PVD

A nurse is providing discharge teaching for a client who has a prescription for furosemide 40 mg PO daily. The nurse should instruct the client to take this medication at which of the following times of day? A. Morning B. Immediately after lunch C. Immediately before dinner D. Bedtime

A. CORRECT: The client should take furosemide, a diuretic, in the morning so that the peak action and duration ofthe medication occurs during waking hours. B. Taking furosemide at this time increases the likelihood of interruption of the client's sleep due to the need to urinate. C. Taking furosemide at this time increases the likelihood of interruption of the client's sleep due to the need to urinate. D. Taking furosemide at this time increases the likelihood of interruption of the client's sleep due to the need to urinate.

A nurse is screening a male client for hypertension. The nurse should identify that which of the following actions by the client increase his risk for hypertension? (Select all that apply.) A. Drinking 8 oz nonfat milk daily B. Eating popcorn at the movie theater C. Walking 1 mile daily at 12 min/mile pace D. Consuming 36 oz beer daily E. Getting a massage once a week

A. Consuming low-fat beverages and foods lowers the risk for developing hypertension. B. CORRECT: Popcorn at a movie theater contains a large quantity of sodium and fat, which increases the risk for hypertension. C. Engaging in regular exercise, such as walking, lowers the risk of developing hypertension. D. CORRECT: Consuming more than 24 oz beer per day for a male client increases the risk for hypertension. E. Stress management activities, such as a massage, lower the risk of hypertension.

A nurse is providing teaching fora client who has a new diagnosis of hypertension and a new prescription for spironolactone 25 mg/day. Which of the following statements by the client indicates an understanding of the teaching?A. "I should eat a lot of fruits and vegetables, especially bananas and potatoes." B. "I will report any changes in heart rate to my provider." C."I should replace the salt shaker on my table with a salt substitute." D."I will decrease the doseof this medication when I no longer have headaches and facial redness."

A. The nurse should teach the client that potatoes and bananas are high in potassium, and can lead to hyperkalemia when taken with a potassium-sparing diuretic such as spironolactone. B. CORRECT: The nurse should teach the client to monitor her heart rate and report any changes to her provider. C. The nurse should teach the client that salt substitutes are commonly high in potassium and can lead to hyperkalemia when taken with a potassium-sparing diuretic such as spironolactone. D. The nurse should teach the client to continue taking her medication as prescribed even if she does not have any manifestations of hypertension.

Which nursing action should be included in the plan of care after endovascular repair of an abdominal aortic aneurysm? A. Record hourly chest tube drainage. B. Monitor fluid intake and urine output. C. Check the abdominal incision for any redness. D. Teach the reason for a prolonged recovery period.

B

A nurse in the emergency department is assisting with the admission of a client who has a possible dissecting abdominal aortic aneurysm. Which of the following is the priority nursing intervention? A. Administer pain medication as prescribed. B. Ensure a warm environment. C. Administer IV fluids as prescribed. D. Initiate a 12-lead ECG.

C

Venous Insufficiency

Caused by prolonged venous HTN standing/sitting long time, pregnancy, obesity stretches and damages valves of vein results in edema long term can result in venous stasis ulcers, cellulitis S/S: Edema (Usually bilateral) Pain worse at _night_____ (improves with _elevation________) stasis dermatitis venous ulcers - typical over malleolus, chronic, difficult to heal - 75% reoccurrence rate pulses unaffected

A nurse is assessing a client who has PAD. Which of the following should the nurse expect? a. edema around ankles and feet b. ulceration around the medial malleoli c. scaling edema of the lower legs with stasis dermatitis d. pallor on elevation of the limbs, and rubber when the limbs are dependent

D. In a client who has PAD, pallor is seen in the extremities when the limbs are elevated, and rubor occurs when they are lowered

A nurse is teaching a client who has a new diagnosis of severe peripheral arterial disease. Which should the nurse include? a. Wear tightly fitting insulated socks with shoes when going outside b. elevate both legs above heart when resting c. apply a heating pad to both legs for comfort d. place both legs in dependent position while sleeping

