Ch. 38

When caring for a client with an abdominal aortic aneurysm (AAA), the nurse suspects dissection of the aneurysm when the client states which of these? A. "I feel my heart beating in my abdominal area." B. "I just started to feel a tearing pain in my belly." C. "I have a headache. May I have some acetaminophen?" D. "I have had hoarseness for a few weeks."

"I just started to feel a tearing pain in my belly."

The nurse is teaching the young female client how to prevent venous thromboembolism specific to her hospital stay after intensive orthopedic surgery. Which statement made by the client indicates the need for further teaching? A. "I must stop taking my birth control pills." B. "I should drink lots of water so I don't get dehydrated." C. "I should exercise my legs when I have been sitting or standing for a long time." D. "If I wear pantyhose, I won't have to wear the stockings the hospital gives me."

"If I wear pantyhose, I won't have to wear the stockings the hospital gives me."

The client has just undergone arterial revascularization. Which statement by the client indicates a need for further teaching related to postoperative care? A. "My leg might turn very white after the surgery." B. "I should be concerned if my foot turns blue." C. "I should report a fever or any drainage." D. "Warmness, redness, and swelling are expected."

"My leg might turn very white after the surgery."

The client undergoing femoral popliteal bypass states that he is fearful he will lose the limb in the near future. Which response by the nurse is most therapeutic? A. "Are you afraid you will not be able to work?" B. "If you control your diabetes, you can avoid amputation." C. "Your concerns are valid; we can review some steps to limit disease progression." D. "What about the situation concerns you most?"

"Your concerns are valid; we can review some steps to limit disease progression."

A desirable LDL-C level is one below _______ for healthy people and below _______for those diagnosed with CVD or who are diabetic.

100 mg/dL 70 mg/dL

The nurse is teaching the client precautions to take while on warfarin (Coumadin) therapy. Which statement made by the client demonstrates that teaching has been effective? A. "I can use an electric razor or a regular razor." B. "Eating foods like green beans won't interfere with my Coumadin therapy." C. "If I notice I am bleeding a lot, I should stop taking Coumadin right away." D. "When taking Coumadin, I may notice some blood in my urine."

"Eating foods like green beans won't interfere with my Coumadin therapy."

Patients with diabetes and heart disease should have a blood pressure below

130/90

Total serum cholesterol levels should be below

200 mg/dL. Healthy range is 122-200 mg/dL

Normal range for triglycerides

35-160

A desirable HDL-C level is

40 mg/dL or above

intermittent claudication

A characteristic leg pain experienced by patients with chronic peripheral arterial disease. Typically, patients can walk only a certain distance before a cramping muscle pain forces them to stop. As the disease progresses, the patient can walk only shorter and shorter distances before pain recurs. Ultimately, pain may occur even at rest.

metabolic syndrome

A collection of related health problems with insulin resistance as a main feature. Other features include obesity, low levels of physical activity, hypertension, high blood levels of cholesterol, and elevated triglyceride levels. Metabolic syndrome increases the risk for coronary heart disease. Also called "syndrome X."

venous duplex ultrasonography

A noninvasive test using ultrasonic waves; the preferred diagnostic test for deep vein thrombosis.

percutaneous transluminal angioplasty (PTA)

A nonsurgical method of improving arterial flow by opening the vessel lumen and creating a smooth inner vessel surface. One or more arteries are dilated with a balloon catheter advanced through a cannula, which is inserted into or above an occluded or stenosed artery.

arterial ulcers

A painful complication in the patient with peripheral arterial disease. Typically, the ulcer is small and round, with a "punched out" appearance and well-defined borders. Ulcers develop on the toes (often the great toe), between the toes, or on the upper aspect of the foot. With prolonged occlusion, the toes can become gangrenous.

aneurysm

A permanent localized dilation of an artery (to at least two times its normal diameter) that forms when the middle layer (media) of the artery is weakened, stretching the inner (intima) and outer (adventitia) layers. As the artery widens, tension in the wall increases and further widening occurs, thus enlarging the aneurysm.

