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week 4 Flashcards

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1
Q

peripheral artery disease

A

NARROWING of lower extremity arteries for atherosclerosis = inadequate blood flow

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2
Q

peripheral artery disease manifestations

A

pain at rest (aka intermittent clausication)
parethesia
bruit of femoral & aortic arteries
pallor
dependent rubor
cool extremities
nonpalpable peripheral pulses
calf muscle atrophy
shiny skin w hair loss & thick toenails

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3
Q

6P’s manifestations of acute occlusion from thrombosis

A

Pain
Pallor
Paralysis
Parethesia
Pulselessness
Poikilothermia (cant regulate temp)

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4
Q

lab values indicating risk for peripheral arterial disease

A

elevated:
*c-reactive protein
*homocysteine level
* lipids— hyperlipidemia

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5
Q

PAD manifestations commonly occur

A

**aggravated by limb elevation
occurs @ night
@ rest

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6
Q

diagnostic studies for PAD

A
  1. Ankle-Brachial Index <0.9
  2. 6min walk test
  3. doppler ultrasound
  4. Segmental systolic BP measurements
  5. Peripheral vascular angiography
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7
Q

meds for intermittent claudication

A

**pain @ rest w PAD

  1. Cilostazol
  2. Pentoxifylline
  3. Statins
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8
Q

med to increase blood flow

A

*PAD = ramipril

*risk for hyperkalemia –muscle weakness, paralysis, abdominal cramps

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9
Q

PAD complications

A
  1. ulcers
  2. wounds
  3. compartment syndrome
  4. infection
  5. amputation
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10
Q

Buerger’s disease

A

*THROMBOANGIITIS OBLITERANS

recurring inflammation of the arteries & veins resulting in THROMBOSIS w OCCLUSION

** men 20 - 35yrs old **

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11
Q

Buerger’s disease risk factors

A

genetics
smoking
tobacco
men: 20 to 35yrs old

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12
Q

Buerger’s manifestations

A

painful open sores
ulcers w gangrene
claudication
cold sensitivity

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13
Q

nursing care for buerger’s

A
  1. smoking cessation
  2. avoid cold & constrictive clothing
  3. pain meds
  4. antibiotics
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14
Q

Raynaud’s Syndrome

A

EPISODIC vasospastic disorder of arteries/arterioles cold & stress

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15
Q

manifestations of Raynaud’s Syndrome

A

2 phases

  1. Vasoconstrictive phase = cold/white extremities w pain
  2. Hyperemic phase = blood flow to extremities (red & swelling)
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16
Q

nursing care for Raynaud’s

A
  1. avoid cold & keep warm
  2. stop smoking
  3. limit caffeine
  4. manage stress
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17
Q

Virchow’s triad

A

presence of 3 factors predisposes a person to develop vascular thrombosis

(1) hypercoagulability
(2) venous stasis
(3) endothelial damage

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18
Q

Risk factors for venous thromboembolisms

A

surgery / immobility
oral contraceptives
65+
pregnancy
obesity
catheters

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19
Q

clinical manifestations of venous thromboembolisms

A

asymptomatic
calf/groin tenderness
warm, erythematous skin
change in circumference of extremity

