Triad is…
endothelial damage, hypercoagulation, and venous stasis
58
smaller and less invasive option to surgery
endovascular therapies
59
What are the nursing actions for exercise testing?
ensure the patients that running is not required
60
How often should pulses, color/temp, capillary refills, and sensory and motor functions be monitored in a post-op patient with PAD?
every 15 minutes initially and progressively longer if pt is stable
61
How often should small aneurysms be evaluated?
every 6 months
62
How often should ABI be monitored in a post-op patient with PAD?
every 8 hours in the first 24 hours and then once a day until discharge
63
patients walk for a max of 5 minutes to the point of claudication and ankle SBP are measured
Exercise Testing
64
Lymphedema complications
flap necrosis, hematoma, abscess under flap, cellulitis
65
aneurysm where the entire arterial segment becomes dilated
fusiform aneurysm
66
What are possible complications of both an angioplasty and an atherectomy?
hematoma formation, embolus, dissection, acute arterial occlusion, and bleeding
67
Pharmacologic treatment options of arterial embolism and thrombosis
heparin and t-PA
68
increase in protein that promotes coagulation
hyperhomocystemia
69
Stable PE priority management is…
immediate anticoagulation therapy
70
What are the main focuses of nursing care for patients with PAD?
improving peripheral arterial circulation, promoting vasodilation, relieving pain, maintaining tissue integrity
71
When can PAD lead to the formation of gangrene?
In extreme and prolonged cases of ischemia
72
vessels stiffening causes:
increased peripheral resistance, impaired blood flow, and increased left ventricular workload
73
What are the potential complications of leg ulcers?
infection and gangrene
74
improves blood supply from aorta into femoral artery
inflow procedures
75
muscular, cramp-type pain, or fatigue with any degree of activity and relieved at rest; seen in arterial insufficiency
intermittent claudication
76
Clinical manifestations of arterial leg ulcers
intermittent claudication, foot pain at rest, ischemic pain unrelieved by opioids, small circular ulcerations on the tips of toes or on toe webbing
77
Vessels failing to respond to increases blood flow needs causes this
ischemia
78
Edema formation with PAD is usually caused by what?
Keeping the extremity in a dependent position for too long
79
an excavation of the skin surface that occurs when inflamed necrotic tissue sloughs off
leg ulcers
80
What is most usually affected by PAD?
legs
81
Duplex Ultrasonography is the standard in diagnosing what?
lower extremity DVTs
82
inflammation or infection of the lymph nodes
lymphadenitis
83
inflammation or infection of the lymphatic channels
lymphangitis
84
tissue swelling related to obstruction of lymphatic flow
lymphedema
85
provides computer images of blood vessels
Magnetic Resonance Angiography (MRA)
86
Nursing management considerations for PEs
monitor thrombolytic therapy, pain management, manage oxygen therapy, relieve anxiety, monitor for complications, proved post-op care
87
List the prevalence of AAAs
most common in white men over the age of 65
88
What can help relieve rest pain? How does this work?
moving the extremity into a dependent position to improve perfusion to distal tissues
89
What patient prep is required for Duplex Ultrasonography?
none except NPO for 6 hours prior if it's an abdominal study
90
What is an important thing to keep in mind when assessing a pt with an aneurysm?
nursing assessments should be focused on anticipation of rupture
91
What are the requirements of “high risk” PAD pts?
older than 65, diabetes mellitus, nicotine use, people undergoing arterial interventions/surgery
92
When is surgery of an AAA performed?
only when surgery to prevent the rupture outweighs the risk of all the possible complications of the surgery
93
What is procedural treatment for renal impaired pts undergoing a CT scan?
oral or IV hydration for 6-12 before (or sodium bicarb administration)
94
provides blood supply to vessels below femoral artery
outflow procedures
95
Clinical manifestations of venous ulcers
pain described as aching or heavy, foot/ankle edema, ulcerations around the ankle, discoloration, ulcerations on the side of the foot
96
What can pain tell us about PAD?
pain is usually in the muscle group distal to the occlusion
97
Main signs/symptoms of arterial embolism and thrombosis
pain, pallor, paresthesia, pulselessness, paralysis, and poikilothermia
98
clinical manifestations of DVT
pain, warmth, tenderness, edema of extremity
99
Contraindications of compression stocking therapy
patients with PAD, severe cardiac insufficiency, allergy to compression material, severe diabetic neuropathy with sensory loss
100
Intermittent claudification is a hallmark sign of…
peripheral arterial disease
101
Leg ulcer management
pharmacologic therapy, compression therapy, cleansing/debridement, topical therapy, wound dressing, simulated healing, hyperbaric oxygen, negative pressure wound therapy
102
How can peripheral arterial circulation be improved?
positioning affected body part below heart level
walking and isometric exercises
SET program for pts with claudication
103
begins 24hrs post stent graft placement; spontaneously occurring fever, leukocytosis, transient thrombocytopenia
post implantation syndrome
104
What is the primary objective of DVT management?
