Peripheral Vascular disorders FINAL EXAM

1. Cool 2. Edema

Arterial Insufficiency 1. _______________ and pale extremity When elevated, becomes even more pale Rubor (reddish blue color) may be seen in a short time after extremity dependent Cyanosis- when very severe limitation in oxygen supply Loss of hair, brittle nails, dry and scaly skin, atrophy, ulcerations 2. E_________________ may be apparent due to constant dependency to relieve pain. Gangrene may appear after prolonged, severe ischemia

1. Intima 2. Media 3. Adventitia

Arteries - thick walled 3 layers in walls: 1. _________________- smooth surface in contact with blood 2. __________________ - smooth muscle and elastic tissue 3.______________________- outer layer connective tissue

1. doppler

Assessing Peripheral Pulses Popliteal, pedal, post tibialis If you can't feel on one side - use a 1._______________ to confirm. Neuro vascular assess-Temp, edema, hair, cap refill, color(pale), shiny, muscle strength, test with something sharp for feeling

1. Doppler

Continuous-wave 1. ______________ ultrasound detects blood flow, combined with computation of ankle or arm pressures; this diagnostic technique helps characterize the nature of peripheral vascular disease.

Angioplasty with Stent

Medical management Control risk factors, controlled exercise, medications and or surgical graft procedures A____________________ with Stent Nursing management Assessment Interventions

1. Intermittent claudication 2. exercise 3. rest

Pain 1. I____________________ C_____________________ Due to arterial system inability to supply blood flow to tissues Pain is caused by 2. ____________________ or activity and relieved by 3. ______________ Pain in forefoot at rest is severe! (rest pain) (worse at night and may interfere with sleep) Pain may be relieved by lowering leg to be dependent position

1. Claudication 2. Exercise 3. Rest intermittent = When you increase demand, but when you decrease, it goes away Insufficient supply for the demand If you have pain at rest, you have no blood supply to the foot If pain, PAD, legs should hang down ("dependent" position) not up (will make it worse)

Peripheral Arterial Occlusive Disease PAD Hallmark symptom is Intermittent 1. C___________________ described as aching, cramping, or inducing fatigue or weakness Occurs with some degree of 2. E_______________________ or activity Relieved with 3. R_________________ Pain is associated with critical ischemia of the distal extremity and is described as persistent, aching, or boring (rest pain) Ischemic rest pain is usually worse at night and often wakes the patient

1. O2 2. Nutrients -peripheral vasc diseases- problem with blood supply to the tisues -Reduced flow

Reduced blood flow thru peripheral blood vessels is the main characteristic of all peripheral vascular diseases Physiologic effects depends on the extent that tissue demands exceed the supply of 1.______________ and 2. __________________ Reduced flow occurs with Heart failure Atherosclerosis (plaque) Thromboemboli Trauma Inflammatory processes Incompetent valves Edematous tissues Diseases that affect vasculature - DM

C. Keep the lower extremities in a neutral or dependent position Rationale: For patients with PAD, blood flow to the lower extremities needs to be enhanced; therefore, the nurse encourages keeping the lower extremities in a neutral or dependent position. In contrast, for patients with venous insufficiency, blood return to the heart needs to be enhanced, so the lower extremities are elevated. Exercise can be prescribed to aid in the development of collateral circulation. Some pain is associated with PAD

The nurse is teaching a patient diagnosed with peripheral arterial disease (PAD). What should be included in the teaching plan? A. Elevate the lower extremities B. Exercise is discouraged C. Keep the lower extremities in a neutral or dependent position D. PAD should not cause pain

1. Debridement

Ulcer Management Antibiotics if infected 1. D________________________ - to keep clean and free of necrotic tissue Surgical Enzymatic ointments Apply to necrotic tissue not normal tissues- Debrisan for example, cover with dressing Wound dressing if no necrosis Keep moist- use hydrocolloids such as DuoDerm Assessing Wounds - What is documented

1. stenosis

Arterial Insufficiency Pulses Absence may indicate 1. S________________ May reduce or obliterate palpable pulses Use Doppler to evaluate Other tests- Duplex ultrasound, CT Scan, CT Angiography, MRI, Angiography, Ankle-brachial index

1. venules 2. 75% 3. valves Veins - greater capacitance 75% of total blood volume Veins have valves

Veins Capillaries join and form 1. _________________ Thinner walls than arteries Have greater ability to distend (capacitance vessels) can hold large volumes of blood under low pressure Contain 2. ______________% of total blood volume Contain 3____________________ to transport blood against the force of gravity