Exam 2: Vascular Disorders
Varicose Veins
-Aching feeling or pain after prolonged standing or sitting -Itchy, burning, tingling, throbbing leg sensation These are clinical manifestations for what?
Varicose Veins
-Family history -Weakness of vein structure -Female gender -Hispanic -Tobacco use -Increased age -Obesity -Multiparity These are risk factors for what?
c
A 50 year old woman weighs 95 kg and has a history of tobacco use, high blood pressure, high sodium intake, and sedentary lifestyle. When developing an individualized care plan for her, the nurse determines that the most important risk factors for peripheral artery disease that must be modified are a. weight and diet b. activity level and salt intake c. tobacco use and high blood pressure d. sedentary lifestyle and exercise training
Valve
A common site for thrombus formation is in the ______ cusps of the veins, where venous stasis occurs
4
A resident in a long-term care facility who has venous stasis ulcers is treated with an Unna boot. Which nursing activity included in the resident's care is best for the nurse to delegate to the unlicensed assistive personnel (UAP)? 1. Teaching family members the signs of infection 2. Monitoring capillary perfusion once every 8 hours 3. Evaluating foot sensation and movement each shift 4. Assisting the client in cleaning around the Unna boot
Thrombosis
A venous ____________ involves the formation of a thrombus in association with inflammation of the vein. It is the most common disorder of the veins
Chronic venous insufficiency
As a result of this, serous fluids and RBCs leak from capillaries and venules into the tissue, causing edema and chronic inflammatory changes
Hemosiderin
Enzymes that break down RBCs cause the release of _____________, which causes a brown discoloration of the skin
Pulmonary
If a thrombus forms within a lung, it is called a _________ embolis. The patient will complain of shortness of breath and chest pain
Diabetes
Patients with _________ are at a higher risk of developing peripheral artery disease
Atherectomy
Radiology Catheter-Based Procedures Complete removal of the obstructing plaque
Reticular Veins
Varicose Vein: Smaller varicose veins that appear flat, less tortuous, and blue green in color
Secondary Varicose Veins
Varicose Vein: result from direct injury, a previous VTE, or excessive vein distention
Phlebitis
Venous Disorder An acute inflammation of the walls of small cannulated veins of the hand and arm. Causes pain, tenderness, warmth, swelling, and erythema
b d e f
What are characteristics of peripheral artery disease? (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
Vena Cava
______ ______ interruption devices can be placed percutaneously through the right femoral or right internal jugular veins. The filter is opened, and the spokes penetrate vessel walls, allowing filtration of clots without interruption of blood flow
Varicose Veins
tortuous, dilated veins due to incompetent valves
Peripheral Artery Disease
-Tobacco -Chronic kidney disease -HTN -hypercholesterolemia -family history -Elevated c-reactive protein -obesity -stress these are risk factors for what?
Doppler Ultrasound with Duplex Imaging
Diagnostic Studies for PAD This maps blood flow throughout the entire artery. It can determine the degree of blood flow
Intermittent Claudication
In peripheral vascular disease, this disorder is not present due to the fact that it is only associated with the arteries
Lower
Peripheral artery disease of the __________ extremities can affect the iliac, femoral, popliteal, or peroneal arteries
Stents
Radiology Catheter-Based Procedures These are placed within an artery after a balloon angioplasty is done
Cryoplasty
Radiology Catheter-Based Procedures This procedure combines percutaneous transluminal angioplasty with cold therapy
Percutaneous Transluminal Angioplasty (PTA)
Radiology Catheter-Based Procedures Uses a catheter with a balloon at the tip that is moved to the narrowed area of the artery and inflated
Thrombosis
Superficial venous ____________ is the most frequent complication of varicose veins
Endarterectomy
Surgical Therapy for PAD This is the opening of an artery and removing an obstructed plaque
Patch Graft Angioplasty
Surgical Therapy for PAD This procedure consists of opening the artery, removing plaque, and sewing a patch to the opening to widen the lumen
2
The clinic nurse obtains this information about a client who is taking warfarin after having a deep vein thrombosis. Which finding is most indicative of a need for a change in therapy? 1. Blood pressure is 106/54 mm Hg. 2. International normalized ratio (INR) is 1.2. 3. Bruises are noted at sites where blood has been drawn. 4. Client reports eating a green salad for lunch every day.
c
The first priority of interprofessional care of a patient with a suspected acute aortic dissection is to a. reduce anxiety b. monitor for chest pain c. control blood pressure d. increase myocardial contractility
Atherosclerosis
The leading cause of death associated with peripheral artery disease is what?
