Nursing 2209: Peripheral Vascular Disease (PVD) – Flashcards
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What is the peripheral vascular system composed of?
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veins and arteries outside of the chest, abdomen, and brain
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What do peripheral arteries do?
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distribute oxygenated blood to the body
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What do peripheral veins do?
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carry deoxygenated blood back to lungs for reoxygenation
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What is peripheral vascular disease?
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aka PVD; disorders that alter blood flow through the arteries and veins outside the chest
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What is perfusion and what can it do?
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adequate blood flow to body tissues and allows for tissue repair and provides resistance to infectious organisms
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What is the process of perfusion?
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1. nutrients and oxygen arrive to capillaries and move into the cells 2. cells metabolize the nutrients and produce waste products 3. waste exchange between the cells and capillaries for removal
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What are risk factors of PVD?
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if somebody is over 50 years old, has heart disease, males are more prone to PVD, has diabetes mellitus, family history of dyslipidemia, if they smoke, if they are obese
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What is dyslipidemia?
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high cholesterol
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What is arteriosclerosis?
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the hardening of artery walls, loss of elasticity
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What is atherosclerosis?
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the build up of plaque on the inside layer of the arterial wall
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What are ways to prevent arterial disease?
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avoid tobacco, maintain a healthy diet, staying active, controlling blood pressure
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What are signs and symptoms of arterial disease?
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pale skin, dependent rubor, absent or diminished pulses, intermittent claudication
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What is rubor?
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a red hue to the skin d/t a lack of blood flow
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What is intermittent claudication?
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pain or discomfort that occurs in the legs while walking or using the legs for other activities
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What is the pathophysiology of PAD?
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blood is unable to get to the distal areas of the legs, which causes a development of collateral circulation
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What is Raynaud's disease?
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vasospasms in the fingers or toes d/t the cold or stress; fingers or toes go from white to blue to red coloring
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What are nursing interventions to help alleviate pain in a patient with PAD?
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changing the patient's position every 30 mins, using pillows, massaging, lift or move the patient, keeping the patient's skin dry, ensuring adequate nutrition, promote vasodilation/prevent compression
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What sort of activity is contraindicated in patients with severe PAD?
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exercising is contraindicated
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What issues can lead to thrombophlebitis?
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Virchow's triad
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What is Virchow's Triad?
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1. vessel wall damage 2. venous stasis 3. altered coagulation
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What is stasis dermatitis, what is indicative of it, and where can it occur?
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pressure ulcers caused by pooled venous blood under the skin that is evidenced by a brown discoloration of the skin; typically occurs at the medial ankle and lower legs
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What is deep vein thrombosis (DVT), what causes it, and what are signs and symptoms of it?
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blood clots in leg veins d/t lack of mobility, trauma, hormone use (especially with increased estrogen use), obesity; signs and symptoms can be calf or leg pain, swelling in the leg, warm, red skin
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How can venous disorders be prevented?
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through the use of compression stockings, a sequential compression device, ambulation, medication
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In what ways can nurses manage venous disorders?
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monitoring of the patient, providing comfort, compression therapy, positioning and exercise (elevating the legs), patient education
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What is an angiogram?
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a catheter is used to insert dye so an x-ray of blood vessels can be obtained
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What is a contrast venogram?
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dye and x-ray of veins to show any blockages, narrowing of veins, or a presence of blood clots in deep veins
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What is an MRA?
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magnetic resonance angiography is used to scan the body, highlighting blood vessels; is less invasive than angiogram or venogram
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What is an ankle-brachial index (ABI)?
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compares indexes in the brachial artery to the ankle artery; a value of 0.9 or less is indicative of a blockage
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What labs are performed to rule out PVD?
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D-dimer, prothrombin time (PT), partial thromboplastin time (PTT), platelet count
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In what two ways can Heparin be given?
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subcutaneously (SQ)- prevention intravenously (IV)- treatment; though not given in either form until lab values are checked
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What blood work needs to be monitored with a patient on Heparin?
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PTT, INR, platelet count, signs of bleeding
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What can Heparin be reversed with if a patient experiences bleeding?
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can be reversed with a slow infusion of protamine sulfate
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What is Lovenox used for and how is it given?
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used for DVT prevention primarily, but can also be used for unstable angina; given subcutaneously (SQ) and is given without checking lab values
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What is Coumadin used for and how is it given?
