Prep U- PVD/PAD

A nurse is caring for a client following an arterial vascular bypass graft in the leg. What should the nurse plan to assess over the next 24 hours?

Peripheral pulses every 15 minutes after surgery

QUIZ Q: what is the patient with primary hypertension likely to report?

No symptoms (silent killer)

What are important instructions for a client who is diagnosed with Reynaud's disease to prevent an attack?

Avoid situations that contribute to ischemic episodes.

A client admitted to the medical-surgical unit with a venous thromboembolism (VTE) is started on enoxaparin and warfarin. The client asks the nurse why two medications are needed. Which response by the nurse is accurate?

"The enoxaparin will work immediately, but the warfarin takes several days to achieve its full effect."

QUIZ Q: Characteristics of arterial disease

1-Pallor on elevation 2-Thickened toenails 3-Decreased peripheral pulses 4-Ulcers over bony prominences on toes and feet

activated partial thromboplastin time (aPTT) is within the therapeutic range of:

1.5 to 2.5 times the baseline control.

PT therapeutic range

1.5-2x (normal or control value)

INR therapeutic range

2.0-3.0

When caring for a patient who has started anticoagulant therapy with warfarin (Coumadin), the nurse knows that therapeutic benefits will not occur for:

3 to 5 days.

The nurse explains to a patient that the primary cause of a varicose vein is:

An incompetent venous valve.

What would you name as the most common cause of peripheral arterial problems in the older adult?

Atherosclerosis

QUIZ Q: which test is most useful in differentiating dyspnea related to pulmonary effects of heart failure?

BNP levels

BP goal for PAD patients

Blood pressure should be less than 130/90 mm Hg.

QUIZ Q!: which initial assessment fininding would the nurse expect to be present in a patient with acute left-sided heart failure?

Bubbling crackles and tachycardia

Which is a risk factor for venous disorders of the lower extremities?

Clients with a history of varicose veins, hypercoagulation, neoplastic disease, cardiovascular disease, or recent major surgery or injury are at high risk. Other clients at high risk include those who are OBESE or older adults and women taking oral contraceptives.

signs and symptoms of abdominal aneurysm rupture

Constant, intense back pain and falling blood pressure

The nurse assessing a client who has arterial insufficiency of the legs and an ulcer on the left great toe would expect to find which characteristic?

Diminished or absent pulses

What advice should the nurse provide to clients with venous insufficiency?

Elevate the legs periodically for at least 15 to 20 minutes.

Which class of medication lyses and dissolves thrombi?

Fibrinolytic

Which sign or symptom suggests that a client's abdominal aortic aneurysm is extending?

Increased abdominal and back pain. The pulse rate would increase with aneurysm extension. Systolic bruit.

indications of a rupturing aortic aneurysm

Indications of a rupturing abdominal aneurysm include constant, intense back pain; falling blood pressure; and decreasing hematocrit.

QUIZ Q: The nurse suspects stable angina rather than MI pain in the pt who reports that his chest pain

Is relieved by nitro

Aortic dissection may be mistaken for which disease processes?

MI

ABI ranges

Normal people without arterial insufficiency have an ABI of about 1.0. Those with an ABI of 0.95 to 0.5 have mild to moderate arterial insufficiency. Those with an ABI of less than 0.50 have ischemic rest pain. Those with tissue loss have severe ischemia and an ABI of 0.25 or less.

Which complication is most common following abdominal aortic aneurysm resection?

Renal failure

most effective intervention for preventing progression of vascular disease

Risk factor modification

alterations noted in Virchow's triad

Stasis of blood Vessel wall injury Altered coagulation

The most important factor regulating the caliber of blood vessels, which determines resistance to flow, is:

The sympathetic nervous system.

most common site for a dissecting aneurysm

Thoracic area

Pentoxifylline (Trental) is a medication used for which conditions?

Trental and Pletal are the only medications specifically indicated for the treatment of claudication.

"What percentage of the arterial lumen must be obstructed before intermittent claudication is experienced?"

Typically, about 50% of the arterial lumen or 75% of the cross-sectional area must be obstructed before intermittent claudication is experienced.

Oral anticoagulants antidote

Vitamin K

Which diagnostic test with the physician likely perform right in the office to determine PAD?

ankle-brachial index

The most important reason for a nurse to encourage a client with peripheral vascular disease to initiate a walking program is that this form of exercise:

decreases venous congestion.

The location of claudication occurs in muscle groups

distal to the diseased vessel

Antiembolism stockings help prevent deep vein thrombosis (DVT) by:

forcing blood into the deep venous system.

Intermittent claudication is caused by

he inability of the arterial system to provide adequate blood flow to the tissues when increased demands are made for oxygen and nutrients during exercise. Pain is then experienced. When the client rests and decreases demands, the pain subsides.

Most serious complication from procedures is always

hemorrhage

A client is recovering from surgical repair of a dissecting aortic aneurysm. Which assessment findings indicate possible bleeding or recurring dissection?

hypotension with reflex tachycardia (as evidenced by a blood pressure of 82/40 mm Hg and a heart rate of 125 beats/minute), decreased urine output, and unequal or absent peripheral pulses

Alteplase

is considered a thrombolytic, which lyses and dissolves thrombi

Characteristics of arterial insufficiency ulcers include

location at the tips of the toes, great pain, and circular shape with a pale to black ulcer base. Border regular and well demarcated.

QUIZ Q: Following femoral bypass graft surgery, immediately notify provider of

loss of palpable pulses and numbness and tingling of feet

abdominal aortic aneurysm nursing goal

nursing interventions focus on preventing aneurysm rupture by stabilizing heart rate and blood pressure. Easing anxiety also is important because anxiety and increased stimulation may raise the heart rate and boost blood pressure, precipitating aneurysm rupture.

Early sign of vasoconstriction in Reynaud's

pallor

Symptoms of venous insufficiency include

present pedal pulses, edema, pigmentation in gater area, and a reddish blue color. Ulcers caused by venous insufficiency will be irregular in shape and usually located around the ankles or the anterior tibial area

Heparin antidote

protamine sulfate

nicotine causes

vasospasm