mod 2 peripheral vascular disorders

PVD definition

peripheral vascular disease

- disorders with altered flow of blood through the arteries and/or veins of the peripheral circulation

major causes for vascular disorders

pump failure

alterations in blood and lymphatic vessels

circulatory insufficiency of the extremities

why is pump failure (HF) a cause of vascular disorders

inefficient pumping results in reduction of forward flow (CO)

what is circulatory insufficiency referring to

stenosis

what causes intermittent claudification

lactic acid release from anaerobic respiration

what is rest pain also known as

critical limb ischemia

what is rest pain

persistent pain in the anterior portion of the foot when patient is resting

skin findings in PVD

cool, pale on elevation, pallor, dependent rubor, loss of hair, brittle nails, dry or scaling skin , atrophy, edema, ulcers and wounds

why is dependent rubor present

the vessels are so damaged they can't constrict so they remain dilated

pulses findings in PVD

diminished or absent

when is pain present

when they wake up

how do they relieve pain when sleeping

dangling their leg

how to monitor progression of arterial disease

document amount of exercise, or distance in blocks the pt can walk before onset of pain

what is the doppler ultrasound flow studies

measures speed and volume or blood flow

it is used when pulses can not reliably be palpated

it emits a continuous signal through the patient's tissue

pt prep for doppler ultrasound

place in the supine position

HOB @ 20 - 30 degrees

legs externally rotated

apply acoustic water soluble gel

tip of transducer positioned at @ 45 - 60 degrees

Ankle brachial index procedure

lay supine for 5 minutes

identify artery in posterior tibial and dorsalis pedis

measure BP of ankle and then the brachial

(ankle BP should be higher)

when is ankle brachial index indicated

sudden cold or painful limb

indications of PAD

after arterial intervention surgery

pt teaching for ankle brachial index test

avoid nicotine and caffeinated beverages 2 hours before

exercise testing procedure

brachial SBP is taken before treadmill

treadmill at 1.5 mph with 12% incline for max 5 minutes or walks to point of claudification

measure ankle SBP

exercise testing results: normal

little to no drop in ankle SBP

exercise testing results: claudification

ankle pressure drops

what is duplex ultrasonography

B-mode grayscale imaging of tissue, organs, and blood vessels

used to determine the level and extent of venous disease

able to evaluate flow of distal vessels, and assess blood flow, locate disease, discover anatomic morphology, and hemodynamic significance of plaque causing stenosis

pt prep for abdominal duplex ultrasonography

no eating or drinking at least 6 hours prior

purpose of CT scan

assessing characteristics and monitoring changes within aorta

what does increase in diameter mean (CT scan)

aneurysm

pt prep for CT scan

if scheduled for multidetector CT: oral or IV hydration 6 to 12 hours before procedure and admin sodium bicarbonate

CT scan nursing interventions

monitor urinary output

continue to encourage fluid

pt ed for MRA

pt will be lying on a cold hard surface that slides into a closed small tube

they will hear noises

MRA nursing interventions

if claustrophobic: use headsets, prescribed sedatives , tell them close their eyes before entering the tube, tell them their is a panic button to stop the procedure

what is angiography for

confirm the diagnosis of occlusive arterial disease

risks with angiography

vessel injury, acute arterial occlusion

allergic reaction with angiography s/s

can be immediate or delayed

dyspnea, N/V, sweating, tachycardia, numbness of extremities

treatment of allergic reaction to angiography

report to MD, give corticosteroid, epinephrine, antihistamine agents

which procedures use dye

CT scan

MRA

angiography

hallmark s/s of PAD

intermittent claudication

when is ischemic rest pain worse

at night

risk factors for PAD

smoking

high saturated fats diet

HTN

diabetes

sedentary lifestyle

increasing age

female

FHx

critical limb ischemia s/s

persistent, aching or boring

intermittent claudication s/s

aching, cramping, or inducing fatigue or weakness

the 5 P's of PAD

pallor

pulselessness

paralysis

paresthesia

pain

pulse findings with PAD

unequal pulses between extremities or absent pulse

diagnostics for PAD

doppler

ankle brachial index

treadmill testing

duplex arterial ultrasound

medical management for PAD

platelet aggregation inhibitors (Cilostazol)

antiplatelet agents (Aspirin and Clopidogrel)

statins

BBW for cilostazol

contraindicated in pts with CHF

surgical management for PAD

endovascular management: balloon angioplasty, stent, atherectomy, bypass grafts, and endarterectomy

what is cliostazol

phosphodieterase 3 inhibitor agent

vasodilator that inhibits platelet aggregation

who is surgery indicated

treatment for rest pain, severe and disabling claudication, or when limb at risk for amputation because of tissue necrosis