1
The nurse is working in an outpatient clinic where many vascular diagnostic tests are performed. Which task associated with vascular testing is most appropriate to delegate to experienced unlicensed assistive personnel (UAP)? 1. Measuring ankle and brachial pressures in a client for whom the ankle-brachial index is to be calculated 2. Checking blood pressure and pulse every 10 minutes in a client who is undergoing exercise testing 3. Obtaining information about allergies from a client who is scheduled for left leg contrast venography 4. Providing brief client teaching for a client who will undergo a right subclavian vein Doppler study
b
The nurse teaches a patient with peripheral arterial disease. The nurse determines that further teaching is needed if the patient makes which statement? a."I should not use heating pads to warm my feet." b."I should cut back on my walks if it causes pain in my legs." c."I will examine my feet every day for any sores or red areas." d."I can quit smoking if I use nicotine gum and a support group."
a
The nurse teaches the patient with any venous disorder that the best way to prevent venous stasis and increase venous return is to a. take short walks b. sit with the legs elevated c. frequently rotate the ankles d. continuously wear elastic compression stockings
Telangiectasia
This term defines small visible vessels that appear bluish black, purple, or red. They are also called "spider veins"
d
To help prevent embolization of a thrombus in a patient with acute VTE and severe edema and limb pain, what should the nurse teach the patient to do first? a. dangle the feet over the edge of the bed every 2-3 hours b. ambulate around the bed 3-4 times a day c. keep the affected leg elevated above the level of the heart d. maintain bed rest until edema is relieved and anticoagulation is established
Deep Vein Thrombosis
Type of Venous Thrombosis Involves a thrombus in a deep vein, most commonly the iliac and/or femoral veins
Superficial Vein Thrombosis
Type of Venous Thrombosis The formation of a thrombus in a superficial vein, usually the greater or lesser saphenous vein
Sclerotherapy
Varicose Vein Surgical Therapy Direct IV injection of a liquid or foam sclerosing substance that chemically ablates the treated veins. Complications are residual pigmentation and matting, HA, skin necrosis, sensory nerve injury
Transilluminated Powered Phlebectomy
Varicose Vein Surgical Therapy Involves the use of a tissue resector to destroy clusters of varicosities and removes the pieces via aspiration
Ambulatory Phlebotomy
Varicose Vein Surgical Therapy Pulling the varicosity through a "stab" incision followed by excision of the vein
Endovenous Ablation
Varicose Vein Surgical Therapy Uses thermal energy from radiofrequency or laser therapy. A catheter is inserted into the vein to heat the vein wall, causing the vein to collapse
Transcutaneous Laser Therapy
Varicose Vein Surgical Therapy Works by heating the hemoglobin in the vessels, resulting in vessel sclerosis. Also known as light therapy
Primary Varicose Veins
Varicose Vein: Due to a weakness in vein walls, and are more common in women
Congenital Varicose Veins
Varicose Vein: Result from a chromosomal defect which causes abnormal development of the venous system
Intermittent Claudication
What is the most common symptom of peripheral artery disease?
