vascular disorders - PAD Flashcards by Amanda S.

Assessment of the Patient with Peripheral Vascular Problems (arms and legs)

Health history
Medications
Risk factors
Signs and symptoms of arterial insufficiency
Claudication and rest pain
Color changes
Weak or absent pulses
Skin changes and skin breakdown (pale or ruddy, shiny)

How well did you know this?

Not at all

Perfectly

arterial sclerosis

arterial sclerosis = generic term for thickening of artery walls, usually associated with aging.

How well did you know this?

Not at all

Perfectly

risk factors (the usual SOD for PAD)

diabetes (A1C), obesity (BMI), smoking or any vasoconstriction. stressors in life, activity,

How well did you know this?

Not at all

Perfectly

clottication advances to

pain at rest, can they keep going or does it make them stop?

How well did you know this?

Not at all

Perfectly

use a skin pen

to mark where a pulse is if it’s hard to find

How well did you know this?

Not at all

Perfectly

grade the

pulse - 0 -4 0 = absent, 3+ is very strong, 4+ is bounding

How well did you know this?

Not at all

Perfectly

Major goals include: (think venous and artery)

Increased arterial blood supply
Decrease in venous congestion
Promotion of vasodilatation and prevention of vascular compression
Relief of pain
Attainment/maintenance of tissue integrity
Adherence to the self-care program

How well did you know this?

Not at all

Perfectly

if no venous congestion and it’s an arterial problem, you want to

lower the extremity. if it’s venous, elevate.

How well did you know this?

Not at all

Perfectly

how to improve peripheral arterial circulation - position - below what?

body part below the heart

How well did you know this?

Not at all

Perfectly

how to improve peripheral arterial circulation - exercise (can’t exercise on PADs)

walking, graded isometric exercises - consult doc before exercising

How well did you know this?

Not at all

Perfectly

how to improve peripheral arterial circulation - temp

effects of heat and cold

How well did you know this?

Not at all

Perfectly

how to improve peripheral arterial circulation - nicotine

discourage nicotine use

How well did you know this?

Not at all

Perfectly

how to improve peripheral arterial circulation - stress

reduction

How well did you know this?

Not at all

Perfectly

Aneurysms

thoracic, abdominal, other (don’t need to memorize all of them)

How well did you know this?

Not at all

Perfectly

Arteriosclerosis

Hardening of the arteries
Diffuse process whereby the muscle fibers and the endothelial lining of the walls of small arteries and arterioles become thickened

How well did you know this?

Not at all

Perfectly

Risk Factors for Atherosclerosis and PAD - traditional (nicotine diabetes, hyper and hyper, diet, stress, and the weird ones)

nicotine, diabetes, hypertension, hyperlipidemia, diet, stress, sedendtary, c-reative protein, hyperhomctyeinemia, age

How well did you know this?

Not at all

Perfectly

Risk Factors for Atherosclerosis and PAD - non - traditional (SEE, PADs are non-traditional)

socioeconomic, environmental pollution, endothelial disease

How well did you know this?

Not at all

Perfectly

PAD - how to reduce risk - the obvious one and blood sugar? (PADS should eat less than 7 sugars a day)

quit smoking, hgb A1C < 7.0% for diabetics,

How well did you know this?

Not at all

Perfectly

PAD description (PADs keeping more and more narrow)

Involves progressive narrowing and degeneration of arteries of upper and lower extremities. it’s all of the arteries.

How well did you know this?

Not at all

Perfectly

leading cause of PAD (athena causes pads)

Atherosclerosis is leading cause in majority cases

How well did you know this?

Not at all

Perfectly

Patients with PAD are more likely to have what diseases? (CAD CAD and PAD are best friends)

coronary artery disease and/or cerebral artery disease

How well did you know this?

Not at all

Perfectly

Symptoms of PAD occur when what % of vessels are blocked?

vessels are 60-75% blocked, usually not symptomatic until then.

How well did you know this?

Not at all

Perfectly

PAD Typically appears at what age? (wear PADs from 60 - 80)

Typically appears at 60-80 years of age, getting younger and younger though.

How well did you know this?

