PVD/DVT/Arteriosclerosis Flashcards
(69 cards)
1
Q
are conditions affecting the peripheral arteries and veins. (can’t get blood back up)
A
PVD’s; Peripheral Vascular Disease
2
Q
thickening, loss of elasticity and buildup of calcification on arterial walls.
A
Arteriosclerosis
3
Q
a form of arteriosclerosis in which deposits of fat and fibrin obstruct and harden the arteries.
-These pathologic changes impair perfusion to the peripheral tissues and this is PVD.
A
Atherosclerosis
4
Q
Inadequate venous return
DVT is most common cause
A
Chronic venous insufficiency
5
Q
Peripheral Arterial Disease/Peripheral Atherosclerotic Disease
A
PAD
6
Q
lesions obstruct vessel lumen
- Collateral circulation develops; inadequate to meet tissue needs.
- Manifestations occur when vessels are more than 60% occluded.
- Arterial Ulcers may develop.
A
Peripheral Arterial Disease/Peripheral Atherosclerotic Disease (PAD)
7
Q
Venous blood stagnates. (can’t get blood back to heart).
- Pressures increase and may impede arterial flow.
- Cells die. Red cell breakdown causes brown pigmentation. (hemosiderin; iron deposited)
- Venous stasis ulcers develop
A
Chronic venous insufficiency (CVI)
8
Q
Affects people in their 60’s and 70’s; Men more than women.
A
Etiology of Arterial insufficiency
9
Q
Diabetes mellitus
- hypercholesterolemia
- hypertension
- cigarette smoking
- high homocystine levels; increasing PVT
- obesity
- sedentary lifestyle
A
Risk factors for Arterial insufficiency
10
Q
- thrombophlebitits
- obesity
- prolonged standing or sitting.
- Right sided heart failure
A
Risk Factors for Venous insufficiency
11
Q
- Intermittent claudication
- Rest pain
- Paresthesias (numbness)
- weak, absent pulses
- Pallor with extremity elevation, dependent rubor (redness)
- Thin, shiny, hairless skin, thickened toenails
- Areas of discoloration/skin breakdown
A
Clinical Manifestations of Peripheral Atherosclerosis
12
Q
-Edema
-Itching, dull leg pain increases with standing
-Thin shiny atrophic skin
-Cyanosis and brown skin pigmentation of lower leg and foot (hemosiderin)
-Possible weeping dermatitis
-Thick, fibrous (hard) SC tissue
-Recurrent ulcerations of medial or anterior ankle.
-
A
Clinical Manifestations of Chronic Venous Insufficiency
13
Q
- Toes, feet, shin
- Ulcer appears-deep, pale
- skin, normal to atrophic
- pallor on elevation and Rubor when dependent
- skin temp Cool
- Edema; absent or mild
- Pain; severe/intermittent claudication/rest pain
- Gangrene may occur
- Pulses decreased or absent
A
Arterial Ulcers
14
Q
- Ankle (medial and anterior)
- Ulcer; pink superficial
- Skin; brown, stasis dermatitis, Cyanosis on dependency (down)
- Skin temp; normal warmer
- Edema may be significant
- Pain-usually mild/aching
- No gangrene
- pulses normal.
A
Venous Ulcers
15
Q
- Slow atherosclerosis
- maintain tissue perfusion
- keep legs dependent/down
A
Management of PAD; Peripherial Arterial Disease/ Atherosclerotic
16
Q
- Relieving symptoms, promoting adequate circulation and prevent tissue damage.
- Reduce edema; diuretics.
- Treat ulcers
- Hosiery/teds
- Elevation of the legs frequently during day and above heart level at night.
A
Management of CVI; chronic venous insuff
17
Q
Diagnostic tests
Segmental pressure measurements
Stress testing
Doppler ultrasound; DVT?
Transcutaneous oximetry evaluates oxygenation of tissues
Angiography or Magnetic resonance angiography. SP of ankle over SP of brachial
ankle pressure should be higher than brachial
A
Management of PAD and CVI
(Perpheral Arterial Disease/Peripheral Atherosclerotic Disease)
(Chronic Venous Insufficiency)
18
Q
- Aspirin; decreases PLT aggregation
- Clopidogrel (Plavix)
- Cilostazol (Pletal); vasodilator properties
- Pentoxifylline (Trental); decreases viscosity; thickness of blood, better flow; Increase perfusion
A
Pharmacologic therapies
-Inhibit platelet aggregation
19
Q
- Smoking cessation (promotes atherosclerosis and Vasospasm)
- Foot care
- Pain relief
- Progressive strenuous exercise (30-40 min walk daily)
- Control
- Diabetes
- Hypertension
- Cholesterol levels
- Weight
A
Clinical Therapies Arterial/Venous Insufficency
20
Q
- Revascularization; jump the clot
- Percutaneous transluminal angioplasty
- Stent placement
- Atherectomy (cut out plaque)
- Endarterectomy (roto rooter; carotid artery)
- Bypass grafts (jump over, block CABG)
A
Surgery for Arterial insufficiency
21
Q
- Aromatherapy
- Biofeedback
- Healing/therapeutic touch
- Massage
- Herbal therapy
- Exercise/Yoga
- Very low fat/vegatarian diet
- Antioxidants
A
Complementary Therapies (Arterial/venous insufficiency)
22
Q
- Elevate legs at rest and sleep
- Walk
- Avoid sitting or standing for prolonged periods
- Avoid Crossing legs
- Avoid tight-fitting garments
- Wear elastic hose as prescribed-tighter at foot instead of calf.
