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Intro to MedSurg > Vascular > Flashcards

Vascular Flashcards

(58 cards)

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1
Q

what is Peripheral Artery Disease (PAD)

A

-Involves progressive narrowing and degeneration of arteries of neck, abdomen, and extremities

-Atherosclerosis (plaque)is the leading cause in majority of cases.

-causes ischemia

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2
Q

what is ischemia

A

-Lack of blood flow to an extremity
-Decreased oxygen delivery to the tissues

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3
Q

what are the causes of PAD

A

-Atherosclerosis
-Emboli formation (blood clot)
-Septic embolism
-Infection (swelling, necrotisis facitis caused by staff)
-Any thing that descreases blood flow and O2 delivery
-Thrombosis

Trauma fracture (compartment syndrome r/t broken bones)

Vasculitis- autoimmune, inflammation of the vasculature

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4
Q

what are the risk factors of PAD

A

-Cigarette smoking
-Hypercholesterolemia
-Hypertension
-Chronic kidney disease
-Diabetes mellitus
-Family History
-Coronary artery disease

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5
Q

what is Critical Limb Ischemia (CLI) characterized by (don’t forget the ulcers)

A

-Chronic ischemic pain at rest lasting more than 2 weeks
-Arterial leg ulcers or gangrene
-Can have it an any other extremities

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6
Q

what is pain at rest from Critical Limb Ischemia (CLI)

A

-(pt could be diabetic) wounds on the lower exreeties= check their blood sugar
-Occurs in the forefoot or toes (elevating makes the pain worst)
-Aggravated by limb elevation
-Occurs from insufficient blood flow
-Occurs more often at night

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7
Q

what are the characteristics of arterial diseases

A

-intermittent claudication pain
-no edema
-pulse or weak pulse
-no drainage
-round smooth sores
-black eschar

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8
Q

what are the 5 P’s that you need to recognize for PAD, what do you need to do for the pulses

A

-Pain
- pallor
-paresthesia,
-pulselessness,
-paralysis
-Doppler the pusles- you wont be able to feel them other wise

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9
Q

how will the the extremities feel and what will the wounds look like with PAD

A

-Wounds that are not healing/slow to heal, appear dy round and possibly necrotic
-Affected extremity cool
-Changes in skin color, texture, and hair growth
-Dependent rubor/pallor with elevation (redness/ flushed when it is dangled)

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10
Q

what is Intermittent claudication-

A

spasmotic pain, decreased blood flow or oxygenation of the tissue

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11
Q

what is the main diagnostic test of PAD

A

Angiography:
-imaging of the vessels
and magnetic resonance angiography
-can see all of the vessels, tells us the severity

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12
Q

what are the more general diagnostics for PAD

A

-Doppler ultrasound
-Ankle-brachial index (ABI)
-Severity of disease? (Acute vs Chronic)?

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13
Q

what will Interventional Radiology Procedures tell us

A

-Intermittent claudication: -symptoms become incapacitating (they can’t get up and move, stents placed or meds to dissolve the clot)
-Pain at rest

-Ulceration or gangrene (rotten tissue, no O2 or blood floow) severe enough to threaten viability of the limb

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14
Q

what is Percutaneous transluminal angioplasty (PTA)

A

-his is an interventional procedures
-Involves insertion of a catheter into an artery
-Catheter contains a cylindrical balloon that is inflated
-This compresses the atherosclerosis into the vessel wall
-if more than 90% occlusion then you run the risk of perforating the vessel wall if you place a balloon
Post op- check pulses more frequently (q15x2, q30x2, q1x2)

Atherectomy:
Removal of obstructing plaque using a cutting balloon, laser, or drill

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15
Q

what is surgical therapy for PAD

A

-Most common surgical approach
-Peripheral artery bypass surgery with autogenous(taking part of the pt original vasculature and graft it to where you need to do a bypass) vein or synthetic graft to bypass blood around the lesion
-PTA with stenting may also be used in combination with bypass surgery
-Amputation
-2 different types of graft are autogenous and synthetic

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16
Q

what are the goals for PAD

A

-Adequate tissue perfusion
-Relief of pain
-Increased exercise tolerance
-Intact, healthy skin on extremities
-Increased knowledge of disease and treatment plan

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17
Q

what interventions for PAD in an acute care setting

A

-Frequently monitor after surgery
-Skin color and temperature
-Capillary refill
-Presence of peripheral pulses distal to the operative site
-Sensation and movement of extremity
-This is all under peripheral vascular assessment
-Continued circulatory assessment
-Monitor for potential complications
-Edema, bleeding, thrombosis
-Knee-flexed positions should be avoided except for exercise
-Turn and position frequently

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18
Q

what is health promotion for PAD (this is an intervention)

A

-ambulatory care
-Importance of meticulous foot care
-Daily inspection of the feet
-Comfortable shoes with rounded toes and soft insoles
-Shoes lightly laced

