- Ascending Aorta - Aortic Arch - Thoracic Arch - Abdominal Aorta

PVD Flashcards by 10 - COLOBONG, DIANA YSABEL

Three layers in blood vessels:

Tunica intima
Tunica media
Tunica externa

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forms a friction-reducing lining
Endothelium

Tunica intima

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Smooth muscle and elastic tissue
Controlled by sympathetic nervous system

Tunica media

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forms protective outermost covering
Mostly fibrous connective tissue
Supports and protects the vessel

Tunica externa

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have a heavier, stronger, stretchier tunica media than to withstand changes in pressure

Arteries

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have a thinner tunica media and operate under low pressure
also have valves to prevent backflow of blood
Lumen is larger
Skeletal muscle “milks” blood here toward the heart

Veins

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Only one cell layer thick
Allow for exchanges between blood and tissue

Capillaries

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Form networks that consist of:
- A vascular shunt
- True capillaries

capillary beds

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Blood flow through a capillary bed is known as

microcirculation

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A permanent localized
dilation of an artery,
which enlarges the artery
to at least 2 times its
normal diameter

ANEURYSM

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diffuse dilation affecting the entire circumference of the artery

Fusiform

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an outpouching affecting
only a distinct portion of the artery

Saccular

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what specific anatomic sites
is aneurysm most common?

abdominal aorta.

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Aneurysm forms when
the ____ of the artery is
weakened, producing a
stretching effect in the
inner layer (T. intima) and
outer layers (T. adventitia)
of the artery

middle layer (T.
media)

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most common cause of all
aneurysm with hypertension & cigarette smoking
being contributing factors

Atherosclerosis

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signs of rupturing AAA

hypotension
diaphoresis
mental obtundation,
oliguria
dysrhythmias
S/S of hypovolemic shock
DIAGNOSTI

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reveals “eggshell” appearance in cases of AAA

X-ray

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Standard tool that determines the size and location or aneurysm

CT scan

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Nonsurgical management of aneurysm:

frequent CT scanning
maintenance of BP
treated with
anti-hypertensive agent

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surgical management of aneurysm:

Abdominal Aortic Aneurysm
Resection

Goal: to secure a
stable aortic integrity & tissue
perfusion throughout the
body

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excision of aneurysm from the abdominal aorta to prevent or repair the rupture

Abdominal Aortic Aneurysm
Resection

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Disorders that alter the natural flow of blood
through the arteries & veins of the peripheral
circulation

PERIPHERAL VASCULAR DISEASE

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most frequently affected are the lower
extremities

PERIPHERAL VASCULAR DISEASE

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AORTIC BRANCHES:

Ascending Aorta
Aortic Arch
Thoracic Arch
Abdominal Aorta

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noninvasive technique that provides accurate diagnosis, as well as information about the size & location of AAA

Ultrasonography

Pain: Intermittent claudication

Arterial insufficiency

Pain: aching, cramping

Venous insufficiency

Pulse: diminished or absent

Arterial insufficiency

Pulse: present, assessment may be difficult due to edema

Venous insufficiency

Skin: dependent rubor

Arterial insufficiency

Skin: increased pigmentation in the gaiter area

Venous insufficiency

Location: tip of toes, heels (pressure areas)

Arterial insufficiency

Location: medial malleolus, lateral malleolus, anterior tibial areas

Venous insufficiency

Depth: deep, may affect the joint

Arterial insufficiency

depth: superficial

Venous insufficiency

Shape: circular

Arterial insufficiency

Shape irregular

Venous insufficiency

Ulcer base: pale to black, dry gangrene

Arterial insufficiency

Ulcer base: granulation tissue

Venous insufficiency

Leg edema: minimal

Arterial insufficiency

Leg edema: moderate to severe

Venous insufficiency

Thickening or hardening of the arterial wall

Arteriosclerosis

A type of arteriosclerosis that involves the formation of plaque within the arterial wall

Atherosclerosis

involves the distal end of the aorta & the common, internal, external iliac arteries (located above the inguinal ligament)

INFLOW OBSTRUCTION

involves femoral, popliteal & tibial arteries (below the superficial femoral artery)

OUTFLOW OBSTRUCTION

- Most common cause - Risk factor includes hypertension, hyperlipedimia, DM, CIGARETTE SMOKING, obesity & familial predisposition

ATHEROSCLEROSIS

discomfort in the lower back, buttocks or thighs

Inflow disease

burning or cramping in the calves, ankles, feet & toes

Outflow disease

- Intermittent claudication - Rest Pain - Loss of hair on the lower calf, ankle & foot; - dry, scaly, dusky, pale or mottled skin - thickened toenails - Cold extremity & cyanotic - pallor occurs when the extremity is elevated - Diminished or absent distant peripheral pulses