difference between atherectomy and endartectomy

atherectomy uses a catheter

endartectomy slices open the artery

how often are sensory and motor checks done post op

every 15 minutes and then progessively longer

when is ABI not done

for pedal artery bypasses post op

how to reduce edema post op

elevate the extremity

encourage exercising while in the bed

graduated compression or anti-embolism stockings

is edema expected post op

yes because of increased arterial blood flow

compartment syndrome s/s

severe edema of extremity, pain, decreased sensation of toes or fingers

how often is ABI done postop

every 8 hours for the first 24 hours and then once a day until discharge

what is an aneurysm

localized sac or dilation formed at weak point in the wall of the artery

saccular aneurysm

one side of the artery is dilated

fusiform aneurysm

two sided bulge

dissecting aneurysm

aneurysm bursting open

causes of aneurysms

congenital, traumatic, inflammatory, infectious, pregnancy related

most common site for dissection

thoracic aorta

risk factors for thoracic aortic aneurysm

age, HTN, genetics, CAD, males

thoracic aortic aneurysm s/s

depends on rate of dilation or if dissection

can be asymptomatic

sudden, tearing chest pain radiating to shoulders, neck, back

dyspnea

cough, hoarseness, weak voice

dysphagia

aphonia

what causes the cough, hoarseness, weak voice

the aneurysm pushing on the laryngeal nerve

what causes the dysphagia

the aneurysm pushing on esophagus

what causes the aphonia

the aneurysm pushing in the larygneal nerves

what happens when pt with thoracic aorta is supine

they may feel a constant boring pain

assessment findings with thoracic aortic aneurysm

superficial veins of chest/neck/arms dilate ( bc large veins are compressed)

cyanosis in the chest area

edema in the chest area

unequal pupuls

diagnostics for thoracic aortic aneurysm

CTA chest, Chest xray, MRI/MRA, TEE

goal for thoracic aortic aneurysm management

maintain SBP at 90-120 mmHg and MAP at 65 - 75 mmHg

meds for thoracic aortic aneurysm

BB, ARBs, hydralazine, sodium nitroprusside

surgical management for thoracic aortic aneurysm

endovascular graft

if hydralazine is used which other med must be used too

Beta blockers

look out for what with hydralazine

reflex tachycardia

risk factor for AAA

causasian, men, older age, genetics, smoking, HTN

s/s of AAA

pulsation in the abdominal area

feel heart beating in belly

dull abdominal or low back pain or ache

N/V

syncope

s/s of rupture

severe, sharp, sudden abdominal pain, continuous, radiates to back, hips, scrotum, and pelvis

s/s of leaking

intense back pain, falling BP, decreasing Hct

what can cause mottling of the toes

if there is a thrombus

s/s of retroperitoneal rupture

hematomas in the scrotum perineum, flank or penis

what is the common cause of AAA

athersclerosis

post op nursing considerations for AAA

supine for 6 hours

HOB: elevated no more than 30 degrees or no more than 45 degrees for 2 hours

BP control

check for bruit over graft site

monitor urine output

monitor distal pulses

monitor bowel function

s/s of post-implantation syndrome

elevated CBC (leukocytosis and transient thrombocytopenia)

fever (spontaneous)

fatigue

occurs within 24 hours

treatment for post implantation syndrome

analgesics

anti-inflammatory

if patient is persistently coughing, sneezing, and vomiting

notify the MD

s/s of embolization

extremely tender

irregularly tender

cyanotic areas

changes in pulse, doppler signal, VS, bleeding, pulsation, swelling, pain or hematoma

how often should temp be monitored

every 4 hours

what is raynaud's phenomenon

form of intermittent arteriolar vasoconstriction

cause of raynaud's phenomenon

idiopathic or secondary to

- lupus

- rheumatoid arthritis

- scleroderma

- trauma

- obstructive arterial lesions

if the cause is idiopathic what is it called?

raynaud's disease

if the cause is secondary what is it called?

raynaud's syndrome

what triggers raynaud's phenomenon

emotional factors

stress/illness/anxiety

cold temperatures

who is raynaud's phenomenon more common in

women before 30

characteristics of raynaud's phenomenon

bilateral and episodic

the color changes of raynaud's phenomenon

White → Blue → Red

why do the extremities turn white (raynaud's)

lack of blood flow

why do the extremities turn blue (raynaud's)

the vessels dilate

why do the extremities turn red (raynaud's)

blood flow returns

s/s of raynaud's phenomenon

sudden vasoconstriction

color changes

numbness

tingling

burning

diagnostics for raynaud's phenomenon

ESR

antibodies ( to rule out autoimmune)

sympathectomy

what is a sympathectomy

interrupting the sympathetic nerves by removing the sympathetic ganglia or blocking or dividing their branches