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med-surg ch 31 notes

vascular & peripheral circulation disorders

anastomosis junction of two vessels
aneurysm localized sac or dilation of an artery formed at a weak point in the vessel wall
Ankle Brachial Index (ABI) Ankle Arm Index (AAI) ratio of the ankle systolic pressure to the arm systolic pressure; an objective measurement of arterial disease /provide degree of stenosis info
arteriosclerosis diffuse process - muscle fibers and endothelial lining of small arteries and arterioles THICKEN
ATHEROSCLEROSIS imflammatory process involving the accumulation of lipids, calcium, blood components, carbs, and fibrous tissue on the intimal layer of a lg-med artery
bruit sound of turbulent blood flow thru an irregular, tortuous, stenotic, or dilated vessel
dissection separation of the weakened elastic and fibromuscular elements in the medial layer of an artery
ischemia deficient blood supply
rubor reddish blue discoloraton of the extremities; indicative of severe peripheral arterial damage; vessels remain dilated, unable to constrict
stenosis narrowing or constriction of a vessel
arterioles are also referred to as.. 'resistance vessels' bcuz they alter their diameter and offer resistance to blood flow
veins distend more than arteries. large volumes of blood can remain. veins are also called... capacitance vessels
@ what % of total blood volume is contained in the veins @ 75% total blood volume is contained in the veins
the __ nervous system __ veins, thereby __ the blood volume in circulation. the SYMPATHETIC nervous system CONSTRICTS veins, thereby INCREASEING blood volume in circulation.
when metabolic needs increase, blood vessels... dilate to increase the flow of oxygen and nutrients to the tissues.
when metabolic needs decrease, blood vessels... constrict and blood flow to the tissues decreases.
reasons metabolic needs increase: -physical activity -local heat application -fever -infection
reasons metabolic needs decrease: -rest / inactivity -local cold applicatoin -cooling of the body
systemic arteriovenous oxygen difference blood in the Vena Cava contains @25% less oxygen than aortic blood.. ~ > diff when less O2 delivered than tissues require~
location of arterial ulcers: -tip of toes -toe webs -heels or pressure areas if confined to bed
location of venous ulcers: -medial malleolus (rarely: lat malleolus / ant tibial)
pain characteristic of arterial ulcers: VERY PAINFUL
pain characteristic of venous ulcers: -minimal pain if superficial (possibly very painful depending..)
shape of arterial ulcers: usually circular
shape of venous ulcers : irregular borders
arterial ulcer base characteristics pale to black and dry gangrene
venous ulcer base characteristics granulation tissue beefy red to yellow fibrinous (long term ulcer)
leg edema in arterial ulcers minimal unless extremity kept in dependent position constantly to relieve pain
leg edema in venous ulcers moderate to severe
arterial ulcer pain characteristics intermittent claudication to sharp, unrelenting, constant
venous ulcer pain characteristics aching, cramping
arterial insufficiency skin characteristics -dependent rubor -elevation foot pallor -dry, shiny, skin -cool - cold -loss of hair -nails-thickened and ridged
venous insufficiency skin characteristics -pigmentation in gaiter area (medial and lateral malleolus) -skin thickened and tough -may be reddish/blue -frequently assoc. w. dermatitis
all blood vessels are innervated by the __ nervous system all blood vessels are innervated by the SYMPATHETIC nervous system
SYMPATHETIC nervous system stimulation causes vaso___? SYMPATHETIC nervous system stimulation causes vasoCONSTRICTION
LEFT sided heart failure causes: -accumulation of blood in the lungs -reduction in cardiac output -inadequate blood flow to tissues
RIGHT sided heart failure causes: -systemic venous congestion -reduction in cardiac output
arteries can become damaged or obstructed as result of: -atherosclerotic plaque -thromboemboli -chemical/mechanical traums -infection / inflammation - congenital or vasospastic disorder
venous blood flow can be reduced by: -thromboembolus -incompetent venous valves -ineffective pumping of muscles
decreased venous blood flow results in: -subsequent EDEMA
MOST PVD's result in .. -pain -skin changes -diminished pulse -possible edema
aging considerations in peripheral vascular fxn: -stiffened vessels -increased peripheral resistance -impaired blood flow -increased left ventricular workload
REST PAIN: persistent pain in the forefoot when resting indicates... severe degree of arterial insufficiency and critical state of ischemia. usually worse at night.
diagnosis of arterial disorders requires thorough assessment of... -skin color / temp / character -peripheral pulses
in inactive elderly people __ may be the first sign of PVD in inactive elderly people GANGRENE may be the first sign of PVD
arterial insufficiency effects on ADLs.. -reduced mobility / activity -reduced or loss of independence -higher rates of hospitalization -poorer quality of life
What is the most common disease of the arteries? ARTERIOSCLEROSIS
The most common direct results of atherosclerosis in arteries include: -stenosis of the lumen -obstruction by thrombosis -aneurysm -ulceration - rupture
what is ischemic necrosis? death of cells due to deficient blood flow
gradual narrowing of the lumen stimulates the development of... collateral circulation
RISK FACTORS FOR ATHEROSCLEROSIS & PAD -TABACO/NICOTINE US -diet - hyperlipidemia -hypertension - obesity -stress -diabetes - age -gender
prevention of atherosclerosis includes: -reduce fat consumption -lowering cholesterol -use saturated fats -lower BP -QUIT SMOKING -GET EXERCISE
PTA = percutaneous transluminal angioplasty
nurses can help pts improve peripheral arterial circulation by.. -assisting w/ ambulation or -isometric exercises STOP IF PAIN
peripherl vascular conditions that worsen with exercise: -ulcers -cellulitis -gangrene -acute thrombotic occlusions
RN interventions to promote vasodilation/prevent vascular compression: -warm applications -better applied to abdomen than extremities USE W. CAUTION & NOT > THAN BODY TEMP -teach avoid cold -ENCOURAGE STOP SMOKING -AVOID STRESS (vasoconstrictor)
RN DX with PVD = -ineffect. periph. tissue perfusion -chronic pain -risk for impaired skin integrity -deficient knowledge r/t self care
peripheral arterial occlusive disease / arterial insufficiency of the extremities.. most often occurs in .. -men -diabetes -elderly
hallmark symptom of peripher arterial occlusive disease / PAD.. INTERMITTENT CLAUDICATION: pain w. activity, relieved with rest. severe if rest pain. elevation = pain. dependent position = less pain
Rx for PAD -Trental / Pletal -antiplatelet agents (Plavix) -Statin therapy
Created by: rtcdavis