Vascular Problems Chapter 33 Flashcards
(298 cards)
1
Q
What is acute arterial occlusion?
A
The sudden blockage of an artery, typically in the lower extremity, in the patient with chronic peripheral arterial disease.
2
Q
Define aneurysm.
A
A permanent localized dilation of an artery that enlarges the artery to at least two times its normal diameter.
3
Q
What is an aneurysmectomy?
A
A surgical procedure performed to excise an aneurysm.
4
Q
What does the ankle-brachial index (ABI) measure?
A
Measurement of arterial insufficiency based on the ratio of ankle systolic pressure to brachial systolic pressure.
5
Q
What is arterial revascularization?
A
A surgical procedure most commonly used to increase arterial blood flow in the affected limb of a patient with peripheral arterial disease.
6
Q
What are arterial ulcers?
A
Painful ulcers caused by diminished blood flow through an artery that develop on the toes, between the toes, or on the upper aspect of the foot.
7
Q
Define arteriosclerosis.
A
A thickening or hardening of the arterial wall, often associated with aging.
8
Q
What is arteriotomy?
A
A surgical opening into an artery.
9
Q
What is atherectomy?
A
An invasive nonsurgical technique in which a high-speed, rotating metal burr uses fine abrasive bits to scrape plaque from inside an artery while minimizing damage to the vessel surface.
10
Q
Define atherosclerosis.
A
A type of arteriosclerosis that involves the formation of plaque within the arterial wall; the leading contributor to coronary artery and cerebrovascular disease.
11
Q
What does autogenous mean?
A
Belonging to the person; for example, when a person’s vein is moved from one part of the body to another.
12
Q
What is the process of clotting?
A
A complex, multistep process by which blood forms a protein-based structure (clot) in an appropriate area of tissue injury to prevent excessive bleeding while maintaining whole-body blood flow (perfusion).
13
Q
Define collateral circulation.
A
Blood supply that provides blood to an area with altered tissue perfusion through smaller vessels that develop and compensate for the occluded vessels.
14
Q
What is deep vein thrombosis (DVT)?
A
A blood clot that forms in one or more of the deep veins in the body, usually the legs.
15
Q
What is an embolus?
A
A blood clot or other object (e.g., air bubble, fatty deposit) that is carried in the bloodstream and lodges in another area.
16
Q
What are endovascular stent grafts used for?
A
The repair of abdominal aortic aneurysms using a stent made of flexible material.
17
Q
Define essential hypertension.
A
The most common type of hypertension that is not caused by an existing health problem. Also called primary hypertension.
18
Q
What is heparin-induced thrombocytopenia (HIT)?
A
A potentially devastating immune-mediated adverse drug reaction caused by the emergence of antibodies that activate platelets in the presence of heparin.
19
Q
What does hyperlipidemia refer to?
A
An elevation of serum lipid levels in the blood.
20
Q
What is a hypertensive crisis?
A
A severe elevation in blood pressure (greater than 180/120), which can cause damage to organs such as the kidneys or heart. Also called malignant hypertension.
21
Q
What is inferior vena cava filtration?
A
A type of vascular filter inserted by a surgeon percutaneously into the inferior vena cava; indicated for deep vein thrombosis (DVT) or pulmonary embolism (PE) when anticoagulation therapy is contraindicated.
22
Q
Define inflow disease.
A
Obstructions in the distal end of the aorta and the common, internal, and external iliac arteries that results in pain or discomfort in the lower back, buttocks, or thighs.
23
Q
What is intermittent claudication?
A
Characteristic leg pain experienced by patients with chronic peripheral arterial disease, typically causing them to stop walking after a certain distance.
24
Q
What does lipid refer to?
A
Fat, including cholesterol and triglycerides, that can be measured in the blood.
25
True or False: Malignant hypertension is the same as hypertensive crisis.
True.
26
What is orthostatic hypotension?
A decrease in blood pressure (20 mm Hg systolic and/or 10 mm Hg diastolic) that occurs when the patient changes position from lying or sitting to standing.
27
Define outflow disease.
Obstructions in the femoral, popliteal, and tibial arteries and below the superficial femoral artery (SFA) that cause burning or cramping in the calves, ankles, feet, and toes.
28
What is percutaneous vascular intervention?
A nonsurgical procedure used to treat blood vessels that are narrowed or closed because of vascular disease.
29
What is peripheral vascular disease (PVD)?
Disorders that change the natural flow of blood through the arteries and veins of the peripheral circulation, causing decreased perfusion to body tissues.
30
Define phlebitis.
Inflammation of a vein, which can predispose patients to thrombosis.
31
What is phlebothrombosis?
A thrombus in the vein without inflammation.
32
What does rubor refer to?
Dusky red discoloration of the skin.
