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Acute Arterial Occulusion/arterial embolism
- trauma, embolism, thrombosis
- emobolus from heart- A.fib, MI, prosthetic heart valve
- 90% in lower limbs
- no time for collateral circulation
- muscle necrosis starts as early as 2-3 hrs
- - d/t anarobic metabolism- lactic acid- pain
- this happens so fast
- prior 2 weeks MI or arrthimia
- - inc thrombi, emboli
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Clinical manifestation- acute arterial occulusion- P's 6
- Pain or loss of sensory nerve- distal to occulsion occurs at rest
- Paresthesisas & loss of position sense
- Poikilothermia- cool , irreg, varies- cool- cold
- Paralysis
- Pallor- mottle to necrosis
- Pulselessness
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Acute Arterial treatment
- depends on time since symptom onset
- tx immediate
- surgery-
- - revasculation tx: thrombectomy, angioplasty, arterial revasculation
- - embolus- embolectomy
- - amputation0 worst, gangrene
- Medical- fibrinolytic or IV heparin
- goal- preserve the tissue and save limb
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Nursing consideration- acute arterial
- assessment- # 1 pulse, color, temp, CSM
- Bedrest- dec metabolic demand
- warm environment- no direct heart on leg
- protect limb from pressure
- keep limb level to slightly dependent
- +/- heparin- if med tx or surg delay- b/c if going to surgery
- - cont x2-7 d after surgery, then po anticoagulant long term
- - may Trental (Pentoxyifylline)
- --- s/e bleeding, dizzy, H/A, incr flexibility of rbc- so it could get thru easier. platelet aggregation so they dont stick. helps symptoms not a cure
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Arterial Ulcers
- maybe caused by local pressure
- usual sites medial & lateral metatarsal heads & tips of heels
- very painful, dry, black,punched out
- heal poorly if at all
- may need arterial revascularization of leg
- - this is to re-estab blood flow
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nursing consideration for arterial ulcers
- BR- dec O2 demands
- keep clean and free of pressure/irritation (footcradle, etc)
- +/- debridement followed by moisture retaining dsg
- +/- whirlpool therapy debridment- wound vac
- patient teaching- risk factor
- - poor circulation
- - # 1 artheoscelorosis
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Chronic Arterial Occlusion
- ** Artherosclerosis
- collateral circulation over time
- more common in LE- aortoiliac & femoral
- risk factor
- - smoking, DM, HLD, sendentary lifestyle, HTN, age, gender, ethnicity, FH
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chronic arterial occlusion manifestation
- ** intermittent claudification** to rest pain- worst slow circulation
- dusky, purplish discoloration and or rubor with legs dependent, pallor with elevation
- +/- coldness
- weak or absent pulses
- hypertrophied toenail
- tissue atrophy
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manifestation chronic arterial occulaton
- ulcerations
- parasthhesias
- ABI
- arteriography
- - dec blood flow
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Medical management- chronic arterial occlusion
- for mild to mod disease (no rest pain)
- - exercise- gradual progression, rest periods- improve circulation to feet
- - wt loss
- - health diet- dec fat, na, inc fiber
- - smoking cessation
- - control lipid levels
- - meds- antihyperlipidemics, vasodilators
- walk to pain/discomfort then rest
- inc vit b, folic acid
- - helps with walking
- - genko helps- becareful of interaction warafin
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chronic aterial- altered tissue perfusion
- mild- sitting with feet flat- no crossing legs
- avoid legs above heart- dec circulation
- warm room, pre-heat car, no direct heat to limb- promote vasodilation
- prevent vasocontriction- avoid nicotine, high emotion, chilling
- severe- 'arterial position'
- - watch for edema
- - legs in neutral position
- - no elevation
- - no blood flow
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nursing consideration- chronic arterial
- pain- can be difficult to control
- - neurotin
- risk activity intolerance- pt with ulcer, gangrene, rest pain, cellulitits, should not excerise
- - no blood flow so if you move it will make things worst
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surgical management- chronic arterial
- PTCA- sames as with cardiac- stents +/-
- peripheral arthectomy
- - care like PTCA
- improve blood flow
- - worry about pulses
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surgical management other chronic arterial
- endarterectomy as with carotids
- - worry about bleeding, pressure points, pulses
- thrombolytic therapy
- - intra arterial streptokinase, tpa
- - strict bleeding precaution__
- - massive bleed GI, intracranial
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surgical management- arterial bypass
- saphenous vein or synthetic graft
- name according to anatomy- axillofemoral, fem-pop, fem-tibial, fem-peroneal
- - creating pathway to improve blood circulation
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nursing consideration- preop/post op
- pre-op= document and mark pulses
- post-op-
- - BR with leg flat first night- no flexion
- - leg edema COMMON may last for 4-8 weeks
- - CSM extremity with VS (BP)- no pillow under knees
- - no leg crossing
- - bleeding precautions- +/- anticoags, antiplatelets
- may have pain after surgery- normal
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