1. T or F: PAD is asymptomatic until 50% blockage occurs
    False: 60-75%
  2. What is the number 1 risk factor for PAD? What are the other risks?
    • #1: Smoking
    • DM, Hyperlipidemia, Increased C reactive protein, uncontrolled HTN, obesity, stress
  3. Fill in:
    This is the number cause of PAD in 90% of all cases
  4. This cause of PAD is 90% of all cases, and is d/t inflammation and endothelial injury
  5. This term is a symptom of PAD that is characterized as pain with walking or exercise and is relieved with rest
    Intermittent Claudication (caused by too little blood flow)
  6. Are these common locations of PAD typically found on a diabetic or non diabetic patient:

    - Anterior or posterior Tibial areas
    - Peroneal Arteries
  7. Are these common locations of PAD typically found on a diabetic or non diabetic patient:

    - Femoral popliteal
    - Femoral bifurcation
    - Aortoiliac bifurcation
    Non diabetic
  8. T or F: a sign of PAD is a weak or absent pulse
  9. List the Ankle/Brachial Index ranges for each:
    1. Normal
    2. Mild
    3. Moderate
    4. Severe
    • 1) 0.91-1.3
    • 2) 0.71-0.90
    • 3) 0.41-0.70
    • 4) 0.00-0.40
  10. How is the ankle/brachial index done?
    • Done by dividing ankle systolic BP by brachial systolic BP
    • Right ABI: Right ankle pressure / Both arm pressure
  11. T or F: Diabetics may get falsely high ABI measurements
  12. List drug types to manage PAD (5)
    • 1. Statin (simvastatin, atorvastatin)
    • 2. Antiplatelet (aspirin, plavix)
    • 3. ACE inhibitors (ramipril)
    • 4. Blood Viscocity reducing agent (pentoxifyiline)
    • 5. Phosphodieterase inhibitor
  13. Pletal is a phosphodieterase inhibitor (antplatelet) for PAD tx. What two things should patients avoid when taking it?
    Grapefruit juice and Omeprazol
  14. List 4 nursing goals of PAD
    • 1. Adequate tissue perfusion
    • 2. Relief of pain
    • 3. Increased exercise tolerance
    • 4. Intact Healthy skin on the extremities
  15. Surgery for PAD may be done if blockage is at ____%.
    90-100% blockage
  16. Go in and dilate blood vessel, insert cath, and compress plaque walls

  17. Removal of plaque 

  18. Making an incision in a vessel, widening and cleaning it out

  19. This surgical procedure of PAD has a 95% success rate and uses liquid nitrous oxide.
  20. List nursing interventions after a patient has a vascular stent
    • Keep leg straight
    • Check groin site for bleeding
    • Check CSM
    • Don't let patient move leg too much if high risk of bleeding
  21. When checking patient Q15min post-op of bypass graft, you see an increase in pain, pulse, pallor extremities and numbness. What should you do?
    Notify MD promptly
  22. T or F: Initially a patient post op will receive warfarin as anticoagulant therapy, then go home with Coumadin for home tx.
    False: initially with lovenox or coumadin, then home with warfarin or aspirin
  23. What are the six P's of ACUTE Arterial occlusion
    • 1. Pain
    • 2. Parathesias
    • 3. Poikilothermia
    • 4. Paralysis (late sign - irreversible nerve dmg)
    • 5. Pallor
    • 6. Pulselessness
  24. This is the emergency surgical removal of emboli which are blocking blood circulation. It usually involves removal of thrombi (blood clots)
  25. This drug is a blood viscocity reducing agent and is used to treat intermittent claudication.

    A. Pentoxifylline (Trental) 400mg PO TID

    • Pletal - Phosphodidieterase Inhibitor
    • Plavix - Antiplatelet
    • Altace - ACE inhibitor
  26. This drug is a Phosphodieterase inhibitor used for intermittent claudication. It inhibits the enzymes that make cAMP for platelets.