33
What is secondary hypertension?
Elevated blood pressure that is related to a specific disease (e.g., kidney disease) or medication.
34
Define stasis dermatitis.
In patients with venous insufficiency, discoloration of the skin along the ankles; may extend up to the calf.
35
What are stasis ulcers?
Ulcers associated with long-term venous insufficiency, formed as a result of edema or minor injury to the limb; typically occurs over the malleolus.
36
What are telangiectasias?
Vascular lesions with a red center and radiating branches, commonly referred to as spider veins or spider angiomas.
37
What is thrombectomy?
A surgical procedure used to remove deep thrombosis, or blood clots that have formed in the deep veins.
38
What is thrombophlebitis?
A thrombus that is associated with inflammation.
39
Define thrombus.
A blood clot believed to result from an endothelial injury, venous stasis, or hypercoagulability.
40
What is an Unna boot?
A wound dressing constructed of gauze moistened with zinc oxide; used to promote venous return in the ambulatory patient with a stasis ulcer and form a sterile environment for the ulcer.
41
What are varicose veins?
Distended, protruding veins that appear darkened and tortuous.
42
What is venous insufficiency?
Alteration of venous efficiency by thrombosis or defective valves; caused by prolonged venous hypertension, resulting in further venous hypertension, edema, and eventually venous stasis ulcers.
43
Define venous thromboembolism (VTE).
A term that refers to both deep vein thrombosis and pulmonary embolism; obstruction by a thrombus.
44
What does the Virchow triad describe?
The three factors that contribute to thrombosis: stasis of blood flow, endothelial injury, and hypercoagulability.
45
What is hypertension?
Hypertension, or high blood pressure (BP), is the most common health problem seen in primary care settings.
46
What can untreated hypertension lead to?
Stroke, myocardial infarction (MI), kidney failure, and death.
47
What is the recommended BP according to the ACC/AHA guidelines?
Below 130/80 mm Hg in all people.
48
What BP does JNC 8 recommend for the general population aged 60 years and older?
Below 150/90 mm Hg.
49
What BP does JNC 8 recommend for people younger than 60 years?
Below 140/90 mm Hg.
50
What should be done for patients with BP above the recommended goals?
They should be treated with medication and lifestyle modifications.
51
What are the four control systems that maintain blood pressure?
* The arterial baroreceptor system
* Regulation of body fluid volume
* The renin-angiotensin-aldosterone system
* Vascular autoregulation
52
Where are arterial baroreceptors primarily located?
In the carotid sinus, aorta, and wall of the left ventricle.
53
What role do arterial baroreceptors play in blood pressure regulation?
They monitor arterial pressure and counteract rises through cardiac slowing and vasodilation.
54
What effect does excess sodium and/or water have on blood pressure?
It raises blood pressure through mechanisms that change venous return to the heart.
55
What is the function of the renin-angiotensin-aldosterone system?
It regulates blood pressure by controlling sodium retention and fluid volume.
56
What happens to renin levels in patients with essential hypertension?
Renin levels remain normal despite high blood pressure.
57
What is essential hypertension?
The most common type of hypertension not caused by an existing health problem.
58
What is secondary hypertension?
Hypertension that results from specific disease states or drugs.
59
What is a hypertensive crisis?
A severe type of elevated BP that rapidly progresses and is considered a medical emergency.
60
What symptoms might indicate a hypertensive crisis?
* Morning headaches
* Blurred vision
* Dyspnea
* Symptoms of uremia
61
What systolic BP indicates a hypertensive crisis?
Greater than 200 mm Hg.
62
What diastolic BP indicates a hypertensive crisis with pre-existing complications?
Greater than 130 mm Hg.
63
What organ damages can continuous BP elevation in essential hypertension cause?
* Myocardial infarctions (MIs)
* Strokes
* Peripheral vascular disease (PVD)
* Kidney failure
64
Fill in the blank: The systemic arterial BP is a product of _______ and _______.
cardiac output (CO), total peripheral vascular resistance (PVR)
65
True or False: Vascular autoregulation is well understood in its mechanism.
False
66
What is essential hypertension?
Essential hypertension can develop when a patient has any one or more of the risk factors listed in Table 33.2
## Footnote
Refers to high blood pressure with no identifiable cause, influenced by various risk factors.
67
What is a common cause of secondary hypertension?
Kidney disease
## Footnote
Kidney disease is frequently linked to secondary hypertension.
68
What can cause hypertension related to sudden kidney damage?
Renovascular hypertension
## Footnote
This condition is associated with narrowing of the arteries supplying blood to the kidneys.
69
What is renal artery stenosis (RAS)?
Narrowing of one or more of the main arteries carrying blood directly to the kidneys
## Footnote
RAS is a key factor in renovascular hypertension.