ankle-brachial index (ABI)

A ratio derived by dividing the ankle blood pressure by the brachial blood pressure; this calculation is used to assess the vascular status of the lower extremities. To obtain the ABI, a blood pressure cuff is applied to the lower extremities just above the malleoli. The systolic pressure is measured by Doppler ultrasound at both the dorsalis pedis and posterior tibial pulses. The higher of these two pressures is then divided by the higher of the two brachial pulses.

venous thromboembolism (VTE)

A term that refers to both deep vein thrombosis and pulmonary embolism; obstruction by a thrombus.

The nurse is caring for a client with dark-colored toe ulcers and blood pressure of 190/100. Which of these nursing actions should you delegate to the LPN/LVN? A. Assess leg ulcers for evidence of infection. B. Administer a clonidine patch for hypertension. C. Obtain a request from the doctor for a dietary consult. D. Develop a plan for discharge, and assess home care needs.

Administer a clonidine patch for hypertension.

atherectomy

An invasive nonsurgical technique in which a high-speed, rotating metal burr uses fine abrasive bits to scrape plaque from inside an artery while minimizing damage to the vessel surface.

When caring for a client with an 8-cm abdominal aortic aneurysm (AAA), the nurse recognizes that which problem must be addressed immediately to prevent rupture? A. Heart rate 52 B. Blood pressure 192/102 C. Report of constipation D. Anxiety

Blood pressure 192/102

inflow disease

Chronic peripheral arterial disease with obstruction at or above the common iliac artery, abdominal aorta, or profunda femoris artery. The patient experiences discomfort in the lower back, buttocks, or thighs after walking a certain distance. The pain usually subsides with rest.

Outflow disease

Chronic peripheral arterial disease with obstruction at or below the superficial femoral or popliteal artery. The patient experiences burning or cramping in the calves, ankles, feet, and toes after walking a certain distance; the pain usually subsides with rest.

collateral circulation

Circulation that provides blood to an area with altered tissue perfusion through smaller vessels that develop and compensate for the occluded vessels.

When caring for a client who has received recombinant tissue plasminogen activator (t-PA), for a large deep vein thrombosis (DVT), the nurse would be most concerned if the client developed which of these? A. Small amount of blood at the IV insertion site B. Heavy menstrual bleeding C. +1 pitting edema of the affected extremity D. Client stating that the year is 1967

Client stating that the year is 1967

The nurse suspects that the client has developed an acute arterial occlusion of the right lower extremity based on which of the following? Select all that apply. A. Hypertension B. Tachycardia C. Bounding right pedal pulses D. Cold right foot E. Numbness and tingling of right foot F. Mottling of right foot and lower leg

Cold right foot Numbness and tingling of right foot Mottling of right foot and lower leg

When administering furosemide (Lasix) to a client who states she does not like bananas or orange juice, the nurse recommends that the client try which intervention to maintain potassium levels? A. Increase red meat in the diet. B. Consume melons and baked potato. C. Add several portions of dairy products each day. D. Try replacing your usual breakfast with oatmeal or cream of wheat.

Consume melons and baked potato.

The nurse is caring for a client who is being treated for hypertensive emergency. Which medication prescribed for the client should the nurse question? A. Enalapril (Vasotec) B. Sodium nitroprusside (Nipride) C. Dopamine (Intropin) D. Clevidipine (butyrate)

Dopamine (Intropin)

hypertriglyceridemia

Elevated levels (150 mg/dL or above) of triglyceride in the blood.

