vascular disorders - aorta Flashcards by Amanda S.

aorta details

Largest artery in the body
Responsible for supplying oxygenated blood to essentially all viral organs
Branches include right and left common carotid, right and left subclavian, right and left coronary, brachiocephalic, celiac trunk, superior and inferior mesenteric, renal, gonadal, and common iliac

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Most common vascular problems of aorta (3 of them)

Aneurysms
Aortoiliac occlusive disease
Aortic dissection

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Aneurysms

Localized sac (outpouching) or dilation formed at a weak point in the wall of the artery

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Aneurysms classified by (aneuysms shape ppl)

its shape or form

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aneurysms increase with

age

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AAA - where do they occur? And mostly below what arteries?

¾ occur in abdominal aorta
¼ occur in thoracic aorta
Most occur below renal arteries
The larger the aneurysm, the greater the risk

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AAA patho (triple A is dilated)

Dilated aortic wall becomes lined with thrombi that can embolize
Leads to acute ischemic symptoms in distal branches

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AAA causes (Triple a degrades from birth due to mechanics, trauma, inflammation or infection

Degenerative
Congenital
Mechanical
Penetrating or blunt trauma
Inflammatory
Infectious

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AAA risk factors (triple A is male)

Age
Male gender
HTN
CAD

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AAA clinical manifestations (opposite of what you think)

Often asymptomatic
Frequently detected during a routine physical exam or when patient is examined for an unrelated problem (KUB, abdominal CT scan)

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AAA complications - rupture into retroperitoneal space

Bleeding may be tamponaded by surrounding structures, thus preventing exsanguination and death.

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AAA xrays - chest (Triple A’s x-ray is wide)

Chest –demonstrate mediastinal silhouette and any abnormal widening of thoracic aorta

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AAA ECG used to rule out what?

ECG to rule out MI

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AAA echocardiography (triple A echoes in the valve)

Assists in diagnosis of aortic valve insufficiency

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AAA ultrasonography monitors what? (ultra sound for baby’s size)

Useful in screening
Monitors size

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AAA CT scan (Triple A needs a cutie for cross-section)

Most accurate to determine anterior-posterior length and cross-sectional diameter, presence of thrombus, type of surgery

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AAA MRI (Mr, I need Triple A to locate the severity of the crash)

diagnose and assess location and severity

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AAA angiography (Angie can provide valuable info to triple A)

Can provide accurate information about involvement of intestinal, renal or distal vessels

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AAA If ruptured

emergent surgical intervention is required
90% mortality

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AAA - pre op

Preop routines; bowel prep, NPO, shower. IV antibiotic (usually keflex) prior to incision

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AAA Expectations after surgery - what meds? (Triple A before Beta B)

PACU, tubes, drains, ICU, beta blocker

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AAA - Postoperative Nursing - how long in the ICU?

Postoperative Nursing
ICU monitoring 48 hours

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AAA - Discharge teaching - what about ambulation?

Increase ambulation
No heavy lifting or staining
Teach about signs and symptoms of complications
Infection
Neurovascular changes

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Venous thromboembolism (VTE) - where are they?

Venous thromboembolism (VTE) condition
Blood clots form in the deep veins of the leg,, groin or arm

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Leg ulcers

Arterial Venous Mixed and other

varicose veins

valves give out, genetics and weight. painful.

venous disorders - Caused by Virchow’s triad (the end of virtue is hyper or stasis)

2/3 must be present Endothelial injury Venous Stasis Hypercoagulability

venous stasis - causes (As you age with afib, HF, and obesity you become stasis)

Advanced age, a fib, chronic HF, obesity

endothelial damage - causes - what types of surgeries? (just stay around the abdomen)

Abdominal/pelvic surgery

hypercoagulability causes - what about thrombin?

