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MedSurge-VASCULAR
MedSurge VASCULAR DISORDERS review
| Question | Answer |
|---|---|
| Peripheral arterial disease (PAD) is caused by? | atherosclerosis |
| PAD is related to? | cardiovascular disease (eg. coronary / carotid artery disease) |
| a pouch-like bulge of an artery is what type of aneurysm? | saccular aneurysm |
| A disruption of all layers of an artery with bleeding is what type of aneurysm? | pseudoaneurysm |
| A uniform, circumferential dilation of artery is what type of aneurysm? | fusiform aneurysm |
| An abdominal aortic aneurysm (AAA) may be heard as? | bruits in the periumbilical area slightly to the left of the midline |
| S/S present in rupture of an abdominal aortic aneurysm include? | severe back pain with flank ecchymosis |
| Hoarseness and dysphagia may occur with aneurysms of? | the ascending aorta and the aortic arch |
| S/S present with pressure of a thoracic aneurysm may include? | neurologic loss in the lower extremities |
| Most accurate test to determine size/structure of aneurysm and whether thrombus is present? | computed tomography (CT) scan |
| Good way to prevent expansion of an abdominal aortic aneurysm? | control HTN with controlled therapy |
| Calcium intake (is / is not) related to the calcification of arteries? | is not |
| Periop a pt. with AAA should be monitored for? | cardiac, pulmonary, cerebral or lower-vascular problems since AAA is a systemic disease |
| Postop pt. with AAA BP will be maintained how? | BP is balanced: high enough to keep adequate flow through the artery to prevent thrombosis, but low enough to prevent bleeding at surgical site |
| Which type of aneurysm may be treated by excising only the weakened area and suturing the artery closed? | saccular |
| Postop aneurysm repair, nurse should ensure that? | BP and all peripheral pulses are evaluated at least every hour to ensure adequate BP and perfusion of extremities |
| Postop aneurysm repair, high BP may cause? | leaking or rupture at the suture line |
| Postop aneurysm repair, low BP may cause? | thrombosis of the graft |
| Periop aneurysm repair, (hypothermia / hyperthermia) is induced | hypothermia; pt. is rewarmed soon after surgery |
| Following an ascending aortic aneurysm repair, nurse should immediately report? | a change in level of consciousness and ability to speak (pt. may also experience: altered pupil response to light, changes in facial symmetry, movement in upper extremities) |
| Following an ascending aortic aneurysm repair, lower lend pulses are normally? | decreased or absent for a short time after surgery |
| Presence of a G____ T____ would indicate a complication following aortic aneurysm repair. | Graft Thrombosis |
| Pt. teaching following aortic aneurysm repair should include? | avoid heavy lifting, some permanent sexual dysfunction may result, low-fat/cholesterol diet should be maintained |
| Expected finding in assessment of pt. with distal descending aortic dissection? | severe "ripping" back or abdominal pain with decreasing urine output |
| Aortic dissection of the ascending aorta and aortic arch may affect? | the heart and circulation to the head, with development of murmurs, ventricular failure and cerebral ischemia |
| Initial treatment of pt. with dissection of arch of aorta, experiencing decreased LOC and weak carotid pulses is? | immediate surgery to replace the torn area with a graft |
| Administration of packed RBCs in dissection of arch of aorta, would be indicated if? | the dissection ruptures |
| Relief of pain following a dissection indicates? | the dissection has stabilized, and it may be treated with drugs that ↓ BP and myocardial contractility |
| Paresthesia, is indicative of (arterial / venous) disease? | arterial |
| Heavy ulcer drainage, is indicative of (arterial / venous) disease? | venous |
| Edema around the ankles, is indicative of (arterial / venous) disease? | venous |
| Ulcers over bony prominences of toes and feet, is indicative of (arterial / venous) disease? | arterial |
| Decreased peripheral pulses, is indicative of (arterial / venous) disease? | arterial |
| Brown pigmentation of the legs, is indicative of (arterial / venous) disease? | venous |