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19
Q

what are the Risk Factor Modifications for PAD

A

-Tobacco cessation (constrictic vessels if you keep smoking)
-Diabetic
-Glycosylated hemoglobin <7.0% for diabetics
-Aggressive treatment of hyperlipidemia
-BP maintained <140/90 (you will releave the pressure on the arteries and makes blood flow easier)

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20
Q

what type of drug therapy would be the priority

A

Antiplatelet agents (aggregate):
-Agent that inhibits platelet aggregation and thus reduces the risk of thrombus formation
e.g. Aspirin, Clopidogrel (Plavix)

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21
Q

Describe what ACE inhibitors would do for PAD

A

-↑ Peripheral blood flow
-↑ ABI (ankle-brachial index)
-↑ Walking distance

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22
Q

Describe cholesterol medications and what they do for PAD

A

-statin used to drop the amount of cholesterol in the blood
-To treat hyperlipidemia

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23
Q

describe what excersise can do for PAD

A

-Helps blood flow
-Exercise improves oxygen extraction in legs and skeletal metabolism
-Walking is most effective exercise for individuals with claudication
-30 to 45 minutes daily, 3 times/week

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24
Q

descibe what nutrition and monitoring for bleeding risk can do for PAD

Study These Flashcards
A

-Recommend reduced calories and salt for obese or overweight persons
-Long-term antiplatelet therapy