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20
Q

diagnostic studies for VTE

A

D-dimer
ultrasound
CT / MRI
CT pulmonary angiography
V/Q scan

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21
Q

antidote for heparin

A

protamine sulfate

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22
Q

white clot syndrome

A

antibody development to a heparin-platelet membrane complex
*arterial thrombi

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23
Q

enoxaparin

A

SubQ low-molecular weight heparin

1mg/kg of body weight not to exceeed 90mg BID

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24
Q

antidote for warfarin

A

Vitamin K

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25
3 IV thrombolytics & monitoring for...
Reteplase tenecteplase activase (tPA) *neuro status bleeding anaphylaxis Intracranial bleeding
26
Dabigatran
PO direct thrombin inhibitor antidote= idarucizumab
27
venous vs arterial ulcer
1. location (A) =
28
anemia manifestations
increased HR orthostatic hypotension fatigue decreased O2 SOB / dyspnea cold sensitivity
29
irony deficiency anemia manifestations
glossitis (beefy red tongue) chelitis (swollen lips) asymptomatic decreased iron increased total iron binding capacity
30
Thalassemia manifestations
**inherited blood disorder-- abnormal hgb resulting in RBC destruction facial bone deformities growth failure jaundice
31
Thalassemia collaborative care
blood transfusion folic acid bone marrow transplant splenectomy
32
B12 deficiency anemia manifestations
parethesia ataxia glossitis jaundice
33
tests for vitamin B12 deficiency anemia
labs Shilling test *swallowing radio-labeled tablet
34
Aplastic Anemia
result of bone marrow suppression INCREASED iron total iron binding capacity DECREASED hgb wbc platelets reticulocytes
35
risk factors for hemolytic anemia
trauma lead poisoning infection transfusion reaction
36
clinical manifestations of hemolytic anemia
chills jaundice hepato/spleno-megaly dark urine
37
medication for patient with anemia AND kidney disease
epoetin alfa
38
sickle cell anemia
abnormal hgb = sickled red cells that clump together *african-american or Mediterranean origin
39
sickle cell anemia manifestations
*hypoxia fever jaundice swelling pain hematuria priapism
40
med for sickle cell anemia
hydroxyurea & O2 therapy pain = morphine or hydromorphone
41
thrombocytopenia manifestations
petechiae purpura ecchymoses *if bleeding* increased HR decreased BP LOC change abdominal pain dizziness weakness
42
meds for heparin induced thrombocytopenia
protamine sulfate alternative anticoagulant (warfarin or argatroban)
43
pulse pressure in PAD
is lower in the thigh, calf, & ankle than in upper extremities
44
ankle brachial index range
0.9 to 1.3 *less than 0.9 = PAD
45
PAD is treated w/ (2)
(1) = antiplatelets : aspirin, clopidogel, pentoxifylline (2) = statins : simvastatin, atorvastatin
46
a nurse should expect to see a client with PAD
have pallor on elevation of limbs & rubor when limbs are dependent sleep with both legs in dependent position
47
test to determine PVD
d-dimer test
48
teaching to client w PVD
apply stockings in the morning upon awakening & before getting out of bed keep legs elevated for at least 20 min 4 to 5x a day
49
folate diet
spinach lentils bananas
50
iron dextran
parenteral iron Z-track methos *SEVERE anemia only
51
Vitamin C w/ anemia
increases oral iron absorption
52
total iron binding capacity test
diagnoses anemia is an indirect measurement of transferring (indicates total iron stores)
53
medication for client with DIC
heparin-- decreases microclots
54
aPTT range
30 to 40 sec *measures clotting factors *1.5 to 2x baseline range when taking heparin
55
pTT range
*how long it takes blood to clot 60 to 70 seconds
56
fibrinogen range
200 to 400 mg/dL
57
prothrombin time range
11.0 to 12.5 seconds
58
3 anticoagulants with direct thrombin inhibitor
1. argatroban 2. lepirudin 3. bivalrudin
59
disseminated intravascular coagulation
clotting and anti-clotting mechanisms occur at the same time *internal and external bleeding
60
immune thrombocytopenic purpura (ITP)
autoimmune disorder that results in the body producing antibodies that decreases platelet lifespan with normal platelet production females 20 - 50
61
epoetin alfa considerations
increases erythrocytes (rbc's) treats anemia monitor hgb & Hct 2x a week (increased = effective) monitor iron levels DO NOT SHAKE VIAL adv effects = HEADACHE & HYPERTENSION
62
iron dextran
IM & IV form of iron for iron deficiency anemia
63
adverse effect of vitamin b12 meds
hypertension hypokalemia erythema
64
s/s of hypokalemia
muscle weakness nausea palpitations paresthesia
65
Alteplase
thrombolytic drug that can dissolve thrombi *taken within 3 hours
66
adverse effects of alteplase
*thrombolytic drug that dissolves thrombi intracranial bleeding headache bronchospasm bleeding hypotension
67
antidote for alteplase
alteplase= thrombolytic drug that dissolves thrombi ***AMINOCAPROIC ACID = coagulator

Med Surg 1 (8 decks)

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