D. Such as hanging off of the bed. This can alleviate discomfort of the legs

Varicose Veins

Distended, protruding veins that become tortuous Risks - occupation with prolonged standing (nurses), pregnant, obese, family hx, women, tight clothes S/S: Pain, fullness in legs, distended firm veins Treatment: - 1) Conservative - wear TEDS, elevate legs often - 2) Sclerotherapy - surgeon injects veins with something to make them shrink - 3) Surgical ligation/stripping (removal) - If > 4 mm

Diagnostic testing

Doppler

A nurse is assessing a patient in the emergency department with the complaint of sudden onset of severe back pain, tachycardia, and hypotension, which interventions should the nurse anticipate?

EKG (electrocardiogram), Ultrasonography (US), computed tomography scan

Review: Preventive Measures

Elastic compression stockings Pneumatic compression devices: SCDs Subcutaneous heparin or LMWH, warfarin (Coumadin) for extended therapy Positioning: periodic elevation of lower extremities Exercises: AROM and PROM Early ambulation Avoid sitting/standing for prolonged periods; walk 10 minutes every 1-2 hours.

Exercise tolerance testing

For patients with chronic pulmonary disease to see if you have CAD

Amputation complications

Hemorrhage Infection Phantom Limb Pain (can put in nerve blocks for this to stop feeling the pain) Risks associated with immobility Flexion Contractures

Nursing Process: Peripheral Arterial Insufficiency What are these patients at risk for? What are your goals for a patient with peripheral arterial insufficiency?

Impaired skin integrity, risk for infection, pain, altered tissue perfusion Skin care (dry and intact), maintain tissue profusion, control pain

Vena cava intervention: IVC filters

Indications -prevent large emboli from reaching the lungs -contraindication for anticoagulation therapy -complications while receiving anticoagulant therapy -high risk for mortality from recurrent PE A filter basically Placement -below renal veins -inserted via jugular or femoral vein -may be easily removed

Computed Tomography (CT) with/without dye

Magnetic Resonance Angiogram (MRA)

Nursing Interventions Post Surgical Repair of AAA

Monitor peripheral pulses Monitor for graft occlusion (cyanotic/mottled extremities, pain or abd distension) Monitor kidney function Review activity restrictions at discharge No pulling/pushing/lifting heavy (20 lb) objects 6-12 weeks Monitor for signs of hemorrhage

Nursing Process: The Care of the Patient with an Amputation—Assessment

Neurovascular status and function of affected extremity or residual limb and of unaffected extremity Signs and symptoms of infection Nutritional status Concurrent health problems Psychological status and coping

Safety Note to self

Never use a heating pad or hot water bottle on a client's extremities to promote vasodilation.

What is the priority risk on post-op day 1 from an Arterial Bypass Graft

Nursing interventions Routine post-op care Pain (first sign of reocclusion!!!)!!!!!! most likely to occur within the first 24 hours at the site of graft Assess for graft occlusion - check CSM q 15 min to extremity for first hour, then hourly, then q 4 hrs (circulation, sensation and motion) Mark the area where pulse heard best No bending of extremity until ordered Encourage ambulation (once the doctor says so) Assess for hypotension/hypertension Assess for compartment syndrome/edema Assess for graft infection

5 P's

Pain- Ouch Pulse- Blood flow Pallor- Pale Paresthesia- Can you feel this? Numbness and tingling Paralysis- Can you move this?

Raynaud's

Peripheral vasospasm and ischemia (Fingers/toes) caused by cold or stress Phenomenon - Caused by: - Ex. Arterial disease, conn tissue disease - > in women 15-40 yrs Disease - Not assoc with underlying condition - > in women - > over age 30 yrs Treatment: 1) Prev3nting vasoconstriction (avoid supper cold, wear mittens, stop smoking to avoid vasoconstriction)

Nursing Interventions: Achieving Physical Mobility

Proper positioning of limb; avoid abduction, external rotation and flexion Turn frequently; prone positioning if possible Use of assistive devices ROM exercises Muscle strengthening exercises "Pre-prosthetic care"; proper bandaging, massage, and "toughening" of the residual limb

