N242
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| 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
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| characteristics of venous insufficiency | reddish blue. warm. hair is present. moderate to severe edema. pulses may be difficult to palpate. ACHY
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| 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
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| venous ulcers | foot/ankle area, medial malleolus, uneven edges, superficial, a lot of exudate, edema. ACHY
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| 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
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| treatment of intermittent claudication | statins, antihypertensives, hypoglycemic, thrombo therapy
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| 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
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| 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
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| goals for peripheral arterial insufficiency | inc. arterial blood supply, promotion of vasodilation, prevention of vascular compression, relief of pain, attainment/maintenance of tissue integrity
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| improving peripheral arterial circ | walking, graded isometric exercises, positioning strategies, avoid temp extremes, smoking cessation, stress reduction
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| 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
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| ankle-arm index | 1.0-1.2 is NORMAL. >.9 suggest SEVERE PAD
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| medical management | prevention, exercise program, meds
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| 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
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| risk factors for atherosclerosis and PAD | smoking, htn, diabetes, hyperhomocysteinemia, diet, sedentary lifestyle, obesity, c-reactive protein
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| 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
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| 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
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| meds for raynauds | ca channel blockers, vasodilators, alpha adrenergic antagonist (minipres)
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| inflow procedures | from aorta to femoral
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| outflow procedures | from femoral downwards
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| 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
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| goals for leg ulcers | restoration of skin integrity, improved physical mobility, adequate nutrition, absence of complications
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| 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
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| 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
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| AAA | lower back to groin pain. may see it pulsating thru skin. want to maintain constant & controlled BP. measure abd girth
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| 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
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