Term
_______ take oxygenated blood away from the heart to tissue.
_______ Veins take deoxygenated blood to the heart |
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Definition
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Term
--Disturbances in blood flow through peripheral vessels
-- Results in tissue damage |
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Definition
| Peripheral Vascualr disease |
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Term
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Definition
Risk factors-
artherosclerosis
diabetes
venous disorders
medications
Age- loss of elasticity in arteries
Family HX-
Occupation - many hours on feet/sitting
Nutrition |
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Term
| chronic Arterial Occlusion |
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Definition
narrowing of the arterial lumen or damage to the endothelial lining
Caused by:
Arteriosclerosis - build up of plaque
Atherosclerosis - hardening
Tobacco
obesity/sedentary/diet
Stress
Diabetes |
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Term
| Clinical manifestations of chronic arterial occlusion |
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Definition
Intermittent claudication - leg pain when walking due to lack of oxygen in leg
-muscle atrophy
-Distal pulses absent
-ulceration
-pale & cool
-hypertophied nails
loss of hair on fingers& toes
parasthesias - numbness & tingling |
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Term
| What to do when you cant feel distal pulses |
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Definition
1-Check w/ doppler
2- Get another nurse to Verify
3- Call Dr Stat |
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Term
| Dxing Arterial insufficiency |
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Definition
Ankle-Brachial index
Treadmill
Doppler
arteriography/angiography
transcutaneas oximetry |
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Term
| Tx for Arterial insufficiency |
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Definition
promote circulation and Inc. blood supply
Drug TX
-Trental - reduces viscosity by altering membrane flexibility
-Pletal - Widens arteries & lowers platelet aggregation
- Plavix - inhibits platelet aggregation |
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Term
Percutaneous Transluminal Angioplasty
(PTA) |
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Definition
Dilate vessel to crush plaque
remove plaque
may have stent to hold open
may be repeated as necessary |
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Term
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Definition
-A laser catheter breaks up plaque w/out damaging tissue
-A ballon is passed to further open obstruction |
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Term
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Definition
-controlled removed of deposits
-Done under angioscopic guidance
*like a rotor-rooter - break it up&suck it out. |
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Term
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Definition
thrombus or emobolus: 7 Ps
-Pain
-Pallor
-pulselessness
-Paralysis
-Parasthesia
-Possible line of demarcation
-poikilo thermic - cool extremities |
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Term
| nursing interventions for pt with arterial insufficiency |
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Definition
-Elevate HOB with blocks 3-5 inches
-Sitting with feet on the floor
-Walking- it hurts but is necessary
-Keep extremities warm (not hot)
-heating pad on abdomen
-stop smoking
-decrease stress
-assess pain q 4 hrs
-foot cradle
-frequent position changes |
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Term
| Surgical procedures for arterial insufficiency |
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Definition
Endarterectomy - surgically remove diseased tissue (tunica intima&media, not tunica externa)
Graft- Graft the artery - put in new artery
Amputation |
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Term
| TX for acute arterial occlusion |
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Definition
-Fibrinolytics- clot buster drugs
-Heparin - anticoagulant
-Embolectomy - Surgical removal of embolus
-Re-constructive procedure for revascularization - apply passgraft |
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Term
| Medical Management of the chronic venous insufficiency |
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Definition
a. Goal of tx to relieve venous hypertension and prevent further tissue destruction. Goal is control not cure!!
b. Prescription support hose
c. Local ulcer management
- Wet saline dressings
- Unna boot, dome-paste, duaderm elastic wraps
d. Surgery
- Debridement, excision, grafting of ulcers
e. Elevate legs fequently during the day
f. No prolonged sitting or standing
g. No crossing legs
h. Walk around every 2 hours
i. Elastic stockings
- Morning to night, elevate legs at night
j. Watch for injuries to legs
k. See health care provider every 3-6 months if there is no current problem |
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Term
| Promote healing of Ulcerations and Lesions |
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Definition
a. Nutrition
i. Weight control, increase protein, Vitamins A &C, maintain adequate hydration, avoid caffeine and nicotine.
b. Decrease trauma to legs
c. Wear shoes that fit properly. Check feet daily for lesoins
d. Use foot cradle to protect feet
e. Soak nails before cutting, cut straight across |
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Term
| Ulcer Characteristics due to chronic venous insufficiency |
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Definition
- Medial malleolus or infrequently, lateral malleolus or anterior tibial area
- Superficial or shallow
- Irregular shape
- Beefy red to yellow fibrinous granulation tissue in the chronic long-term ulcer
- Moderate severe edema (pitting) |
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Term
| Signs and Symptoms of Chronic Venous Insufficiency |
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Definition
- Rosy, pink, warm
- Nails normal
- Superficial veins are dilated
- Circulation improves with elevation
- Pretibial, "brawny" edema
- Brownish/red discoloration
- Dermatitis with or without ulceration |
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Term
| Chronic venous insufficiency |
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Definition
a. Occurs from prolonged venous hypertension, which stretches and damages the valves. (post-phlebitic syndrome)
b. Follows most cases of severe deep vein thrombosis but may take 5-10 years to manifest
- 20% of patients have no history of DVT |
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Term
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Definition
a. Permanently distended veins that develop because of loss of valvular competence
- Primary varicose veins: Born with them. Congenital
- Secondary varicose veins: Caused by injury, hypertension, etc. |
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Term
| Clinical Manifestations of vericose veins |
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Definition
| Clinical manifestations: heaviness, itching, moderate swelling, may have superficial inflammation, unsightly appearance (ropey appearance under skin). |
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Term
| Med. Magagement of vericose veins |
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Definition
a. Reduce venous pooling, prevent compl. And improve comfort level
b. Compression stocking and elastic wraps |
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Term
| Surg. Management of vericose veins |
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Definition
a. Schelerotherapy
b. Vein ligation and stripping: Tie off ends and pull out vein |
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Term
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Definition
-Inflamed response AND clot
-usually occurs in an extremity - they can easily break off and travel.
Etiology - Virchows triad
1Stasis of blood
2injury to vessel Must have 2/3
3Altered coagulation |
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Term
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Definition
-Thrombus formation - life threating Blood clots
-Defective valves - lead to varicose veins. |
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Term
| Nursing intervention for acute arterial occlussion |
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Definition
-Monitor
-Maintain IV fluids
-Extremity lower than heart
-dont apply cold or heat
-Avoid raising knee or sitting @ 90 degree hip flexion
-lower stress
-Monitor labs |
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Term
| Clinical manifestations of DVT |
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Definition
-50% dont have symptoms
-edema in calf
-calf pain - heavy & tight
-red, tender, warm extremity
-Ropy-like vein
-Positive homan's sign
sometimes embolus is 1st sign |
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Term
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Definition
-Doppler
-plethysomography
-MRI
Ascending contrast venography |
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Term
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Definition
Elastic stockings
Elevate legs
Encourage ROM
Ambulation
heparin SQ
Stay hydrated |
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Term
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Definition
Anticoagulants-
1-Heparin IV
2-Coumadin 2-3 days into hep. tx
Fibrinolytics- Break up clots |
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