Rehabilitation needs

Psychological support Prostheses fitting and use Physical therapy Occupational training and counseling Use a multidisciplinary team approach; The health care team needs to communicate a positive attitude to facilitate acceptance and participation in rehabilitation. Patient teaching

Virchow's triad

Stasis, hypercoagulability, endothelial damage

Peripheral Arterial Insufficiency—Assessment

Subjective: Health history Nutrition Activity Fatigue Intermittent claudication (have to wake up in the middle of the night and dangle their leg on the bed to get the blood back down) Rest pain Objective: Skin changes and skin breakdown Weak or absent pulses Color changes; dependent rubar Sensation Bruit (whooshing sound) Medications

Amputation

Surgical amputation Indications Sites Traumatic Amputation Might get amputation bc of necrosis, gangrene or osteomyelitis

Venous disorders

Thrombosis Venous Insufficiency Varicose Veins

Veins

Vein functioning depends on: 1) Valves prevent backflow of blood (Unidirectional) 2) Also require muscle to help pump (squeeze) blood back to heart Two things alter venous blood flow: 1) Thrombus formation"DVT" "Thrombophlebitis" 2) Defective valves

A patient has been admitted to the hospital for a PE. what is the primary nursing intervention? a. insert an IV line b. begin heparin drip as ordered c. check O2 saturation d. determine pt allergies

c

Necrosis

tissue death

Nursing Process: The Care of the Patient with Leg Ulcers- Nursing Problems

-Impaired skin integrity -Impaired physical mobility -Imbalanced nutrition

Resolving Grief and Enhancing Body Image

-accept and acknowledge your feelings -focus on the journey -find a purpose -learn to think of yourself in a new way -talk to other amputees

Nursing Process: PAD: Nursing Interventions to achieve patient goals: (non-surgical)

1) Exercise 2) Foot care 3) Positioning (don't cross legs) 4) Promote vasodilation (decrease caffeine and nicotine to it doesn't vasoconstriction) 5) Drug therapy 6) Reduce risk factors (anti platelets meds) 7) Nutrition

AAA Non-Urgent Management

1) Non-surgical Tight control of HTN Monitor size with frequent CT scans or US (above 5 cm go to surgery or 2 inches) Nursing Interventions: - Modifiable risk factors: smoking, BP - Teach early s/s of rupture (SOB, back pain, abdominal pain) - Importance of compliance with meds and follow-up visits - Emotional support

PAD: Surgical Interventions

1. Angioplasty 2. Endarterectomy 3. Surgical arterial bypass graft 4. Amputation

Nursing Process: The Care of the Patient with an Amputation— Nursing Problems

Acute pain Risk for disturbed sensory perception Disturbed body image Ineffective coping Risk for anticipatory or dysfunctional grieving Self-care deficit Impaired physical mobility

When checking a client's capillary refill, the nurse finds that the color returns in 10 seconds. The nurse should understand that this finding indicate ____________ insufficiency.

Arterial If the skin color takes longer than 3 seconds to return to normal, this indicates impaired arterial blood flow to the extremity.Arteries push blood from heart to extremities.

Review: Differences between Arterial & Venous Insufficiency

Arterial disease -skin is cool or cold, hairless, dry, shiny, pallor on elevation, rubber on dangling -pain sharp, stabbing, worsens with activity and walking, lowering feet may relieve pain -ulcers severely painful, pale, gray base, found on heel, toes, dorm of foot -pulse often absent or dimished -edema infrequent Venous disease -skin warm, though, thickened, mottled, pigmented areas -pain aching, cramping, activity and walking sometimes help, elevate the feet relieves pain, -ulcers moderately painful, pink base, found on medial aspect of the ankle -pulse usually present -edema frequent especially at the end of the day and in areas of ulceration

Arterial Bypass Graft

Arterial revascularization Surgically creating a "bridge" around occluded segment of the artery with use of a vein or synthetic graph Make an incision in the leg and usually use the saphenous vein to bypass plaque

A nurse is caring for a client who has chronic venous insufficiency and a prescription for thigh high compression stockings. Which action should the nurse take? a. elevate legs for 10 min, 2-3 times a day while wearing stockings b. apply the stockings in the morning upon awakening and before getting out of bed c. roll the stockings down to the knees to relieve discomfort on the legs d. remove the stockings while out of bed for 1 hour, 4 times a day, to allow the legs to rest

B. Applying the stockings in the morning upon waking up before getting out of bed reduces venous stasis and assists in the venous return of blood to the heart.