Nonsurgical Management used to increase arterial flow to the affected leg(s)

Exercise, positioning, promoting vasodilation, drug therapy, and invasive nonsurgical procedures

Etiology of Essential or Primary Hypertension

Family history of hypertension African-American ethnicity Hyperlipidemia Smoking Older than 60 years or postmenopausal Excessive sodium and caffeine intake Overweight/obesity Physical inactivity Excessive alcohol intake Low potassium, calcium, or magnesium intake Excessive and continuous stress

The nurse in the cardiology clinic is reviewing teaching about hypertension, provided at the last appointment. Which actions by the client indicate that teaching has been effective? Select all that apply. A. Has maintained a low-sodium, no-added-salt diet B. Has lost 3 pounds since last seen in the clinic C. Cooks food in palm oil to save money D. Exercises once weekly E. Has cut down on caffeine

Has maintained a low-sodium, no-added-salt diet Has lost 3 pounds since last seen in the clinic Has cut down on caffeine

Etiology of Secondary Hypertension

Kidney disease Primary aldosteronism Pheochromocytoma Cushing's disease Coarctation of the aorta Brain tumors Encephalitis Pregnancy Drugs: Estrogen (e.g., oral contraceptives) Glucocorticoids Mineralocorticoids Sympathomimetics

The nurse is providing community education about prevention of atherosclerosis-related diseases. Which risk factors should the nurse include in the presentation? Select all that apply. A. LDL cholesterol of 160 mg B. Smoking C. Aspirin (ASA) consumption D. Type 2 diabetes E. Vegetarian diet

LDL cholesterol of 160 mg Smoking Type 2 diabetes

Risk factors for atherosclerosis

Low HDL-C, High LDL-C, Increased triglycerides, Genetic predisposition, Diabetes mellitus, Obesity, Sedentary lifestyle, Smoking, Stress, African-American or Hispanic ethnicity, Older adult

The nurse is caring for a client with an abdominal aortic aneurysm (AAA). Which finding in the history does the nurse recognize as a risk factor for aneurysm formation? A. Peptic ulcer disease B. Deep vein thrombosis (DVT) C. Osteoarthritis D. Marfan syndrome

Marfan syndrome

Those with acute arterial insufficiency often present with the "six P's" of ischemia:

Pain Pallor Pulselessness Paresthesia Paralysis Poikilothermy (coolness)

The client with peripheral arterial occlusive disease has undergone percutaneous transluminal angioplasty (PTA) of the lower extremity. What is essential for the nurse to assess after the procedure? A. Ankle-brachial index (ABI) B. Dye allergy C. Pedal pulses D. Gag reflex

Pedal pulses

The client is receiving unfractionated heparin by infusion. Of which finding should the nurse notify the provider? A. Partial thromboplastin time (PTT) 60 seconds B. Platelets 32,000 C. White blood cells (WBCs) 11,000 D. Hemoglobin 12.2 g/dL

Platelets 32,000

thrombectomy

Removal of a clot (thrombus) from a blood vessel.

The professional nurse and the nursing student are caring for a group of clients with hypertension. Which of these problems identified by the nursing student correctly identifies the client at risk for secondary hypertension? A. Psychiatric disturbance B. High sodium intake C. Physical inactivity D. Renal failure

Renal failure

The nurse is caring for a client with peripheral arterial occlusive disease (PAD). For which symptoms should the nurse assess? A. Reproducible leg pain with exercise B. Unilateral swelling of affected leg C. Decreased pain when legs are elevated D. Pulse oximetry reading of 90%

Reproducible leg pain with exercise

What is the most frequent complication of aneurysms and is life threatening ?

Rupture because abrupt and massive hemorrhagic shock results. Thrombi within the wall of an aneurysm can also be the source of emboli in distal arteries below the aneurysm.