70
What procedure can help patients reduce the use of antihypertensive drugs?
Angioplasty with stent placement
## Footnote
This procedure dilates narrowed arteries, improving blood flow to the kidneys.
71
What can dysfunction of the adrenal medulla or cortex cause?
Secondary hypertension
## Footnote
Hormonal imbalances from these glands can lead to high blood pressure.
72
What is adrenal-mediated hypertension caused by?
Primary excesses of aldosterone, cortisol, and catecholamines
## Footnote
These hormones, when in excess, can lead to elevated blood pressure.
73
What does primary aldosteronism lead to?
Hypertension and hypokalemia
## Footnote
Excessive aldosterone production is typically due to benign adenomas of the adrenal cortex.
74
What are pheochromocytomas?
Tumors that originate most commonly in the adrenal medulla
## Footnote
These tumors result in excessive secretion of catecholamines, leading to high blood pressure.
75
What is Cushing syndrome characterized by?
Excessive glucocorticoids excreted from the adrenal cortex
## Footnote
This condition can lead to multiple health issues, including hypertension.
76
What are the most common causes of Cushing syndrome?
* Adrenocortical hyperplasia
* Adrenocortical adenoma (tumor)
## Footnote
Both conditions lead to excess glucocorticoid production.
77
What are diuretics primarily used for?
Managing hypertension
## Footnote
Diuretics decrease blood volume and lower blood pressure.
78
Name the three basic types of diuretics.
* Thiazide diuretics
* Loop diuretics
* Potassium-sparing diuretics
79
What is the mechanism of action of thiazide diuretics?
Inhibit sodium, chloride, and water reabsorption in the distal tubules while promoting potassium, bicarbonate, and magnesium excretion
80
What is a key benefit of thiazide diuretics regarding calcium?
They decrease calcium excretion, which helps prevent kidney stones and bone loss
81
What is a common side effect of thiazide and loop diuretics?
Hypokalemia (low potassium level)
## Footnote
Monitor serum potassium levels and assess for irregular pulse, dysrhythmias, and muscle weakness.
82
What should patients taking potassium-depleting diuretics be advised to do?
Eat foods high in potassium, such as bananas, potatoes, and orange juice
83
What is a common side effect of potassium-sparing diuretics?
Hyperkalemia (high potassium level)
## Footnote
Symptoms can include weakness, irregular pulse, and cardiac dysrhythmias.
84
Why are loop diuretics not commonly used in older adults?
They can cause dehydration and orthostatic hypotension, increasing the risk for falls
85
What do calcium channel blockers (CCBs) do?
Lower blood pressure by interfering with the transmembrane flux of calcium ions, resulting in vasodilation
86
What are the potential complications of CCBs reacting with grapefruit juice?
Kidney failure, heart failure, GI bleeding, or even death
87
What is the action of angiotensin-converting enzyme inhibitors (ACEIs)?
Block the action of angiotensin-converting enzyme (ACE) to decrease sodium and water retention and lower peripheral vascular resistance
88
What is a common side effect of ACE inhibitors?
A nagging, dry cough
89
What should patients be instructed to do when taking an ACEI for the first time?
Get out of bed slowly to avoid severe hypotensive effects
90
What are angiotensin II receptor antagonists (ARBs) used for?
Block the binding of angiotensin II to receptor sites in vascular smooth muscle and adrenal tissues
91
Name some examples of angiotensin II receptor antagonists.
* Candesartan
* Valsartan
* Losartan
* Azilsartan
92
What are beta-adrenergic blockers primarily used for?
Lowering blood pressure by blocking beta receptors in the heart and peripheral vessels
93
What are the side effects associated with beta blockers?
* Fatigue
* Weakness
* Depression
* Sexual dysfunction
94
Why might patients with diabetes not show usual manifestations of hypoglycemia when taking beta blockers?
The sympathetic nervous system is blocked
95
What is the recommended method for discontinuing beta blockers?
Tapering off over a 2-week period
96
What are the key assessment signs of a hypertensive crisis?
Severe headache, extremely high blood pressure, dizziness, blurred vision, shortness of breath, epistaxis, severe anxiety
## Footnote
These symptoms indicate a critical condition requiring immediate intervention.
97
What position should a patient be placed in during a hypertensive crisis?
Semi-Fowler position
## Footnote
This position helps to facilitate breathing and reduce pressure on the heart.
98
What should be administered to a patient in a hypertensive crisis?
Oxygen and IV beta blocker or nicardipine or other infusion drug as prescribed
## Footnote
These medications help to lower blood pressure and stabilize the patient.
99
What is the recommended monitoring frequency for blood pressure during a hypertensive crisis?
Every 5 to 15 minutes until diastolic pressure is below 90
## Footnote
After stabilization, monitor BP every 30 minutes.
