Section 1
Preview this deck
six Ps
Front
| 5 | 0 | ||
| 4 | 0 | ||
| 3 | 0 | ||
| 2 | 0 | ||
| 1 | 0 |
Active users
1
All-time users
1
Favorites
0
Last updated
1 year ago
Date created
Mar 14, 2020
Cards (121)
Section 1
(50 cards)
six Ps
-paresthesia -pain -poikilothermia -pallor -paralysis -pulsnessness
peripheral arterial disease
-systemic -thickening of artery wall -involves progressive narrowing and degeneration of arteries of upper and lower extremities -vessels lose elasticity
PAD nutritional therapy
-BMI less than 25 -waist circumference: less than 40 men, less than 35 women -3% to 5% weight loss yields reduced triglycerides, glucose, A1C, and decreased risk of type 2 DM -recommend reduces calories and salt for those with obesity
ultimate goal for plan of care of PAD
reduce risk for CV disease
capillary refill norm
<2 seconds
main cause of peripheral arterial disease
elevated lipids aka atherosclerosis
neurovascular assessment: pain
severe, unrelieved by pain relief measures
borderline ankle-brachial index
.91-.99
drugs prescribed for treatment of intermittent claudication
-pletal -trental
PAD: duplex imaging
color doppler signals map blood flow through region
teaching for PAD
same as teaching for diabetics--- exercise, no smoking, protect feet
interprofessional care of PAD
-diet -meds -exercise -interventional radiology -surgical intervention (bypass graft)
nursing diagnoses for PAD
-ineffective tissue perfusion -activity intolerance
exercise therapy for PAD
-walking is most effective for intermittent claudication (30-45min daily, 3 times a week) -women have faster decline and mobility loss than men -daily exercise increases survival rates
neurovascular assessment for PAD
six Ps
abnormal ankle-brachial index
< .90
athersclerosis
-systemic -blockage is where the symptoms are present
classification of PAD severity: ankle-brachial index
-.90-.71 mild PAD -.71-.41 moderate PAD -<.40 severe PAD
neurovascular assessment: paresthesia
numbness and tingling
neurovascular assessment: poikilothermia
adaptation of the limb to environmental temp; most often cool
antiplatelet agents for PAD
-aspirin -clopidogrel (plavix)
neurovascular assessment: pulselessness
diminished/absent peripheral pulses and increased capillary refill
risk factors for peripheral vascular disease
-age -obesity -smoking -DM -HTN -hyperlipidemia -family history
neurovascular assessment: paralysis
loss of function due to lack of perfusion
increased risk for critical limb ischemia
-diabetes -HF -history of stroke
intermittent claudication
-ischemic muscle pain that is caused by a constant level of exercise -resolves within 10 minutes or less with rest -reproducible -pain due to lactic acid buildup
PAD: health and physical examination
-palpation of peripheral pulses -6 P's
reducing CVD risk factors for PAD
-BP control by reducing sodium in diet -tobacco cessation -glycosylated hemoglobin (HgB A1C <7.0% for diabetics) -aggressive treatment of hyperlipidemia
overall goals for patient with PAD
-adequate tissue perfusion -relief of pain -increased exercise tolerance -intact, healthy skin on extremities -increased knowledge of disease and treatment plan
normal ankle-brachial index
1.00-1.30
nursing assessment: past health history relevant to PAD
-diabetes -smoking -HTN -hyperlipidemia -obesity/exercise intolerance -loss of hair on legs and feet -decreased or absent peripheral pulses -intermittent claudication
PAD: ankle-brachial index (ABI)
-done using a handheld doppler -calculate by dividing ankle systolic blood pressure by the highest brachial SBP -does not work well with calcified arteries (ex: patients with DM)
peripheral vascular disease
-may be arterial or venous or both -usually arterial (PAD is systemic)
neurovascular assessment: pallor
coolness and loss of normal color of extremity
critical limb ischemia (CLI)
-chronic ischemic rest pain lasting more than 2 weeks -can lead to nonhealing arterial leg ulcers or gangrene due to PAD
clinical manifestations of PAD
-intermittent claudication, which is the classic symptom -paresthesia -reduced blood flow to limb (pallor, dependent rubor) -pain at rest -critical limb ischemia (CLI)
peripheral venous diseases
-primarily affect lower extremities -categorized as thrombus (DVT/VTE) or chronic venous insufficiency -can be due to incompetent valves
ramipril and PAD
-decreases cardiovascular morbidity -decreases mortality -increases peripheral blood flow -increases ABI -increases walking distance
acute arterial ischemia
-sudden interruption of arterial blood flow -caused by embolism, thrombus -requires immediate intervention
PAD: doppler ultrasound
-audible sounds related to blood speed in vessels -segmental blood pressures of the thigh, below knee, and ankle -differences greater than 30mmHg indicate PAD
ACE inhibitors for PAD
Ramipril (altace)
complications of PAD
-prolonged ischemia -nonhealing arterial ulcers -gangrene -may result in amputation
peripheral vascular system
all vessels outside the heart; ie. extremities can be arterial or venous
prolonged ischemia leads to
-atrophy of skin and underlying muscles -delayed healing -wound infection -tissue necrosis -arterial ulcers over bony prominences
PAD: angiography
-dye in vessel and then radiographed -magnetic resonance angiography (MRA)
what can prevent gangrene in a PAD patient?