Which symptom reported by the client who has had a total hip replacement requires emergency action? A. Localized swelling of one of the lower extremities B. Positive Homans' sign C. Shortness of breath and chest pain D. Tenderness and redness at the IV site

Shortness of breath and chest pain

Which vascular assessment technique by the student nurse requires intervention by the supervising nurse? A. Measuring capillary refill in the fingertips B. Assessing pedal pulses by Doppler C. Measuring blood pressure in both arms D. Simultaneously palpating the bilateral carotids

Simultaneously palpating the bilateral carotids

A client has undergone an embolectomy for acute arterial occlusion after creation of a lower arm A-V fistula for dialysis. Which finding should the nurse report to the provider immediately? A. Swelling and tenseness in the affected area B. Incisional pain and tenderness at the surgical site C. Pink, mobile fingers D. Client who has order for heparin infusion

Swelling and tenseness in the affected area

bruit

Swishing sound in the larger arteries (carotid, aortic, femoral, and popliteal) that can be heard with a stethoscope or Doppler probe; may indicate narrowing of the artery and is usually associated with atherosclerotic disease.

Prehypertension

Systolic 120-139 mm Hg or diastolic 80-89 mm Hg

Stage 1: Hypertension

Systolic 140-159 mm Hg or diastolic 90-99 mm Hg

Normal Blood Pressure

Systolic <120 mm Hg and diastolic <80 mm Hg

Stage 2: Hypertension

Systolic ≥160 mm Hg or diastolic ≥100 mm Hg

The client with hypertension is started on verapamil (Isoptin). What teaching does the nurse provide for this client? A. Encourages foods high in potassium B. Monitors for irregular pulse C. Monitors for muscle cramping D. Teaches the client to avoid grapefruit juice

Teaches the client to avoid grapefruit juice

Which of these clients who have just arrived in the emergency department should the nurse classify as emergent and needing immediate medical evaluation? A. The 60-year-old with venous insufficiency who has new-onset right calf pain and tenderness B. The 64-year-old with chronic venous ulcers who has a temperature of 100.1° F (37.8° C) C. The 69-year-old with a 40-pack-year cigarette history who is reporting foot numbness D. The 70-year-old with a history of diabetes who has "tearing" back pain and is diaphoretic

The 70-year-old with a history of diabetes who has "tearing" back pain and is diaphoretic

All of these client assignments have been made by the charge nurse. Which assignment would you question? A. The RN with 3 years of experience caring for a client with a pulmonary embolism (PE) who is receiving heparin therapy B. The LPN/LVN with 5 years of experience caring for a client with leg ulcers who is awaiting nursing home placement C. The RN with 8 years of experience caring for a client with peripheral arterial disease (PAD) and a total cholesterol of 390 D. The LPN/LVN with 20 years of experience caring for a client with a headache whose blood pressure is 210/150

The LPN/LVN with 20 years of experience caring for a client with a headache whose blood pressure is 210/150

Which of the following is essential to report to the provider when caring for a client with Raynaud's phenomenon? A. Nifedipine (Procardia) administration caused the blood pressure to change from 134/76 to 110/68. B. The client's extremity became white, then red temporarily. C. The affected extremity becomes purple and cold. D. The client states that the digits are painful when they are white.

The affected extremity becomes purple and cold.

heparin-induced thrombocytopenia and thrombosis (HIT)

The aggregation of platelets into "white clots" that can cause thrombosis, usually in the form of an acute arterial occlusion; occurs with heparin administration; also called "white clot syndrome."

Four control systems play a major role in maintaining blood pressure:

The arterial baroreceptor system Regulation of body fluid volume The renin-angiotensin/aldosterone system Vascular autoregulation.

The nurse is assigned to the following group of clients. Which of these clients should be assessed first? A. The client who had percutaneous transluminal angioplasty of the right femoral artery 30 minutes ago B. The client admitted with hypertensive crisis who has a nitroprusside (Nipride) drip and blood pressure (BP) of 149/80 C. The client with peripheral vascular disease who has a left leg ulcer draining purulent yellow fluid D. The client who had a right femoral-popliteal bypass 3 days ago and has ongoing edema of the foot

The client who had percutaneous transluminal angioplasty of the right femoral artery 30 minutes ago

Virchow's triad

The occurrence of stasis of blood flow, endothelial injury, or hypercoagulability; often associated with thrombus formation.

endovascular stent graft

The repair of an abdominal aortic aneurysm using a stent made of flexible material; the stent is inserted through a skin incision into the femoral artery by way of a catheter-based system.

acute arterial occlusion

The sudden blockage of an artery, typically in the lower extremity, in the patient with chronic peripheral arterial disease.

arterial revascularization

The surgical procedure most commonly used to increase arterial blood flow in the affected limb of a patient with peripheral arterial disease.