A nurse is admitting a client with a suspected occlusion of a graft of the abdominal aorta. Which of the following is an expected clinical finding? A. Increased urine output B. Bounding pedal pulse C. Increase abdominal girth D. Redness of the lower extremities

C

AAA surgical repair

Elective or Emergent Open aneurysm repair (OAR) - Excision of aneurysm, placement of synthetic graft -more invasive because you make a cut and clamp both sides of aneurism Endovascular Graft Procedure (EVAR) - Sutureless aortic graft placement inside aneurysm - Provides conduit for blood to bypass the aneurysm -tubes are inserted in femoral artery and less invasive and a graft is placed where the AAA is so it relieved the pressure Complications: Endoleak Intraabdominal hypertension Hemorrhage Graft occlusion or rupture Hypovolemia Renal failure

Abdominal Aortic Aneurysm (AAA)

Risk factors Atherosclerosis, HTN, smoking, familial risk, trauma, > men Signs/symptoms Most often __asymptomatic_______________ Constant abdominal or low back pain SOB or difficulty swallowing Epigastric discomfort Diminished femoral pulses On exam pulsating abdominal mass with bruits Complication: rupture/dissection

Venous Thromboembolism (VTE)

Risk factors Venous stasis A-fib Obesity Prolonged immobility (bed rest, long trips) Advanced age Endothelial injury Hx of VTE IV drug abuse Trauma Altered coagulation Factor V/Antithrombin III deficiency Pregnancy/ Oral contraceptives Tobacco use Manifestations Deep veins (DVT) Superficial veins (SVT) Pulmonary embolism (PE)

Contractures

Shortening or contraction of a muscle. May be due to spasms or paralysis and may be permanent

AAA rupture

Signs/Symptoms Symptoms vary from "small leak" to "complete rupture", also depends on size of aneurysm Severe abdominal or back pain Grey Turner's Sign Abdominal distension (measure girth) Hypotension, tachycardia/shock Loss of consciousness Urgent Management Poor prognosis Immediate transfer to OR -very serious you need to go to OR or you die

Venous Insufficiency Tx

Treatment/ Nursing Interventions: Goal: decrease edema, promote venous return Treating ulcers - (may last years) Duoderm - hydrocolloid dsg leave in place 3 days Unna boot - gauze and zinc oxide - change once/wk Debridement Nutrition Antibiotics Psychosocial considerations

A 46-year-old is diagnosed with thromboangiitis obliterans (Buerger's disease). When the nurse is developing a discharge teaching plan for the patient, which outcome has the highest priority for this patient? A. Cessation of all tobacco use B. Control of serum lipid levels C. Maintenance of appropriate weight D. Demonstration of meticulous foot care

A

While working in the outpatient clinic, the nurse notes that a patient has a history of intermittent claudication. Which statement by the patient would support this information? A. "When I stand too long, my feet start to swell." B. "I get short of breath when I climb a lot of stairs." C. "My fingers hurt when I go outside in cold weather." D. "My legs cramp whenever I walk more than a block."

D- pain should go away when you stop walking and rest for a little

Buerger's disease

A condition in which the blood vessels, especially those supplying the legs, are constricted whenever nicotine enters the bloodstream, the ultimate result being gangrene and amputation. Scared ti bump into stuff because then a clot could form which stops the blood flow which can lead to amputation of the area

A nurse is teaching a client who has a new prescription for clopidogrel. Select all that the nurse should include. a. avoid consumption of grapefruit and herbal supplements b. monitor black and tarry stools c. take this when you have pain d. schedule weekly PT test e. Limit food sources containing vit. K while taking this

A, B

A nurse is planning caring for a client who had a surgical placement of an synthetic graft to repair an aneurysm. Which of the following interventions should the nurse include in the plan of care?A. Assess pedal pulses. B. Monitor for an increase in pain below the graft site. C. Maintain client in high Fowler's position. D. Monitor the femoral site for bleeding. E. Report an hourly urine output of 60 mL.