25
what are the expected outcomes for PAD
-Increased perfusion (pulses present) -CMS returns to baseline -Wound healing -Pain controlled or alleviated -Increased activity tolerance -Participation in walking program -Verbalizing step to improve health (diet, exercise, smoking cessation) -Able to afford and obtain medications
26
what are the manifestations of Chronic venous insufficiency (brings deoxygenated blood)
-Swelling in feet/lower legs that improves with elevation (priority) Itching -Pain or numbness -Discoloration of lower extremities (rubor) -Wounds on legs -History of obesity, diabetes, DVT, pregnancy, varicose veins -Changes in skin color, texture, and hair growth -Warm skin -Leathery brownish skin- -Hemosiderin staining -Edema -Pruritus (stasis dermatitis) Ulceration- wounds are wet/sloughy with irregular borders -Pain -Palpable pulses
27
what are the diagnostics for CVI
-Doppler ultrasound -Venogram(to see the veins all coiled up) (priority) -CT scan (priority) -Severity of disease?
28
what are the goals that we have for CVI
-Improve venous return (priority) -Decrease swelling/pressure in legs -Restore skin integrity -Improve nutritional status -Increase/promote activity -Decrease pain
29
what are the interventions for CVI (Increase venous blood return, decrease pressure)
Increase venous blood return, decrease pressure: -Compression therapy and elevation of legs: TED hose, ACE wraps
30
what are the interventions for CVI (Treat venous stasis ulcers & restore skin integrity)
-wound care, bed cradle
31
what are the interventions for CVI (adequate nutrition)
Diabetic diet, monitoring blood glucose (high during infection)- weight management and wound healing
32
what are the interventions for CVI (medication therapy)
Topical agents- hydrocortisone (steroid anti inflammatory cream), antifungal (bc it is a wet open wound, at risk for yeast infection), zinc oxide Antibiotics (blood cultures to check for bacterial infections)
33
what are the expected outcomes for CVI
Edema-Reduction in severity Wound Care: Healing/prevention of stasis ulcers Most management will be outpatient: Lifestyle modification Adherence to compression therapy
34
what is the signs of arterial disease (away)
color-Pale when elevated Rubor in dependent position edema-None or minimal nails-tick and brittle pulse- Decreased, weak or absent temp of the extremity-cool pain-Worse with elevation, claudication, worsening disease-pain at rest  ulcers- dry and necrotic
35
what is the signs of venous disease (towards)
color-Ruddy (brownish/red)-hemosiderin Cyanotic (if dependent) edema-present nails-normal pulse-normal temp of extremity-warm pain-Better with elevation; dullness or heaviness ulcers-Moist and Malleolar (ankle)
36
what diagnostics test do you run for varicose veins
-Manual compression test -Doppler ultrasound- a non-invasive diagnostic
37
what are the treatment options for varicose veins
Sclerotherapy: Injecting a saline solution closes those veins Laser: fades the appearance of veins Vein stripping: Outpatient procedure surgical removal vein removal Ambulatory phlebectomy: Removal smaller varicose veins through a series of tiny skin punctures. Endoscopic vein surgery: A small video camera inserted in your leg to visualize and close varicose veins, and then removes the veins through small incisions Angiogenesis: can happen with arteries and veins
38
what is the main nursing intervention for varicose veins
-Compression stockings and SCDs
39
what are the non priority nursing interventions for varicose veins
Prevent skin breakdown Pain relief Prevention/Reduce risk factors
40
what are the expected outcomes for varicose veins after all of the interventions
-Relief from discomfort -Improved circulation -Avoidance of complications (blood clot and ischemia)
41
what is Venous thrombosis/thromboembolism
Formation of a thrombus in association with inflammation of the vein. 
42
what is the biggest clue of Venous thrombosis/thromboembolism
Sudden onset: -Shortness of breath (SOB) -Chest pain that worsens with inspiration -Check for pulmonary embolism (neuro can respiratory checks are also done) -Hemoptysis
43
what are the risk factors Venous thrombosis/thromboembolism
-Prolonged immobility -Smoking -Using oral contraceptives -Recent injury to extremity -Pregnancy/Post-partum
44
what do you check for when you suspect Venous thrombosis/thromboembolism
-Unilateral edema -Red and warm -Pain/tenderness with palpation -Dilated superficial veins -Full sensation in calf or thigh -Paresthesia in affected extremity -Positive Homan’s sign (dorsiflextion of the foot hurts in the calf)
45
what are the acute symptoms of Pulmonary Embolism
-Rapid onset -Chest pain - Stabbing -Shortness of breath -Hypoxia, hemoptysis
46
what are the interventions for a pulmonary embolism and what is the primary diagnostic tool
-Rescue positioning: Fowlers/O2 -Call for HELP!!! -CT and VQ scan is the primary diagnostic tool for PE
47
what are the other diagnostics for pulmonary embolism
-Doppler ultrasound -Manual compression test -Venogram Echocardiogram: -we want to see if there is any pressure on the lung caused by a clot -MRI lung Lab results: -D-dimer (specific to clot formation, if + it means we havea clot but we don’t know where), coagulation studies (PT, INR, CBC
48
what are the goals for VTE and PE
-give O2 and anticoagulants- give through IV so that it is absorbed faster. this is so you can get rid of it to prevent the formation of more -improve venous return -decrease swelling/ pressure -restore skin integrity -improve nutritional status -increase nutritional status -increase activity -reduction of risk factors (surgery or cancer)
49
how would you prevent VTE and PE
-THIS IS KEY! -TED hose, Early ambulation -Sequential compression device -No massage -Assess for more blood clots
50
what are the medications that we could give for VTE and PE
-Low molecular weight heparin -Unfractionated heparin -Coumadin Thrombolytics (tPa)--> don’t do it unless you know a lot of history and the clot cannot be resolved Complications of therapy- bleeding precautions
51
what are the priority actions for emergency VTE and PE treatment
-Initial priority actions -Call Rapid Response Team (RRT) and provider -Administer oxygen -Need to reduce hypoxemia -Non rebreather mask -Place patient in high fowlers -Continuous monitoring of VS -Medications (what kind?) -Emotional support for patient and family -Watch for increasing pain or changes in LOC -DOCUMENTATION OF EVENTS
52
what is the surgical interventions for VTE and PE
Pulmonary embolectomy for massive PE: -For hemodynamically unstable patients in whom thrombolytic therapy is contraindicated Inferior vena cava (IVC) filter: -Prevents migration of clots in pulmonary system
53
what are the risks for anticoagulation
-bleeding! -bleeding from the gums -bleeding from the liver -rectal bleedings -dark or bloody stools
54
what do you have to monitor for anticuagulation
-Monitor VS and bleeding Obtain Baseline labs (over/under coagulated): -Troponin, ABG, BNP -PTT and anti-Xa: Heparin -PT, INR: Coumadin, INR goal >2 D-Dimer: Blood clots slowly break down after they are formed, and this process releases D-dimer into the blood. Platelets: concern for HIT (platelet count) (Heparin‐induced thrombocytopenia)
55
what are the antidotes for anticoagulation
Coumadin: Vitamin K Heparin: Protamine Sulfate
56
what do you (and the pt) need to know about anticoagulation upon discharge (blood work and safety measures)
Blood work: -Anticoagulant therapy for at least 6 months Safety measures: -Taking other medications- MANY drugs interact with anticoagulants -Soft toothbrushes -Report signs of bleeding to physician -Shoes when ambulating- NO bare feet Coumadin- check blood levels every week bc low therapeutic indes
57
what do you (and the pt) need to know about anticoagulation upon discharge (symptoms of bleeding and nutrition)
Symptoms of bleeding: -Hematuria -Dark or blood stools -Bleeding gums Nutrition: Food restrictions due to anticoagulation Many foods contain Vitamin K (kale, green leafy veggies) do not give these foods
58
what are the outcomes expected outcomes for VTE and PE
-Stable vital signs -Mentation at baseline -Anxiety alleviated; Pain decreased/resolved -Absence/resolution of chest pain -Prevention of further thromboembolic phenomena -Education -Understanding of medications and therapeutic dosing- INR goals? -Dietary education if on warfarin

Intro to MedSurg (4 decks)

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