The nurse caring for a client who has had AAA repair would be most alarmed by which finding? A. Urine output of 20 mL over 2 hours B. Blood pressure of 106/58 C. Absent bowel sounds D. +3 pedal pulses

Urine output of 20 mL over 2 hours

The nurse teaches a client who has had a myocardial infarction (MI) which information regarding diet? A. Less than 30% of the daily caloric intake should be derived from proteins. B. Use canola oil rather than palm or coconut oil. C. Consume 10 mg fiber daily. D. Work toward lowering your HDL cholesterol levels.

Use canola oil rather than palm or coconut oil.

Which teaching should the nurse include for a client with peripheral arterial disease (PAD)? A. Elevate your legs above heart level to prevent swelling. B. Inspect your legs daily for brownish discoloration around the ankle. C. Walk to the point of leg pain, then rest, resuming when pain stops. D. Apply a heating pad to the legs if they feel cold.

Walk to the point of leg pain, then rest, resuming when pain stops.

The most common side effect of ACE inhibitors is

a nagging, dry cough. Teach patients to report this problem to their health care provider as soon as possible. If a cough develops, the drug is discontinued.

The most common surgical procedure for AAA has traditionally been

a resection or repair (aneurysmectomy)

Aortic dissection is thought to be caused by

a sudden tear in the aortic intima, opening the way for blood to enter the aortic wall. Degeneration of the aortic media may be the primary cause for this condition, with hypertension being an important contributing factor.

Atherosclerosis,

a type of arteriosclerosis, involves the formation of plaque within the arterial wall and is the leading risk factor for cardiovascular disease.

Assess patients with a known or suspected abdominal aortic aneurysm (AAA) for

abdominal, flank, or back pain. Pain is usually described as steady with a gnawing quality, unaffected by movement, and lasting for hours or days. A pulsation in the upper abdomen slightly to the left of the midline between the xyphoid process and the umbilicus may be present. A detectable aneurysm is at least 5 cm in diameter. Auscultate for a bruit over the mass, but avoid palpating the mass because it may be tender and there is risk for rupture! If expansion and impending rupture of an AAA are suspected, assess for severe pain of sudden onset in the back or lower abdomen, which may radiate to the groin, buttocks, or legs.

Abdominal aortic aneurysms (AAAs)

account for most aneurysms, are commonly asymptomatic, and frequently rupture. Most of these are located between the renal arteries and the aortic bifurcation (dividing area).

Angiotensin II receptor antagonists,

also called angiotensin II receptor blockers (ARBs) or the -sartan drugs, make up a group of drugs that selectively block the binding of angiotensin II to receptor sites in the vascular smooth muscle and adrenal tissues by competing directly with angiotensin II but not inhibiting ACE.

Angiotensin-converting enzyme (ACE) inhibitors,

also known as the "pril" drugs, are also used as single or combination agents in the treatment of hypertension. These drugs block the action of the angiotensin-converting enzyme as it attempts to convert angiotensin I to angiotensin II, one of the most powerful vasoconstrictors in the body. This action also decreases sodium and water retention and lowers peripheral vascular resistance, both of which lower blood pressure.