collateral circulation
patho of atherosclerosis
amputation: last resort
-if adequate blood flow is not restored and if severe infection occurs -indicated with uncontrolling pain and spreading infection
diagnostic studies for PAD
-health and physical exam -doppler ultrasound -duplex imaging -ankle-brachial index -angiography
drug therapy for PAD
-ACE inhibitors -antiplatelet agents
Section 2
(50 cards)
aortic aneurysm
-arch or ascending -hoarseness from pressure on recurrent laryngeal nerve -dysphagia from pressure on esophagus
conservative treatment for legs with critical limb ischemia
-protect from trauma -decrease pain -prevent/control infection -improve arterial perfusion
lab tests for aneurysms
-investigating D-dimer -fibrinogen -interleukin-6
venous leg ulcer other names
venous stasis ulcers, varicose ulcers
renal perfusion status post-op aneurysm care
-risk for lodging of embolus in renal artery -assess foley/urinary outputs hourly -careful I and O -daily weights -daily BUN and serum creatinine
treatment for venous ulcers
compression therapy
GI status post-op aneurysm care
-monitor for bowel infarct or ischemic bowel: fever, ileus, abdominal distention, diarrhea, and bloody stool -paralytic ileus: unusual for 4th day post-op, check bowel sounds and note flatus -NG tube to LIWS: irrigate with NS, record amount and drainge -early ambulation -mouth care while patient NPO q2-3 hours
true aneurysm
saccular or fusiform; all layers intact
venous ulcers
-drainage, bronzy coloration due to iron -skin thick, hard, warm -edema; seen in ankles -sluggish blood flow -painful (elevation relives it) -pulse normal
peripheral perfusion status post-op what to report
-absent pulses -vasospasms -hypothermia -cool, pale, mottled, or painful extremity -embolus? thrombus? plaque occlusion of graft?
infection post-op aneurysm care
-rare, but life threatening -broad spectrum antibiotics -assess temp regularly and report -check WBCs, adequate nutrition, observe incision for signs of delayed healing -look for signs of infection and prolonged drainage -keep incision clean and dry -care for IVS and catheters
true vs false aneurysm
True Aneurysm - intact thinned wall False Aneurysm - defect in vascular wall leading to extraversion and hematoma
evaluation after surgery or intervention for PAD
-adequate peripheral tissue perfusion -increased activity tolerance -effective pain management -knowledge of disease and treatment plan -plans for walking program -verbalize key elements of treatment plan
treatment of critical limb ischemia
-revascularization via bypass surgery (optimal) -percutaneous transluminal angioplasty -IV prostanoids (decrease rest pain and improve ulcer healing) -spinal cord stimulation (managing pain and preventing amputation) -angiogenesis
evaluation of aneurysm post-op care
-patent arterial graft with adequate distal perfusion -adequate urine output -no signs of infection
S/S of venous leg ulcers
-gaiter pattern of hyperpigmentation around ankle -pressure and edema -over time, tissue hardens and thickens -not life threatening, but painful, debilitating -swelling due to inability to pump blood back up into system
diagnostic studies for aneursysms
-Xrays -ECG -echocardiography -ultrasonography -CT, MRI -angiography -lab tests
amputation treatment
-least desirable -may be required with extensive gangrene, bone infection, or major artery occlusions
nursing assessment for aneurysm
watching for signs of rupture
large aneurysm
-5.5 cm or more -surgical repair recommended plus other considerations such as genetic disorder, expands rapidly, symptomatic, or risk for rupture high
CV status post-op aneurysm care
-electrolytes such as K and Na -oxygen -ECG monitoring for arrhythmias -ABG determinations -adequate pain control -large midline incision or femoral artery puncture site if (EVAR)
causes of venous leg ulcers
-valve incompetence -deep vein obstruction -thrombophlebitis -congenital venous malformation
aneurysm etiology
-#1 degenerative: athersclerosis (plaques of lipids, cholesterol, and fibrin that deposit beneath intima) -systemic disease -assess all pulses -congenital, mechanical or infectious (HIV, syphilis)
thoracic aortic aneurysm
-usually asymptomatic until aneurysm has grown -deep diffuse chest pain
false aneurysm
disruption in layers
risk factors for aneurysms
-age -gender -smoking -HTN -coronary artery disease (athersclerosis) -genetics
aneurysm