| Thickened, brittle nails, is indicative of (arterial / venous) disease? | arterial |
| Ulceration around the medial malleolus, is indicative of (arterial / venous) disease? | venous |
| Pallor on elevation of the legs, is indicative of (arterial / venous) disease? | arterial |
| Dull ache in calf or thigh, is indicative of (arterial / venous) disease? | venous |
| Pruritus, is indicative of (arterial / venous) disease? | venous |
| The classic ischemic pain of PAD is known as? | intermittent claudication |
| Lower limb amputation in PAD is normally due to _____ or _____? | non-healing ischemic ulcers; gangrene |
| Oral anticoagulants (are / are not) recommended for treatment of PAD? | are not |
| Appropriate pt. teaching for PAD pt? | keep legs and feet warm / walk min. 30 min/daily, use nicotine to substitute for smoking if unable to stop smoking |
| Major risk factors for PAD include? | HTN, smoking, hyperlipidemia |
| Postop femoral bypass graft surgery, HCP should be notified if pt. experiences? | loss of palpable pulses and numbness and tingling in feet |
| Expected finding postop femoral bypass graft surgery include? | pain, redness, serous drainage at incision site |
| The SIX P's of acute arterial occlusion are? | pain / pallor / pulselessness / paresthesia / paralysis / poikilothermia |
| Poikilothermia is? | the inability to maintain a constant core temperature independent of ambient temperature |
| Arteriospastic disease is commonly known as | Raynaud's syndrome |
| Raynaud's syndrome involves _____ and is associated with _____? | small cutaneous arteries of the fingers and toes; autoimmune disorders |
| Medication classes used to treat Raynaud's syndrome include? | calcium-channel blockers (eg. nifedipine (procardia) |
| Episodes of white, blue, red color changes in fingertips is indicative of? | Raynaud's syndrome |
| Thromboangitis Obliterans is commonly known as? | Buerger's disease |
| Buerger's disease involves _____ and is associated with _____? | inflammation of midsized arteries and veins; smoking |
| Ulceration and gangrene in Buerger's disease, may result in? | amputation of digits, or legs below the knee |
| Pts. with Buerger's disease, may present with? | intermittent claudication of feet, arms and hands |
| Virchow's Triad describes? | describes the three broad categories of factors that are thought to contribute to thrombosis |
| Virchow's Triad pneumonic | SHE --- Stasis (Venous) / Hypercoagulabilty / Endothelial Cell Injury |
| IV Therapy, Virchow's Triad factor? | Endothelial Cell Injury |
| Prolonged immobilization, Virchow's Triad factor? | Stasis (Venous) |
| Estrogen therapy, Virchow's Triad factor? | Hypercoagulabilty |
| Orthopedic surgery, Virchow's Triad factor? | Stasis (Venous) |
| Smoking, Virchow's Triad factor? | Hypercoagulabilty |
| Pregnancy, Virchow's Triad factor? | Stasis (Venous) |
| Superficial thrombophlebitis is? | inflammation of a vein due to a blood clot in a vein located just below the skin's surface |
| Most common cause of superficial thromboplebitis in the legs is? | varicose veins |
| Characteristics of Superficial thrombophlebitis include? | tender, red, inflamed induration along the course of a subQ vein |
| Venous thromboembolism (VTE) is? | a blood clot (thrombus) that forms within a vein |
| Prevention of emboli formation can be achieved by? | bed rest and limiting movement of involved extremity until the clot is stable, inflammation receded and anticoagulation is achieved |
| Heparin, characteristics? | protamine sulfate is antidote, admin IV or SubQ, monitor aPTT |
| Lovenox, lower molecular weight heparin, characteristics? | admin SubQ only, routin coagulation tests usually not required |
| Hirudin derivatives, characteristics? | admin only IV, no antidote available, monitor aPTT |
| Warfarin (Coumadin), characteristics? | vitamin K antidote, admin PO only, monitor INR |
| Heparin mechanism of action? | prevents new clots from forming, does not break apart existing clots |
| Pt. teaching of VTE patient on Warfarin (Coumadin) should include? | exercise programs (swimming), drug will not blacken stools, dark-leafy veges have VitK (don't intake huge amounts), do not massage legs for risk of dislodging clot |
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