- Foot care
A
Patient Education for Venous Insufficiency
23
Q
- Health Hx; evaluate Pain
- CAD, PVD, Hyperlipidemia, HTN, DM, Smoking, Diet, Activity
- Physical examination
- Pulses
- Sensation
- Capillary refill
- Temperature, warm venous, cool arterial
- Color
- Movement
- hair distribution
A
Assessment PVD
24
Q
- Disturbed body image
- Ineffective Health Maintenance
- Risk for Infection
- Impaired Physical Mobility
- Impaired Skin Integrity
- Ineffective Tissue Perfusion: Peripheral
- Pain
- Activity Intolerance
A
Nursing Diagnoses for PVD
25
- Promote wound healing
- Manage Pain
- Promote tissue perfusion
- Optimize activity tolerance
- Educate on medications
Plan for PVD
26
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Assess peripheral pulses
Position extremities
Regular exercise benefits
Support extremities with foot cradle, warmth (arterial insufficiency)
Frequent position changes
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Implementation;
Ineffective Tissue Perfusion: Peripheral
(PVD)
27
Assess q 4hr
Keep extremities warm
Pain relief strategies
Implementation;
Pain
(PVD)
28
Meticulous skin care
Bed cradle
Specialty mattress
Implementation
Implementation;
Impaired Skin Integrity
(PVD)
29
Assist with care as needed
Gradual increase in activity/exercise
Diversional activities/stress reduction
Frequent position changes
Implementation;
Activity Intolerance
(PVD)
30
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Positioning to promote perfusion to extremities
Abstinence from tobacco products
Appropriate wound care/healing
States symptoms to report to provider
Pain Control
```
Evaluation for PVD
31
Virchow's triad
- stasis of blood
- vessel damage
- increased blood coagulability
3 pathological factors assoc with thrombophlebitis
| Virchow's triad
32
Deep or superficial veins
Common complication hospitalization, surgery
OB, orthopedic procedures; genetics
Etiology of Deep Vein Thrombosis
33
Prevention Minimizes Risk
Special Considerations;
-Orthopedic procedures (bones)
-Atrial fibrillation (upper chambers arent' pumping blood; stagnant)
-Acute myocardial infarcion; doesn't pump well
-Ischemic stroke
-Genetic predisposition
Risk Factors DVT
34
Protein C deficiency
Protein S deficiency
Antithrombin III deficiency
Factor V Leiden
Genetic Predisposition to DVT
| ****Remember*****
35
Calf pain; dull, aching, increases with walking
Tenderness
Swelling
Warmth
Erythema
Cyanosis and edema;
**Could be bilateral with OB patients (DVT legs)
-get on anticoagulant then increase walking
**Rare; Palpaple cord along affected vein
Homan's sign unreliable indicator
Clinical Manifestations of DVT
36
Chronic venous and pulmonary embolism;
usually unilateral but can be bilateral (heart pts)
Flex pt. foot look for pain. Cont pain after flex DVT
Gold standard; Spiral CT Scan ; emboli
Complications DVT
37
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Duplex venous ultrasonography
Plethysmography
MRI; decreased perfusion
Ascending contrast venography; injectable dye and see where it didn't go
Spiral CT
```
Diagnostic tests DVT
38
-Low-molecular-weight heparins; lovenox
-Oral anticoagulation; warfarin, PTT, INR
-Elevating foot of bed, knees slightly flexed
-Early mobilization
-Leg exercises
-Intermittent pneumatic compression devices
-Elastic stockings; TEDS
Reverse heparin with Vitamin K
Prophylaxis DVT
39
Anticoagulants;
Use of heparin.
-dosage calculated to maintain a PTT 2x control ; (usual double PTT range, if normal 23 would be 46)
-continuous infusion
-subcutaneous heparin; not looking @ PTT
IF PLT decrease count or less than 100 call Dr.; consider something else besides heparin.
Warfarin;
Given with IV heparin for 4-5 days.
Takes up to 5 days for full effects
Doses adjusted to maintain INR at 2-3 (level)
Cont. for at least 3 months; DVT coumadin for 3 months
Coumadin with heparin at 1st. takes 4 to 5 days to work
Can increase risk of clotting.
