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Peripheral atherosc.
pn 141 test 1 book: med surg nursing pg 680
| Question | Answer |
|---|---|
| def of arteriossclerosis | a common arterial disorder characterized by thickening, loss of elesticity and calcification of arterial walls. (atherosclerosis is a form of arterial sclerosis) |
| what does arteriosclerosis do to peripherial circulation | they decreased blood supply to tissues leading to perihperal vascular disease (PVD) |
| where in the body does PVD usually effect | the lower extremities |
| who is it most common in | ppl >50 yo, men > WN, |
| risk factors | DM, high fat diet, HTN, smoking, obesity, stress |
| why does the vessel lumen narrow | b/c peripheral arteries thicken and harden b/c of plaque deposits |
| where does plaque form more often in arteries | in bifurcations (where the artery divides) |
| what arteries are more often affected by peripheral plaque deposits | femeral, iliac, abdominal aorta |
| What happens to the blood flow and oxygenation to the tissues distal of the plaque deposits | they decrease |
| if the occlusion develops slowly, ______ is also able to develop | collateral circulation |
| def of collacteral circulation | growth of small blood vessels to maintain tissue perfusion |
| is collateral circulation adequate to supply tissue needs | no |
| at what percent of arterial occlusion can s/s be seen | 60% |
| s/s: what is the primary s/s | pain |
| def of intermittent claudication | cramping aching sensation in the calves of legs or the arch of the foot. it develops with walking and is relieved by rest |
| rest pain: when does it occur | during periods of inactivity often at night. it increases when the legs are elevated and decreases when they are dependent |
| rest pain: how is it described | gnawing aching, burning of the lower legs feet or toes. |
| rest pain: what do clients often C/O | their legs feeling cold or numb as well as painful |
| skin color when legs are elevated | pale |
| skin color when legs are dependent | dark red (dependent rubor) |
| charecteristics of the skin | shiny with areas of discoloration and hair loss, skin breakdown may be present |
| What will the toenails look like | they are thick |
| what can the skin breakdown lead to: | ulcerations anf gangrene |
| what happens to the peripheral pulses | they are decreased or absent |
| What is a bruit | a harsh muscial sound caused by turbulant blood flow |
| what can be heard over large effected arteries (like femoral or abdominal aorta) | a bruit |
| what are complications of it | gangrene and amputation of one or both lowe extremities |
| medical management of it | to maintain or improve blood supply to tissues and relieve s/s |
| Why are segmented BP done | they are used to compare blood pressure measurements between the upper and lower extremities and within different portions of an extremity. Normally BP readings are normal when pt is supine; in PVD the BP is lower in legs then arms |
| why is exercise stress test done | to see pt physical limitations r/t PVD |
| why is a doplar ultrasound done | to eval blood flow |
| why is angiography done | if surgery is planned to located the extent of arterial obstruction |
| therapy: why should pt quit smoking | nicotine increases vasoconstriction, further decreasing blood supply to the extremities. Also increased the risk for ulcerations, gangrene, and amputations |
| Therapy: why does exercise help | improves collateral circulation and reduces stress. Pt shoould rest when pain develops and resume activity when pain is relieved |
| therapy: why should pt lose wt | to improve activity intolerance. |
| meds: why are meds given; what are they | to reduce the risk of clotting in partially obstructed BV; aspirin, clopidogrel (plavix), cilostazol (pletal) |
| meds: what med also acts as a vasodilator as well as a platelet inhibitor | cliostazol |
| Revascularization: what pt will get this | pt w/ severe intermittent claudication, rest pain, or gangrenous lesions to restore blood flow |
| Revascularization: what are none surgical procedures | percutaneous transluminal angioplasty, placement of a stent amd atherectomy |
| def of atherectomy | removal of plaque |
| endarterectomy : what is done in this surgical procedure | removal plaque and a bypass or graft |
| endarterectomy : risk associated with it | infection, embolizm, acute MI, stroke |
| older adult and PVD; what happens to the blood vessels with age | the thicken and become less compliant; this decreases oxygen delivery to tissues and impair the removal of CO2 and waste |
| what are skin changes with an emboli | pale and cold |
| for arterial bypass graft: what material is used for bypass | it is usually synthetic because so much is needing grafting |
| arterial bypass graft: why is post op pain soooooo severe | because the nerve ending are recieving blood and oxygen and they are coming back so there is sensation and lots of pain |
| arterial bypass graft: what is used to relieve pain | narcopitcs, PCA, epidural (hard to assess with epidural sensations of legs) |
Created by:
jmkettel
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