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T1 Exam 5
arterial disorders
| Question | Answer |
|---|---|
| What are the 6 P's of Ischemia? | Pain, Pallor, Poikilothermia, Pulse, parasthesia, and paralysis |
| What kind of pain usually comes with ischemia? | Sharp pain |
| what is paresthesia? | Numbness and tingling |
| At what age does PAD usually start? | 60-70 |
| Is PAD more frequent in men? | yes |
| What is the top risk factor for PAD? | Smoking #1, |
| What are some non-modifiable risk factors for PAD? | Aging, family history |
| What are common locations for PAD? | Abdominal aorta, iliac, femoral, popliteal & tibial, bifurcations |
| When do clinical manifestations take place for PAD? | When 60% or more of the blood is occluded |
| Symptoms of Stage I PAD? | Usually asymptomatic |
| Symptoms of stage II PAD? | Pain (intermittent claudication) |
| What is intermittent claudication? | pain affecting the calf, and less commonly the thigh and buttock, that is induced by exercise and relieved by rest. |
| Symptoms of stage III PAD? | Pain at rest/ Pain all the time, aggravated with limb elevation This is more common at night and may dangle leg to use gravity to improve blood flow. |
| Symptoms of stage IV PAD? | Necrosis and gangrene/Urgent intervention is needed. Can result in amputation |
| What are some skin changes with PAD? | Thin, shiny, hairless skin. Areas of discoloration or skin breakdown |
| Lack of blood flow in lower extremities can lead to? | Delayed healing and lack of blood flow can lead to arterial ulcers |
| Characteristics of arterial ulcers..... | Deep with a pale ulcer bed, even circular edges, painful and occur where there is a bony prominence |
| Why do arterial ulcers look pale? | Because they don't get the blood supply that they need to heal. |
| Laboratory studies for PAD? | Total cholesterol and lipid panel, fasting glucose. A1C for known diabetics |
| What is the Ankle -Brachial index? | Compares the systolic ankle pressure to the systolic brachial pressure. |
| How is the ankle-brachial index configured? | Ankle SBP divided by Brachial SBP >1 is normal <1 is a range of mild, moderate, or severe PAD |
| Ranges for Ankle-Brachial index | >1-1.29 Normal 0.91-0.99 Borderline 0.71-0.9 Mild PAD 0.41-0.7 Moderate PAD <0.4 Severe PAD |
| What is a Segmental Systolic BP measurement? | Compares various SBP readings |
| What would indicate a narrowing or blockage on a Segmental Systolic BP measurements? | Significant drop in SBP from higher location to lower location. |
| What is a quick, noninvasive means to show vessels and blood flow? | Color duplex ultrasonography |
| What is Angiography or arteriography? | Where IV contrast is injected to trace arterial circulation to look for blockages. |
| What are the advantages of using an Angiography or arteriography? | You can possibly fix the issue of blockage at the same time as diagnosing. |
| Can a patient with a metal implant have an MRA? | No |
| Why is an MRA usually done before and after surgery? | To compare the vessel and make sure it has opened up and the surgery is successful. |
| An MRA is done with or without contrast, True or False? | True |
| In management of PAD what is the goal of total cholesterol level? Triglyceride level? HDL? LDL? | Total cholesterol is <200mg/dl; Triglycerides <150mg/dl; LDL <100mg/dl; HDL>40mg/dl |
| What type of risk factor modification is lowering saturated fat and increasing complex carbohydrates? | Nutritional therapy |
| What family of medications are typically used to lower cholesterol levels? | Statins- Simvastatin (zocor); astoravastin (lipitor) |
| What meds help modify your LDL | Bile acid sequestrants are medicines that help lower your LDL (bad) cholesterol |
| What type of medications are Gemfibrozil (lopid) and fenofibrate (tricore)? What are these meds used for? | These are Fibric acids In adults, they reduce low-density lipoprotein cholesterol, total cholesterol, triglycerides, and apolipoprotein B and increase high-density lipoprotein cholesterol |
| What drugs are used to dilate the blood vessels? (Think of the pearl necklace from picmonic) | Ace inhibitors, the "pril" family (Typically used for hypertension but dilate the blood vessels so they are used in PAD) |
| Asprin (ASA), Clopidogrel (plavix), and Cilostazol are examples of what type of medicine used for PAD? | Platelet aggregation inhibitors |
| What do platelet aggregation inhibitors do for a patient with chronic PAD? | Used to help reduce the risk of thrombosis. |
| What do blood viscosity reducing agents do in the body? | Makes the blood less "sticky" to help it flow. |
| What is an example of a blood viscosity reducing agent? | Pentoxifylline (trental) |
| How long does it take for pentoxifylline (trental) to work? | This takes up to eight weeks. Patients need to know this is not a "quick fix" |
| What are some factors to promote circulation? Select all that apply. 1)Warm socks 2)Drinking caffeinated coffee 3) Reduce stress 4) Take a cool bath 5)Active ROM and assisted exercise | 1)Maintaining a warm environment can help with vasodilation✔ 2)Patients should avoid caffeine 3) Stress causes vasospasms ✔ 4)Prevent exposure to cold 5)Activity will help increase circulation✔ |