preventing the thrombus from extending and fragmenting
105
congenital malformations leading to lymphedema
primary lymphedema
106
varicose veins without involvement of deep veins
primary varicose veins
107
Venous insufficiency management
protect extremities from trauma, report signs of ulceration ASAP, increase venous blood flow
108
obstruction of pulmonary artery or one of its branches by a thrombus that originates somewhere in the venous system or in the right side of the heart
pulmonary embolism (PE)
109
Assessment of an AAA may reveal…
pulsatile mass in the middle/upper abd
systolic bruit heard over mass
110
What are the nursing interventions in the case of compartment syndrome?
put the limb in a flat, neutral position at heart level
111
How often should doppler assessments be performed on a patient post-endovascular repair of an aneurysm? Temperature?
q15mins initially; longer intervals when stable
q24h for temp
112
no underlying disease causing Raynaud's
Raynaud's Disease (Primary/Idiopathic)
113
Raynaud's caused by an underlying disease
Raynaud's syndrome (secondary Raynaud's)
114
What are the indications for endovascular managements of DVTs?
recurrent or extensive thrombi, high risk for PE, or anticoagulant therapy is contraindicated
115
What is the goal of chronic venous insufficiency treatments?
reduce venous stasis and prevent ulceration
116
persistent pain in the anterior portion of the foot during rest
rest pain
117
Leg ulcer nursing interventions
restoring skin integrity, improving physical mobility, promoting adequate nutrition, promoting home and community-based care
118
reddish/blue skin discoloration that occurs anywhere from 20 seconds - 2 minutes of the limb being in a dependent position
rubor
119
aneurysm only on one side of the vessel
saccular aneurysm
120
acquired obstruction leading to lymphedema
secondary lymphedema
121
varicose veins resulting from obstruction of deep veins
secondary varicose veins
122
Rest pain is indicative of what?
severe adrenal insufficiency and critical state of ischemia
123
Pulses in patients with PAD are often…
severe and diminished
124
List the signs and symptoms of compartment syndrome.
severe edema, pain, decreased sensation of toes or fingers in affected extremity
125
Many patients with an AAA are asymptomatic, but those that are present what clinical manifestations?
signs of HF or large bruit
abd pain localized in middle/lower abdomen to left of midline
cyanosis
mottling of toes
126
DVT prophylaxis options
SQ heparin or lovenox
126
DVT prophylaxis options
SQ heparin or lovenox
127
Unstable PE priority management…
stabilizing cardiopulmonary system first priority, followed by lysing the embolus
128
Clinical manifestations of venous insufficiency
stasis ulcers, discoloration of tissues (hemosiderin staining), skin dry and cracked, SQ tissue fribrose and atrophy
129
What is the first-line therapy for atherosclerosis?
statins
130
improves endothelial function and reduces severity of intermittent claudication, increases walking distance to the onset of claudication; decreased rates of repeat events reported
Statins
131
reduces risk for restenosis, patients must take antiplatelet meds for 6 mo. post-op
stent/stent graft placement
132
Assessment of a thoracic aortic aneurysm will often show…
superficial veins
edematous areas of chest wall
cyanosis
unequal pupils
133
What is the sitting tolerance and ambulation precautions of patients post-endovascular repair of an aneurysm?
supine for 6 hours
HOB to 45-degrees after 2 hours
pts can roll side to side
ambulating to bathroom w/ assistance 6 hrs post-op
134
lymph nodes have become necrotic and form an abscess
suppurative lymphadenitis
135
What does preserved ejection fraction HF cause?
systemic venous congestion and reduced CO
136
What does preserved ejection fraction HF cause?
systemic venous congestion and reduced CO
137
What is the reason aging can cause peripheral vascular disorders?
the blood vessels start to stiffen
138
70% of cases caused by atherosclerosis, most common in hypertensive men ages 50-70; most common site for a dissecting aneurysm
thoracic aortic aneurysm
139
Endovascular management options for DVTs
thrombectomy or vena cava filter
140
What can cause venous alterations in blood vessels?
thromboembolus obstructing vein, incompetent venous valves, or reduced effectiveness of surrounding muscles
141
Where does the right side of the heart pump blood to?
through the lungs to pulmonary circulation
142
What can cause alterations in lymphatic vessels?
tumors, mechanical trauma, and inflammatory processes
143
4 options of anticoagulant therapy for DVTs are…
unfractioned heparin, low-molecular weight heparins (lovenox), oral anticoagulants (coumadin), oral direct factor Xa inhibitors (apixaban)
144
abnormally dilated, tortuous, superficial veins caused by incompetent venous valves
varicose veins
145
transvenous placement of a grid or umbrella filter in the vena cava to block the passage of emboli, prevent PE
vena cava filter
146
What is the most common cause of leg ulcers?
venous etiologies (PAD leading cause)
147
Name the different venous disorders
venous thromboembolism (DVTs and PEs), chronic venous insufficiency (Posthromboemobolitic syndrome), leg ulcers, varicose veins
148
What is the most serious complication of chronic venous insufficiency?
venous ulceration
149
When should preprocedural treatments be done for CT scans?
when the patient is renal impaired