Antithrombin II deficiency, smoking

DVT signs and symptoms (PEEW, it's a DVT)

Erythema, edema, warmth Pain

DVT complications

PE Chronic venous insufficiency Phlegmasia cerulea dolens (rare) Swollen, blue, painful leg

labs for DVT (don't forget on a dime)

Coags, platelets, H & H, d-dimer

tests for DVT (DVT tests are ultra Cuties, Mr)

ultrasound, CT Venography, MR Venography

DVT meds - anticoagulants (you know 2, and the 3rd?)

Heparin gtt, enoxaparin (Lovenox), Coumadin

DVT surgical treatment (DVTs can be removed or filtered)

Venous thrombectomy Inferior vena cava (VC) filter Filters clots

how to prevent DVT

early ambulation, leg exercises, graduated compression stockings, intermittent pneumatic compression devices, Subcutaneous heparin (unfractionated) LMWH Fondaparinux, Lifestyle changes Weight loss Smoking cessation Regular exercise

DVT nursing management

Pregnancy Obesity Central lines , PICC, PIV

highest risk for DVT

A 25-year-old patient with a central venous catheter in place to treat septicemia - it's the sepsis

chronic veinous insufficiency - causes (chronic bad veins are from Valves, veins, birth or fists)

Damaged valves Deep vein obstruction Congenital venous malformation AV fistula

chronic veinous insufficiency complications - just one, you know it.

ulcers

chronic veinous insufficiency - appearance (veins are itchy leather) Think of the patient

Brownish, leathery, itchy skin

chronic veinous insufficiency prevention (same as the others)

Avoid standing for prolonged periods Use of compression stocking or TED hose Ambulation/Exercise Good skin care –inspection and moisturizer Avoid trauma

chronic veinous insufficiency diet - think infection

Diet Increase protein intake (if medically safe) Vitamin A & C Zinc albumin is ok

chronic veinous insufficiency education - and what about extremities?

keep skin hydrated, don't bump into anything, avoid standing for long periods, elevate the extremity, use compression if possible,

assessment of pt with leg ulcers

History of the condition Assess pain, peripheral pulses, edema Treatment depends on the type of ulcer Assess for presence of infection Assess nutrition

neurovascular assessment - 5 Ps

pain, pulse, pallor, paresthesia, paralysis

leg ulcer medical management - compression?

Anti-infective therapy depends on the infecting agent Oral antibiotics are usually prescribed Compression therapy Debridement of wound Dressings Other

leg ulcer nursing interventions - avoid what?

Restoring skin integrity Cleansing wound; positioning; avoiding trauma; avoid heat sources

leg ulcer nursing interventions - Improving physical mobility - can you walk?

Improving physical mobility Physical activity initially restricted to promote healing; gradual progression of activity Activity to promote blood flow; encourage patient to move about in bed and exercise upper extremities Diversional activities Analgesic agents before scheduled activities

leg ulcer nursing intervetions diet

Promoting adequate nutrition Protein; Vitamins C and A; Iron; Zinc

buerger's disease (burger smokes)

rare, progressive, inflammation and thrombus, almost only young men who smoke, toes and fingers turn blue symptoms include claudication, Raynaud's , pain (often mistaken for joint/muscle pain

varicose vein prevention - how often to walk and elevate leg and compression stockings?

Avoid activities that cause venous stasis (wearing socks that are too tight at the top or that leave marks on the skin, crossing the legs at the thighs, and sitting or standing for long periods) Elevate the legs 3 to 6 inches higher than heart level Encourage to walk 30 minutes each day if there are no contraindications Wear graduated compression stockings Overweight patients should be encouraged to begin weight reduction plans

Lymphangitis - what causes it? (my gitis is obese)

inflammation or infection of the lymphatic channels - from surgery or obstruction, obese. painful. lymph fluid itself can get infected.

