Chapter 26 (Vascular) Bacon

What is intermittent claudication?

Pain, discomfort, or fatigue caused by inadequate arterial blood flow during exercise

When does rest pain typically occur and what position helps relieve it?

Worse at night; lowering the extremity to a dependent position helps

What should you compare when assessing pulses?

Palpate bilaterally and simultaneously, comparing symmetry in rate, rhythm, and quality

What is the ABI (ankle-brachial index)?

Ratio of systolic BP in ankle to systolic BP in arm

What is a normal ABI value?

About 1.0 (indicates no arterial insufficiency)

How long should a patient rest before ABI measurement?

Approximately 5 minutes in supine position

Which arteries are used for ABI measurement at the ankle?

Posterior tibial, dorsalis pedis, or peroneal artery

How is ABI calculated?

Highest ankle systolic pressure divided by higher of two brachial systolic pressures

What happens to ankle pressure after exercise in a patient with vascular claudication?

Ankle pressure drops (normal response is little or no drop)

What is duplex ultrasonography used for?

Determine level, extent, and chronicity of venous disease

What does CT scanning visualize in vascular assessment?

Cross-sectional images showing volume changes to extremity and compartments

What can angiography demonstrate?

Location of vascular obstruction or aneurysm and collateral circulation

What is arteriosclerosis?

Hardening of arteries; thickening of muscle fibers and endothelial lining of small arteries

What are atheromas?

Accumulations/plaques in arteries from atherosclerosis

How does nicotine affect blood flow?

Decreases blood flow to extremities via vasoconstriction

How does nicotine affect heart rate and blood pressure?

Increases both by stimulating sympathetic nervous system

How does nicotine increase clot formation?

Increases platelet aggregation

How much does diabetes increase PAD risk?

Two- to fourfold overall risk

How much higher are amputation rates in diabetic patients?

5 to 10 times higher than non-diabetics

What is the hallmark symptom of PAD?

Intermittent claudication (aching, cramping, fatigue with activity, relieved by rest)

How do PAD patients sometimes sleep to relieve pain?

Leg hanging over bed side or in reclining chair

What is Raynaud's phenomenon?

Intermittent arteriolar vasoconstriction causing coldness, pain, and pallor of fingertips or toes

What is primary (idiopathic) Raynaud's?

Raynaud's disease occurring without underlying disease

What is secondary Raynaud's?

Raynaud syndrome occurring with underlying disease (usually connective tissue disorder)

Name three diseases associated with secondary Raynaud's

Systemic lupus erythematosus

rheumatoid arthritis

scleroderma

What triggers Raynaud's episodes?

Emotional factors

stress

unusual sensitivity to cold

What demographic is most affected by Raynaud's?

Women (5 times more common), typical onset before age 30

What is primary management for Raynaud's?

Avoiding stimuli that provoke vasoconstriction (cold, nicotine)

What should nurses teach Raynaud's patients to minimize?

Exposure to cold and stressful situations

What are clinical manifestations of deep vein obstruction?

Edema and swelling

extremity may feel warmer

superficial veins more prominent

What are signs of superficial thrombophlebitis?

Pain or tenderness

redness

warmth in involved area

What is the major challenge in recognizing DVT?

Signs and symptoms are nonspecific (except phlegmasia cerulea)

Can anticoagulants dissolve an already-formed thrombus?

No, they cannot dissolve existing thrombi

What three therapies may be combined for DVT treatment?

Anticoagulation

mechanical thrombectomy

ultrasound-guided thrombolytic therapy

Name a pharmacologic therapy for DVT

Warfarin

What are key nursing assessment concerns for DVT?

Limb pain

Heaviness

Functional impairment

Ankle engorgement

Edema

What temperature change should nurses assess for in DVT?

Increased surface temperature of leg, particularly calf or ankle