100
What diastolic blood pressure should be targeted during treatment of a hypertensive crisis?
Below 90 and not less than 75
## Footnote
Rapid decreases in blood pressure can lead to complications.
101
What are some neurologic or cardiovascular complications to observe for in hypertensive crisis?
Seizures, numbness, weakness, tingling of extremities, dysrhythmias, chest pain
## Footnote
These symptoms may indicate target organ damage.
102
True or False: It is safe to lower blood pressure too quickly during a hypertensive crisis.
False
## Footnote
Blood pressure should be lowered gradually to prevent complications.
103
Fill in the blank: In a hypertensive crisis, after the patient is stabilized, switch to _______.
oral antihypertensive drug
## Footnote
This transition helps in maintaining blood pressure control after initial treatment.
104
What is arteriosclerosis?
A thickening, or hardening, of the arterial wall often associated with aging.
105
What type of arteriosclerosis involves the formation of plaque within the arterial wall?
Atherosclerosis.
106
What is the leading risk factor for cardiovascular disease (CVD)?
Atherosclerosis.
107
Which arteries are typically affected by atherosclerosis?
* Coronary artery beds
* Aorta
* Carotid and vertebral arteries
* Renal arteries
* Iliac arteries
* Femoral arteries
108
What is thought to cause atherosclerosis?
Blood vessel damage that causes inflammation.
109
What appears on the intimal surface of the artery after it becomes inflamed?
A fatty streak.
110
What forms over the fatty streak through cellular proliferation?
A fibrous plaque.
111
What are the two types of plaques in atherosclerosis?
* Stable plaques
* Unstable plaques
112
What happens when unstable plaques rupture?
They cause severe damage and are often clinically silent until rupture.
113
What occurs after a stable plaque ruptures?
Thrombosis and constriction obstruct the vessel lumen.
114
What is the consequence of a thrombus suddenly blocking a blood vessel?
Ischemia and infarction.
115
What can cause endothelial injury of major arteries?
* Elevated levels of lipids (e.g., LDL-C)
* Decreased levels of HDL-C
* Elevated levels of toxins
* Aging
* Diseases like hypertension
116
What is familial hyperlipidemia?
An elevation of serum lipid levels, leading to excessive cholesterol production by the liver.
117
How does diabetes mellitus affect atherosclerosis?
It promotes an increase in LDL-C and triglycerides in plasma and causes microvascular damage.
118
What is a common outcome of premature atherosclerosis in patients with severe diabetes mellitus?
Severe atherosclerosis from microvascular damage.
119
Fill in the blank: The process of atherosclerosis may be influenced by _______.
[genetic factors, chronic diseases, lifestyle habits]
120
True or False: Some people with hereditary atherosclerosis have elevated blood cholesterol levels.
False.
121
What effect does hyperglycemia have on arteries?
It may cause arterial damage.
122
What is the recommended frequency and duration of aerobic physical activity?
Three to four sessions per week, lasting 40 minutes per session
123
What intensity level should physical activity involve?
Moderate-to-vigorous intensity
124
What are the components of a reduced-calorie diet recommended in the guidelines?
Fruits and vegetables (five or more servings per day), whole grains, fish, and lean meats
125
What types of fats should be limited in the diet?
Saturated fats, trans fats, and cholesterol
126
What macronutrients are recommended for LDL-C lowering?
Plant stanols/sterols (∼2 g/day) and soluble fiber
127
What should be strongly encouraged and facilitated according to the guidelines?
Tobacco cessation
128
Why is current smoking considered a high-risk condition?
It is a high-risk condition for future atherosclerotic cardiovascular disease (ASCVD)
129
What is the drug of choice for decreasing lipids?
Statin drugs
130
Who may be treated with combination therapy in addition to statins?
People within high-risk and very-high-risk categories
131
What are some drugs that may be included in combination therapy?
Ezetimibe, bile acid sequestrants, or PCSK9 inhibitors
132
What does peripheral vascular disease (PVD) include?
Disorders that change the natural flow of blood through the arteries and veins of the peripheral circulation.
133
Which body parts are most frequently affected by PVD?
The legs.
134
What does a diagnosis of PVD imply?
Arterial disease (peripheral arterial disease [PAD]) rather than venous involvement.
135
What is the primary cause of peripheral arterial disease (PAD)?
Systemic atherosclerosis.
136
What is the consequence of partial or total arterial occlusion in PAD?
Decreased perfusion to the extremities.
137
What is lower extremity arterial disease (LEAD)?
PAD in the legs.
138
What are inflow obstructions classified by?
The distal end of the aorta and the common, internal, and external iliac arteries.
139
Where are outflow obstructions located?
Below the superficial femoral artery (SFA).
