Term
Peripheral Vascular Disease |
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Definition
Peripheral Vascular Disease •Problems related to arteries, veins, capillaries and lymph vessels-distal to heart •Chronic Problems –Associated with other diseases
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Term
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Definition
Arteries •Consist of 3 Layers –Intima-smooth inner layer –Media-muscular medial layer –Adventitia-fibrous outer layer
•Must be patent •Must be able to constrict and dilate
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Term
Arterial Disorders/Problems |
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Definition
•Etiology –Atherosclerosis –Arterial spasms –Structural defects –Trauma –Blood clots• Failure of Artery= IschemiaTissue necrosis and death |
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Term
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Definition
Same layers as arteries, but with minimal muscular layer •Can stretch more than arteries •Depend on valves and skeletal muscle surrounding them to move blood back to the heart •Must be patent, have valves that function, and muscles around them that work! |
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Term
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Definition
Artery-Capillaries-VeinsHypertension 11 Hypertension •Dx as: Persistent high blood pressure •Almost 60 million people in the United States have elevated blood pressure •Occurs primarily in people between 25 to 55 years •Responsible for over 30,000 deaths each year •Called the "silent killer"-lack of specific symptoms
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Term
Hypertension Factors to Determine |
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Definition
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Term
Hypertension Classification |
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Definition
•Classification of B/P –Diastolic •90 -99 –mild •100 -109 –moderate •110 –119-severe •> 120-hypertensive crisis –Systolic pressure >140 •Pressure exerted during ventricular contraction (CO) –Diastolic pressure •Pressure during ventricular relaxation (PVR)
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Term
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Definition
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Term
Hypertension Secondary Disease Complications Renal |
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Definition
Secondary Disease-Complications –Renal •Glomerulus deprived of blood supply •Renal Failure –Stroke •Cerebral hemorrhage •Decreased blood flow and oxygen supply •Weakened vessel walls
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Term
Hypertension Secondary Disease Complications Retinal |
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Definition
•Secondary Disease-Complications –Retinal complications •Narrowing of retinal arteries •Retinal hemorrhages •Papilledema –Edema of the optic nerve •Blindness –CAD and MI –Aneurysms
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Definition
•With prolonged hypertension –Elastic tissue in the arterioles is replaced with fibrous collagen tissue –Thickened arteriole & decreased distensible –Increased resistance to blood flow –Which increases the blood pressure
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Term
| Hypertension Manifestations |
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Definition
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Term
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Definition
•Essential/Primary Hypertension –Etiology •Unknown OR •Multifactorial –Smoking –Diet –Chronic stress
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Term
Hypertension Secondary Hypertension Caused by other disease process |
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Definition
Secondary Hypertension –Caused by other disease process •Chronic nephritis •Diabetic nephropathy •Hyperthyroidism •PIH •Alcohol •Drugs
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Term
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Definition
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Term
| Non-Modifiable Risk Factors |
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Definition
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Term
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Definition
•Nonpharmacologic –Weight reduction –Diet –Low sodium, low cholesterol, high potassium diet –Smoking cessation –Restrict alcohol and caffeine –Relaxation techniques –Monitor B/P -same time every day –Exercise
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Term
Hypertension Treatment what we would like to use |
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Definition
Well-if we had the "Ideal drug" –No long term toxic or unpleasant side effects –Once daily medication –Would not require complex dosing formulas & trial periods-works great right away –Reduce the number of hypertension related serious illnesses & death –Moderately priced
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Term
Hypertension Treatment What we Really Use |
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Definition
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Term
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Definition
Ht & Wt Edema B/P assessment –Both arms –Supine, sitting, standing –Appropriate size cuff
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Term
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Definition
•Disease process •Diet –dietician •Exercise program •How to take B/P and pulse - •Medications
- –How to take
- –Action
- –S/E
- –Take at the same time every day
- –Change positions slowly
- •Orthostatic hypotension
