Peripheral Vascular Disease
Terms
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- classic symptom-cranping in the lower extramities
- Arterial intermittent claudication
- determined by the amount of docimented exercise that the pt can tolerate before pain actually occurs
- progression of arterial occlusion
- occurrs with exercise, relieved by rest
- ischemic pain
- persistant in forefoot when at rest..does not go away with rest,,when there is severe occlusion and ish.
- rest pain
- cool aple extremities, pallor with elevation, rubor with dependant positioning, cyanosis, shiny skin with brittle nails and hair loss
- arterial insufficiancy
-
altered tissue perfusion
risk for inpaired skin integrety pain-due to insufficient o2 - Nursing Dx=atrial insuff
- aching cramping pain
- venous
- diminished or absent pulses
- arterial
- pigmentation in gaitor area, skin thickened and tough, may be reddish blue, associated with dermatitis
- venous
- pulses present, may be diffacult to palpate through edema
- venous
- granulation tissue--beefy red to yellow in chronic long term ulcer
- venous
- pale to black and dry gangrene
- arterial
- circular ulcer
- art
- deep ulcers, often involving joint space
- art
- superficial ulcers
- venous
- warm enviornment, aviod cold, avoind hot, avoind restrictive clothing, don't cross legs, keep dependent, no smoking
- Nursing interventions..promoting tissue perfusion
- daily skin assess, gentle cleaning, moisturize, properly fitting shoes, protect feet-no barefoot, lose weaight, proper nutrition
- maintaining skin integrety
- increacing exercise tolerance-exercise develops collateral circu. slow progressive exercise 30-45 min.bid ROM
- reducing pain
- handheld doppler when pulsus are not palpable,
- doppler flow studies
- compares systolic BP of arm to BP of ankle, usually ratio of 1:0, if less then arterial insufficiancy is presesnt
- ankle-brachial index-ABI
- ultrasonic waves produce waveform with peaks and valleys, flattened waveform=obstruction
- duplex ultrasound
- treadmill 5 min or untill apin is disabling, ankle BP monitores
- exercise testing
- determine location and extent of disease, assess for contrast media uses contrast--allergies
- angiography
- maintain circulation through repair, VA and pulses frequently, color and temp, I+o, CVP, LOC, fluid imbalances, elevate legs, pressure dressings
- Post op care after vascular procedures
- smoking, HTN, diabetes, viruses, hyperlipidemia
- endothelial injury...causes of artherosclerosis
- platelets and monocytes aggragate at site, fatty streaks and fibrous plaques form, rupture causing thrombus
- artherosclerosis
- legs most oftern affected, severity depends on extent of obstructive lesions, confined to segments of aorta below renal arteries to popliteal art.
- arterial occlusive disease
- position below heart, exercise, postural exercise, sit in chair with feet flat on floor
- improve arterial circulation
- warmth with caution, stop smoking, stress managment, no cross legs, constrictive clothing, vasodialators, adrenergic blockers
- promoting vasodialation
- med that reduces blood viscosity
- Trental
- ASA, Persantine, Ticlid, Plavix
- anti-platelets
- vasodialators, adenergic blocking agents, CCB, trental, anti-platelet, meds for DM, HTN
- Meds for arterial occlusive disease
- ADA-low fat, low cholesterol, because of artherosclorosis
- diet for AOD
- chronic tissue ish, gangrene, necrosis, last resort when med. intervention fails
- amputation
- tissue is dry, cold, and black
- dry gangrene
- after trauma with infection..very bad odor
- moist gangrene
- obstructive vascular disorder cause by recurring inflammation in arteries and veins
- Buerger's Disease (Thromboangiitis obliterans)
- localized, episodic, vasoconstriction of disorder of small arteries in hands and feet that cause temp and color changes
- Raynaud's Disease
- Thrombosis, embolisim, trauma, occurs suddenly nad w/o warning
- Acute arterial Occlusive Disease
- autoimmune vasculitis, inflammatory response, white cells infiltrate, fibrosis occurs w/healing causing occlusion
- Buergers
- rheumatic heart disease, artificial heart valves, MI, AFib, vascualr surgeryinvasive arterial procedures, trauma or compression of artery
- risk factors for acute arterial occlusive disease
- necrotic lesions at tips of fingers and toes, see areas that are inflammed then they become necrotic
- Buergers
- winter, lupus, RA, trauma or obstruction, cooupational trauma--typistis, pianists, cold, stress, caffine, tobaco
- Risk factors--Raynauds
- pain, pallor, pulselessness, parasthesia, poikilnthermia, paralysis
- 6 p's of NV assess. Acute Occ. art. disease
- bilateral, instep claudication-main symptom! intense rubor, cyanosis,rest pain, diminished or absent pulses
- S/S Buergers
- stop smoking, CCB or antiplatelet, sympathectomy to eliminate vasospas. amputation.BKA vs. toe
- Buergers
- symmetrical and bilateral, usually tip, not thumb, vasospas. in fingers, pallor early, then reddness as blood returns..very painful
- Raynauds
- emergency embolectomy, balloon angioplasty, artherectomy stents, bypass
- trestment of Acute occlusion
- circumferential dialation, relatively uniform in shape
- fusiform
- localized outpouching on one side
- saccular
- tear in the intima layer with accumulation b.t the intima and the media layer
- dissecting
- elderly, female, immobility, increaced viscosity, intimal damage, oral contraceptives
- rick factors for DVT
- pain or tenderness, edema, reddness, fever, +Homans
- s/sDVT
- promanant, abmormally dialated veins
- varacose
- pregnancy, obsiety, prolonged standing, chronic diseases
- varacose veins..rick fac.
- inadequate venous return over a long period of time, chronic pooling of blood leads to hyperpigment and edema over ankles
- chronic venous insufficinecy
- used for small, localized vari., agent in injected into the vein (NS)
- sclerotherapy
- dyspnea, hypotension, tachy card./tacypnea, hypoxemia, hemoptysis, chest pain
- S/S pulm embolus
- increaced venous tension, and valve imcompatence leads to venous stasis, poor venous return, edema and ulceration
- venus ulcer path
- irregular margins, copious serous exudate, occurrs over the medial or lateral malleolus(ankle bone)
- Venous ulcer