140
Which type of occlusion typically causes significant tissue damage?
Gradual outflow occlusions.
141
What are the risk factors for PAD?
Atherosclerosis risk factors, advancing age, diabetes, and hypertension.
142
What percentage of individuals aged 40 and older in the United States have PAD?
About 8.5 million people.
143
Which demographic is most affected by PAD?
African Americans.
144
What are the four stages of chronic PAD?
Stage I: Asymptomatic, Stage II: Claudication, Stage III: Rest Pain, Stage IV: Necrosis/Gangrene.
145
What characterizes Stage I of chronic PAD?
No claudication is present; bruit or aneurysm may be present; pedal pulses are decreased or absent.
146
What symptoms are present in Stage II of chronic PAD?
Muscle pain, cramping, or burning occurs with exercise and is relieved with rest.
147
What is rest pain in chronic PAD?
Pain while resting, often described as numbness or burning, and usually occurs in the distal part of the extremity.
148
What occurs in Stage IV of chronic PAD?
Ulcers and blackened tissue occur on the toes, forefoot, and heel; distinctive gangrenous odor is present.
149
What is intermittent claudication?
A classic leg pain that occurs during walking and is relieved with rest.
150
What is a characteristic of mild inflow disease?
Discomfort after walking about two blocks.
151
What does severe outflow disease typically cause?
Inability to walk more than one-half block and more frequent rest pain.
152
What specific findings may indicate severe arterial disease?
Cold and gray-blue extremity, loss of hair, dry or dusky skin, thickened toenails.
153
What is dependent rubor?
Redness that occurs when the extremity is lowered.
154
True or False: Patients with PAD may experience muscle atrophy from prolonged chronic arterial disease.
True.
155
What maintains control of PVR?
The autonomic nervous system and circulating hormones such as norepinephrine and epinephrine.
156
What happens to systemic arterial pressure if PVR, HR, or SV increases?
It increases.
157
What are the four control systems that maintain blood pressure?
* The arterial baroreceptor system
* Regulation of body fluid volume
* The renin-angiotensin-aldosterone system
* Vascular autoregulation
158
Where are arterial baroreceptors primarily found?
In the carotid sinus, aorta, and wall of the left ventricle.
159
How do arterial baroreceptors respond to a rise in arterial pressure?
Through vagally mediated cardiac slowing and vasodilation with decreased sympathetic tone.
160
What occurs when there is an excess of sodium and/or water in the body?
Blood pressure rises.
161
What is the role of the kidneys when systemic arterial pressure rises?
They produce diuresis, which helps to lower blood pressure.
162
What does the renin-angiotensin-aldosterone system regulate?
Blood pressure.
163
What does renin act on to produce angiotensin I?
Angiotensinogen.
164
What is the effect of angiotensin II on blood vessels?
It has strong vasoconstrictor action.
165
What does aldosterone do in the kidneys?
It reabsorbs sodium.
166
What condition may cause increased peripheral vascular resistance (PVR)?
Inappropriate secretion of renin in patients with hypertension.
167
What are the classifications of blood pressure levels?
* Normal
* Elevated (or prehypertension)
* Stage 1 hypertension
* Stage 2 hypertension
168
What type of hypertension is most common and not caused by an existing health problem?
Essential (primary) hypertension.
169
What can continuous elevation of blood pressure in essential hypertension lead to?
Damage to vital organs through medial hyperplasia of the arterioles.
170
What is hypertensive crisis considered?
A severe type of elevated blood pressure that is a medical emergency.
171
What symptoms may accompany hypertensive crisis?
* Morning headaches
* Blurred vision
* Dyspnea
* Symptoms of uremia
172
What is one of the most common causes of secondary hypertension?
Kidney disease.
173
What is renovascular hypertension associated with?
Narrowing of the main arteries carrying blood to the kidneys, known as renal artery stenosis (RAS).
174
What causes adrenal-mediated hypertension?
Primary excesses of aldosterone, cortisol, and catecholamines.
175
What condition is characterized by excessive aldosterone and hypokalemia?
Primary aldosteronism.
176
What are pheochromocytomas associated with?
Excessive secretion of catecholamines.
177
What is Cushing syndrome caused by?
Excessive glucocorticoids from the adrenal cortex.
178
What is vasodilation and how can it be achieved?
Vasodilation can be achieved by providing warmth to the affected extremity and preventing long periods of exposure to cold.
179
What should patients with affected limbs do to maintain warmth?
Encourage the patient to maintain a warm environment at home and to wear socks or insulated shoes at all times.
180
What caution should be taken regarding heat application to the limb?
Avoid the application of direct heat to the limb with heating pads or extremely hot water due to decreased sensitivity.
181
What effect does cold exposure have on blood vessels?
