ch 37 Vascular Disorders (PAD, VTE, Raynaud's)

Raynaud's phenomenon

-PAD -episodic vasospastic disorder of small cutaneous arteries, most often involving the fingers or toes -occurs primarily in young women -characterized by vasospasm-induced color changes of fingers, toes, ears, and nose

Buerger's disease

-PAD -inflammatory disorder of the small and medium arteries of the veins of the upper and lower extremities -occurs primarily in young men -symptoms: ischemic ulcerations, cold sensitivity, color and temperature changes of the limbs, paresthesia

peripheral artery disease (PAD)

-PAD results from atherosclerosis that usually occurs in the arteries of the lower extremities and is characterized by inadequate flow of blood -narrowing of the arteries of the upper and lower extremities caused by atherosclerosis

rest pain

-a manifestation of PAD that occurs due to a chronic decrease in arterial blood flow to the nerves of the feet -numbness or pain primarily in the feet when in bed -relieved by placing legs at rest in dependent position (dangling over side of bed)

intermittent claudication

-classic symptom of lower extremity PAD -ischemic muscle pain precipitated by exercise -resolves within 10 min. with rest

DVT prevention

-early ambulation -leg elevation -active leg exercises -compression stockings -intermittent pneumatic calf compression -hydration (dehydration predisposes clotting) (NCLEX)

superficial vein thrombosis

-formation of a thrombus in a superficial vein -can lead to DVT

phlebitis

-inflammation of the veins resulting from an IV catheter -symptoms: pain, tenderness, warmth, erythema, swelling, palpable cord

lower-limb PAD appearance

-loss of hair on legs and feet -elevation pallor (pallor of extremity with elevation) -dependent rubor (redness) of extremity -thickened toenails -thin, shiny, taut skin -cold extremities -decreased or absent peripheral pulses

causes of venous stasis

-prolonged immobility -long plane ride -pregnancy and postpartum -varicose veins -obesity -chronic heart failure

peripheral artery disease risk factors (5)

-tobacco use -diabetes -chronic kidney disease -hypertension -hyperlipidemia

causes of blood hypercoagulability

-tobacco use -oral contraceptives (esp. with tobacco use) -pregnancy and postpartum period -severe anemia -dehydration or malnutrition -cancer -sepsis -diabetes -polycythemia

symptoms of lower extremity VTE

-unilateral leg edema -pain -tenderness with palpation -dilated superficial veins -paresthesias -warm skin -erythema -fever greater than 100.4 F

3 peripheral venous disorders

1. VTE (venous thromboembolism) 2. venous insufficiency 3. varicose veins

6 P's of acute arterial ischemia

1. pain 2. pallor 3. pulselessness 4. paresthesia (numbness or tingling) 5. paralysis 6. poikilothermia (adaption of the limb to the environmental temp, most often cool)

A nurse is caring for a client who is on strict bed rest and creates a plan of care with goals related to the prevention of deep vein thrombosis and pulmonary emboli. Which nursing action is most helpful in preventing these disorders from developing? 1. Restricting fluids 2. Placing a pillow under the knees 3. Encouraging active range-of-motion exercises 4. Applying a heating pad to the lower extremities

3. Encouraging active range-of-motion exercises NCLEX

The nurse creates a plan of care for a client with deep vein thrombosis. Which client position or activity in the plan should be included? 1. out-of-bed activities as desired 2. bed rest with the affected extremity kept flat 3. bed rest with elevation of the affected extremity 4. bed rest with the affected extremity in a dependent position

3. bed rest with elevation of the affected extremity (elevation of the affected leg facilitates blood flow by the force of gravity and decreases venous pressure, which relieves edema and pain) NCLEX

A client has been diagnosed with thromboangiitis obliterans (Buerger's disease). The nurse is identifying measures to help the client cope with lifestyle changes needed to control the disease process. The nurse plans to refer the client to which member of the health care team? 1. dietitian 2. medical social worker 3. pain management clinic 4. smoking cessation program

4. smoking cessation program NCLEX

PAD vs VTE: capillary refill

PAD: > 3 sec VTE: < 3 sec

PAD vs VTE: skin temperature

PAD: cool VTE: warm

PAD vs VTE: peripheral pulses

PAD: decreased or absent VTE: present, may be difficult to palpate with edema

PAD vs VTE: edema

PAD: no edema VTE: lower leg edema, unilateral

PAD vs VTE: pain

PAD: rest pain, intermittent claudication VTE: dull ache or heaviness in calf or thigh

PAD vs VTE: toenails

PAD: thickened, brittle VTE: normal or thickened

PAD vs VTE: skin texture

PAD: thin, shiny, taut VTE: thick, hardened, indurated

superficial vein thrombosis can lead to what?

