Help
Options
Didn't know it?
click below
click below
Knew it?
click below
click below
Don't Know
Remaining cards (0)
Know
retry
shuffle
restart
0:00
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
chpt 38 O2 Perfusion
aneurysms, PAD, venous insufficiency
| Question | Answer |
|---|---|
| Following abdominal aneurysm repair, the nurse should | maintain adequate B/P to avoid dissection, hydration, diuretics, hourly urine I/O, pulses, color, temp, capillary refill time, NPO, do not remove NGT till flatuence, ANTBX for 4-6 weeks for infx, no heavy lifting |
| Pre-Op for aortic aneurysm repair | NPO, bowel prep (laxative, enema), preoperative ANBX, TUBES: A-line, catheters, EKG monitoring, pain meds, ANBX b/f to prevent infx |
| what is PAD | advanced marker for advanced systemic atheroscerosis, progressive narrowing & degeneration of neck, extremities, & abd |
| 4 most significant causes of PAD | #1 smoking,hyperlipidemia, HTN, DM |
| risk factors for PAD | obesity, hypertriglyceridemia, family hx, sedentary, stress |
| Atherosclerosis pathophysiology | migration & replication of smooth ms cells, deposition of CT,lymphocyte, macrophage infiltration, accumulation of lipids |
| Artherosclerosis causes 2 main things | 1. narrowing of artery-->insufficient blood supply to organ 2. d/t use of compensatory artery enlargement, aneurysm results |
| Aortic aneurysm risk factor and etiology | highly genetic, etiology is atherosclerosis, |
| pseudoaneurysm | enlargement of the outer layer of the blood vessel d/t leakage of blood. Enlargement of the outer layer only |
| Thoracic aneurysm | usually asymptomatic, deep chest pain to nterscapula, dysphagia(swallowing), distended neck veins, edema in bilateral upper extremities, tamponaded by surrounding structures, Grey Turner sign |
| Abdominal aortic aneurysm | often asympomatic, deadly, pain in abd to the back, may embolize plaque causing "blue toe,"massive hemmorhage into abd, hypovolemic shock w/tachycardia, pale and clammy, do not palpate abdominal mass |
| size of aortic aneurysm | small:<4 cm--> risk factor modification, decrease BP, CT Q6 months large:>5.5 cm--> conventional surgery |
| Aortic dissection | a tear in the intimal lining, more common in thoracis d/t HTN, "tearing pain" anterior chest to intrascapula, abd, legs. initial tx w/antihypertensive meds/lower contractility, sugery |
| PAD lower extremities s/s | absent pulse, intermittent claudicatio (w/exercise), rest pain (surgery), parathesia,ulcer pain/shooting (oversensitive), have pt check feet,atropphy,thin/shiny skin, hair loss, elevation pallor, dependent rubor, gangrene, bony area/toes/forefoot,cold |
| venous ulcer s/s | varicose/spider, ted hose/ACE, no claudication/rest pain, pruritis, damp to dry, skin masceration, elevate leg, pulses present, brown pigmentation, granulation present(pink). ankle area, superficial/uneven edges |
| Intermittent claudication | classic symptom PAD d/t exercise, recurrent, resolves in 10 min or less, pt should walk till pain, rest & walk again |
| PAD lower extremity dx: segmental blood pressure | B/P @ thigh below knee & ankle--> falloff >30mmHG+ PAD |
| Ankle brachial index for PAD | ankle/brachial SBP Normal is 0.9-1.3 |
| Risk factor Modification PAD | complete smoking cessation, tx hyperlipidemia (cholesterol <200- statin drugs), tx HTN & DM, HbA1C <7% |
| Drug tx for PAD | antiplatelet- (ASA & Ticlid), ACEI(ramipril to increase walking), ASA & Plavix can be taken together |
| 2 drugs to tx intermittent claudication (PAD) | 1. Trental: dec blood viscosity 2. Pletal: inc vasodilation, inc walking |
| most effective tx for intermittent claudication | walking 30-60 min daily and nutritional tx |
| Ginko Biloga | increases walking distance for intermittent claudication |
| folate, vitamin B6 and B12 | lowes homocystrine levels: >10micromoles/L associated w/atherosclerosis, strokes, MI, blood clots, & Alzheimers |
| Critical limb ischemia | chronic w/ischemic rest pain, arterial leg ulcers, gangrene |