Cold temperatures cause vasoconstriction, decreasing the diameter of blood vessels and arterial perfusion.
182
What substances can cause vasoconstriction?
Emotional stress, caffeine, and nicotine can all cause vasoconstriction.
183
What is essential for patients to prevent vasoconstriction?
Complete abstinence from smoking or chewing tobacco.
184
What is pentoxifylline and what is its function?
Pentoxifylline is a hemorheologic agent that increases the flexibility of red blood cells and decreases blood viscosity.
185
What common antiplatelet agents are used for patients with chronic PAD?
Aspirin and clopidogrel are commonly used antiplatelet agents.
186
What is dual antiplatelet therapy?
Dual antiplatelet therapy involves using both aspirin and clopidogrel to reduce the risk of MI, stroke, and vascular death.
187
What should patients taking clopidogrel avoid?
Patients taking clopidogrel should not eat grapefruit or drink grapefruit juice.
188
What is cilostazol and what benefits does it provide?
Cilostazol is a phosphodiesterase inhibitor that improves symptoms and increases walking distance in patients with intermittent claudication.
189
What are the expected outcomes of surgical procedures for PAD?
Warmth, redness, and edema of the affected extremity are expected outcomes as a result of increased arterial perfusion.
190
What types of procedures are classified as inflow or outflow?
Inflow procedures involve bypassing occlusions above the superficial femoral arteries, while outflow procedures bypass occlusions at or below the SFAs.
191
What is the preferred graft material for outflow procedures?
The preferred graft material for outflow procedures is the patient's own (autogenous) saphenous vein.
192
What are common complications to monitor for after a percutaneous vascular intervention?
Complications include hematoma, retroperitoneal bleeding, pseudoaneurysm, arteriovenous fistula, nerve compression, and atheroembolism.
193
What is the priority for nursing care following a percutaneous vascular intervention?
Observe for bleeding at the arterial puncture site and monitor for signs of impending hypovolemic shock.
194
What is the role of anticoagulants or antiplatelet therapy in surgical management?
Patients usually receive anticoagulant or antiplatelet therapy before and/or during the procedure to prevent arterial clotting.
195
What is the significance of hand-off reporting in patient care?
Hand-off reporting provides accurate information about a patient’s care and is essential for promoting safety.
196
What monitoring is required after arterial revascularization?
Monitor extremity color, temperature, and pulse intensity every 15 minutes for the first hour and then hourly.
197
What is the treatment for acute graft occlusion?
Emergency thrombectomy is the most common treatment for acute graft occlusion.
198
What are the signs of graft or wound infection?
Signs include induration, erythema, tenderness, warmth, edema, drainage, fever, and leukocytosis.
199
What is the importance of interprofessional team approach in home care for PAD?
An interprofessional team approach helps manage chronic PAD effectively across the continuum of care.
200
Fill in the blank: Patients with PAD are encouraged to avoid _______ to promote vasodilation.
raising their legs above heart level.
201
What is peripheral arterial disease (PAD)?
A chronic, long-term problem with frequent complications.
202
What is a potential benefit for patients with PAD?
A case manager who can follow them across the continuum of care.
203
What is the desired outcome for patients with PAD?
The patient can be maintained in the home.
204
What type of approach is often required for home management of PAD?
An interprofessional team approach.
205
What does home management of PAD often include?
Several home care visits.
206
What should patients be instructed on to help with PAD?
Methods to promote vasodilation.
207
True or False: Patients with PAD should raise their legs above the level of the heart.
False.
208
When is it acceptable for patients with PAD to raise their legs above the level of the heart?
Unless venous stasis is also present.
209
Fill in the blank: Management of PAD at home often requires an ________ team approach.
interprofessional
210
What is the most common cause of peripheral arterial occlusions?
An embolus
## Footnote
An embolus is a piece of a clot that travels and lodges in a new area.
211
Which extremities are more commonly affected by acute arterial occlusions?
Lower extremities
## Footnote
Although occlusions can affect upper extremities, they are more commonly seen in the lower extremities.
212
What are the common medical conditions preceding an embolic occlusion?
Acute myocardial infarction (MI) and/or atrial fibrillation
## Footnote
Most patients with an embolic occlusion have had these conditions within the previous weeks.
213
What are the 'six Ps' of ischemia?
* Pain
* Pallor
* Pulselessness
* Paresthesia
* Paralysis
* Poikilothermy (coolness)
## Footnote
These symptoms help identify acute arterial insufficiency.
214
What is the first intervention for treating acute arterial occlusion?
Anticoagulant therapy with unfractionated heparin (UFH)
## Footnote
This is done to prevent further clot formation.
215
What surgical procedures can be performed to remove an occlusion?
* Thrombectomy
* Embolectomy
## Footnote
These procedures may be performed with local anesthesia.