Lymphadenitis (the dentist inflames me)

inflammation or infection of the lymph nodes

Lymphedema - primary and secondary

tissue swelling related to obstruction of lymphatic flow Primary: congenital Secondary: acquired obstruction

promote lymphatic drainage by (nymphs fly high)

Constant elevation of the affected extremity

cellulitis

S&S: localized swelling or redness, fever, chills, sweating, pain Treat with oral or IV antibiotics based on severity

cellulitis nursing management - leg position and warm packs? (cellulitis elevated me)

Mark the cellulitis with a skin pen and date and time, then take a photo as per your agency’s policy Elevate affected area 3 to 6 inches above heart level Warm, moist packs to site every 2 to 4 hours Educate regarding prevention of recurrence Reinforce education about skin and foot care

raynaud's phenonmenon

Intermittent arterial vasoocclusion, usually of the fingertips or toes

AAA risk factors (Grandma, butter and pads are risky)

Family history High cholesterol Lower extremity PAD

AAA risk factors (Triple A in my carotid stroking me out)

Carotid artery disease Previous stroke Tobacco use Being overweight or obese

AAA - May mimic pain associated with...

abdominal or back disorders

AAA - symptoms (Claud works for Triple A)

May cause back pain, epigastric discomfort, altered bowel elimination, intermittent claudication

AAA - blue toe syndrome (Triple A makes me blue, spontaeously blue)

May spontaneously embolize plaque causing “blue toe syndrome”

AAA rupture - symptoms

Severe back pain May/may not have back/flank ecchymosis (Grey Turner’s sign)

AAA Rupture into thoracic or abdominal cavity

Massive hemorrhage Most do not survive long enough to get to the hospital

AAA xrays - abdomen (Triple A has calcium on the xray)

Abdomen (KUB) =may show calcification within wall of AAA

AAA post op - what to monitor? (the usual)

Neuro, cardia, resp function, Renal GI FEN (fluid electrolytes nutrition)

AAA post op - monitor graft for...

Pain control Monitor graft patency Infection check LOC

types of venousthromboembolisms (the veins in my embolus are DVT, SVT, and PE)

DVT and PE SVT (superficial vein)

causes of venousthromboembolisms (think venous, smoking and what else) cancers?

smoking, cancer, birth control, cancer in abdomen, ascities, liver disease

endothelial damage - IVs?

caustic IV meds

endothelial damage - fractures? (endothelial is down low)

pelvic, hip leg fractures

endothelial damage - history of...(the end of you)

history of previous VTE, PICC or central line, IVDU, trauma

hypercoaguability - (think thick blood)

dehydration, malnutrition, increased factor VIII or lipoprotein

hypercoagulability - HMOSS is hyper (Moss on a mountain)

high altitude, malignancies, oral contraceptives, sepsis, severe anemia

complications of DVT surgery (Davit has air when he migrates)

Air embolism, improper placement, filter migration , perforation of vena cava

DVT nursing management - No mechanical prophylaxis for...

those with skin breakdown or limb ischemia due to PVD

Contraindications for pharmacological DVT prophylaxis (think bleeding, that's it)

Active or recent bleeding Coagulopathy (INR > 1.5 Planned surgical procedure in next 6-12 hours Thrombocytopenia (<50,000, sometimes < 100,000) Bleeding disorders

varicose veins - use stockings?

yes

raynaud's disease vs. raynaud's syndrome (the disease is idiopathic)

Raynaud’s disease: primary or idiopathic Raynaud’s syndrome: associated with other underlying disease such as scleroderma

raynaud's symptoms - don't forget tingling

Manifestations: sudden vasoconstriction results in color changes, numbness, tingling, and burning pain

raynaud's brought on by what?

Episodes brought on by a trigger such as cold or stress Occurs most frequently in young women Protect from cold and other triggers. Avoid injury to hands and fingers

AAA - ambulate or not after surgery?

Increase ambulation, don't strain or lift

venous stasis causes (this pregnancy and surgery are giving me static)

ortho surgery, pregnancy/postpartum, prolong immobility

venous stasis causes (Static when I stroke my hair with varicose veins)

stroke, varicose veins

chronic veinous insufficiency - where are ulcers located? Are they painful?

Ulcers usually above ankle Ulcers are painful when swollen or infected

vascular disorders - aorta Flashcards

(88 cards)