Peripheral Vascular Diseases

  1. what is an oral anticoagulant?
  2. parenteral anticoagulants
    • heparin
    • lovenox
  3. oral antiplatelet agents?
    aspirin, clopidogrel (Plavix) and dipyridamole (Persantine, Aggranox- includes aspirin)
  4. a blood viscosity reducing agent?
    pentoxifylline (Trental)
  5. antidote for heparin?
    protamine sulfate
  6. antidote for warfarin?
    Vit K
  7. does Hep dissolve clots?
    • NO, prevents formation
    • prevents thrombin from converting fibrinogen to fibrin
  8. therapeutic range for Hep?
    • PTT - 20-36 secs
    • therapeutic is up to 2.5 times normal
  9. therapeutic level for coumadin?
    • PT 11-13, therapeutic is 1.5-2 times
    • over 20 needs to be looked at
    • INR is 2-3
  10. main SE of antiplatelet meds?
    GI bleeding, bruising, hematuria, tarry stools
  11. what are interventions for antiplatelet meds?
    determine sensativity before admin, VS take w/food if GI upset, monitor bleeding time, and for SE of bleeding
  12. HIT or HAT?
    • heparin induced thrombocytopenia, may develop on 8th day of therapy
    • may reduce platelet count to 5,000
  13. name 3 arterial disorders
    • arteriosclerosis- arteries
    • atherosclerosis- intema of large and medium arteries- lipid accumulation
    • Plaque or atheromas- injuries
  14. name 2 types of atherosclerotic lesions
    • fatty streaks
    • fibrous plaque
  15. what is collateral circulation?
    growin more blood vessels around the structure involved
  16. pathophys of atherosclerosis?
    due to damage of the vessal wall, caused by sheering stresses and turbulent flow, there is injury to the endothelium.
  17. high risk factors for an arterial disorder?
    • HTN
    • smoking
    • high fat diet
    • hereditary & sedentary lifestyle
    • DM
    • hyperlipidimia
  18. what are medical treatments for arterial disorders?
    • Angioplasty PTA
    • vascular stents- balloon on femoral artery, blown up, backed out-leg, kidney, lungs
    • Surgery
    • pharmacological managment- aspirin, coumadin, heprain, Plavix, trental
  19. NANDAs?
    • Alertation of peripheral tissue perfusion
    • Pain
    • risk for impaired skin integrity
    • knowledge deficit
  20. Nursing interventions for arterial disorders?
    • (cautiously) apply warmth
    • avoid cold
    • stop smoking
    • avoid constrictive clothing
    • relief of pain
    • avoid trauma to extremities
    • lower cholesterol, increase protein
  21. S/S of intermittent claudication?
    • pain, ache, fatigue, burning, discomfort to muscles of feet, calves or thighs
    • symptoms start during exercise and go away with rest
  22. what is intermittent claudication?
    narrowing or blocking the main artery taking blood to the leg due to hardening of the arteries (atherosclerosis)
  23. what is a bruit, a thrill?
    • bruit- sound made over a narrowing
    • thrill- feel of the turbulence
  24. what are the med/surg managments for peripheral arterial occlusive disease?
    • exercise- start slow
    • weight reduction
    • stop smoking
    • vascular grafting- anastomosis (artificial of one of their own)
    • eddarterectomy- cleaning out
    • femoral/popliteal graft-own autogolous graft best
    • amputation
  25. nursing interventions Post op?
    • VS Q 15 min 1st hr, Q 30 min 2nd hr the Q hr for 24 hrs
    • check distal circulation!
    • dopplers signal checks Q at least 2 hrs
    • notify surgeon immidiatley if loss of pulse, change in color-pale, temp-cold, bleeding
    • BP management, pain
  26. what is Thromboangitis Obliterans or Burger's disease?
    recurring inflammation of the intermediate and small arteries
  27. S/S of buerger's disease?
    pain, cold sensativity, digital rest pain constantly present rubur (reddish-blue discoloration of the feet
  28. what is treatment for Burgers disease?
    same as atherosclerotic peripheral disease
  29. what are aortitis and aortaliliac diseases?
    inflammation of the aorta
  30. what is an aortic aneurysm?
    loacalized sac or dilation involving an artery formed at a weak point in the vessel wall
  31. who does the aortic aneurysm most often affect? what part of the aorta and how many die?
    • Men 40-70
    • the thoracic segment
    • and 1/3 die from rupture
  32. S/S of an aortic aneurysm?
    • pain- constant and boring to back
    • dyspnea, hoarseness, loss of voice from pressure of the sac against trachea, main bronchus or lung
    • pulsatile mass of the abdomen
  33. signs of an impending ruptire of aortic aneurysm includes
    severe back or abdominal pain
  34. nursing considerations for pt with an aortic aneurysm?
    dont palpate, you can hear systolic bruit over the mass, the aneurysm will be reassessed Q 6 monthsif it is 5-7 cm
  35. what are the signs of a dissecting aorta?
    • Unrelievable PAIN
    • pt will show signs of shock
  36. Dx of dissecting aorta?
    angiogram, CT scan, transesophageal echocardiography, duplex ultrasound, MRI
  37. Medical treatment of arterial embolism?
    • embolectomy- stent to pull clot out
    • thrombolytic therapy- to dissolve clot, cant use if pt has had surgery within past 6 months
  38. what are the 5 P's / symptoms of an arterial embolism?
    • Pain
    • Pallor
    • Pulselessness
    • Parethesia
    • Paralysis
  39. what are risk factors for getting an arterial embolism?
    • atrial fibrillation (should be on anticoagulants)
    • trauma- DIC, crush injury
  40. what is the medical managment for arterial embolism or thrombosis?
    heparin therapy w/inital bolus of 5000 to 10,000 U followed by continous drip at 1000 U per hr. a PTT. Heparin prevents further clotting
  41. Raynaud's disease?
    intermittent arteriolar vasoconstriction due to stress or cold
  42. S/S of Raynaud's disease?
    coldness, pain, pallor of the fingertips, toes and ears
  43. who does Raynaud's disease most commonly occur in?
    women 16-40 years old
  44. Mngmnt of Raynauds disease includes?
    • avoid cold, no smoking
    • Ca channel blockers
    • use hot mitts to get ice trays
  45. Venous disorders can cause?
    thrombophlebitis, DVT, leg ulcers, varicose veins
  46. treatment for venous disorders?
    exercise, anticoagulant therapy- coumadin
  47. what lab test will be ordered to monitor therapy for DVT?
    CBC coagulation panel, aPTT, D-Dimer
Card Set
Peripheral Vascular Diseases
Exam #3