216
What should be monitored after an arterial thrombectomy?
Improvement in color, temperature, and pulse of the affected extremity
## Footnote
This should be done every hour for the first 24 hours.
217
What are common symptoms of pulmonary emboli (PE)?
* Chest pain
* Dyspnea
* Acute confusion (in older adults)
## Footnote
These symptoms should prompt immediate notification of the health care provider.
218
What is compartment syndrome?
Elevated tissue pressure within a confined body space restricting blood flow
## Footnote
This can lead to ischemia, tissue damage, and eventually tissue death.
219
What surgical procedure may be necessary to prevent further injury from compartment syndrome?
Fasciotomy
## Footnote
This is a surgical opening into the tissues.
220
Why has systemic thrombolytic therapy been disappointing for acute arterial occlusions?
Bleeding complications often outweigh the benefits
## Footnote
This has limited its use in treatment.
221
What is catheter-directed intra-arterial thrombolytic therapy?
A procedure where a catheter is placed into the artery to deliver thrombolytics directly to the clot
## Footnote
This can be an alternative to surgical treatment in selected settings.
222
What should be monitored during thrombolytic infusion?
Complications such as bleeding and hemorrhagic stroke
## Footnote
Maintaining normal blood pressure is essential to prevent a potential stroke.
223
What is patient-controlled analgesia (PCA) used for after reperfusion?
Severe pain due to reperfusion
## Footnote
This typically occurs as the clot dissolves.
224
What types of aneurysms are discussed in the text?
Femoral and popliteal aneurysms
## Footnote
These aneurysms may be associated with other aneurysms in the arterial tree.
225
How can a popliteal aneurysm be detected?
Assess for a pulsating mass in the popliteal space.
226
How can a femoral aneurysm be detected?
Observe a pulsatile mass over the femoral artery.
227
What should be avoided when detecting an aneurysm?
Do not palpate the mass!
228
What symptoms may indicate limb ischemia due to aneurysms?
Diminished or absent pulses, cool to cold skin, and pain.
229
What is the recommended treatment for femoral and popliteal aneurysms?
Surgery due to the risk for thromboembolic complications.
230
What surgical method is preferred for treating femoral aneurysms?
Aneurysm removal and restoration of circulation using a synthetic or autogenous saphenous vein graft-stent repair.
231
What is the preferred method for treating popliteal aneurysms?
Bypass rather than resect.
232
What should be monitored after surgery for lower-limb ischemia?
Palpate pulses below the graft to assess graft patency.
233
What imaging technique may be necessary when pulses are not palpable?
Doppler ultrasonography.
234
What should be reported immediately to the surgeon after surgery?
Sudden development of pain or discoloration of the extremity.
235
What is aortic dissection previously referred to as?
Dissecting aneurysm.
236
What does aortic dissection accurately describe?
A dissecting hematoma.
237
What causes aortic dissection?
A sudden tear in the aortic intima allowing blood to enter the aortic wall.
238
What is the primary cause of aortic dissection?
Degeneration of the aortic media.
239
What is a significant contributing factor to aortic dissection?
Hypertension.
240
Which genetic condition is commonly associated with aortic dissection?
Marfan syndrome.
241
What age group is most commonly affected by aortic dissection?
Adults in their 50s and 60s.
242
Which gender is more commonly affected by aortic dissection?
Men.
243
Where can aortic dissection occur?
Ascending aorta, descending thoracic aorta, abdominal aorta, and other arteries.
244
What is the most common symptom of aortic dissection?
Pain described as sharp, tearing, ripping, and stabbing.
245
Where might the pain be felt depending on the site of dissection?
Anterior chest, back, neck, throat, jaw, or teeth.
246
What is the typical pain intensity level for aortic dissection?
10 on a 0-to-10 pain intensity scale.
247
What are common symptoms associated with aortic dissection?
Diaphoresis, nausea, vomiting, faintness, pallor, rapid and weak pulse, apprehension.
248
What happens to blood pressure in aortic dissection unless complications occur?
Usually elevated.
249
What happens to blood pressure if cardiac tamponade or rupture occurs?
Patient becomes rapidly hypotensive.
250
What is a common cardiovascular sign of aortic dissection?
Decrease or absence of peripheral pulses.
251
What murmur is associated with aortic regurgitation?
Musical murmur best heard along the right sternal border.
252
What neurologic deficits can occur with aortic dissection?
Altered level of consciousness, paraparesis, and strokes.
253
What is the test of choice to confirm aortic dissection diagnosis if the patient is stable?
Computed tomographic angiography (CTA).
254
What may be performed at the bedside to confirm aortic dissection diagnosis if the patient is unstable?
Transesophageal echocardiography (TEE).