Not at all

Perfectly

is PAD easily diagnosed?

Largely underdiagnosed

How well did you know this?

Not at all

Perfectly

Hallmark symptom of PAD is (wear PADs with your clauds)

intermittent claudication described as aching, cramping, or inducing fatigue or weakness

PAD symptoms

Occurs with some degree of exercise or activity. Relieved with rest (usually 10 minutes or less) & is reproducible.

Pain is associated with

critical ischemia of the distal extremity

Ischemic rest pain is usually worse

at night and often wakes the patient

PAD symptoms

Thin, shiny and taut skin, Loss of hair on the lower legs, Diminished or absent pedal (need to use a doplar), popliteal, or femoral pulses, Pallor of foot with leg elevation, Reactive hyperemia of foot with dependent position

arterial - feet will look

pale when elevated and red when down

PAD clinical manifestations

Pain at rest As PAD progresses Occurs in feet or toes Aggravated by limb elevation Occurs from insufficient blood flow Occurs more often at night

meds for PAD (don't really need to memorize these)

Phosphodiesterase III inhibitor Cilostazol Antiplatelet agents Aspirin Clopidogrel Coumadin Statins Ace inhibitors RAMIPRIL Intermittent claudication: Cilostazol (Pletal) Pentooxifylline (Trental)

exercise PAD - and how often and minutes? (PADs keep me walkin)

Walking is most effective exercise for individuals with claudication - 30-45 minutes daily, 3 times/week

nutrition for PAD - and how low should fat be? (PAD fat before 7)

Nutritional therapy -78% of vascular surgical patients can be classified as malnourished Low energy to metabolize, high protein, low in fat DASH _fruits, vegetables, nuts and fiber, augmented by low sodium Limit saturated fats to < 7% of total caloric intake, enjoy omega-3 fatty acids Vitamin D can improve endothelial dysfunction

PAD complications - Critical limb ischemia (CLI) (PADS are critical if you need more than 2 weeks)

Characterized by rest pain lasting more than 2 weeks & or arterial leg ulcers or gangrene

PAD complications - atrophy

of the skin and underlying muscles

PAD complications - wounds

delayed wound healing, wound infection, tissue necrosis

PAD complications - arterial ulcers

Arterial ulcers and gangrene are most serious complications May result in amputation if adequate blood flow is not restored or if severe infection

PAD diagnosis (need a PAD for my ankle bracelet)

doppler angiography and MRI duplex imaging - bidirectional color doppler ankle-brachial index (ABI) = ABI - ankle BP/highest arm BP

PAD diagnosis

doppler angiography and MRI duplex imaging - bidirectional color doppler ankle-brachial index (ABI) = ABI - ankle BP/highest arm BP

Continuous wave (CW) Doppler Ultrasound (continuous doppler is moving)

Handheld ultrasound device that detects blood flow, combined with ankle or arm pressures. Signals are reflected by the moving blood cells.

Interprofessional Care  Leg with Critical Limb Ischemia (critical needs, by the stint, meds, or spinal cord)

Revascularization via bypass surgery, Percutaneous transluminal angioplasty (PTA) (putting a stint in), IV prostanoids (iloprost [Ventavis]), spinal cord stimulation, angiogenesis

Conservative Treatment for Care Leg with Critical Limb Ischemia

Protect form trauma Decrease ischemic pain Prevent/control infection Improve arterial perfusion

Radiology Procedures - when is it necessary? (radiate my pain at rest)

Indications Intermittent claudication symptoms become incapacitating Pain at rest - this is when you do radiology procedures Ulceration or gangrene severe enough to threaten viability of the limb

intra-radial PTA - inserted where? (fem at the PTA)

Involves insertion of a catheter through the femoral artery Catheter contains a cyndrical balloon Balloon is inflated dilating the vessel by compressing atherosclerotic intimal lining Stent is placed

intra-radial - Atherectomy (athens is cutting edge)

Removal of obstructing plaque Performed using a cutting disc, laser, or rotating diamond tip

intra-radial - Cryoplasty

Combines PTA and cold therapy Liquid nitrous oxide

peripheral artery bipass (most common) (just a regular bypass) and what can be used with it?

