Shared Flashcard Set

Details

PAD
PAD
16
Nursing
Undergraduate 4
02/13/2016

Additional Nursing Flashcards

 


 

Cards

Term

PAD incidence and prevalence

 

Definition

 

§A common condition affecting  8-10 million Americans

 

 

§Most common cause is atherosclerosis

 

 

§Prevalence increases with age

 

§10%-30% of persons over 65 y.o. suffer from PAD

 

 

§30% of persons with PAD also have CAD

 

 

§Persons with PAD have a mortality rate 3 times higher than the healthy population

 

Term
risk factors for PAD
Definition

 

nAge: increased incidence with aging

 

nAtheroscleosis: hx. CAD, hx. CVD, Carotid  Stenosis)

 

nTobacco Smoking

 

nDiabetes

 

nHypertension

 

nHyperlipidemia

 

nElevated Homocysteine (unknown reason why)

 

nLack of Use / Inactivity

 

Term
s and s of PAD
Definition

 

nIntermittent claudication with use:

 

nDull, cramping pain in buttock, thighs & calf muscles occurring with walkingà relieved with rest

 

nIschemic Rest Pain:

 

nPain at rest while supineàrelieved with dangling of leg or dependent position of leg

 

Term
complete vascular assessment
Definition

 

nSkin color & temperature

 

nLook for edema & ulcers

 

nSigns of Chronic Ischemia:

 

nPallor, cyanosis, gangrene, atrophy, delayed capillary refill

 

nLoss of hair, shiny pale skin, thickened/tropic toenails

 

nPalpation & Auscultation of Arteries:

 

nCarotid, aorta, femoral, popliteal, pedal

 

Term
DX testing of PAD
Definition

 

nABI: Ankle-brachial Index

 

nSequential Limb Toe pressures

 

nDoppler Ultrasound (U/S)

 

nComputed Tomography Angiogram (CTA)

 

nMagnetic Resonance Angiography (MRI)

 

nContrast Angiogram

 

nInvasive

 

nMost accurate

 

Term

meaning of ABI

 

Definition

 

The Meaning of  ABI

 

Simple, non-invasive test

 

Measures ratio of ankle to arm BP

 

Normal ABI= >0.90

 

 

A value <0.90 indicates presence of PAD

 

Pt usually symptomatic with ABI 0.70-0.90

 

Lower ABI indicates more severe PAD

 

ABI 0.40-0.60 = indicates ischemic disease

 

                            rest pain is usually seen

 

ABI <0.40 indicate impending tissue loss** necrosis

 

Term
medical management of PAD
Definition

risk modification cornerstone of managment

 

Smoking cessation

 

 

Treat to Goal:

 

BP Control (Anti-hypertensives)

 

Blood Glucose Control (oral agents  &/or insulin)

 

Cholesterol reduction  (statins, bile sequestering agents, niacin)

 

 

Additional Medications

 

Vasodilators (Dypramidole 400mg 3x day  with food)

 

Antiplatelet agents( Plavix 75 mg daily, ASA)

 

 

Exercise as tolerated/Rest to relieve claudication
tailored to patient's needs (diabetic, htn, etc)

 

Term
surgical tx for PAD
Definition

 

When medical management fails àrefer to Vascular Surgeon

 

Invasive treatment is considered when:

 

  1. patient experiences recurrent rest pain

 

  2. evidence of tissue loss

 

  3. disabling claudication interferes with QOL

 

Term
types of surgical options for PAD
Definition

 

nPercutaneous Transluminal Angioplasty (PTA)

 

nNot appropriate for longer lesions

 

nNot cardiac-another artery of the body

 

nInflate with balloon

 

nRisk of re-stenosis (only fair to poor long-term patency)

 

nPTA with Stent

 

nHigher success rates than with PTA alone

 

nBypass Graft Surgery

 

nMost invasive

 

nImproved  long term patency

 

nHigher rate of mortality

 

Term
complications from PTCA/stent placement
Definition

 

nBleeding

 

nHematoma Formation

 

nRetroperitoneal Bleeding

 

nEmboli

 

nContrast Media Reaction

 

nContrast Induced Renal Failure (kidneys already stressed)

 

Term
long term self managment of PAD
Definition

 

nAddress individual’s modifiable risk factors

 

nEncourage exercise to build collateral circulation

 

nWalk to the point of painàSTOP & RESTà then walk further

 

nAvoid leg crossing

 

nAvoid constricting clothing

 

Term
nursing interventions post PAD
Definition

 

 

üMark site for assessment of pulse (if not done pre-op)

 

 

üMaintain Bedrest

 

üsupine/flat

 

üNon-flexion of affected extremity

 

 

üVS assessment

 

üHYPOTENSION, TACHYCARDIA,TACHYPNEA
üAssessment of Groin Area
MONITOR FOR BLEEDING, HEMATOMA FORMATION AT PUNCTURE SITE
üNeuro vascular  assessment (according to policy)
üQ15 minutes x 1 hr
üQ30 min x1 hr
üAssessment of Distal pulses
üPopliteal , posterior tibial,  & pedal pulses

 

Term
promoting vasodilation and preventing vasoconstriction in PAD
Definition

 

Keep warm, wear insulated socks

 

Avoid Direct application of heat

 

Avoid direct exposure to cold temperatures

 

Avoid: stress, caffeine & nicotine

 

Complete abstinence from smoking or tobacco chew

 

(effect of vasoconstriction of one cigarette lasts up to 1 hour)

 

Term
medications for PAD avoid constriction/promoting dilation
Definition

 

Administer Medications as prescribed

 

Trental-treats claudication, affects blood viscosity

 

Dypramidol-vasodilator

 

Clopidogrel (Plavix)

 

ASA

 

Antihypertensives

 

Term
5 p's of acute limb ischemia
Definition

 

üPallor

 

üPain

 

üParesthesia

 

üParalysis

 

üPulseless

 

üSkin may become edematous & blisters may form within 24 hours after acute ischemia occurs

 

Term
nursing interventions for PAOD
Definition

 

nAssess & treat Pain

 

 

nAssess hydration status

 

 

nMonitor Urinary Output

 

nAssist with initial ambulation when allowed
Patient teaching regarding post-procedure follow-up
Patient teaching regarding management of modifiable risk factors for PAD
Patient teaching regarding resuming activity & exercise

 

nMonitor lab results

 

nElectrolytes

 

nHbg/Hct

 

nPT/PTT

 

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