How doe we measure flow rate?
Flow rate = pressure difference/resistance
What are you assessing for with (PAD) Peripheral Arterial Disorder? List 5
- intermittent claudication
- absent or diminished pulses
- oedema- none or minimal
- skin changes= cold/dry/shiny/thick opaque toe nails
- pallor when elevated
- red when dangling
- ulcers
What are you assessing for with (PVD) Peripheral Venous Disorders? List 3
- pain= aching cramp like that is relieved by activity or elevation
- pulses usually present
- oedema=present/increases by the end of the day
- skin changes
- ulcers
What is intermittent claudication?
pain caused by the inability of the arterial system to provide adequate blood flow to the tissue of face of increased demands for nutrient during exercise.
- muscular cramping (ischaemic) type pain that usually resolves within 10 minutes of rest.
- caused by arterial supply failure.
- lack of blood supply of oxygen/nutrients when increase in demand
Where is the most common site for atherosclerotic obstruction?
Most common place for atherosclerotic obstruction to occur is in the Illiac and common femoral arteries.
List 5 modifiable risk factors for PAD.
- smoking
- diet
- hypertension
- hyperlipidaemia
- diabetes
- obesity
- stress
- sedentary lifestyle
- c-reactive protein (inflammation)
- hyperhomocysteinemia (clotting factor)
List at least 2 non modifiable risk factors for PAD?
- age
- gender
- genetics
List 2 complications that can occur with PAD.
- Atrophy of skin/nerves/muscles
2. Delayed healing/wound necrosis/infection/gangrene
What is an Arterial Aneurysm?
An aneurysm is a localised sac or dilation formed at a weak point in the wall of the aorta.
-it causes a ballooning effect in the blood vessel.
Explain the nursing process of an assessment on a pt with PAD?
-health hx =medications, risk factors
-clinical manifestations of arterial insufficiency =
claudication and rest pain, colour changes, weak and absent pulses, skin changes and skin breakdown
-arterial/venous/lymphatic (medical) diagnosis made
What type of nursing care would we be implementing with a pt who has altered tissue perfusion?
- Exercise and activities:
- walking (stop with pain-gradually increase tolerance)
- graded isometric exercises (promotes circulation and development of collateral circulation)
- specialist advice before commencement (contraindication include leg ulcers/cellulitis/thrombotic occlusions)
- Position strategies
- Temperature
- effects of heat (vasodilation) or cold (avoid)
- Stop smoking
- Stress reduction (counselling)
What would we be trying to plan for with a pt with altered tissue perfusion?
- increase arterial blood supply (dependant on what stage they are at)
- promote vasodilation
- prevent vascular compression
- pain relief management
- attainment or maintenance of tissue integrity
- adherence to self-care programme
Due to poor nutrition and oxygen supply the extremities are susceptible to injury/infection/poor healing in people who suffer from altered peripheral tissue perfusion. What nursing interventions would we try to implement to counteract this?
- protection of extremities and avoidance of trauma
- good hygiene/gentle soap/moisturisers
- regularly inspecting the extremities for infection and inflammation
- podiatric care (footwear and nail care)
- not wearing constricting clothing
- good nutrition (weight reduction if necessary)
- stop smoking
- pt education
what nursing management would we performing on a pt who has undergone peripheral arterial bypass graft?
- vital signs
- neurovascular obs (pulses)
- graft patency obs(doppler)
- ABI (ankle brachial index) performed 8hrly
- IDC (1hrly measures)
- complex invasive line care
- wound care (bleeding/haematoma)
- elevation of extremity/ gently exercise
- graduated compression stockings
- analgesia
- discharge advice/pt education
- care of co-morbidities
what is an arterial aneurysm?
an aneurysm is a localised sac or dilation formed at a weak point in the wall of the aorta.
who is at risk of an aortic aneurysm?
- atherosclerosis (most cases)
- genetic link
- congenital wall weakness
- trauma/disease/inflammation
- smokers
- pt with hypertension
- those who have already have one formed as they tend to enlarge
what are the clinical manifestations of an aortic aneurysm?
clinical manifestation do vary as often it can be asymptomatic/varies.
-pain/throbbing/”beating”
-ascending = distended neck vessels, oedema, venous return interruption, dysphagia, voice hoarseness
-thoracic= deep spreading chest pain
-abdominal= back pain, bowel pressure/palpable/bruit (narrowing of an artery)
thrombosis of smaller vessels
how would we be diagnosing an aortic aneurysm?
- routine examination
- chest x-ray (calcification/widening of aorta)
- ECG (to rule out MI)
- ultrasound/CT scan/MRI scan
- Echocardiology -aortic insufficiency
- possible Angiography (to rule out any other vessel involvement)
What post operative care would we be doing on a pt who has had an open repair of an ascending aortic aneurysm?
- vital signs/neurovascular obs (frequently/regularly)
- monitoring for signs of occlusion/thrombosis/emboli
- monitoring all systems (resp/renal-IDC=1hrly)
- monitoring temp (graft rejections) =4hrly
- assessing the site/wound - haematoma/ ooze/ inflammation
- 1st or 2nd day post op trying to get them ambulating (dependant on facility/surgeon)
list the top 3 things a nurse should be trying to implement as preventative measures for a pt at risk of DVT?
- compression stockings= need to be fitted correctly
- Pneumatic compression devices= SCDs/ICDs
- Drugs (anticoagulants) =heparin/enoxaparin/warfarin(phasing out)
What is the treatment for a pt who has been diagnosed with DVT?
- prevent further growth and fragmentation (into PE)
- bed rest with limb elevation
- anticoagulants (to prevent further thrombi)
- eventually mobilise with quality stockings
For a pt receiving anticoagulant therapy what nursing assessments would we as nurses be performing?
- monitoring vitals
- monitoring COAG test results
- inspecting skin for bruising/bleeding
- testing urine and faeces for blood regularly
- monitoring antiembolic stockings
- weighing the benefits of medication versus becoming a falls risk
List the contraindications in using Pneumatic Compression Devices/stockings?
May be contraindicated for:
- the obese (can’t fit correctly or may torniquet the limb)
- heart failure
- certain conditions or diseases of the lower limbs
- diabetic neuropathy
- severe oedema of the lower limb
List some adverse events that may occur from using Pneumatic Compression Devices.
- nerve palsies
- paraesthesia of legs/feet
- compartment syndrome
- pressure ulcers
- slipping while walking
