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Med Surg: PVD part 1 (PAD)

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who can use thrombolytic therapy

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Last updated

6 years ago

Date created

Mar 1, 2020

Cards (24)

Section 1

(24 cards)

who can use thrombolytic therapy

Front

PE, occulusion, ISCHEMIc stroke not hemorrhagic bc risk of bleeding

Back

How may a venous ulcer look like?

Front

medial, beefy red, irregular borders, not punched out, much bigger, thick and hard texture

Back

nursing diagnosis: imbalance nutrition Outcomes: interventions:

Front

serum album at least 3 mg/dl dietary consult lipid control- no more than 30% daily calories from fat & no more than 7% from saturated & trans fat limit na to no more than 2400 mg (2.4 g)

Back

how to insert a stent

Front

push sheath, open up wire mesh, opens to vasculature, leave stent in place

Back

Nursing diagnosis: impaired tissue integrity Outcomes: Interventions:

Front

skin will remain intact, no redness or drainage, signs of granulation and tissue growth regular skin care prevent pressure- float heels monitor tops of toes, medial malleois foot cradle foot care: wash, dry, check, don't walk barefoot, change socks, examine shoes everyday, no lotion in between toes roomy footwear prevent injury

Back

Arterial vs venous pulses cap refill ABI edema hair ulcer skin color texture of skin

Front

look at notes

Back

Patho of PAD

Front

ischemia- anaerobic- lactic acid- pain tries to vasodilate collateral circulation- compensating for blockage by building new capillaries

Back

what is a... doppler arteriogram duplex scan

Front

determines blood flow; DVT dye in artery to show where blockage is ultrasound waves to determine blockage

Back

nursing diagnosis: pain outcomes: interventions:

Front

reduce pain proper positioning avoid standing for more than a few minutes avoid leg crossing assess for edema antiplatelet and vasoldialting drugs chronic management- gabapentin

Back

indications for revascularization

Front

lack of adequate response to exercise and pharm severe disability abscene of other disease that would limit exercise even if claudation was imrpvoed )angine,chornic resp disease) lesion

Back

What is PAD?

Front

narrowing of arterial lumen, stenosis or occlusion, may include intimal lining damage, affects lower extremities & areas with bifurcations

Back

nursing diagnosis: activity intolerance outcome: interventions:

Front

patient will walk carefully look at history to ID activities PT patients who should not exercise: ulcers, DVT, pain at rest, cellulitis, gangrene

Back

safety precautions with anticoagulants

Front

dietary restrictions, be cautious of injury, use electric razors, fall risk= can cause intracranial hemorrhage, avoid IM injections (bruising, bleeding), watch out for invasive procedures bc coumadin takes a while to leave

Back

what is an ABI? normal?

Front

ankle/brachial systolic; .9-1.3

Back

Medical management of PAD- goals

Front

promote bf to area prevent MI,stroke, vasculardilation

Back

risk factors for PAD

Front

obesity smoking (doubles risk of amputation, 1/2) diabetes hyperlipidemia greater than 60 yo HTN homocysteine (amino acid that we ingest from eating meat) CKD stress

Back

PAD goals BMI cholesterol BP

Front

18.5-24.9 less than 100, or 70 140/90 or 130/80 DM/renal insufficiency

Back

Incidence of PAD

Front

greater in AA, worst outcomes in DM women, common preventable- less intensively managed

Back

How may an arterial ulcer look like?

Front

skin punched out, raised edges, regular border, smaller

Back

Clinical manifestations of PAD

Front

pain with walking-claudation (pain with activity and goes away at rest) cramps/pains at night, relieved by hanging down hanging down rubor (red); elevate blanch (white) cool extremity, weak pulse tissue atrophy, gangrene, ulceration hypertropic changes in nails paresthesias (numbness, tingling) impotence (no erection in males) critical limb ischemia: pain @ rest; non-healing wounds; gangrene

Back

surgical interventions for PAD

Front

angioplasty with stent peripheral artery bypass graft patch graft angionplasty endarterectomy or artherectomy amputation

Back

Etiology of PAD

Front

atherosclerosis, embolism, thrombosis, inflammation, spasm and trauma

Back

would we use wet to dry dressings on PAD

Front

no bc not much to pacl

Back

Nursing diagnosis: Impaired tissue perfusion Outcomes: Interventions: pharmacologic therapy:

Front

Palpable pulses, pink/warm dry skin, cap refill less than 3 secs prevent limb ischemia -avoid knee flex -reverse Trendelenburg -balance activity with rest; bedrest if ulcer -avoid crossing of legs and constrictive clothing prevent vasoconstriction -smoking, cold, stress antiplatelet aspirin ticlodipine (ticlid) clopidogrel (Plavix) cilostazol (pletal)- also vasodilates , no grapefruit juice decrease blood viscosity pentoxifylline- intermittent claudation thrombolytic therapy to break clots -streptokinase, urokinase tissue plasminogen activator

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