d
When obtaining a heath history from a 72 year old man with peripheral artery disease (PAD) of the lower extremities, the nurse asks about a history of related conditions, including a. venous thrombosis b. venous stasis ulcers c. pulmonary embolism d. coronary artery disease (CAD)
b
When teaching the patient with PAD about modifying risk factors associated with the condition, what should the nurse emphasize? a. Amputation is the ultimate outcome if the patient does not alter lifestyle behaviors b. Modifications will reduce the risk for other atherosclerotic conditions such as stroke c. Risk-reducing behaviors initiated after angioplasty can stop the progression of the disease d. Maintenance of normal body weight is the most important factor in controlling arterial disease
a e
Which characteristics describe the anticoagulant warfarin (coumadin)? (select all that apply) a. vitamin k is the antidote b. protamine sulfate is the antidote c. may be administered orally or subcutaneously d. may be administered intravenously or subcutaneously e. dosage monitored using international normalized radio (INR) f. dosage monitored using activated partial thromboplastin time (aPTT)
b c d
Which clinical manifestations are seen in patients with either Buerger's disease 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 d f
Which conditions characterize critical limb ischemia? (select all that apply) a. cold feet b. arterial leg ulcers c. venous leg ulcers d. gangrene of the leg e. no palpable peripheral pulse f. rest pain lasting more than 2 weeks
d
Which indirect thrombin inhibitor is only administered subcutaneously and does not need routine coagulation tests? a. warfarin (coumadin) b. unfractioned heparin c. hirudin derivatives (bivalirudin [angiomax]) d. low-molecular-weight heparin (enoxaparin [lovenox])
a b
A nurse is teaching a client who has a prescription for clopidogrel. Which of the following instructions should the nurse include? (Select all that apply) a. "avoid taking herbal supplements while taking this medication." b. "monitor for the presence of black, tarry stools." c. "take this medication when you have pain." d. "schedule a weekly PT test." e. "limit food sources containing vitamin K while taking this medication."
b c e
A patient with PAD has a nursing diagnosis of ineffective peripheral tissue perfusion. What should the nurse include in the teaching plan for this patient? (select all that apply) a. Apply cold compress when the legs become swollen b. Wear protective footwear and avoid hot or cold extremes c. Walk at least 30 minutes per day, at least 3 times per week d. Use nicotine replacement therapy as a substitute for smoking e. Inspect lower extremities for pulses, temperature, and any injury
a
A key aspect of teaching for the patient on anticoagulant therapy includes which instructions? a. monitor for and report any signs of bleeding b. do not take acetaminophen (Tylenol) for a headache c. decrease your dietary intake of foods containing vitamin K d. arrange to have blood drawn twice a week to check drug effects
d
A nurse is assessing a client who has chronic peripheral artery disease. Which of the following findings should the nurse expect? a. edema around the ankles and feet 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
c
A nurse is caring for a client who has a deep-vein thrombosis and has been taking unfractionated heparin for 1 week. 2 days ago, the provider also prescribed warfarin. The client asks the nurse about receiving both heparin and warfarin at the same time. Which of the following statements should the nurse give? a. "I will remind your provider that you are already receiving heparin." b. "Your laboratory findings indicated that two anticoagulants were needed." c. "It takes 3-4 days before the therapeutic effects of warfarin are achieved, and then the heparin can be discontinued." d. "Only one of these medications is being given to treat your deep-vein thrombosis
b
A nurse is caring for a client who has chronic venous insufficiency and a prescription for thigh-high compression stockings. Which of the following actions should the nurse take? a. elevate the client's legs for 10 min, 2-3 times daily 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 hr, 4 times a day, to allow the legs to rest
d
A nurse is teaching a client who has a new diagnosis of severe peripheral artery disease. Which of the following instructions should the nurse include? a. wear tightly-fitted insulated socks with shoes when going outside b. elevate both legs above the heart when resting c. apply a heating pad to both legs for comfort d. place both legs in dependent position when sleeping
d
A patient with VTE is to be discharged on long-term warfarin (coumadin) therapy and is taught about prevention and continuing treatment of VTE. The nurse determines that discharge teaching for the patient has been effective when the patient makes which statement? a. "I should expect that coumadin will cause my stools to be somewhat black" b. "I should avoid all dark green and leafy vegetables while I am taking coumadin" c. "Massaging my legs several times a day will help increase my venous circulation" d. "Swimming is a good activity to include in my exercise program to increase my circulation"
a
A patient with peripheral artery disease has marked peripheral neuropathy. An appropriate nursing diagnosis for the patient is a. Risk for injury related to decreased sensation. b. Impaired skin integrity related to decreased peripheral circulation. c. Ineffective peripheral tissue perfusion related to decreased arterial blood flow. d. Activity intolerance related to imbalance between oxygen supply and demand.