outpouching or dilation of an arterial wall
aneurysm patho
-plaques beneath intima cause degenerative changes in the media -inflammation -loss of elasticity, weakening, and eventual dilation
acute care after leaving recovery area, after surgery or radiologic intervention for PAD
-continued circulatory assessment -monitor for potential complications -report increased pain, loss of pulses, pallor or cyanosis, numbness or tingling -avoid knee-flexed positions -turn and position frequently, ambulate -avoid prolonged sitting -graduated compression stockings
EVAR
endovascular aneurysm repair; least amount of time with least amount of complications, but still need continuous monitoring
compression therapy
-30-40mmHg proven beneficial for venous ulcers
small aneurysm
-4-5.4 cm -conservative therapy: --decrease lipids and BP --stop smoking --surveillance --beta blockers, statins, ACE inhibitors to decrease growth rate
home care after intervention or surgery for PAD
-management of risk factors -long term antiplatelet therapy -supervised exercise training after revascularization -importance of meticulous foot care
post-op care of aneurysm
-ICU for 24-48 hours -graft patency -CV status -pain control -infection -GI status -neuro status -peripheral perfusion -renal perfusion
signs of ruptured aneurysm
-diaphoresis -paleness -weakness -tachycardia, hypotension -abdominal/back/groin pain -flank ecchymosis or periumbilical pain -changes in LOC -pulsatile abdominal mass (tenderness)
arterial ulcers
-skin pale; rubor/pallor -skin thin, dry cool -no edema, seen mostly in toes -ulcers drain minimally -nails thick and brittle -pain -weak pulses -paresthesias
femoral-popliteal bypass
-a peripheral arterial bypass operation with autogenous vein or synthetic graft material to bypass blood around the lesion -assess Six Ps and compare against baseline in recovery
graft patency post-op aneurysm care
-maintain adequate BP -prolonged low BP can cause graft thrombus due to decreased BF -severe HTN may stress new sutures
surgical repair of aneurysm
A, Incising the aneurysmal sac. B, Insertion of synthetic graft. C, Suturing native aortic wall over synthetic graft.
health promotion: PAD
-identification of at risk patients -diet modification -proper care of feet -avoidance of injuries -regular follow up care
how often should you do neurovascular checks for aneurysm?
every hour
neuro status post-op aneurysm care
-ascending aorta: pupil check, LOC, cranial nerve check, facial symmetry, tongue deviation, speech, movement and sensation of upper and lower extremities (stroke may occur) -descending aorta and abdominal: movement and sensation of upper and lower extremities; alteration from baseline unusual; report coolness or mottling
peripheral perfusion status post-op aneurysm care
-ascending or aortic arch: assess pulse of carotid, radial, and temporal sites -descending aorta: assess femoral, popliteal, posterior tibial, and dorsalis pedis -peripheral pulses distal to incision, urine output -areas of major concern are dictated by repair location -mark pulse locations with felt-tip pen -note skin temperature and color, capillary refill time, sensation, and movement
collateral circulation assists to
keep limb alive over time; when blocked, the limb dies which is why surgery is indicated
in recovery area, after surgery or radiologic intervention for PAD, frequently monitor
-skin color and temp -capillary refill -presence of peripheral pulses distal to operative site (assess baseline before surgery) -6 Ps -administer IV fluids to keep the BP WNL -sensation and movement of extremity
extremity assessment post op aneurysm care
-temp, color, capillary refill time, sensation, and movement of extremities -vasospasm and hypothermia may cause absence of lower extremity pulses
indications of critical limb ischemia
-intermittent claudication symptoms that become incapacitating -pain at rest -ulceration or gangrene severe enough to threaten viability of the limb
absent pulses + cool, pale, mottled, or painful extremity means
embolization or graft occlusion, report immediately
goal of interprofessional care of aneurysms
-prevent aneurysm rupture #1 -correct any obstructions
abdominal aortic aneursym
-most common (75%) -pulsatile mass or bruit (abnormal blowing or swishing sound, means occlusion) -compression of lumbar nerves causes back pain -compression of bowel causes gastric discomfort
Section 3
(21 cards)