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med-surg ch 31 notes
vascular & peripheral circulation disorders
| Question | Answer |
|---|---|
| anastomosis | junction of two vessels |
| aneurysm | localized sac or dilation of an artery formed at a weak point in the vessel wall |
| Ankle Brachial Index (ABI) Ankle Arm Index (AAI) | ratio of the ankle systolic pressure to the arm systolic pressure; an objective measurement of arterial disease /provide degree of stenosis info |
| arteriosclerosis | diffuse process - muscle fibers and endothelial lining of small arteries and arterioles THICKEN |
| ATHEROSCLEROSIS | imflammatory process involving the accumulation of lipids, calcium, blood components, carbs, and fibrous tissue on the intimal layer of a lg-med artery |
| bruit | sound of turbulent blood flow thru an irregular, tortuous, stenotic, or dilated vessel |
| dissection | separation of the weakened elastic and fibromuscular elements in the medial layer of an artery |
| ischemia | deficient blood supply |
| rubor | reddish blue discoloraton of the extremities; indicative of severe peripheral arterial damage; vessels remain dilated, unable to constrict |
| stenosis | narrowing or constriction of a vessel |
| arterioles are also referred to as.. | 'resistance vessels' bcuz they alter their diameter and offer resistance to blood flow |
| veins distend more than arteries. large volumes of blood can remain. veins are also called... | capacitance vessels |
| @ what % of total blood volume is contained in the veins | @ 75% total blood volume is contained in the veins |
| the __ nervous system __ veins, thereby __ the blood volume in circulation. | the SYMPATHETIC nervous system CONSTRICTS veins, thereby INCREASEING blood volume in circulation. |
| when metabolic needs increase, blood vessels... | dilate to increase the flow of oxygen and nutrients to the tissues. |
| when metabolic needs decrease, blood vessels... | constrict and blood flow to the tissues decreases. |
| reasons metabolic needs increase: | -physical activity -local heat application -fever -infection |
| reasons metabolic needs decrease: | -rest / inactivity -local cold applicatoin -cooling of the body |
| systemic arteriovenous oxygen difference | blood in the Vena Cava contains @25% less oxygen than aortic blood.. ~ > diff when less O2 delivered than tissues require~ |
| location of arterial ulcers: | -tip of toes -toe webs -heels or pressure areas if confined to bed |
| location of venous ulcers: | -medial malleolus (rarely: lat malleolus / ant tibial) |
| pain characteristic of arterial ulcers: | VERY PAINFUL |
| pain characteristic of venous ulcers: | -minimal pain if superficial (possibly very painful depending..) |
| shape of arterial ulcers: | usually circular |
| shape of venous ulcers : | irregular borders |
| arterial ulcer base characteristics | pale to black and dry gangrene |
| venous ulcer base characteristics | granulation tissue beefy red to yellow fibrinous (long term ulcer) |
| leg edema in arterial ulcers | minimal unless extremity kept in dependent position constantly to relieve pain |
| leg edema in venous ulcers | moderate to severe |
| arterial ulcer pain characteristics | intermittent claudication to sharp, unrelenting, constant |
| venous ulcer pain characteristics | aching, cramping |
| arterial insufficiency skin characteristics | -dependent rubor -elevation foot pallor -dry, shiny, skin -cool - cold -loss of hair -nails-thickened and ridged |
| venous insufficiency skin characteristics | -pigmentation in gaiter area (medial and lateral malleolus) -skin thickened and tough -may be reddish/blue -frequently assoc. w. dermatitis |
| all blood vessels are innervated by the __ nervous system | all blood vessels are innervated by the SYMPATHETIC nervous system |
| SYMPATHETIC nervous system stimulation causes vaso___? | SYMPATHETIC nervous system stimulation causes vasoCONSTRICTION |
| WHAT CHARACTERIZES ALL PERIPHERAL VASCULAR DISEASES? | REDUCED BLOOD FLOW THROUGH PERIPHERAL BLOOD VESSELS |
| LEFT sided heart failure causes: | -accumulation of blood in the lungs -reduction in cardiac output -inadequate blood flow to tissues |
| RIGHT sided heart failure causes: | -systemic venous congestion -reduction in cardiac output |
| arteries can become damaged or obstructed as result of: | -atherosclerotic plaque -thromboemboli -chemical/mechanical traums -infection / inflammation - congenital or vasospastic disorder |
| venous blood flow can be reduced by: | -thromboembolus -incompetent venous valves -ineffective pumping of muscles |
| decreased venous blood flow results in: | -subsequent EDEMA |
| MOST PVD's result in .. | -pain -skin changes -diminished pulse -possible edema |
| aging considerations in peripheral vascular fxn: | -stiffened vessels -increased peripheral resistance -impaired blood flow -increased left ventricular workload |
| REST PAIN: persistent pain in the forefoot when resting indicates... | severe degree of arterial insufficiency and critical state of ischemia. usually worse at night. |
| diagnosis of arterial disorders requires thorough assessment of... | -skin color / temp / character -peripheral pulses |
| in inactive elderly people __ may be the first sign of PVD | in inactive elderly people GANGRENE may be the first sign of PVD |
| arterial insufficiency effects on ADLs.. | -reduced mobility / activity -reduced or loss of independence -higher rates of hospitalization -poorer quality of life |
| What is the most common disease of the arteries? | ARTERIOSCLEROSIS |
| The most common direct results of atherosclerosis in arteries include: | -stenosis of the lumen -obstruction by thrombosis -aneurysm -ulceration - rupture |
| what is ischemic necrosis? | death of cells due to deficient blood flow |
| gradual narrowing of the lumen stimulates the development of... | collateral circulation |
| RISK FACTORS FOR ATHEROSCLEROSIS & PAD | -TABACO/NICOTINE US -diet - hyperlipidemia -hypertension - obesity -stress -diabetes - age -gender |
| prevention of atherosclerosis includes: | -reduce fat consumption -lowering cholesterol -use saturated fats -lower BP -QUIT SMOKING -GET EXERCISE |
| PTA = | percutaneous transluminal angioplasty |
| nurses can help pts improve peripheral arterial circulation by.. | -assisting w/ ambulation or -isometric exercises STOP IF PAIN |
| peripherl vascular conditions that worsen with exercise: | -ulcers -cellulitis -gangrene -acute thrombotic occlusions |
| RN interventions to promote vasodilation/prevent vascular compression: | -warm applications -better applied to abdomen than extremities USE W. CAUTION & NOT > THAN BODY TEMP -teach avoid cold -ENCOURAGE STOP SMOKING -AVOID STRESS (vasoconstrictor) |
| RN DX with PVD = | -ineffect. periph. tissue perfusion -chronic pain -risk for impaired skin integrity -deficient knowledge r/t self care |
| peripheral arterial occlusive disease / arterial insufficiency of the extremities.. most often occurs in .. | -men -diabetes -elderly |
| hallmark symptom of peripher arterial occlusive disease / PAD.. | INTERMITTENT CLAUDICATION: pain w. activity, relieved with rest. severe if rest pain. elevation = pain. dependent position = less pain |
| Rx for PAD | -Trental / Pletal -antiplatelet agents (Plavix) -Statin therapy |
Created by:
rtcdavis
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