A, B, D

A nurse is reviewing clinical manifestations of a thoracic aortic aneurysm with a newly hired nurse. Which of the following should the nurse include in the discussion? (Select all that apply.) A. Cough B. Shortness of breath C. Upper chest pain D. Diaphoresis E. Altered swallowing

A, B, E

The nurse is caring for a patient with critical limb ischemia who has just arrived on the nursing unit after having percutaneous transluminal balloon angioplasty. Which action should the nurse perform first? A. Begin oral intake. B. Obtain vital signs. C. Assess pedal pulses. D. Start discharge teaching.

B

When caring for a patient on the first postoperative day after an abdominal aortic aneurysm repair, which assessment finding is most important for the nurse to communicate to the health care provider? A. Presence of flatus B. Loose, bloody stools C. Hypoactive bowel sounds D. Abdominal pain with palpation

B

When developing a teaching plan for a 76-year-old patient newly diagnosed with peripheral artery disease (PAD), which instructions should the nurse include? A. "Exercise only if you do not experience any pain." B. "It is very important that you stop smoking cigarettes." C. "Try to keep your legs elevated whenever you are sitting." D. "Put elastic compression stockings on early in the morning."

B

When evaluating the discharge teaching for a patient with chronic peripheral artery disease (PAD), the nurse determines a need for further instruction when the patient says, "I will A. have to buy some loose clothes that do not bind across my legs or waist." B. use a heating pad on my feet at night to increase the circulation and warmth in my feet." C. change my position every hour and avoid long periods of sitting with my legs crossed." D. walk to the point of pain, rest, and walk again until the pain returns for at least 30 minutes 3 times a week."

B

A nurse is assessing a male client who has advanced peripheral artery disease (PAD). Which of the following findings should the nurse expect? A. Thin, pliable toe nails B. Leg pain at rest C. Hairy legs D. Flushed, warm legs

B PAD is an oxygen problem and ischemia can occur because there is no oxygen or blood going to the extremeties.... very bad (ARTS A- absence of pulses, no leg hair, shiny R- round, red, smooth sores, rubor T- toes and feet pale, sometimes black from eschar S- sharp calf pain at rest or when walking) PVD is not an oxygen problem it is a valve problem and the blood pools because the valves are back flowing when the veins try to get blood back to the heart (VEINY V- voluptuous pulses, warm legs E- edema I- irregularly shaped sores N- no sharp pain during exercise, dull pain Y- yellow and brown ankles)

After receiving report, which patient admitted to the emergency department should the nurse assess first? A. 67-year-old who has a gangrenous left foot ulcer with a weak pedal pulse B. 58-year-old who is taking anticoagulants for atrial fibrillation and has black stools C. 50-year-old who is complaining of sudden "sharp" and "worst ever" upper back pain D. 39-year-old who has right calf tenderness, redness, and swelling after a long plane ride

C

Which assessment finding for a patient who has been admitted with a right calf venous thromboembolism (VTE) requires immediate action by the nurse? A. Erythema of right lower leg B. Complaint of right calf pain C. New onset shortness of breath D. Temperature of 100.4° F (38° C)

C

The nurse is caring for patient who had just returned from the cardiac catheterization laboratory following a percutaneous transluminal coronary angioplasty (PTCA). Which of the following problems is a priority during the immediate post-procedure care of this patient? A: Impaired coronary tissue perfusion related to presence of atherosclerotic plaque B: Potential for internal hemorrhage related to warfarin (Coumadin) therapy C: Alteration in INR related to aspirin therapy D. Potential for chest pain related to coronary artery spasm/reocclusion

D

A nurse is caring for a client who has a DVT and has been taking heparin for a week. Two days ago, the provider also prescribed warfarin. The client asks the nurse about receiving both at the same time. What should the nurse say? a. I will remind your provider that you are already receiving heparin b. your lab findings indicate that 2 anticoagulants are needed c. it takes 3-4 days for the therapeutic effects of warfarin, and then heparin can be discontinued d. only one of these medications are being given to treat your DVT

C. warfarin depresses synthesis of clotting factors but does not have an effect on clotting factors that are present. It takes 3-4 days for the clotting factors that are present to decay and for the therapeutic effects of warfarin to occur.