A decrease in intensity or a complete loss of a pulse in a patient with atherosclerosis may indicate .

an arterial occlusion (blockage).

familial hyperlipidemia,

an elevation of serum lipid levels. In these people, the liver makes excessive cholesterol and other fats. However, some people with hereditary atherosclerosis have a normal blood cholesterol level.

saccular

an outpouching affecting only a distinct portion of the artery

Impedance plethysmography

assesses venous outflow and can detect most DVTs that are located above the popliteal vein. It is not helpful in locating clots in the calf and is less sensitive than Doppler studies.

When a thoracic aortic aneurysm is suspected, assess for

back pain and manifestations of compression of the aneurysm on adjacent structures. Signs include shortness of breath, hoarseness, and difficulty swallowing. TAAs are not often detected by physical assessment, but occasionally a mass may be visible above the suprasternal notch. Assess the patient with suspected rupture of a thoracic aneurysm for sudden and excruciating back or chest pain. Hypovolemic shock also occurs with TAA.

The classic signs and symptoms of DVT are

calf or groin tenderness and pain and sudden onset of unilateral swelling of the leg.

Central alpha agonists act on the

central nervous system, preventing reuptake of norepinephrine and resulting in lower peripheral vascular resistance and blood pressure. Side effects include sedation, postural hypotension, and impotence.

Monitor the patency of the graft by

checking the extremity every 15 minutes for the first hour and then hourly for changes in color, temperature, and pulse intensity. Compare the operative leg with the unaffected one. If the operative leg feels cold; becomes pale, ashen, or cyanotic; or has a decreased or absent pulse, contact the surgeon immediately!

Statins reduce

cholesterol synthesis in the liver and increase clearance of LDL-C from the blood.

fusiform

diffuse dilation affecting the entire circumference of the artery

Alpha-adrenergic antagonists,

dilate the arterioles and veins. These drugs can lower blood pressure quickly, but their use is limited because of frequent and bothersome side effects.

Teach patients about common side effects of beta blockers, including

fatigue, weakness, depression, and sexual dysfunction.

For patients with chronic PAD, prescribed drugs include

hemorheologic and antiplatelet agents.

Assess _______________for for patients taking potassium-sparing diuretics, such as spironolactone.

hyperkalemia (high potassium level) Like hypokalemia, an increased potassium level can also cause weakness and irregular pulse.

Beta blockers are the drug of choice for .

hypertensive patients with ischemic heart disease (IHD) because the heart is the most common target of end-organ damage with hypertension.

Patients with diabetes who take beta blockers may not have the usual manifestations of

hypoglycemia because the sympathetic nervous system is blocked.

The most frequent side effect associated with thiazide and loop diuretics is

hypokalemia (low potassium level). Monitor serum potassium levels, and assess for irregular pulse and muscle weakness, which may indicate hypokalemia.

Signs of rupturing AAA include

hypotension, diaphoresis, decreased level of consciousness, oliguria (scant urine output), loss of pulses distal to the rupture, and dysrhythmias. Retroperitoneal hemorrhage is manifested by hematomas in the flanks (lower back). Rupture into the abdominal cavity causes abdominal distention.

Beta-adrenergic blockers,

identified by the ending -olol, are categorized as cardioselective (working only on the cardiovascular system) and non-cardioselective. Cardioselective beta blockers, affecting only beta-1 receptors, may be prescribed to lower blood pressure by blocking beta receptors in the heart and peripheral vessels. By blocking these receptors, the drugs decrease heart rate and myocardial contractility.

Peripheral vascular disease (PVD)

includes disorders that change the natural flow of blood through the arteries and veins of the peripheral circulation. It affects the legs much more frequently than the arms.

The most serious complication from thrombolytic therapy is

intracerebral bleeding. Closely monitor patients for signs and symptoms of increasing intracranial pressure. A decreased level of consciousness (LOC) is the earliest indicator of this complication. Assess for other neurologic changes and report them immediately to the physician.

Orthostatic hypotension

is a decrease in blood pressure (20 mm Hg systolic and/or 10 mm Hg diastolic) when the patient changes position from lying to sitting.