VTE

risk factors for VTE / Virchow's triad

Virchow's triad: 1. venous stasis 2. endothelial damage 3. blood hypercoagulability

deep vein thrombosis (DVT)

a thrombus (blood clot) in a deep vein, most commonly the iliac and/or femoral veins

What medications should the nurse expect to include in the teaching plan to decrease the risk of cardiovascular events and death for PAD patients (select all that apply.)? a. Ramipril (Altace) b. Cilostazol (Pletal) c. Simvastatin (Zocor) d. Clopidogrel (Plavix) e. Warfarin (Coumadin) f. Aspirin (acetylsalicylic acid)

a. Ramipril (Altace) c. Simvastatin (Zocor) f. Aspirin (acetylsalicylic acid) -a.ACE inhibitor to treat hypertension -c. statin to treat high cholesterol -f. anticoagulant MS ch 37

Assessment of a patient's peripheral IV site reveals that phlebitis has developed over the past several hours. Which intervention should the nurse implement first? a. Remove the patient's IV catheter. b. Apply an ice pack to the affected area. c. Decrease the IV rate to 20 to 30 mL/hr. d. Administer prophylactic anticoagulants.

a. Remove the patient's IV catheter. MS ch 37

The patient at highest risk for VTE is: a. 62-yr-old man with spider veins who is having arthroscopic knee surgery b. 32-yr-old woman who smokes, takes oral contraceptives, and is planning a trip to Europe c. 26-yr-old woman who is 3 days postpartum and received maintenance IV fluids for 12 hrs during her labor d. active 72-yr-old man at home recovering from transuretheral resection of the prostate for benign prostatic hyperplasia

b. 32-yr-old woman who smokes, takes oral contraceptives, and is planning a trip to Europe -smoking and oral contraceptives = blood hypercoagulability -long plane ride = venous stasis MS ch 37

A nurse is caring for a patient with a diagnosis of deep venous thrombosis (DVT). The patient has an order to receive 30 mg enoxaparin (Lovenox). Which injection site should the nurse use to administer this medication safely? a. Buttock, upper outer quadrant b. Abdomen, anterior-lateral aspect c. Back of the arm, 2 inches away from a mole d. Anterolateral thigh, with no scar tissue nearby

b. Abdomen, anterior-lateral aspect MS ch 37

Which assessment findings of the left lower extremity will the nurse identify as consistent with arterial occlusion (select all that apply.)? a. Edematous b. Cold and mottled c. Complaints of paresthesia d. Pulse not palpable with Doppler e. Capillary refill less than three seconds f. Erythema and warmer than right lower extremity

b. Cold and mottled c. Complaints of paresthesia d. Pulse not palpable with Doppler MS ch 37

The nurse is assessing a client with Buerger's disease. The nurse should determine if the client is experiencing: a. Thickening of the intima and media of the artery. b. Inflammation and fibrosis of arteries, veins, and nerves. c. Vasospasm lasting several minutes. d. Pain, pallor, and pulselessness.

b. Inflammation and fibrosis of arteries, veins, and nerves.

Which are clinical findings in a person with an acute lower extremity VTE? Select all that apply: a. Pallor and coolness of foot and calf b. Mild to moderate calf pain and tenderness c. Grossly diminished or absent pedal pulses d. Unilateral edema and induration of the thigh e. Palpable cord along a superficial varicose vein

b. Mild to moderate calf pain and tenderness d. Unilateral edema and induration of the thigh -a. and c. = PAD -e. = superficial vein thrombosis MS ch 37

Which assessment finding would alert the nurse that a postoperative patient is not receiving the beneficial effects of enoxaparin (Lovenox)? a. Crackles bilaterally in the lung bases b. Pain and swelling in a lower extremity c. Absence of arterial pulse in a lower extremity d. Abdominal pain with decreased bowel sounds

b. Pain and swelling in a lower extremity (enoxaparin is used to prevent DVT postoperatively) MS ch 37