A 73-year-old patient with chronic atrial fibrillation develops sudden severe pain, pulselessness, pallor, and coolness in the right leg. The nurse should notify the health care provider and immediately A. apply a compression stocking to the leg. B. elevate the leg above the level of the heart. C. assist the patient in gently exercising the leg. D. keep the patient in bed in the supine position.

D

A nurse is discussing a new diagnosis of an aneurysm with a client. The client asks the nurse to explain what causes an aneurysm to rupture. Which of the following is an appropriate response by the nurse? A. "The wall of an artery becomes thin and flexible." B. "It is due to turbulence in blood flow in the artery." C. "It is due to abdominal enlargement." D. "It is due to hypertension."

D

A nurse is reviewing discharge instructions with a client who has Raynaud's disease. Which of the following client statements indicates an understanding of the teaching? "I plan to use nicotine gum to help me quit smoking." "I am going to take a stress management class." "I will limit myself to only two cups of coffee in the morning." "I should not drive in the winter months."

"I am going to take a stress management class." The nurse should instruct the client that stress can elicit attacks. The client should learn to avoid stressful situations when possible and learn to manage stress to limit the occurrence of attacks.

Aneurysm

An aneurysm is a sac (outpouching) of an artery formed by weakness or stretching of arterial wall Occur most commonly on aorta ¾ of aortic aneurysms occur in abdomen (AAA) Three types: Fusiform - total cirumference dilated Saccular - one side dilated Dissecting - artery wall is completely separated (happens very quick cause all the blood leaves)

After teaching a patient with newly diagnosed Raynaud's phenomenon about how to manage the condition, which action by the patient demonstrates that the teaching has been effective? A. The patient exercises indoors during the winter months. B. The patient places the hands in hot water when they turn pale. C. The patient takes pseudoephedrine (Sudafed) for cold symptoms. D. The patient avoids taking nonsteroidal anti-inflammatory drugs (NSAIDs).

A

A nurse is caring for a client who is admitted to the emergency department with a blood pressure of 266/147 mm Hg. The client reports a headache and double vision. The client states that she ran out of her diltiazem 3 days ago, and is unable to purchase more. Which of the following actions should the nurse take first? A. Administer acetaminophen for headache. B. Provide teaching regarding the importance of not abruptly stopping an antihypertensive. C. Obtain IV access and prepare to administer an IV antihypertensive. D. Call social services for a referral for financial assistance in obtaining prescribed medication.

A. Administering acetaminophen will treat the client's pain, but there is another action that the nurse should take first. B. Providing teaching regarding medication administration can help promote future compliance with taking medication, but there is another action that the nurse should take first. C. CORRECT: The greatest risk to the client is injury due to a blood pressure of 266/147 mm Hg, which can be life-threatening and should be lowered as soon as possible. ObtainingIV access will permit administration of an IV hypertensive,which will act more rapidly than by the oral route. D. Calling social services will help connect the client with financial resources, but there is another action that the nurse should take first.

A nurse in an urgent care clinicis obtaining a history from aclient who has type 2 diabetes mellitus and a recent diagnosis of hypertension. This is the second time in 2 weeks that the client experienced hypoglycemia. Which of the following client data should the nurse report to the provider? A. Takes psyllium daily as a fiber laxative B. Drinks skim milk daily as a bedtime snack C. Takes metoprolol daily after meals D. Drinks grapefruit juice daily with breakfast

A. Adverse effects of psyllium do not include hypoglycemia. B. Skim milk increases blood glucose levels and lowers cholesterol. C. CORRECT: Metoprolol can mask the effects of hypoglycemia in clients who have diabetes mellitus. D. Grapefruit juice increases blood glucose levels.