A D-dimer test

is a global marker of coagulation activation and measures fibrin degradation products produced from fibrinolysis (clot breakdown). The test is used for the diagnosis of DVT when the patient has few clinical signs and stratifies patients into a high-risk category for reoccurrence. Useful as an adjunct to noninvasive testing, a negative D-dimer test can exclude a DVT without an ultrasound.

Graft occlusion (blockage)

is a postoperative emergency that can occur within the first 24 hours after arterial revascularization. Monitor the patient for and report severe continuous and aching pain, which may be the first indicator of postoperative graft occlusion and ischemia. Many people experience a throbbing pain caused by the increased blood flow to the extremity

Malignant hypertension

is a severe type of elevated blood pressure that rapidly progresses. A person with this health problem usually has symptoms such as morning headaches, blurred vision, and dyspnea and/or symptoms of uremia

hypertension

is a systolic blood pressure at or above 140 mm Hg and/or a diastolic blood pressure at or above 90 mm Hg in people who do not have diabetes mellitus.

Arteriosclerosis

is a thickening, or hardening, of the arterial wall that is often associated with aging.

Buerger's disease (thromboangiitis obliterans)

is an uncommon occlusive disease of the arteries and veins in the distal portion of the upper and lower extremities. The disease often extends into the tissues around the vessels, resulting in fibrosis and scarring that bind the artery, vein, and nerve firmly together.

Renin inhibitors are effective for

mild to moderate hypertension. Renin is an enzyme produced in the kidneys that causes vasoconstriction, increases peripheral resistance, and increases cardiac output. The result is an increase in blood pressure. Renin inhibitors prevent renin from producing this action.

ARBs are excellent options for patients who

report a nagging cough associated with ACE inhibitors. In addition, these drugs do not require initial adjustment of the dose for older adults or for any patient with renal impairment.

After TAA repair, patients are especially likely to develop

respiratory distress from atelectasis or pneumonia. This problem occurs as a result of both CPB and incisional discomfort. Both atelectasis and pneumonia may cause shallow breathing and poor cough effort. These patients are often mechanically ventilated at least overnight after surgery.

A major priority for nursing care after an AAA surgical repair is to assess for

signs of graft occlusion or rupture. Assess vital signs and circulation every 15 minutes for the first hour and then hourly, with assessment of pulses distal to the graft site (including the posterior tibial and dorsalis pedis pulses).

PAD is a result of

systemic atherosclerosis.

When dissecting aneurysms occur,

the aneurysm enlarges, blood is lost, and blood flow to organs is diminished.

In true aneurysms,

the arterial wall is weakened by congenital or acquired problems.

Statin drugs are discontinued if

the patient has muscle cramping or elevated liver enzyme levels. Some patients also report abdominal bloating, flatulence, diarrhea, and/or constipation as side effect of these drugs.

Compartment syndrome occurs when

tissue pressure within a confined body space becomes elevated and restricts blood flow. The resulting ischemia can lead to tissue damage and eventually tissue death. Assess the motor and sensory function of the affected extremity. Monitor for increasing pain, swelling, and tenseness.

The priority for nursing care following a PTA or atherectomy is

to observe for bleeding at the arterial puncture site, which is usually sealed with special collagen plugs. Monitor for manifestations of impending hypovolemic shock, including a decrease in blood pressure, increased pulse rate, and decreased urinary output. Perform frequent checks of the distal pulses in both legs to ensure adequate perfusion and oxygenation.

Raynaud's phenomenon is caused by

vasospasm of the arterioles and arteries of the upper and lower extremities, usually unilaterally. Raynaud's disease occurs bilaterally.

Calcium channel blockers such as

verapamil hydrochloride (Calan, Nu-Verap ) and amlodipine (Norvasc) lower blood pressure by interfering with the transmembrane flux of calcium ions. This results in vasodilation, which decreases blood pressure. These drugs also block SA and AV node conduction, resulting in a decreased heart rate.