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Term
Hypertension Teaching Diuretics |
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Definition
Diuretics –Avoid night time dose –High potassium foods •Unless it is K+ sparing (Aldactone) –Cautious use of cold & sinus medications –Know SE •Hypovolemia •Hypokalemia •Hyponatremia •Hypomagnesium •Hypotension
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Term
Hypertension Medications Ace Inhibitors |
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Definition
Ace Inhibitors •Action –Inhibits conversion of Angiotensin I to Angiotensin II –Decreases the secretion of Aldosterone –Reduces peripheral vascular resistance –S/E •Hypotension •Proteinuria (renal damage) •Chronic cough •Dizziness •HA •Fatigue
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Term
Venous Disorders/Problems Etiology |
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Definition
Venous Disorders/Problems •Etiology –Valve defects –Thrombi –Thrombophlebitis-DVT
•Failure of valve= blood pooling in the periphery which allows accumulation of media for bacterial growth. •Eventually this leads to stasis ulcers
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Term
Venous Disorders/Problems Focused Assessment - Objective NV Assessment |
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Definition
•NV assessment –Color •Pallor •Cyanosis –Temp •Cool •Warm –Pulses •Compare bilaterally •Strong/diminished •Palpable/ Doppler –Edema •Amount •Location •Pitting –Sensation •Sharp/dull •Cool/ warm •Paresthesia •Pain –Movement •Passive/active
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Term
Focused Assessment Objective Varicose Veins Cellulitis |
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Definition
•Varicose veins •Cellulitis •Trophic Changes –Thickened nail beds –Appearance of skin –Hair growth (sparse) –Skin Color •Rubor-red/brown (arterial) •Brown-venous stasis (venous)
•Bruits •Lesions or Stasis ulcers
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Term
Focused Assessment - Subjective |
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Definition
•Homan’s sign •Leg cramps/ aching calves •Numbness/ tingling at rest •Intermittent Claudication •aresthesia –Altered sensation –"Gone to sleep"
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Term
Focused Assessment - Subjective Pain |
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Definition
•Pain –Sharp/throbbing –Tenderness –Fullness –Heavy –Continuous/Intermittent –What starts it –What relieves it
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Term
Focused Assessment - Subjective History |
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Definition
•History –Nicotine and Etoh use •Constricts –Diabetes •Microcirculation damage –HTN •Damage to vessels –Thrombophlebitis •Immobility
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Term
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Definition
Arterial | Venous | Absence of hair Small painful ulcerations –lateral malleolus Thick, shiny skin Thick toenails | Brown skin Broad shallow ulcers –medial malleolus Varicosities Eczema, stasis dermatitis Nocturnal aching | Intermittent claudication Cramping with elevation Decreased sensation Itching, thingling, numbness | Legs elevated –decreases pain "Heavy" legs –end of day Pruritus Job history –standing, multiple pregnancies |
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Definition
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Definition
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Definition
Lung/Nuclear Scan •Diagnostic of pulmonary emboli •Compares pulmonary circulation with pulmonary ventilation–Radiographic isotope injected and “tracked” by geiger counter–At the same time isotope is inhaled and tracked as well to determine if areas of the lung are being ventilated •Rapidly being replaced by pulmonary angiography |
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Term
Arterial Aneurysms (Aortic) |
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Definition
Arterial Aneurysms (Aortic) •Medial layer of artery weakens and causes other layers to bulge •Pulsation pressure and blood pressure enlarge the defect •Especially dangerous in patients with HTN |
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Term
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Definition
Etiology –Congenital –Hypertension –Atherosclerotic plaque
•Types –Fusiform •Tubular swelling of arterial wall –Saccular •Weak area on one side of artery –Dissecting •Blood is pushed between artery wall layers causing separation & necrosis
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Term
Aneurysms Common Locations |
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Definition
Aneurysms •Common locations –Thoracic Aorta –Abdominal Aorta –Cerebral •Circle of Willis |
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Term
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Definition
Aneurysms •S/S-depends on location –Pulsating mass –Bruit –Visual changes –Frequent headaches –Mostly silent until rupture
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Definition
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Definition
Aneurysm-RUPTURE!! •S/S –Sharp pain –Chest pain –Dyspnea –Intense headache –Visual changes –Photophobia –Extreme rise in BP
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Term
Aneurysms Diagnosis Treatment |
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Definition
Aneurysms •Diagnosis –X-ray –US –Chest/ Abdominal CT –Angiogram •Treatment –Graft replacement •Triple A •Organs distal cut off from blood flow –Coil embolization or "coiling" –Clipping •Prevention –Antihypertensives |
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Definition