255
What are the expected outcomes for emergency care in aortic dissection?
Increased comfort and reduction of systolic blood pressure to 100 to 120 mm Hg.
256
What should be ensured for a patient with aortic dissection in emergency care?
Two large-bore IV catheters to infuse 0.9% sodium chloride and give medication.
257
What medication is prescribed to relieve pain in aortic dissection?
IV morphine sulfate.
258
What medication is prescribed to lower heart rate and blood pressure in aortic dissection?
IV beta blocker, such as esmolol.
259
What medications may be used if initial regimens are not effective in aortic dissection?
Nitroprusside or nicardipine hydrochloride.
260
What does VTE stand for?
Venous thromboembolism
261
What are the two main complications included in VTE?
* Thrombus
* Embolus
262
What is a thrombus?
A blood clot believed to result from endothelial injury, venous stasis, or hypercoagulability
263
What are the three elements that can contribute to thrombus formation?
* Endothelial injury
* Venous stasis
* Hypercoagulability
264
What is pulmonary embolism (PE)?
The most common type of embolus
265
What is phlebothrombosis?
A thrombus without inflammation
266
What does thrombophlebitis refer to?
A thrombus that is associated with inflammation
267
Where does thrombophlebitis most frequently occur?
In the deep veins of the lower extremities
268
What is deep vein thrombosis (DVT)?
The most common type of thrombophlebitis
269
Why is DVT more serious than superficial thrombophlebitis?
It presents a greater risk for pulmonary embolism
270
What is the medical emergency associated with PE?
A dislodged blood clot traveling to the pulmonary artery
271
What is the Virchow triad?
Stasis of blood flow, endothelial injury, and/or hypercoagulability
272
What surgical procedures are associated with the highest incidence of clot formation?
* Hip surgery
* Total knee replacement
* Open prostate surgery
273
What conditions promote thrombus formation?
* Ulcerative colitis
* Heart failure
* Cancer
* Oral contraceptives
* Immobility
274
What is a common risk factor for thrombosis during prolonged bedrest?
Immobility
275
What is the Padua Prediction Score (PPS)?
A model for assessing the risk of VTE
276
What percentage of patients with DVT will have long-term complications?
Over half
277
What percentage of patients with DVT will have a recurrence within 10 years?
One-third
278
What does VTE-1 measure?
The number of patients who received VTE prophylaxis or documentation regarding why none was given
279
What does VTE-2 measure?
The number of patients who received VTE prophylaxis on ICU admission or documentation regarding why none was given
280
What does VTE-6 measure?
The number of patients who developed VTE while hospitalized
281
What are low-molecular-weight heparins (LMWHs) preferred for?
Prevention and treatment of DVT
## Footnote
Examples include enoxaparin and dalteparin.
282
How do LMWHs affect thrombin formation?
Inhibit thrombin formation due to reduced factor IIa activity and enhanced inhibition of factor Xa and thrombin.
283
What conditions must patients meet to be candidates for home therapy with LMWH?
* Stable DVT or PE
* Low risk for bleeding
* Adequate renal function
* Normal vital signs
* Willingness to learn self-injection or have assistance
284
What is the therapeutic range of the anti-Xa factor for LMWH therapy?
0.5 to 1.2 IU/mL
## Footnote
Source: Pagana & Pagana, 2018.
285
What is the purpose of overlapping warfarin therapy with continuous UFH?
Heparin provides therapeutic anticoagulation until warfarin takes effect.
286
What INR range is typically desired for patients receiving warfarin to prevent DVT?
1.5 to 2.0
287
What is the critical INR value that requires immediate notification to a healthcare provider?
Greater than 5
288
What should patients on warfarin avoid in their diet?
Foods with high concentrations of vitamin K, especially dark green leafy vegetables.
289
What are direct oral anticoagulants (DOACs) also known as?
Novel oral anticoagulants (NOACs)
290
List some examples of DOACs.
* Dabigatran
* Rivaroxaban
* Apixaban
* Edoxaban
* Betrixaban
291
What is the significance of idarucizumab in relation to DOACs?
It is the only reversal agent specifically for dabigatran.
292
What is the purpose of andexanet alfa?
Reversal of rivaroxaban and apixaban.
293
What is the preferred therapy for most patients with an uncomplicated DVT?
Anticoagulant therapy
294
What is thrombectomy?
A surgical procedure for clot removal.
295
What type of therapy is reserved for extensive DVT?
Thrombolytic therapy
296
True or False: Prothrombin time (PT) and INR are accurate predictors of bleeding time when using DOACs.
False
297
What initial laboratory values are suggested for patients on DOACs?
PT and aPTT
298
Fill in the blank: The therapeutic effect of warfarin takes _______ to _______ days to achieve.
3 to 4