Surgery with autogenous vein or synthetic graft to bypass blood around the lesion PTA with stenting may also be used in combination with bypass surgery

endarectomy (the end is removal)

Opening artery and removing obstructing plaque

patch graft angioplasty - self explanatory

Opening artery, removing plaque, and sewing a patch to the opening to widen the lumen

amputation

Required if tissue necrosis is extensive, gangrene, or osteomyelitis develop, or all major arteries in limb are blocked

nursing management - Post procedure monitor (PADs don't flex)

high risk for bleeding VS Operative site CSM checks Pain management Avoid knee flexed position Encourage ambulation

pain with arterial stuff?

Intermittent claudication to sharp, unrelenting, constant

type of pain you feel with venous (ACT with venous pain)

Aching, throbbing, cramping

pulses with with arterial stuff?

Diminished or absent

pulses with venous stuff?

Present, but may be difficult to palpate through edema

arterial ulcers - pain?

very painful

veinous ulcers - pain?

minimal to very painful

arterial ulcers - shape?

circular

veinous ulcers - shape?

irregular borders

ulcer colors - arterial (art has a black heart)

arterial - pale to black, wet and dry.

abdominal or iliac reduced flow - where would you feel pain? (where the iliac is...)

hip or buttocks

ankle-brachial index (ABI) - when to do it? (older pts get ankle bracelets)

systolic blood pressure in the ankle to the systolic blood pressure in the arm. do ABI if pt is 65 or older or decreased pulse.

CT scan (soft tissue is a cutie)

soft tissue, good for abdominal aorta. uses dye so watch the kidneys.

Arterial disorders cause what?

ischemia and tissue necrosis

Atherosclerotic lesions are of two types (Athens has fat and plaque)

fatty streaks and fibrous plaque

how to increase arterial supply

walking, stopping the constriction, dehydrated, oxygenated, and surgery

how to decrease venous congestion

elevate extremity and arteral blood supply can be increased

how to Promote of vasodilatation and prevention of vascular compression (tight will dilate)

no tight pants, ted hose

how to Attainment/maintenance of tissue integrity - just shower and lotion

shower and use lotion w/out a lot of water

ankle-brachial index (ABI) = how to do it?

highest ankle divided by highest arm

ABI - if doing walk test, systolic will drop if

pt has claudication.

how is PAD pain described? (aching all the time, I need a PAD)

as persistent, aching, or boring (rest pain)

how to reduce PAD - BP goal and what about cholesterol? (I need to get down to 140 PADs)

aggressive treatment for hyperlipidemia, bp < 140/90

continuous wave doppler does what?

helps characterize the nature of peripheral vascular disease

ulcer colors - venous

Granulation tissue—beefy red to yellow

arterial sclerosis - causes (art has plaque)

causes - calcified sclerosis, arterial - small arterioles get thick, LDL build up.

athlosclerosis

means to harden, LDL build up in arteriole wall

is athloslerosis a short or long process?

very slow process, usually starts in childhood.

Computed tomography angiography (CTA) provides what image? (computed the cross sectional)

cross-sectional image

after arterial vascular bypass graft, the nurse should monitor the pulse how often?

Peripheral pulses every 15 minutes after surgery

edema, brown pigmentation is venous or artery?

venous

elevational pallor is artery or vein?

artery

dissection of the aorta - what sensation? (rip van winkle the dissection)

ripping in the chest

BP goal for ppl with diabetes (diabetes have your fav number)

130/80

ventricular gallop is a sign of what?

heart failure

140 bpm on the monitor - monitor for what?

myocardial ischemia

ST-segment elevation requires what intervention?

cardiac catheterization

abrupt onset, abrupt cessation, and a QRS of normal duration

Paroxysmal atrial tachycardia

ventricular bigeminy cardiac rhythm

The rhythm has a normal beat, then a premature beat pattern

F waves represent what? (F for flutter)

The F waves are flutter waves representing atrial activity

frequent episodes of ventricular fibrillation - do what?

internal cardioverter defibrillator insertion

vascular disorders - PAD Flashcards

(92 cards)