Chapter 30: Peripheral Vascular Disease

Pentoxifylline (Trental) is a medication used for which of the following conditions? Hypertension Thromboemboli Claudication Elevated triglycerides

Claudication

INR normals (international normalized ratio)

2.0-3.0

As the clinic nurse caring for a client with varicose veins, what is an appropriate nursing action for this client? a. Demonstrate how to self-administer IV infusions. b. Assess for skin integrity. c. Assess for the sites of bleeding. d. Demonstrate how to apply and remove elastic support stockings.

d. Demonstrate how to apply and remove elastic support stockings.

The nurse is assisting a patient with peripheral arterial disease to ambulate in the hallway. What should the nurse include in the education of the patient during ambulation? "If you feel pain during the walk, keep walking until the end of the hallway is reached." "If you feel any discomfort, stop and we will use a wheelchair to take you back to your room." "As soon as you feel pain, we will go back and elevate your legs." "Walk to the point of pain, rest until the pain subsides, then resume ambulation."

"Walk to the point of pain, rest until the pain subsides, then resume ambulation." so that endurance can be increased as collateral circulation develops

S/S of Abdominal Aortic Aneurysm

- Intense Back Pain - Falling B/P - Decreasing Hct

Teach Pt with PAD

- avoid resting - Buerger Allen Exercises - Keeping legs slightly dependent but not above the heart -

S/S of Peripheral Arterial Disease

- dry scaly mottled skin - muscle atrophy -loss of hair -thick toe nails -Cap Refill over 3 - dependent hyperemia when lowered -pallor with elevation -ischemic ulcers (punched out apperance)

How to promote tissue perfusion with a patient with PAD?

- warmth= vasodilation - no tight clothing - don't cross legs - legs slightly dependent and never above heart - Low Na+/cholestrol diet

PAD DX

-ABI -physical assess -Plethysmography -Arteriogram -Angiogram -MRA

6 P's Occlusion of PAD PT

1. Pain 2. Pallor 3. Pulselessness 4. Poikilothermic 5. Paresthesia 6. Paralysis

3 Phenomena that alter blood flow

1. Venous Insufficiency 2. Varicose Veins 3. Thrombus Formation

What number should Prothrombin Time ( PT) be between?

1.5-2.0

Parethesia

Abnormal sensation such as burning, prickling, or tingling or numbness.

The nurse explains to a patient that the primary cause of a varicose vein is: Phlebothrombosis. Venous occlusion. Venospasm. An incompetent venous valve.

An incompetent venous valve.

The nurse provides care for a client immediately after a femoral-to-popliteal bypass graft. The nurse is most concerned if which symptom is observed?

Clammy Skin COULD BE HYPOVOLEMIC SHOW DUE TO INADEQUATE VOLUME OF BLOOD DUE TO HEMORRHAGE OR SEVERE DEHYDRATION

A woman has sought care from her nurse practitioner for the treatment of a wound on her lower leg that has been slow to heal. When planning this patient's care, what action should the nurse first perform? A. Take a culture and sensitivity swab from the wound bed. B. Determine whether the ulcer results from arterial insufficiency or venous insufficiency. C. Cleanse the wound bed with normal saline and apply a hydrocolloid dressing. D. Prescribe the woman a course of broad-spectrum antibiotics.

B. Determine whether the ulcer results from arterial insufficiency or venous insufficiency.

Which of the following assessment results is considered a major risk factor for PAD? LDL of 100 mg/dL Triglyceride level of 150 mg/dL Cholesterol of 200 mg/dL BP of 160/110 mm Hg

BP of 160/110 mm Hg HTN MAJOR RISK FACTOR FOR PAD

Which of the following is a characteristic of an arterial ulcer? Ankle-brachial index (ABI) > 0.90 Border regular and well demarcated Edema may be severe Brawny edema

Border regular and well demarcated

S/S Venous Ulcer

Brawny Edema/Edema ABI > 0.90

Upon auscultation what are you going to hear for a patient with PAD?

Bruits over femoral and aortic arteries

A client with a diagnosed abdominal aortic aneurysm (AAA) develops severe lower back pain. Which is the most likely cause? A. The client is experiencing normal sensations associated with this condition. B. The aneurysm has become obstructed. C. The aneurysm may be preparing to rupture. D. The client is experiencing inflammation of the aneurysm.