| critical limb ischemia care | prevent trauma to leg, inspect/lubricate both feet, NO BATH/SOAKING d/t masceration avoid heat/cold,chemicals & heel pressure, no compression, cover w/dry dressing, dangle feet |
| PAD lower extremities acute intervention | neuro check Q15 min then Q hour, loss of palpable pulses reported, KNEE FLEX AVOIDED, AMBULATION |
| Acute arterial ischemia | sudden interruption to tissue/organ caused by EMBOLISM- tissue death if not tx immediately |
| 6 P's of Acute Arterial ischemia | pain pallor pulselessness parethesia poikilothermia(adaptation to external environment/cold) |
| Acute ischemia tx | IV heparin- monitor PTT Q6H- does not dissolve clot- thrombolectomy balloon catheter used, surgical revasularization, amputation |
| Buergers dz | thromboangitis obliterans, acute INFLAMMATION/thrombosis of hands/feet occlusive dz of median arteries ischemic,affects men, pain @ rest wake up at night must quit smoking or lose fingers/toes STRONGLY r/t smoking |
| Buerger's dz medications | 1. vasodilators (minoxil, hydralazine), 2. CCB(procardia & Norvasc) 3. antiplatelet (ASA & Ticlid)4. Anticoagulation (Coumadin Trental)--> dec blood viscosity |
| Raynaud's phenomenon | vasospasm of small arteries in fingers/toes, causes discoloration, young women age 14-40, triggered by stress, and cold, have pt wear warm, loose clothing, avoid caffeine/tobacco, CCBS (procardia & diltiazem) |
| venous thrombosis classified as | DVT and thrombophlebitis |
| thrombophlebitis | INFLAMMATION of vein (d/t IV) caused by IRRITATION not infection, swelling/red |
| DVT occurs where... | occurs commonly in femoral and iliac veins |
| Thrombosis etiology | virchow's triad: 1. venous stasis-dysfx valve/inactive extremity 2. endothelial damage (IV or trauma) 3. hypercoagubility- smoking/estrogen/steroids |
| pathophysiology venous thrombus | RBC/WBC, platelets, & fibrin in valve cusp or vein, endothelial cells cover, thrombus may detach & become embolus |
| how long for clot to be lysed by body | 5 days |
| superficial thrombosis | palpable, cord-like, tender to touch,caused by trauma to varicose veins |
| superficial thrombosis tx | NSAIDS, elevate extremity and apply moist heat |
| DVT s/s | unilateral leg edema pain, erythmia, temp >100.4, PE is life threatening |
| DVT tx | bed rest, prevention/prophylaxis (heparin/lovenox), elevation, warm compress, compression stocking |
| coumadin & heparin used together b/c... | coumadin takes time to kick in, while heparin is immediate |
| 1. Coumadin 2. unfractionated heparin 3. fractionated heparin (LMWH) | 1. administer same time Q day, PO,check INR, vit k antidote 2. monitor PTT/ACT, given SQ or IV 3. no monitoring, given SQ, do not expel bubble w/lovenox, |
| hemosiderin causes... | leg discoloration |
| venous leg insufficiency | skin brown, thick, assess for PAD b/f tx w/compression stocking (NOT if PAD present too), moist dressing zinc, protein, vitamin c, skin graft, avoid standing, elevate leg above heart, post healing- daily walking program |
| aortic dissection etiology | a false lumen is created between the intima and media. As the heart contracts, pressure increases the dissection, which could occlude blood flow to brain, abd, kidneys, spinal cord, and extremities. |
| aortic dissection complications | cardiac tamponade--> when ascending aortic arch involved- blood goes to pericardial sac. Rupture could cause death. |
| aortic dissection dx studies | similar to aortic abd aneurysm- MRI, CT, TEE, x-ray, Echocardiogram. After pt is stable--> angiography |
| pt teaching for aortic dissection (meds) | lowering B/P and contractility, pain relief w/opioids (decrease anxiety, bed rest, IV beta blockers, control B/P w/nipride, CCB or ACEI, and to report s/e--> then surgical repair |
| precautions w/anticoagulant therapy | IV unfractionated heparin given for acute arterial ischemic disorder. Pt should avoid taking NSAIDS/ASA, assess and report s/s bleeding. |
Created by:
arsho453
Popular Nursing sets