Pharmacologic therapies for DVT
40
Venous thrombectomy; removed
Filters; Venal Caval filters; Green
(for recurrent thrombosis)
Vein Ligation; open vein and take out clot
Surgery for DVT
41
Measures to reduce symptoms, inflammation.
-warm, moist compresses
-extremity rest
Anti-inflammatory agents
Bed rest
-elevate legs
-antiemolism stockings, PCD (put on other leg that doesn't have DVT
Clinical Therapies for DVT
42
Return to activity
- encourage walking-when ordered. (been on heparin/coumadin long enough)
- avoid prolonged sitting, standing
- avoid tight-fitting garments
Clinical therapies for DVT
43
Position to promote venous blood flow
- Elevate feet with knees slightly bent
- Avoid pillows under knees
- Avoid sharply flexed hips, knees
- Use recliner, foot stool
- Early ambulation
- Teach ankle flexion, extension exercises; foot pumps
Nursing Process: Assessment DVT
44
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Apply elastic stockings, PCD
Avoid crossing legs
Possible prophylaxis with heparin, warfarin (high risk client)
Assess IV sites
(change location with evidence of inflammation)
Assessment
-health hx
-physical exam
-family hx
-vessel damage risk
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Assessment DVT; nursing process
45
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Pain
Ineffective Tissue Perfusion:Peripheral
Ineffective Protection; predisposing hereditary
Impaired Physical Mobility
Ineffective Tissue Perfusion: Cardiac
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Nursing Diagnosis for DVT
46
Client will:
- control pain to allow for rest, comfort
- have no complications, thrombosis will not embolize
- Have increased tissue perfusion
Plan for DVT
47
Assess regularly using pain scale
Sudden chest pain is emergency
Measure calf and thigh diameter
Apply warm moist heat; usually 20min/4xday
Maintain bed rest as ordered. then ambulate when oked.
Implementation: Pain, DVT
48
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Assess skin of affected extremity
Elevate extremity
Limb care
Use specialty mattress
Encourage frequent position changes
If swollen; lotion relieves stretching
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Implementation: Ineffective Tissue Perfusion: Peripheral
| DVT
49
Encourage ROM exercises q 8hr.
Encourage frequent position changes; deep breathing and coughing
Encourage increase in fluids and dietary fiber
Assist with ambulation as needed
Encourage diversional activities (if bored on bedrest)
Implementation: Impaired physical mobility
| DVT
50
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Ineffective Protection
-monitor lab results
Ineffective Tissue Perfusion: Cardiac
-frequent assessment of respiratory status
-signs of pulmonary embolism
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Implementation DVT
51
Pain controlled
No complications
Strategies to prevent reoccurrence of DVT
Evaluation; DVT
52
aka thrombophlebitits. is a condition in which a blood clot (thrombus) forms on the wall of a vein and is accompanied by inflammation of the vein wall and some degree of obstructed venous blood flow.
venous thrombosis
53
deep vein of the body?
those leading to the vena cava
54
Stimulates the clotting cascade.
- inflammation response triggered
- causes tenderness, swelling and erythema in area of thrombus.
- thrombus floats in vein @ 1st,
- then travels as emboli
- fibroblasts invade thrombus, scarring vein wall and destroying venous valves.
Vessel trauma
55
pelvis, thigh or calf
Deep Vein locations
56
thrombus
blood clot
57
emboli?
piece of thrombus that has broken off and is traveling through vein.
58
tend to occur @ sites where the vein may be normal, but blood flow is Low.
Venous thrombi
59
tend to occur @ sites of arterial plaque rupture.
arterial thrombi
60
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immobilization
surgery
cancer
trauma
pregnancy
hormone therapy
coagulation disorders
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Factors assoc with venous thrombosis
61
indomethacin (Indocin)
naproxen (Naprosyn)
reduce inflammation in veins and provide symptomatic relief (part with superficial veneous thrombosis)
NSAIDS DVT
62
prevent clot extension and reduce risk of pulmonary embolism
Anticoagulants
63
prothrombin times; clotting
INR
64
interfers with the clotting cascade by inhibiting the effects of thrombin and preventing the conversion of fibrinogen to fibrin;
prevents the formation of a stable fibrin clot
Heparin
65
aPTT
partial thromboplastin time
IV; immediate
SubQ; within the hour
66
most bioavailable fraction of heparin. more precise and predictable anticoagulant effect than unfractionated heparins
LMW; low-molecular weight heparins
67
ardeparin (Normiflo)
dalteparin (Fragmin)
enoxaparin (Lovenox)!!
tinzaparin (Innohep)
Drug ex of LMW heparins
68
done when thrombi lodge in the femoral vein and its removal is necessary to prevent pulmonary embolism or gangrene.
Venous thrombectomy
69
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Lab values
INR
aPTT
H & H
Encourage Mobility
ROM active q 8hr; prevent contractures and muscle atrophy
Encourage freq. position change
Deep breathing
airway clearance
coughing
Increase fluids and dietary fiber intake
Encourage diversional activities
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Promote Effective Protection