C. The aneurysm may be preparing to rupture.

What medications is given to patients with PAD to prevent vessel spasms?

Calcium Channel Blockers (-pine and -zem) Amlodipine

Health teaching includes advising patients on ways to reduce PAD. The nurse should always emphasize that the strongest risk factor for the development of atherosclerotic lesions is: Cigarette smoking. Stress. Lack of exercise. Obesity.

Cigarette smoking.

Best way to Dx Aneurysms

Computed Tomography Scan (CT SCAN)

What long terms medications are normally prescribed to a patient that has been treated for thrombus development?

Coumadin (warfarin), Pradaxa (dabigatran), Eliquis (apixaban)

Which statement is accurate regarding Raynaud disease? A. The disease generally affects the client trilaterally. B. It is most common in men 16 to 40 years of age. C. It affects more than two digits on each hand or foot. D. Episodes may be triggered by unusual sensitivity to cold.

D. Episodes may be triggered by unusual sensitivity to cold.

__________ restores the force of the heart's contractions by slowing the heart rate and conduction through the AV node.

Digoxin

____________ increases the force of the heart's contraction by slowing the HR and conduction through the AV NODE.

Digoxin

Which is a characteristic of arterial insufficiency? Diminished or absent pulses Superficial ulcer Aching, cramping pain Pulses are present but may be difficult to palpate

Diminished or absent pulses

Which aneurysm results in bleeding into the layers of the arterial wall? Anastomotic Saccular False Dissecting

Dissecting

A patient is having an angiography to detect the presence of an aneurysm. After the contrast is administered by the interventionist, the patient begins to complain of nausea and difficulty breathing. What medication is a priority to administer at this time? Metoprolol (Lopressor) Epinephrine Cimetidine (Tagamet) Hydrocortisone (Solu-Cortef)

Epinephrine

After arterial revasculatization a patient should not experience redness, warmth and edema near the surgical site. T or F

False that is normal and indicates increased blood flow

Non Modifiable Risk Factors of PAD

Genetics Aging (50-70) Male (sex)

Providing postoperative care to a patient who has percutaneous transluminal angioplasty (PTA), with insertion of a stent, for a femoral artery lesion, includes assessment for the most serious complication of: Stent dislodgement. Thrombosis of the graft. Decreased motor function. Hemorrhage.

Hemorrhage.

To decrease risk of clot or graft collapse what two things should teach and monitor for post op of arterial revasculation?

Hypotension and limit bending of knee and hip

The nurse is caring for a patient who has started anticoagulant therapy with warfarin (Coumadin). When does the nurse understand that therapeutic benefits will begin? Within the first 24 hours In 3 to 5 days In 2 days Within 12 hours

IN 3-5 days

The nurse understands that the pain of angina is caused by which mechanism?

Insufficient Oxygen to the Heart Muscle

After Angioplasty Surgery for PAD Tx , what are you going to do?

Monitor: bleeding, pedal pulses, capillary refill Teach: on bed rest with LIMB STRAIGHT for 6-8 hours after surgery then ambulation

Aortic dissection may be mistaken for which of the following disease processes? Pneumothorax Myocardial infarction (MI) Angina Stroke

Myocardial infarction (MI)

Cure for Raynaud's Syndrome

NO CURE

What medication increases blood flow and causes dilation of coronary arteries and could cause hyptoension and tachycardia?

Nitroglycerin

Narrowing or blocking of normal arterial blood flow is what disease?

PAD

Pain in lower extremities not relieved by rest indicates what disease process?

Peripheral Artery Disease

What is the cause of intermittent claudication?

Poor circulation in the arteries of the legs

Digoxin is a _____________ inotropic medications.

Positive Inotropic

Antidote for heparin?