Segmental Blood Pressures
Diagnostic Studies for PAD Obtained at the thigh, below the knee, and ankle level when patient is supine. A drop in this greater than 30 suggests PAD
Ankle-Brachial Index
Diagnostic Studies for PAD Performed using a hand-held doppler. Calculated by dividing the ankle systolic BPs by the higher of the left and right brachial systolic BPs
c
During care of the patient following femoral bypass graft surgery, the nurse immediately notifies the health care provider if the patient experiences a. fever and redness at the incision site b. 2+ edema of the extremity and pain at the incision site c. a loss of palpable pulses and numbness and tingling of the feet d. increasing ankle-brachial indices and serous drainage from the incision
Endothelial damage
Etiology of Venous Thrombosis Damage to this structure stimulates platelet activation and starts the coagulation cascade. This predisposes the patient to thrombus development
Hypercoagulability of the Blood
Etiology of Venous Thrombosis This can occur in many disorders. Basically, all of the disorders associated with this can cause an increased blood coagulation
Venous stasis
Etiology of Venous Thrombosis this occurs when the valves are dysfunctional or the muscles of the extremities are inactive. Occurs more often in people who: -Have chronic heart failure -A-Fib -Have been traveling on long trips w/out exercise -Have a prolonged surgery -Are immobile for a long time
Valves
Every time a muscle contracts, these structures in veins help to push deoxygenated blood back to the heart
b
Following teaching about medications for PAD, the nurse determines that additional instruction is necessary when the patient makes which statement? a. "I should take one aspirin a day to prevent clotting in my legs." b. "The lisinopril I use for my blood pressure may help me walk further without pain." c. "I will need to have frequent blood tests to evaluate the effect of the Trental I will be taking." d. "Pletal should help me increase my walking distance and speed and help prevent pain in my legs."
Amputation
For PAD, uncontrolled pain and severe, spreading infections, are indicators that _____________ is needed in people who are not candidates for revascularization
d
In planning care and patient teaching for the patient with venous leg ulcers, the nurse recognizes that the most important intervention in healing and control of this condition is a. discussing activity guidelines b. using moist environment dressings c. taking horse chesnut and seed extract daily d. applying graduated compression stockings
Standing
Incompetent vein valves allow for backward blood flow, particularly when the patient is in what position?
40 in 35 in
Interprofessional Care for PAD For nutritional therapy, patients are encouraged to maintain a BMI less than 25 and a waist circumference less than ____ in males and less than _____ in females
130/80
Interprofessional Care for PAD For patients with DM or renal insufficiency, a blood pressure less than __________ is recommended
7% 6%
Interprofessional Care for PAD Patients with DM should maintain a glycosylated hemoglobin (AC1) below ___% and, optimally, as near ____% as possible
Exercise
Interprofessional Care for PAD This type of therapy is important for women because they experience faster functional decline and greater mobility loss than men
Peripheral Artery/Vascular Disease
Involves thickening of artery walls. Results in a progressive narrowing of the arteries of upper and lower extremities
Chronic Venous Insufficiency
Long-standing functional abnormalities of the venous system that result in advanced venous signs and symptoms, such as edema, skin changes, and/or venous leg ulcers
Paresthesia
Manifestations of PAD Numbness and tingling in the toes and feet, may result from nerve tissue ischemia. Gradual, reduced blood flow to neurons produces loss of both pressure and deep pain sensations. Thus, patients might not notice lower extremity injuries
Rest Pain
Manifestations of PAD Occurs in the foot or toes and is aggravated by limb elevation. This happens when blood flow is insufficient to meet basic or metabolic demand of distal tissues. Occurs more often at night as cardiac output drops due to limbs being at the same level as the heart.