Which clinical manifestations are seen in patients with either Buerger's diseases or Raynaud's phenomenon? Select all that apply: a. Intermittent fevers b. Sensitivity to cold temperatures c. Gangrenous ulcers on fingertips d. Color changes of fingers and toes e. Episodes of superficial vein thrombosis

b. Sensitivity to cold temperatures c. Gangrenous ulcers on fingertips d. Color changes of fingers and toes MS ch 37

A 62-yr-old Hispanic male patient with diabetes mellitus has been diagnosed with peripheral artery disease (PAD). The patient is a smoker with a history of gout. To prevent complications, which factor is priority in patient teaching? a. Gender b. Smoking c. Ethnicity d. Comorbidities

b. Smoking MS ch 37

A nurse is caring for a client who has SLE and is experiencing an episode of Raynaud's phenomenon. Which of the following findings should the nurse anticipate? a. swelling of the joints and fingers b. pallor of toes with cold exposure c. feet that become reddened with ambulation d. client report of intense feeling of heat in the fingers

b. pallor of toes with cold exposure ATI

What are characteristics of PAD? Select all that apply: a. pruritus b. thickened, brittle nails c. dull ache in calf or thigh d. decreased peripheral pulses e. pallor on elevation of the legs f. ulcers over bony prominences on toes and feet

b. thickened, brittle nails d. decreased peripheral pulses e. pallor on elevation of the legs f. ulcers over bony prominences on toes and feet MS workbook ch 37

A patient with diabetes mellitus has been diagnosed with peripheral vascular disease. Which dermatologic manifestations should the nurse assess? a. Redness of exposed areas of the skin on the hand, foot, face, or neck b. Leathery, brownish skin on lower leg, pruritus, concave lesions with edema, scar tissue with healing c. Loss of hair in periphery, delayed capillary filling, dependent rubor, neuropathy, and delayed wound healing d. Atrophy, epidermal thinning, increased vascular fragility, impaired wound healing, thin loose dermis, and excess fat at the back of the neck

c. Loss of hair in periphery, delayed capillary filling, dependent rubor, neuropathy, and delayed wound healing MS ch 22

critical limb ischemia

characterized by: -chronic ischemic rest pain lasting more than 2 weeks -arterial leg ulcers -gangrene of the leg

The nurse is preparing to administer a scheduled dose of enoxaparin (Lovenox) 30 mg subcutaneously. What should the nurse do to administer this medication correctly? a. Remove the air bubble in the prefilled syringe. b. Aspirate before injection to prevent IV administration. c. Rub the injection site after administration to enhance absorption. d. Pinch the skin between the thumb and forefinger before inserting the needle.

d. Pinch the skin between the thumb and forefinger before inserting the needle. MS ch 37

The patient reports tenderness when she touches her leg over a vein. The nurse assesses warmth and a palpable cord in the area. The nurse knows the patient needs treatment to prevent which sequela? a. Pulmonary embolism b. Pulmonary hypertension c. Post-thrombotic syndrome d. Venous thromboembolism

d. Venous thromboembolism (symptoms indicate superficial vein thrombosis which can lead to VTE) MS ch 37

A nurse is caring for a patient who has chronic peripheral artery disease (PAD). Which of the following findings should the nurse expect? a. edema around the feet and ankles b. ulceration around the medial malleoli c. scaling eczema of the lower legs with stasis dermatitis d. pallor on elevation of the limbs, and rubor when the limbs are dependent

d. pallor on elevation of the limbs, and rubor when the limbs are dependent (other choices are symptoms of venous stasis) ATI ch 35

primary varicose veins

due to a weakness of the vein walls

paresthesia

numbness or tingling

VTE can lead to what?

pulmonary embolism

venous thromboembolism (VTE)

represents the spectrum of pathology from DVT to pulmonary embolism (PE)

secondary varicose veins

result from a direct injury, a previous VTE, or excessive vein distention

acute arterial ischemia

sudden interruption in the arterial blood supply to a tissue, organ, or extremity

varicose veins can lead to what?

superficial venous thrombosis

symptoms of superficial vein thrombosis

vein: -palpable -firm -cordlike area surrounding the vein: -itchy -tender or painful to touch -reddened -warm