Protamine Sulfate

A physician orders blood coagulation tests to evaluate a client's blood-clotting ability. The nurse knows that such tests are important in assessing clients at risk for thrombi, such as those with a history of atrial fibrillation, infective endocarditis, prosthetic heart valves, or myocardial infarction. Which test determines a client's response to oral anticoagulant drugs? Platelet count Bleeding time Partial thromboplastin time (PTT) Prothrombin time (PT)

Prothrombin time (PT)

Stage I PAD name and s/s

Stage I: Asymptomatic -0-1+ pedal pulses -possible bruit -no pain w/ walking

Stages of PAD in order

Stage I: Asymptomatic Stage II: Claudication Stage III: Rest Pain Stage IV: Necrosis/Gangrene

Stage II PAD name and s/s

Stage II: Claudication - muscle pain w/ activity relieved w/ rest

Stage III PAD name and s/s

Stage III: Rest Pain -pain at rest - numbness -burning -ache/ pain in toes

Stage IV PAD name and s/s

Stage IV: Necrosis/ Gangrene -gangrene odor - blackened tissue on foot -ulcers

A nurse is providing education about the prevention of arterial constriction to a client with peripheral arterial disease. Which of the following includes priority information the nurse would give to the client? Stop smoking.' Do not cross your legs for more than 30 minutes at a time. Keep your feet elevated above your heart. Wear antiembolic stockings daily to assist with blood return to the heart.

Stop smoking.

Obstruction or reflux of venous valves in the legs can lead to what?

Venous HTN

Which of the following are alterations noted in Virchow's triad? Select all that apply. Vessel wall injury Stasis of blood Altered coagulation Tenderness Edema

Vessel wall injury Stasis of blood Altered coagulation

Antidote for warfarin? (coumadin)

Vitamin K

The nurse is preparing a teaching plan for a patient with venous insufficiency and plans to address measures to prevent complications from venous insufficiency. What is one measure the nurse should include in the plan? a. Avoiding tight-fitting socks b. Reducing activity c. Sleeping with legs dependent d. Avoiding pressure stockings

a. Avoiding tight-fitting socks

A nurse is caring for a client following an arterial vascular bypass graft in the leg. What should the nurse plan to assess over the next 24 hours? a. Peripheral pulses every 15 minutes after surgery b. Blood pressure every 2 hours c. Ankle-arm indices every 12 hours d. Color of the leg every 4 hours SUBMIT ANSWER

a. Peripheral pulses every 15 minutes after surgery

The nurse is caring for a client who is status post operative from a vein stripping. What would the nurse monitor for? a. Swelling in the operative leg b. Swelling in the inoperative leg c. Blood on the dressing on the inoperative leg d. Warm, pink toes in the inoperative leg

a. Swelling in the operative leg

A client is hospitalized for repair of an abdominal aortic aneurysm. The nurse must be alert for signs and symptoms of aneurysm rupture and thus looks for which of the following? a. Constant, intense back pain and falling blood pressure c. Higher than normal blood pressure and falling hematocrit b. Slow heart rate and high blood pressure d. Constant, intense headache and falling blood pressure

d. Constant, intense headache and falling blood pressure

On a routine visit to the physician, a client with chronic arterial occlusive disease reports that he's stopped smoking after 34 years. To relieve symptoms of intermittent claudication, a condition associated with chronic arterial occlusive disease, which additional measure should the nurse recommend? a. Taking daily walks b. Reducing daily fat intake to less than 45% of total calories c. Engaging in anaerobic exercise d. Abstaining from foods that increase levels of high-density lipoproteins (HDLs)

a. Taking daily walks

What symptoms should the nurse assess for in a client with lymphedema as a result of impaired nutrition to the tissue? a. Ulcers and infection in the edematous area b. Loose and wrinkled skin c. Cyanosis d. Evident scaring

a. Ulcers and infection in the edematous area

Intermittent Claudication refers to a ?

aching pain in legs when walking or excersing that goes away with rest.

arterio-

arteries

A nurse is teaching a client who will soon be discharged with a prescription for warfarin (Coumadin). Which statement should the nurse include in discharge teaching? a. "If you miss a dose, double the next dose." b. "Don't take aspirin while you're taking warfarin." c. "Eat more yogurt and broccoli." d. "This drug will dissolve any clots you may still have."

b. "Don't take aspirin while you're taking warfarin." Because aspirin decreases platelet aggregation and interferes with clotting, concomitant use of aspirin with warfarin, an anticoagulant, may lead to excessive anticoagulant effects — and bleeding.