Aneurysms •Nursing management –Monitor vitals •Shock –Pulses •Distal –Tissue perfusion –Pain meds –DO NOT PALPATE A PULSATING MASS!!! |
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Term
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Definition
Arteriosclerosis •Thickening, loss of elasticity or plaque formation in the intima or medial layers of the artery •Obstructs blood flow •Etiology-Unknown –Hypertesion –Aging –Hyperlipidemia –Diabetes |
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Term
Arteriosclerosis Risk Factors |
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Definition
Arteriosclerosis •Risk Factors –Age –Sedentary –Family hx –Uncontrolled HTN –Poor diet •Elevated lipids –Chol and triglycerides –Smoking –Diabetes Mellitus |
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Term
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Definition
Arteriosclerosis •Symtoms –Claudication (intermittent) –Pain at rest •Burning •Decreases with dangling –Distal to occlusion •Coolness •Color-mottled •Decreased pulses to absent-COMPARE •Ulceration/ gangrene |
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Term
Arteriosclerosis Treatment |
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Definition
Arteriosclerosis •Treatment –Stop smoking –Diet •Decrease sat fat and chol –Control HTN –Vasodilators Blood pressure –Surgery •Graft by-pass •Endarterectomy •Amputation of extremity –Multiple nursing concerns |
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Term
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Definition
Buerger-Allen exercises •Increases peripheral blood circulation –Lay supine –Elevate legs above heart for 2 min or until blanched –Lower legs and flex and extend feet for three min until pink –Lay flat for 5 min –Repeat X6 TID or QID |
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Term
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Definition
Raynaud’s Disease •Abnormal vasoconstriction of extremities (especially the hands) •Primarily effects females 18-40 y/o •S/S-r/t exposure to cold or emotional distress •Hx of symptoms for 2 years to properly diagnose |
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Term
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Definition
Raynaud’s Disease •S/S –Chronic cold hands and feet –Attacks of pallor to cyanosis to digits –Numbness and pain –Followed by •Intense redness •Tingling •Throbbing (reactive hyperemia |
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Term
Raynaud’s Disease Treatment |
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Definition
Raynaud’s Disease •Treatment –Keep warm –Decrease stress –Stop smoking –Vasodilators –Ca++ channel blockers •Cardizem, Verapamil, Procardia –Extreme cases •Amputation or Sympathectomy |
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Term
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Definition
Arterial Embolism •Sudden occlusion of an artery by a foreign substance or blood clot •Cuts off blood flow –#1-blood clot –Air –Fat –Catheter |
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Term
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Definition
Arterial Embolism •S/S –Sudden onset of pain •Coldness •Numbness –Burning or aching in extremities –Decreased or absent pulses –Pallor or cyanosis –Sharp line of color and temp demarcation |
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Term
Arterial Embolism Treatment |
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Definition
Arterial Embolism •Treatment –Bedrest –Anticoagulants –Thrombolytics –Treat shock if necessary –Embolectomy –Chronic •Vena cava umbrella (filter) |
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Term
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Definition
Pulmonary Embolus •Obstruction of the pulmonary artery or its branches •Etiology –Sudden onset –Usually caused by embolus from thrombus in lower extremity (DVT) |
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Term
Pulmonary Emboli •S/S -primary |
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Definition
Pulmonary Emboli •S/S -primary –Sharp chest pain –Dyspnea –Cyanosis –Confusion –Hemoptysis –Fever –Tachycardia |
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Term
Pulmonary Emboli Diagnostics |
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Definition
Pulmonary Emboli •Diagnostics –Pulmonary angiogram –VQ scan –EKG –ABG |
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Term
Pulmonary Embolus Treatment |
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Definition
Pulmonary Embolus •Treatment –Notify the Physician!!! –Thrombolytics •TPA-Tissue plasminogen Activator •Streptokinase •Urokinase) –Emergency Surgery •Embolectomy •Vena Caval filter •Blood flow must be restored |
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Term
Pulmonary Embolus Nursing Care |
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Definition
Pulmonary Embolus •Nursing Care –Stay calm (you AND the patient) –Prevention •TEDs –Off 20 min twice a day •SCDs •Leg exercises •Hydration •Don’t place things behind knees –Support respiratory function •Elevate HOB •O2/ Ventilate if needed •ABG’s •BEDREST |
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Term
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Definition
Thrombolytics •Actually dissolves blood clots involving –Coronary artery thrombi –Deep vein thrombi –Pulmonary embolism –Cerebral artery thrombi •Binds to fibrin –Converts plasminogen to plasmin and degrades fibrin |
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Term
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Definition
Thrombolytics •Used with risk to major organs –Heart –Lung –Kidney –Brain •High Risk for Bleeding –Dissolves ALL clots –Hemorrhagic CVA –Intracranial Bleed •HA •N/V •Confusion |