| Why should patients be warned not to apply direct heat to their limbs? | They may have decreased sensation to the limb and may not feel an injury (encourage patients to inspect limb and feet often) |
| At what level/height should a PAD patient elevate extremities. | Below the level of the heart. |
| Why should PAD patient who is bed bound be encouraged to change positions frequently? | This helps promote the flow of blood through the arteries. |
| What are the benefits of a supervised exercise program for the PAD patient? | Increased arterial blood flow=Increased collateral circulation |
| What is collateral circulation? | alternate or “backup” blood vessels in your body that can take over when another artery or vein becomes blocked or damaged. Your collateral circulation provides alternative routes for blood flow. |
| What are some contraindications to performing a supervised exercise program? | Severe rest pain, venous ulcers, or gangrene |
| What is rest pain? | the constant burning pain you may experience in the lower leg, feet or toes. It is worse when resting. |
| What is the exercise protocol for a patient with PAD who is in a supervised exercise program? | Gradual progression; walk until near max discomfort, rest until it goes away then continue walking. |
| How many times per week is a supervised exercise program recommended? How long are the sessions? | 3-5 sessions per week, 35-50 minutes each session. This will be for about six months and is not typically covered by insurance. |
| What is intermittent claudication? | Pain affecting the calf, and less commonly the thigh and buttock, that is induced by exercise and relieved by rest. |
| What is the DASH diet? How does it apply to a patient with PAD? | Dietary Approaches to Stop Hypertension. Diet low in sodium (minimizing sodium and decreasing saturated fats) |
| What is a nonsurgical procedure where they take a deflated balloon threaded through the femoral artery to the affected artery and balloon is inflated to stretch the artery. Stent may be placed at this time. | (PTA) Percutaneous Transluminal Angioplasty |
| What type of medications may the patient that has a TPA done be put on after procedure. | Patients may be placed on anticoagulants to prevent clot formation |
| How long is a stent good for? | Lasts about 3-5 years |
| What procedure is used to remove plaque in arteries that has become calcified? | Rotational atherectomy |
| What laser probe therapy is used to remove smaller occlusions? | Laser -assister angioplasty (heat induced removal) |
| What are some indications for Arterial Revascularization surgery? | Severe pain, inability to work or function, also when there is threat to the loss of the limb due to ischemia. Allows |
| What is an endarterectomy? What are the risks of this surgery? | Artery is opened and plaque is removed. Risks are that pieces of the plaque may break off and travel, this can cause heart attack or stroke |
| What is the procedure where blood is "routed " around the occlusion? | Vascular bypass graft |
| What three types of veins are typically used in a vascular bypass graft? | Patient vein (saphenous), composite vein or synthetic vein (They may also sew the patients veins together to make one large vein where the occlusion is) |
| Why would we worry about the BP for a patient with Arterial Revascularization surgery? | Hypotension=Hypovolemia=⬆ risk of clotting Hypertension=⬆ pressure on graft |
| Monitoring renal profusion is very important on a patient with Atrial revascularization surgery, what are some ways this can be monitored? | I&O hourly, Daily weights, Lab (BUN and Creatinine) and MAP (mean arterial pressure) |
| What are some clinical manifestations of Thromboangiitis obliterans. (DoG NAPS) | Diminished sensations, Gangrene or ulcera, Nails thickened or malformed, Absent/diminished ulcers, Pain in extremities (rest pain/claudication) Skin thin and shiny. |
| What are the surgical treatments for Thromboangiitis obliterans? | Arterial bypass graft, digital sympathectomy or amputation of affected digit or extremity. |
| Does Raynaud's Disease have an identifiable cause? | No |
| What condition manifests as episodes of intense vasospasm in small arteries and arterioles of the fingers and toes in response to cold or stress? | Raynaud's disease |
| What condition causes chronic, gradual thickening of the artery walls thus causing a progressive narrowing of the arteries in the upper and lower extremities, resulting in total or partial occlusions. | Peripheral artery disease. (PAD) |
| a buildup of plaque from fat or fibrin that causes the vessels to narrow and may harden the artery is also known as? | Atherosclerosis |
| What is one non-invasive way to greatly improve the vessel spasms from Thromboangiitis Obliterans? | Stop Smoking! |
| What are some meds that someone managing their Raynaud's syndrome may take during a severe vasospasm where nothing else has worked. | Vasodilators Nifedipine and ditalizem or Topical Nitroglycerine |
| What are some natural ways to prevent a Raynaud's vasospasm? | Swinging arms or soaking them in warm water. Stress reduction, smoking cessation and avoiding caffeine. |
Created by:
Akrombach
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