PERIPHERAL ARTERIAL DISEASE

PERIPHERAL ARTERIAL DISEASE DIAGNOSTIC ASSESSMENT:

* Arteriography * Segmental Systolic BP measurements * Ankle-Brachial Index (<0.9) * Exercise Tolerance Testing

medications to PERIPHERAL ARTERIAL DISEASE:

Pentoxifylline (Trental) Aspirin

PERIPHERAL ARTERIAL DISEASE SURGICAL INTERVENTIONS:

- Percutaneous Transluminal Angioplasty (PTA) - Laser-Assisted Angioplasty - Bypass procedures

- Reserved for clients with smaller occlusions in the distal superficial femoral, proximal popliteal & common iliac arteries - Heat from the laser vaporizes the arteriosclerotic plaque to open the occluded or stenosed artery

Laser-Assisted Angioplasty

- grafts preferred are saphenous vein, cephalic or basilic arm veins, synthetic materials such as polytetrafluoroethylene, GoreTex & Dacron

Bypass procedures;

recurring inflammation of the intermediate and small arteries and veins of the lower and upper extremities

BUERGER’S DISEASE (THROMBOANGIITIS OBLITERANS)

- Pain - Instep claudication - Aggravated by emotional disturbances, nicotine or chilling - Sensitivity to cold - Dependent rubor - Absent or diminished radial or ulnar pulses - Digital ulceration and gangrene

BUERGER’S DISEASE

NURSING INTERVENTIONS IN BUERGER’S DISEASE:

- Complete abstinence from tobacco - Avoid to extreme cold

Caused by vasospasm of the arterioles and arteries of the upper & lower extremities

RAYNAUD’S DISEASE

- blanching of the extremities occurs followed by cyanosis - Numbness, coldness, pain. swelling - ulcers may also be present

RAYNAUD’S PHENOMENON

management in raynauld's disease:

● Calcium Channel Blockers – potent vasodilator ● Nifedipine – first choice ● Sympathectomy

first choice medication for raynaulds disease

Nifedipine

- Calf or groin tenderness & pain - unilateral swelling of the leg - Localized edema in one extremity may suggest thrombophlebitis

DEEP VEIN THROMBOSIS

DO NOT MASSAGE THE AFFECTED EXTREMITY!!!

DEEP VEIN THROMBOSIS

management for DEEP VEIN THROMBOSIS:

Rest – supportive therapy; bed rest & elevation of the extremity

Drug therapy for deep vein thrombosis:

anticoagulant

- prevent formation of other clots & prevent enlargement of the existing clot. - discontinued if there is severe - heparin-induced thrombocytopenia & thrombosis (due to platelet aggregation) - SE: Bleeding

UNFRACTIONATED HEPARIN Therapy

- Works in the liver to inhibit synthesis of the four vitamin K-dependent clotting factors - Takes 3-4 days before it can exert therapeutic anticoagulation

WARFARIN Therapy

- recombinant tissue plasminogen activator, Alteplase, Reteplase - effective in dissolving clots or preventing new clots - serious complication: intracerebral bleeding

THROMBOLYTIC Therapy

Antidote for heparin

Protamine sulfate

Dilated tortuous veins

VARICOSE VEINS

COMMON AFFECTED SITES in varicose veins:

saphenous leg veins (lack support from surrounding muscles) ● also occurs in - Rectum : Hemorrhoids - Esophagus : Esophageal varices

ASSESSMENT OF VARICOSE VEINS:

- Legs feel heavy & tired - Leg veins look distended & tortuous seen under the skin as dark blue or purple, snakelike elevations - Feet, ankles, legs may appear swollen

VARICOSE VEINS STAGES:

1. Reticular or spider veins 2. Varicose veins or venous nodes 3. Edema of the lower legs 4. Varicose eczema or trophic ulcer

MILD VARICOSE VEINS MANAGEMENT:

* exercise (walking, swimming) * losing weight * wearing elastic support stockings * avoidance of prolonged sitting & standing

SEVERE VARICOSE VEINS MANAGEMENT:

* Vein ligation * Vein stripping * Sclerotherapy

veins are tied off above & below the area of incompetent valves, but the dysfunctional vein remains

Vein ligation

ligated veins are severed & removed

Vein stripping

Injection of chemical in the varicose veins to scar and close it

Sclerotherapy

PVD Flashcards

(78 cards)