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Term
Varicose Veins Pathophysiology |
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Definition
Varicose Veins •Pathophysiology –Enlarged veins –Engorged with blood –Incompetent Valves –Vessel wall weakness |
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Term
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Definition
Varicose Veins •Etiology: 40-60 y/o female –Congenital absence of valves –Increased pressure •pregnancy/ tumor/ ascites –Prolonged standing –Constrictive clothing –Obesity •Deep varicose veins create venous stasis resulting in venous insuffiency |
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Definition
Varicose Veins •S/S –Darkened swollen veins –Heavy feeling in legs –Pain/fatigue –Muscle cramps –Edema –Brown discoloration of skin |
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Definition
Varicose Veins •Dx –Venogram –Doppler US –Brodie Trendelenburg method |
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Term
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Definition
Varicose Veins •Brodie-Trendelenburg Method –Lie flat and elevate the affected leg to empty blood from vessels –Apply soft tourniquet to upper thigh to restrict venous filling –Stand and walk around then release tourniquet –Compare before and after |
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Term
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Definition
Varicose Veins •Treatment –Elevate legs whenever possible at least q 2-3 hours –Elastic stockings-support vessels –Lose weight –Elevate legs when sitting –Exercise |
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Term
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Definition
Varicose Veins •Treatments –Vein ligation/stripping •Saphenous vein is tied at femoral junction •Vein is stripped/ligated from ankle to groin –Sclerotherapy •Inject superficial veins with a sclerosing solution (hypertonic saline) •Permanent obliteration |
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Term
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Definition
Thrombophlebitis •Inflammation of vein accompanied by a clot •Etiology (Virchow’s Triad) –Venous stasis –Damage to vessel wall –Blood hypercoaguability –R/T •Major surgery •Immobility •MI •BCP •Pregnancy •IV’s •Dehydration |
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Term
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Definition
Thrombophlebitis •S/S –Positive Homans’ sign –Skin over vein •Reddened •Swollen •Warm •Tender |
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Term
Thrombophlebitis Treatment Prevention |
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Definition
Thrombophlebitis •Treatment –Bedrest-do nothing that could break the clot loose –No massage –Warm, moist soaks-WMS –Anticoagulants –Elevate leg without pressure under the knee •Prevention –TEDS/ SCD’s –Hydration –DO NOT PUT PILLOWS BEHIND KNEE |
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Term
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Definition
Anticoagulants •Heparin –Inactivates thrombin –IV or SQ-Never IM –Elevates PTT –Antidote-protamine sulfate –SQ-abd no aspiration or massage –Decrease platelet response •Coumadin –Works on prothrombin –PO –Elevates PT/INR –Antidote-Vit K –Slow build up in blood |
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Term
Anticoagulants Side Effects Contraindications |
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Definition
Anticoagulants •Side Effects –Bleeding/ hemorrhage –Occult bleeding (stool or urine) –Bruising –Gums bleeding –Back pain –Petechiae •Contraindications –Anyone with history of bleeding probs –Ulcers –Recent surgery (can be done but very cautiously |
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Term
Surgical Techniques with PVD Sympathectomy Thrombectomy/Embolectomy |
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Definition
Surgical Techniques with PVD •Sympathectomy –Excision of a portion of the sympathetic division of the ANS which supplies peripheral vessels –Relieves vasoconstriction •Thrombectomy/Embolectomy –Open vessel and remove clot –High risk for CVA –Frequent neuro checks |
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Surgical Techniques with PVD Graft Replacement |
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Definition
Surgical Techniques with PVD •Graft Replacement –Excision of aneurysm –Removed tissue replaced with graft •fem-popfem-femaorta-fem •Endarterectomy –Removal of artery lining (intima) from occluded vessel –Carotid/Femoral/ Popliteal •Assess distal to surgical areas |
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Surgical Techniques With PVD Amputation |
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Definition
Surgical Techniques with PVD •Amputation –Removal of limb –Preop •prepare psychologically –Post-op •High risk for bleeding •Elevate limb for 24 hours or more to decrease bleeding and swelling •Maintain extension to decrease contractures •Monitor VS-shock •Monitor dressing and stump –Nursing Considerations •After stump shrinks may have prothesis •Phantom limb pain •PT/Rehab |
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Term
| Implementation and teaching for PVD |
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Definition
Implementation and Teaching for PVD •Keep warm •No restrict. clothing •Elevate Legs •TED’s SCD’s •Progressive Exercise •Buerger Allen exercises •Avoid nicotine •Protect from injury •Keep linen off feet •Daily foot assessment •Encourage fluids •Weight management •Foot care by Dr. •Proper fitting shoes •White socks |
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