A nurse is reviewing self-care measures for a client with peripheral vascular disease. Which statement indicates proper self-care measures? a. "I stopped smoking and use only chewing tobacco." b. "I have my wife look at the soles of my feet each day." c. "I walk only to the mailbox in my bare feet." d. "I like to soak my feet in the hot tub every day."

b. "I have my wife look at the soles of my feet each day."

A nurse assesses a patient for a possible abdominal aortic aneurysm (AAA). Which of the following signs would the nurse recognize as positive indicators? Select all that apply. a. Radiating chest pain b. A systolic bruit c. Lower abdominal pain d. Hypertension e. An abdominal pulsatile mass f. Low back pain

b. A systolic bruit c. Lower abdominal pain e. An abdominal pulsatile mass f. Low back pain

The nurse is working with a client who has just been diagnosed with an aneurysm. What advice should the nurse provide to this client? a. Wear wool socks and mittens during cold weather. b. Avoid straining during bowel movements and coughing. c. Avoid situations that contribute to ischemic episodes. d. Minimize bowel movements and coughing.

b. Avoid straining during bowel movements and coughing.

When caring for a patient with leg ulcers, the positioning of the legs depends on whether the patient's ulcer is arterial or venous in origin. How should the nurse position a patient who has leg ulcers that are venous in origin? a. Keep the patient's knees at a 45-degree angle. b. Elevate the patient's lower extremities. c. Hang the patient's legs over the side of the bed d. Keep the patient's legs flat without the knees raised.

b. Elevate the patient's lower extremities.

A client is diagnosed with deep vein thrombosis (DVT). Which nursing diagnosis should receive highest priority at this time? a. Excess fluid volume related to peripheral vascular disease b. Ineffective peripheral tissue perfusion related to venous congestion c. Risk for injury related to edema d. Impaired gas exchange related to increased blood flow

b. Ineffective peripheral tissue perfusion related to venous congestion

A physician admits a client to the health care facility for treatment of an abdominal aortic aneurysm. When planning this client's care, which goal should the nurse keep in mind as she formulates interventions? a. Increasing blood pressure and reducing mobility b. Stabilizing heart rate and blood pressure and easing anxiety c. Increasing blood pressure and monitoring fluid intake and output d. Decreasing blood pressure and increasing mobility

b. Stabilizing heart rate and blood pressure and easing anxiety

What should the nurse do to manage persistent swelling in a client with severe lymphangitis and lymphadenitis? a. Offer cold applications to promote comfort and to enhance circulation. b. Teach the client how to apply a graduated compression stocking. c. Inform the physician if the client's temperature remains low. d. Avoid elevating the area.

b. Teach the client how to apply a graduated compression stocking.

The most important reason for a nurse to encourage a client with peripheral vascular disease to initiate a walking program is that this form of exercise: a. increases high-density lipoprotein (HDL) level. b. decreases venous congestion. c. aids in weight reduction. d. reduces stress.

b. decreases venous congestion.

A nurse is instructing a client about using antiembolism stockings. Antiembolism stockings help prevent deep vein thrombosis (DVT) by: a. encouraging ambulation to prevent pooling of blood. b. forcing blood into the deep venous system. c. elevating the extremity to prevent pooling of blood. d. providing warmth to the extremity.

b. forcing blood into the deep venous system. Antiembolism stockings prevent DVT by forcing blood into the deep venous system, instead of allowing blood to pool.

A client in the emergency department states, "I have always taken a morning walk, but lately my leg cramps and hurts after just a few minutes of walking. The pain goes away after I stop walking, though." Based on this statement, which priority assessment should the nurse complete? a. Ask about any changes in skin color that occur in response to cold. b. Check for the presence of tortuous veins bilaterally on the legs. c. Attempt to palpate the dorsalis pedis and posterior tibial pulses. d. Assess for unilateral swelling and tenderness of either leg.

c. Attempt to palpate the dorsalis pedis and posterior tibial pulses.