A nurse is caring for a client who has peripheral arterial disease (PAD). Which of the following symptoms should the nurse expect to find in the early stage of the disease? A. Intermittent claudication B. Dependent Rubor C. Rest Pain D. Foot ulcers

B

A nurse is providing discharge teaching to a client who has peripheral arterial disease (PAD). Which of the following instructions should the nurse include in the teaching? A. Apply a heating pad on a low setting to help relieve leg pain B. Adjust the thermostat so that the environment is warm C. Wear antiembolic stockings during the day D. Rest with the legs above heart level

B

A nurse is teaching a client who has a new diagnosis of venous insufficiency. Which of the following instructions should the nurse include? A. "Apply ice packs to your legs" B. "Use elastic stockings" C. "Remain on bed rest" D. "Place your legs in a dependent position while in bed"

B

Vascular disorders

Peripheral vascular disease: progressive circulation disorder Peripheral artery disease: Thickening of artery walls - Leading cause: Atherosclerosis When arteries don't work properly, your feet and legs can't get enough oxygen and other needed supplies, like nutrients. And when veins aren't working, there can be a buildup of blood materials, like fluid, in your limbs. The two diseases differ in several key ways. PAD means you have narrowed or blocked arteries -- the vessels that carry oxygen-rich blood as it moves away from your heart to other parts of your body. PVD, on the other hand, refers to problems with veins -- the vessels that bring your blood back to your heart. PAD-can occur more with atherosclerosis and PVD can have valves in your veins back flow in the wrong direction so this is why is causes the leg edema Risk factors: Tobacco use Diabetes Hyperlipidemia Elevated C-reactive protein Uncontrolled hypertension Stress Sedentary lifestyle Obesity Non-modifiable risk factors: age, gender, familial predisposition/genetics

Buerger's Disease—Thromboangiitis Obliterans

Recurring inflammatory process of the small and intermediate vessels of (usually) the lower extremities Inflammatory thrombus forms and blocks vessels Most often occurs in men ages 20 to 35. Risk or aggravating factor: Progressive occlusion of vessels results in pain, ischemic changes, ulcerations, and gangrene. Treatment: smoking cessation, antibiotics, avoiding cold limb exposure, amputation -

Nursing interventions for amputations

Relief of pain Administer analgesic or other medications as prescribed Changing position Alternative methods of pain relief- distraction, TENS unit Note: Pain may be an expression of grief and altered body image Promoting wound healing Handle limb gently Residual limb shaping

Treatment of DVT/PE

Weight-based heparin infusions Serial measurements: - aPTT Two Nurses Required! Goal is INR of 2.0 to 3.0 - for pt on anticoagulants Monitor Platelet Count!!! 150,000, 450,000 Risk: HIT - Duration of therapy (>4 days) Additional Medications: - lovenox - coumadin

A nurse is assessing a client who has chronic venous insufficiency. Which of the following findings should the nurse expect? a. dependent rubor b. edema c. hair loss d. thick, deformed toenails

b PVD- veins pump blood back to the heart but when it gets occluded the blood pools PAD-arteries carries blood from the heart to the extremities so if it can't get there, the extremities don't get blood

Osteomyelitis

infection of the bone

Gangrene

death of tissue associated with loss of blood supply (necrosis) it turns black

Arteriogram

radiographic image of an artery (after an injection of contrast media)

ABI (ankle brachial index)

test that measures arterial perfusion using a Doppler unit. blood pressures are measured in both UEs and LEs and highest LE systolic pressure is divided by brachial systolic pressure. ABI (Ankle Brachial Index) Ankle systolic pressure divided by brachial systolic pressure normal = 1.0 - 1.2 below 1.0 suggests arterial obstruction 0.8 - 1.0 mild 0.5 - 0.7 moderate < 0.5 severe

Carotid Endarterectomy

the surgical removal of the lining of a portion of a clogged carotid artery leading to the brain

CT Coronary Angiography

views cardiac motion throughout the entire cardiac cycle receive beta blockers to slow the HR to be able to take the pictures Nitroglycerin given immediately before the scan to achieve vasodilation