problems with vascular system

Question 1

vascular system includes

Answer 1

arteries
veins
lymphatic vessels

Question 2

Peripheral Arterial Occlusive Disease

Answer 2

• Involves progressive narrowing and degeneration of arteries of upper and lower extremities.
• Atherosclerosis is the leading cause in majority of cases.

Question 3

what is pad caused by

Answer 3

• Atherosclerosis is the gradual thickening of the artery wall.
• Caused by deposits of cholesterol and lipids within the artery, which leads to narrowing.

Risk factors
- Cigarette smoking: vasoconstritor
- Hyperlipidemia
- Hypertension
- Diabetes mellitus

Question 4

cad clinical manifestations

Answer 4

• Intermittent claudication: pain/cramping when walking, resolves with rest.
• Calf muscle atrophy.
• Skin appears shiny with hair loss and thickened toenails.
• Poor neurovascular integrity.
  Tingling and numbness of toes
• Necrotic ulcers.
• Cool extremities with poor pulses.

Question 5

clautication

Answer 5

walking o2 decreases in legs
- stop walking helps

Question 6

paresthesia

Answer 6

• Numbness or tingling in the toes or feet
• Produces loss of pressure and deep pain sensations
• Injuries often go unnoticed by patient

Question 7

pain at rest symptoms

Answer 7

• Occurs in the foot or toes
• Aggravated by limb elevation
• Occurs from insufficient blood flow
• Occurs more often at night
• don’t elevate blood needs to stay

Question 8

nursing interventions for pad

Answer 8

• Exercise therapy: walk to the point of pain three times a week.
• Encourage tobacco cessation.
• Promote weight reduction.
• Dependent position relieves pain.
• don’t put stockings or boots on

Question 9

meds for pad

Answer 9

• pentoxifylline (Trental)
• cilostazol (Pletal)

Antiplatelet agents
- Aspirin
- Clopidogrel (Plavix)

Question 10

exercise therapy for pad

Answer 10

• Exercise improves oxygen extraction in the legs and skeletal metabolism
• Walking is the most effective exercise for individuals with claudication
• 30 to 60 minutes daily, 3 times/week

Question 11

pad complications

Answer 11

• Atrophy of the skin and underlying muscles
• Delayed healing
• Wound infection
• Tissue necrosis
• Arterial ulcers

Question 12

surgical treatment

Answer 12

• Femoral popliteal bypass surgery
• Angioplasty
• Stenting

Question 13

leg with critical limb ischemia

Answer 13

• Revascularization via bypass surgery
• Protect from trauma
• Decrease ischemic pain
• Prevent/control infection
• Improve arterial perfusion

Other strategies
- Spinal cord stimulation
- Angiogenesis

Question 14

most common surgical approach

Answer 14

• A peripheral artery bypass surgery with autogenous vein or synthetic graft to bypass blood around the lesion
• PTA with stenting may also be used in combination with bypass surgery
• mark pulses
• know sensation, temperature

Question 15

percutaneous transluminal balloon angioplasty (PTA)

Answer 15

• Involves the insertion of a catheter through the femoral artery
• Catheter contains a cylindrical balloon
• Balloon is inflated dilating the vessel by compressing atherosclerotic intimal lining
• Stent is placed

Question 16

issues with artery stent

Answer 16

• platelets love it
• monitor for stroke
• piece break off = stroke

Question 17

A nurse is caring for a client following peripheral bypass graft surgery of the left lower extremity. Which of the following findings pose an immediate concern?
(Select all that apply.)
a. Trace of bloody drainage on dressing
b. Capillary refill of affected limb of 6 seconds
c. Mottled appearance of the limb
d. Throbbing pain of affected limb that is decreased following IV bolus analgesic
e. Pulse of 2+ in the affected limb

Answer 17

B, C

Question 18

cryoplasty

Answer 18

• Combines percutaneous transluminal angioplasty and cold therapy
• Liquid nitrous oxide
• solution

Question 19

pad complications

Answer 19

• Nonhealing arterial ulcers and gangrene are most serious complications

May result in amputation
- If adequate blood flow is not restored
- If severe infection occurs

Question 20

overall goals for patients with PAD

Answer 20

• Adequate tissue perfusion
• Relief of pain
• Increased exercise tolerance
• Intact, healthy skin on extremities

Question 21

Frequently monitor after surgery:

Answer 21

• Skin color and temperature
• Capillary refill
• Presence of peripheral pulses distal to the operative site
• Sensation and movement of extremity

Question 22

ambulatory and home care

Answer 22

• Management of risk factors
• Long-term aspirin therapy
• Importance of gradual physical activity after surgery
• Importance of meticulous foot care
• even stent it won’t be same perfusion
• Daily inspection of the feet
• Comfortable shoes with rounded toes and soft insoles
• Shoes lightly laced

Question 23

aorta

Answer 23

• Largest artery in the body.
• Responsible for supplying oxygenated blood to essentially all vital organs.

Question 24

aortic aneurysm

Answer 24

• Local distention of the aortic artery wall.
• Usually thoracic or abdominal.
• Monitored until above 5cm in size.
• Once above 5cm in size, rate of rupture increases and surgery is usually required.

Question 25

reasons for aortic aneurysm

Answer 25

- infection leaves vessels weak - HTN

Question 26

risk factors for aortic aneurysm

Answer 26

- Atherosclerosis: Most common cause - Infection - Inflammatory disorders - Connective tissue disorders - morphan syndrome

Question 27

clinical manifestations aortic aneurysm (thoracic)

Answer 27

- Pain - Shortness of breath, - Hoarseness, cough - frequently asymptomatic - thrill felt or heard

Question 28

clinical manifestations aortic aneurysm (abdominal)

Answer 28

- Abdominal pain - Persistent or intermittent lower back pain (lack of perfusion to kidneys) - Pulsating abdominal mass - frequently asymptomatic

Question 29

aortic aneurysm diagnostic procedure

Answer 29

- CT scan - MRI - X-Ray - Ultrasound

Question 30

nursing interventions for preop

Answer 30

- Maintain systolic BP 100-120. - Give beta blocker/antihypertensives. (Hydralazine) - Continuous nipride IV infusion may be required. - Monitor closely for rupture.

Question 31

rupture of anerusism symtoms

Answer 31

- intense pain - decreasing bp

Question 32

post op

Answer 32

- Careful monitoring of peripheral circulation below level of aneurysm. - Close BP monitoring. +Low BP may indicate hemorrhage +High BP may put stress on suture line - Postop complications

Question 33

post op complications

Answer 33

Arterial occlusion Hemorrhage Infection Renal failure