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vascular disorders


characteristics of arterial insufficiency pale, cyanotic, mottled, cool skin. thin, shiny, dependent rubor. elevation pallor. brittle nails. loss of hair. no edema or minimal edema. PAINFUL
characteristics of venous insufficiency reddish blue. warm. hair is present. moderate to severe edema. pulses may be difficult to palpate. ACHY
arterial ulcers between toes or tips of toes, heels, lateral malleolus. well-defined edges, deep, circular, ulcer base is black and nonbleeding or gangrenous. PAINFUL
venous ulcers foot/ankle area, medial malleolus, uneven edges, superficial, a lot of exudate, edema. ACHY
intermittent claudication HALLMARK SIGN OF PAD. vessels become narrowed by plaque causing pain. pain when walking-could be severe and reproduced. must check both pedal pulses-could be mismatched. collateral vessels may form to allow blood to flow
treatment of intermittent claudication statins, antihypertensives, hypoglycemic, thrombo therapy
rest pain occurs r/t severe arterial insufficiency caused by critical ischemia. pain doesn't go away with rest. becomes worse at night and interferes w/ sleep. foot below bed=relief. above heart level=pain
rubor reddish-blue discoloration after extremity placed in dependent position. SUGGESTS SEVERE PAD. dec. o2 hgb, cyanosis, brittle nails, gangrene (usually 1st sign in elderly), dry skin, atrophy, loss of hair
goals for peripheral arterial insufficiency inc. arterial blood supply, promotion of vasodilation, prevention of vascular compression, relief of pain, attainment/maintenance of tissue integrity
improving peripheral arterial circ walking, graded isometric exercises, positioning strategies, avoid temp extremes, smoking cessation, stress reduction
maintaining tissue integrity protection of extremities and avoidance of trauma, regular inspection of extremities w/ referral for tx, infection, inflammation. vitamins a,d,e,zinc. weight reduction as necessary
ankle-arm index 1.0-1.2 is NORMAL. >.9 suggest SEVERE PAD
medical management prevention, exercise program, meds
meds for PAD and #1 issue with these meds Trental (dec blood viscosity) Pletal (dec platelets) big issue is compliance bc pain doesn't subside immediately-it takes time. EDUCATION IS KEY
risk factors for atherosclerosis and PAD smoking, htn, diabetes, hyperhomocysteinemia, diet, sedentary lifestyle, obesity, c-reactive protein
raynauds disease intermittent arterial vaso-occlusion (usually of fingertips and toes). associated with scleroderma. s/s: sudden vasoconstriction results in color changes, numbness, tingling, burning. episodes brought on by stress or cold. occurs mostly in younger women
buergers disease autoimmune vasculitis. vessels inflamed & become blocked with clots. most often in men who smoke. progressive occlusion leads to pain, ischemia, ulcerations, gangrene. b/l foot cramps esp at arches, burning pain, red extremities, diminished pulses
meds for raynauds ca channel blockers, vasodilators, alpha adrenergic antagonist (minipres)
inflow procedures from aorta to femoral
outflow procedures from femoral downwards
SCD's applied to PREVENT clots. if clots already there it's ok to use TEDS but not at night. do active and passive limb exercises to avoid throwing another clot
goals for leg ulcers restoration of skin integrity, improved physical mobility, adequate nutrition, absence of complications
mobility with leg ulcers activity is initially restricted to promote healing w gradual progression of activity - encourage pt to exercise in bed and upper extremities, diversion activities, pain meds prior to activities, skin integrity
most common cause of aneurysms atherosclerotic heart disease. its a localized sac/weakening/outpouching. tx depends how large it is. sx depend how rapidly it dilates
AAA lower back to groin pain. may see it pulsating thru skin. want to maintain constant & controlled BP. measure abd girth
aortic dissection @risk for exploding. ppl usually die from this. s/e:stroke, weakness. causes: uncontrolled HTN, blunt chest trauma, cocaine, abuse. SURGICAL EMERGENCY: sudden pain that radiates, pale, tachy, diaphoretic
Created by: eileenrx