Pedal Popliteal Femoral
Manifestations of PAD These 3 pulse locations can be diminished or absent
Skin
Manifestations of PAD This area becomes shiny, thin, and taut, and hair loss occurs on the lower legs.
c
Rest pain is a manifestation of PAD that occurs due to a chronic a. vasospasm of small cutaneous arteries in the feet b. increase in retrograde venous blood flow in the legs c. decrease in arterial blood flow to the nerves of the feet d. constriction in arterial blood flow to the leg muscles during exercise
4
The nurse is preparing to administer the following medications to a client with multiple health problems who has been hospitalized with deep vein thrombosis. Which medication is most important to double-check with another licensed nurse? 1. Famotidine 20 mg IV 2. Furosemide 40 mg IV 3. Digoxin 0.25 mg PO 4. Warfarin 2.5 mg PO
c
The nursing care area is very busy with new surgical patients. Which care could the RN delegate to the unlicensed assistive personnel for a patient with VTE? a. assess the patient's use of herbs b. measure the patient for elastic compression stockings c. remind the patient to flex and extend the legs and feet every 2 hours d. teach the patient to call emergency response system with signs of pulmonary embolus
b
The patient at highest risk for venous thromboembolism (VTE) is a. A 62 year old man with spider veins who is having arthroscopic knee surgery b. A 32 year old woman who smokes, takes oral contraceptives, and is planning a trip to Europe c. A 26 year old woman who is 3 days postpartum and received maintenance IV fluids for 12 hours during her labor d. An active 72 year old man at home recovering from transurethral resection of the prostate for benign prostatic hyperplasia
a
The patient comes to the HCP office with pain, edema, and warm skin on her lower left leg. What test should the nurse expect to be ordered first? a. duplex ultrasound b. complete blood count c. magnetic resonance imaging d. computer venography (phlebogram)
b
The patient is diagnosed with a superficial vein thrombosis (SVT). Which characteristic should the nurse know about SVT? a. embolization to lungs may result in death b. clot may extend to deeper veins if untreated c. vein is tender to pressure and there is edema d. typically found in the iliac, inferior, or superior vena cava
b
The patient with VTE is receiving therapy with heparin and asks the nurse whether the drug will dissolve the clot in her leg. What is the best response by the nurse? a. "this drug will break up and dissolve the clot so that circulation in the vein can be restored" b. "the purpose of heparin is to prevent growth of the clot or formation of new clots where the circulation is slowed" c. "heparin won't dissolve the clot, but it will inhibit the inflammation around the clot and delay the development of new clots" d. "the heparin will dilate the vein, preventing turbulence of blood flow around the clot that may cause it to break off and travel to the lungs"
a b d e f
The surgery area calls the transfer report for a 68 year old, postmenopausal, female patient who smokes and takes hormone therapy. She is returning to the clinical unit after a length hip replacement surgery. Which factors present in this patient increase her risk for developing venous thromboembolism (VTE) related to Virchow's triad? (select all that apply) a. smoking b. IV therapy c. dehydration d. estrogen therapy e. orthopedic surgery f. prolonged immobilization
Bueger's Disease
This disease is an inflammatory disorder of the small and medium arteries and veins of the upper and lower extremities. Symptoms of it are often confused with PAD. They may present with color and temperature changes of the limbs, parasthesia, superficial vein thrombosis
Atherosclerosis
This is a thickening of the intima and media of the arterial wall. This results from the deposit of cholesterol and lipids within the vessel walls and leads to progressive narrowing of the arteries
Duplex Ultrasound Imaging
This is the gold standard to evaluate venous anatomy, valvular competence, and venous obstruction
a b c d f
What are the characteristics of vasoplastic disease? (Raynaud's Phenomenon) (select all that apply) a. predominant in young females b. may be associated with autoimmune disorders c. precipitated by exposure to cold, caffeine, and tobacco d. involves small cutaneous arteries of the fingers and toes e. inflammation of small and medium-sized arteries and veins f. episodes involve white, blue, and red color changes of fingertips
1. Venous stasis 2. Endothelial damage 3. Hypercoagulability of blood
What are the three important factors in the etiology of venous thrombosis, otherwise known as the Virchow's triad?
c
What is the most important measure in the treatment of venous leg ulcers? a. elevation of the affected leg b. application of topical antibiotics c. graduated compression stockings d. application of moist to dry dressings
Doppler
When assessing for a pulse, you cannot say that the pulses are absent. You can say that they are not palpable. The only time you can say that pulses are absent is after the use of a ____________, or if there is an amputation
b d
Which are clinical findings in a person with an acute lower extremity VTE (select all that apply)? a. pallor and coolness on 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