    B.  Pletal - Phosphodidieterase Inhibitor

    • Trental - Blood viscocity reducing agent
    • Plavix - Antiplatelet
    • Altace - ACE inhibitor
  27. Which antiplatelet medicine do you give for a PAD pt. who is non-symptomatic:

  28. Which Thrombolytic Therapy is used most often:

    A. TPA (Activase)
  29. What four labs will you need to check for when giving TPA (Activase)? (Pre-procedure Labs)
    • PTT
    • PT
    • HcT
    • WBC
  30. T or F: During the first PO day after a Femoral Bypass Graft, you want to keep the patient on strict bedrest as not to aggravate the surgical site and cause bleeding.
    False: During first PO day, get patient out of bed several times/day and avoid prolong sittings
  31. List the three meds for Phantom Limb sensations.

    Which of the three do you give only at night?
    • 1. Carbamazepine (Tegretol) - anticonvulsant / moodstabilizer 
    • 2. Gabapentin (Neurontin) - anticonvulsant / mood stabilizer
    • 3. Amitriptyline (Elavil) - TCA 

    Answer: Amitriptyline (Elavil)
  32. What is intermittent claudication?
    • Ischemic muscle pain: occurs with walking and relieved with rest
    •  - pain d/t lack of oxygen, causing lactic acid build up
  33. What time of day is pain worse with PAD?
    During the nighttime when c/o is reduced. Pt. will complain of not getting good sleep, or will want to get up
  34. What is the nnormal ankle/brachial index number?

  35. What is the formula for the ankle brachial index if you take the right brachial BP?
    Right abi =  highest pressure in right foot  / highest pressure in Arm BP
  36. List medical management to help with PAD
    (Which one is the most effective)
    • STOP smoking
    • HTN control
    • low cholsterol / low fat diet
    • Weight control
    • Exercise (most effective)
    • Diabetic control (Hgb1AC <7 (6 preferred))
  37. List common drugs for each type
     - statins
     - antiplatelets
     - ACE inhibitors
    • Statins:
    •  - simvastatin
    •  - lovastatin
    •  - atorvastatin
    • Antiplatelets
    •  - aspirin
    •  - clopidogrel (plavix)
    • ACE
    •  - ramipril (altace)
  38. Which drug will reduce plavix effectiveness by 50%?
    Prilosec: either give different drug or increase plavix
  39. What is Cilostazol (Pletal) and its considerations
    • It is a phosphodieterase inhibitor: should not chew or crush, and takes 2-4 weeks to see results and 2-4 months to receive full benefits.
    •  - Also avoid grapefruit juice and be aware if on omeprazol (decreases drug potency)
  40. List interventions to reduce risk for impaired skin integrity
    • Protect skin from trauma and infection
    •  - clean and dry skin (lubricate prn)
    •  - soft roomy footwear, free of pressure
    •  - avoid extremes of heat/cold
  41. T or F: For a patient who is in bed for long hours of the day, you can help with pain by elevating the patient's feet above heart level
    false: slight elevation or dangle legs on side of bed
  42. What will you be monitoring for postop Endarterectomy and vascular stent
    • s/s of DVT
    • check incision for bleeding
    • CSM
    • Keep leg straight and prevent moving leg too much (bleeding)
    • *In rare cases, the artery can spasm and a sedative may be given*
  43. List the thrombylitic ddrugs and labs to look at
    • Drugs: 
    • Streptokinase (not used in the US)
    • TPA (tissue plasminogen activator) - used most often
    • Urokinase
    • Labs: PTT, PT, platelets, HCT, WBC
  44. List nursing care for femoral bypass graft surgery
    • Postop: check circulation q15mins (notify MD for any increased pain, loss of pulses, extremity pallor or cyanosis, increased numbness, cold extremity
    •  - turn frequently
    • First PO day: out of bed several times/day 
    •  - avoid prolong sitting, no leg crossings
    •  - anticoagulant therapy
  45. What are the 6 ps for acute arterial occlusion?
    • Pain
    • Paresthesias
    • Poikilothermia - cold extremity
    • Paralysis - late sign of nerve death (irreversible) 
    • Pallor
    • Pulselessness
  46. List nursing care for acute arterial occlusion
    • Notify MD if 6 p changes
    • Bed rest
    • Protect limb from pressure, trauma cold
    • Keep limb flat or slightly dependent
Card Set
Exam 1 Lecture notes