Health teaching for a patient diagnosed with Raynaud's phenomenon would include advising the patient to avoid the most common factor known to trigger episodes. Which of the following is the most common factor? a. Jobs/hobbies that involve vibrations b. Allergens c. Cold and stress d. Strenuous exercise

c. Cold and stress

A client is diagnosed with angina and recieves nitroglycerin. The nurse informs the client that which of the following are common adverse effects of nitroglycerin? a. Palpitations, HTN, Tachycardia b. Flusing, Bradycardia, Muscle Weakness c. Dizziness, Headache, Hypotension, Tachycardia d. Flushing, Vertigo, Motor Seizure

c. Dizziness, Headache, Hypotension, Tachycardia

A client is receiving enoxaparin and warfarin therapy for a venous thromboembolism (VTE). Which laboratory value indicates that anticoagulation is adequate and enoxaparin can be discontinued? a. K+ level is 3.5. b. Activated partial thromboplastin time (aPPT) is half of the control value c. International normalized ratio (INR) is 2.5. d. Prothrombin time (PT) is 0.5 times normal.

c. International normalized ratio (INR) is 2.5.

The nurse is caring for a patient with venous insufficiency. For what should the nurse assess the patient's lower extremities? a. Cellulitis c. Ulceration c. Rubor d. Dermatitis

c. Ulceration

Poikilothermia

cool to touch

A client with venous insufficiency asks the nurse what they can do to decrease their risk of complications. What advice should the nurse provide to clients with venous insufficiency? a. Refrain from sexual activity for a week. b. Elevate the legs periodically for at least an hour. c. Avoid foods with iodine. d. Elevate the legs periodically for at least 15 to 20 minutes.

d. Elevate the legs periodically for at least 15 to 20 minutes.

Which of the following is the most effective intervention for preventing progression of vascular disease? a. Avoid trauma b. Use neutral soaps c. Wear sturdy shoes d. Risk factor modification

d. Risk factor modification

A nurse is admitting a new client with a deep vein thrombosis in her left leg. During the admission process, which information provided by the client would be a contraindication to anticoagulant therapy? a. Three vaginal births, the most recent 18 months ago b. A cerebral vascular bleed 10 years ago c. Diet that includes many green, leafy vegetables every day d. Scheduled eye surgery in 1 week

d. Scheduled eye surgery in 1 week

A home health nurse is seeing an elderly male client for the first time. During the physical assessment of the skin on the lower legs, the nurse notes edema, brown pigmentation in the gaiter area, pedal pulses, and a few irregularly shaped ulcers around the ankles. From these findings, the nurse knows that the client has a problem with peripheral circulation. Which of the following does the nurse suspect? a. Trauma b, Neither venous nor arterial insufficiency c. Arterial insufficiency d. Venous insufficiency

d. Venous insufficiency

Varicose Veins are abnormally .........

dilated, tortuous, superficial veins

Buerger's "Inflammed" Disease

inflammatory disease of small arteries and veins cool numb and tingling in hands/feet

Raynaud's "spasm" Syndrome

intermittent vasospastic disorder of small digit arteries ^triggered by cold, stress, smoking, caffeine

Paralysis in Sudden Occlusion leads to.....

loss of motor function due to ischemic death of nerve cells

S/S of Venous Insufficiency

present pedal pulses edema pigmentation in gaiter area (BROWN) reddish blue color Ulcers caused by venous insufficiency will be irregular in shape and usually located around the ankles or the anterior tibial area. superficial ulcer formation aching and cramping pain presence of pulses

-gram

record, writing

angio-

vessel

}The 65 y.o. client diagnosed with a 3-cm AAA asks the nurse, "what will the doctors do for my abdominal aortic aneurysm?" Which statement is the nurse's best response? ◦1. "you will probably have an ultrasound every 6 months to check on the size." ◦2. Usually an endoscopy is done once a year to make sure it doesn't get too big." ◦3. "You will have to check your abdominal girth once a week and keep a record." ◦4. " You will need to have an abdominal aortic aneurysm repair within 2 weeks.

◦1. "you will probably have an ultrasound every 6 months to check on the size."

}A client who has just undergone a femoral-popliteal bypass graft procedure is returning to the surgical floor post-anesthesia recovery. The nurse should first: ◦A. assess the client's level of pain using a standard pain scale ◦B. encourage the client to ambulate to improve circulation and avoid graft occlusion ◦C. assess the client's circulation in the operative leg and compare to non-operative leg ◦D. teach the client to utilize an incentive spirometer every hour to improve lung expansion.

◦C. assess the client's circulation in the operative leg and compare to non-operative leg