False aneurysms occur as a result of

vessel injury or trauma to all three layers of the arterial wall.

Report signs of graft occlusion or rupture, including:

• Changes in pulses • Cool to cold extremities below the graft • White or blue extremities or flanks • Severe pain • Abdominal distention • Decreased urine output

Complications for stent repair include:

• Conversion to open surgical repair • Bleeding • Aneurysm rupture • Peripheral embolization • Misplacement of the stent graft

The expected outcomes for emergency care for a patient with an aortic dissection are:

• Elimination of pain • Reduction of systolic blood pressure to 100 to 120 mm Hg • Decrease in the velocity of left ventricular ejection

Assess for and help prevent postoperative complications that can occur after a thoracic aneurysm repair. Complications include:

• Hemorrhage • Ischemic colitis • Cerebral and spinal cord ischemia (causing paraplegia) • Respiratory distress • Infection • Cardiac dysrhythmias

Commonly used alternatives to unfractionated heparin include:

• Low-molecular weight heparin (e.g., enoxaparin [Lovenox]) (drug class of choice after orthopedic surgery) • Selective factor Xa inhibitors (e.g., fondaparinux [Arixtra]) • Warfarin (Coumadin, Warfilone )

Chronic Peripheral Arterial Disease Stage II: Claudication

• Muscle pain, cramping, or burning occurs with exercise and is relieved with rest. • Symptoms are reproducible with exercise.

Complications of AAA repair include:

• Myocardial infarction • Graft occlusion or rupture causing hemorrhage • Hypovolemia and/or renal failure • Respiratory distress • Paralytic ileus

Chronic Peripheral Arterial Disease Stage I: Asymptomatic

• No claudication is present. • Bruit or aneurysm may be present. • Pedal pulses are decreased or absent.

Chronic Peripheral Arterial Disease Stage III: Rest Pain

• Pain while resting commonly awakens the patient at night. • Pain is described as numbness, burning, toothache-type pain. • Pain usually occurs in the distal portion of the extremity (toes, arch, forefoot, or heel), rarely in the calf or the ankle. • Pain is relieved by placing the extremity in a dependent position.

Emergency Care of Patients with Hypertensive Urgency or Crisis: Intervene

• Place patient in a semi-Fowler's position. • Administer oxygen. • Start IV of 0.9% normal saline (NS) solution slowly to prevent fluid overload (which would increase blood pressure). • Administer IV nitroprusside (Nitropress), nicardipine (Cardene IV), or other infusion drug as prescribed (for nitroprusside, cover infusion bag to prevent drug breakdown by light); when stable, switch to oral antihypertensive drug. • Monitor BP every 5 to 15 minutes until the diastolic pressure is below 90 and not less than 75; then monitor BP every 30 minutes to ensure that BP is not lowered too quickly. • Observe for neurologic or cardiovascular complications, such as seizures; numbness, weakness, or tingling of extremities; dysrhythmias; or chest pain (possible indicators of target organ damage).

Emergency Care of Patients with Hypertensive Urgency or Crisis: Assess

• Severe headache • Extremely high blood pressure (BP) • Dizziness • Blurred vision • Shortness of breath • Epistaxis (nosebleed) • Severe anxiety

Three health problems alter the blood flow in veins:

• Thrombus formation (venous thrombosis) can lead to pulmonary embolism (PE), a life-threatening complication. Venous thromboembolism (VTE) is the current term that includes both deep vein thrombosis and PE. • Defective valves lead to venous insufficiency and varicose veins, which are not life threatening but are problematic. • Skeletal muscles do not contract to help pump blood in the veins. This problem can occur when weight-bearing is limited or muscle tone decreases.

Chronic Peripheral Arterial Disease Stage IV: Necrosis/Gangrene

• Ulcers and blackened tissue occur on the toes, the forefoot, and the heel. • Distinctive gangrenous odor is present.