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used for clot prevention, though it primarily thins the blood; given by mouth (PO) in tablet form
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What blood work needs to be monitored with a patient on Coumadin?
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PT, INR, signs of bleeding
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What can Coumadin be reversed with if a patient begins bleeding while on the medication?
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can be reversed with Vitamin K or fresh frozen plasma with clotting factors
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What fruit should patients on Coumadin avoid?
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cranberries
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What are thrombolytics and how are they given?
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works to break down blood clots (thrombolysis); given intravenously (IV) and works the best if administered within first 45 mins of event
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What are signs of bleeding?
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nosebleeds, tarry, blood stools, blood in urine, easy bruising, petechiae
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What is petechiae?
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engorged blood vessels
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What is angioplasty and stenting?
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a minimally invasive procedure where a catheter is inserted into an artery and guided to the blocked area where a balloon is inflated and deflated several times until the plaque is flattened; a stent is a mesh-metal tube that is inserted into a narrowed portion of an artery to keep it open
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What is bypass surgery?
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detour around a blocked or narrow artery where a vein or man made material is used; the bypass is placed above and below the blocked area to create a new path for blood flow
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What is an endarterectomy?
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a procedure where plaque is surgically removed from an artery
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What is the last resort after all previous methods of PVD treatment have failed?
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amputation
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What are nursing diagnoses for PVD?
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-altered tissue perfusion -pain -impaired skin integrity -risk for infection
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What does the nurse want to plan for a patient with PVD?
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-management of pain -promotion of wound healing -promotion of tissue perfusion -note skin color and temperature -absence of infectious symptoms
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What can a nurse do to promote tissue perfusion?
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-keep the extremities warm, with absence of cyanosis -peripheral pulses are palpable -capillary refill is >3 sec -edema is absent -teach adequate dietary needs -encourage meticulous foot care -for arterial insufficiency patients, position with extremities in dependent position
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What can a nurse do for a patient with arterial insufficiency?
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-do not elevate the legs -encourage exercise, but only in patients with an earlier form of the disease -ensure the patient is warm -take meticulous care in feet care
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What can a nurse do for a patient with venous insufficiency?
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-elevate the legs -apply compression stockings -encourage weight loss in the obese -inquire about patient's occupation and whether or not they are standing for long periods -consult with the provider about a sequential compression device -observe for signs of DVT -observe results of D-dimer test -observe for signs of pulmonary embolism
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How can a nurse promote skin integrity?
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-inspect and assess the skin for any pallor, erythema, breakdown -educate the patient about adequate nutrition, smoking cessation, prevention of tissue breakdown, what to do if edema occurs
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How can the nurse instruct the patient to prevent tissue breakdown?
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-encourage the patient to turn and reposition every 2 hours -encourage the use of pillows or pads to relieve stress placed on bony prominences -encourage the use of lotions or powders for skin health -maintain overall dryness of the skin
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How can the nurse manage pain in a PVD patient?
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-assess pain every 4 hours using OPQRST and the 0-10 pain scale -teach pain relief techniques; intermittent claudication is relieved by rest and venous pain is relieved by elevating the legs
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How can the nurse evaluate that the patient fully understands their education?
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-demonstrates appropriate positioning -verbalizes symptoms -consumes an adequate diet which is high in protein -verbalizes importance of abstinence from tobacco
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What are varicose veins and where do they occur in the body?
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enlarged, twisted, swollen veins that are caused by continuously standing for too long; increased pressure placed upon the legs
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What are symptoms of varicose veins?
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-dark purple or blue in color -twisted, bulging -achy pain -burning pain -throbbing pain -muscle cramping -swelling in the leg(s) -itchy -bleeding
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What are spider veins?
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smaller varicose veins
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How can age cause varicose veins?
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vessels of the body lose elasticity over time, which causes stretching to occur, as well as the valve system in the venous system loses strength and causes blood to pool in the surrounding tissue and veins
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How can pregnancy cause varicose veins?
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increased blood volume in the body and increased weight presented upon the legs and pelvis, as well as circulatory changes that are designed for support of the fetus
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What are complications of varicose veins?
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ulcers, blood clots, and bleeding
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What is sclerotherapy?
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the surgical damaging of the inside of a vein which will cause it to scar and close off and eventually disappear
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What is a phlebectomy?
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vein removal through the process of a series of small skin punctures
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What occurs post-surgery for a varicose vein patient?
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bed rest for 24 hours, then short periods of ambulation while the patient wears pressure bandages and elastic stockings
