Medical-Surgical Nursing Fifth Edition
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| Aneurysm | Is an abnormal dilation of a blood vessel, commonly at a site of weakness or a tear in the vessel wall
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| Aneurysm Pathophysiology | Forms due to weakness of the arterial wall
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| Collagen | Provides tensile strength of the vessel, preventing excessive dilation
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| Elastin | Allows vessel recoil, during which the vessel returns to its original size following systole
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| True Aneurysms | Are caused by slow weakening of the arterial wall due to long-term, eroding effects of atherosclerosis and hypertension
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| False Aneurysms | Are caused by a traumatic break in the vessel wall rather than weakening of the vessel
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| Fusiform Aneurysms | Are spindle shaped and taper at both ends. Considered a true aneurysm
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| Circumferential Aneurysm | Involve the entire diameter of the vessel. Considered a true aneurysm
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| Berry Aneurysm | Is a type of saccular aneurysm. They are often small (less than 2 cm in diameter)Caused by congenital weakness in the tunica media of the artery. Commonly found in the circle of Willis in the brain.
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| Dissecting aneurysms | Develops when a break or tear in the tunica intima and media allows blood to invade or dissect the layers of the vessal wall
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| Aortic Aneurysms - Thoracic (10% of all) Manifestations | May be asymptomatic; back, neck, or substernal pain; dyspnea, stridor, or brassy cough if pressing on the trachea; Hoarseness & dysphagia if pressing on esophagus or laryngeal nerve; edema of the face and neck; distended neck vein
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| Aortic Aneurysms - Abdominal Manifestations | Pulsating abdominal mass; Aortic calcification noted on x-ray; mild to severe mid-abdominal or lumbar back pain; cool, cyanotic extremities if iliac arteries are involved; Claudication (ischemic pain with exercise, relieved by rest)
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| Aortic Aneurysms - Aortic dissection Manifestations | Abrupt,severe, ripping or tearing pain; mild or marked hypertension early; weak or absent pulses and BP in upper extremities; syncope
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| Abdominal Aortic Aneurysms | Associated with: arteriosclerosis,hypertension, age,smoking,found >65, develops below renal arteries(usually where the abd aorta branches to form the iliac arteries
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| intermittent claudication | Cramping or pain in the leg muscles brought on by exercise and relieved by rest
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| Dissection | Is a life-threatening emergency caused by a tear in the intima of the aorta with hemorrhage into the media. The hemorrhage dissects or splits the vessel wall,forming a blood-filled channel between its layers
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| Type A Dissection | Affects the ascending aorta
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| Type B Dissection | Is limited to the descending aorta
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| Thoracic Aortic Aneurysms Meds | Treated with long-term beta-blocker therapy and additional anti-hypertensive drugs as needed to control heart rate and blood pressure
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| Aortic Dissection Meds | Treated with intravenous beta blockers such as propranolol (Inderal), metoprolol (Lopressor), or esmolo (Brevibloc) to reduce the heart rate to about 60 bpm
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| Endovascular Stent Grafts (EVSG) | Treats abd & thoracic aortic aneurysm.The stent, which consists of a metal sheath covered with polyester fabric or a woven polyester tube, usually is placed percutaneously via the femoral artery. Fluoroscopy is used to guid its placement
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| Endovascular Stent Grafts (EVSG) Complication | Is a persistent perfusion of the aneurysm (endoleak) caused by an ineffective seal at the proximal or distal end of the graft.
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| Endovascular Stent Grafts (EVSG) Follow-up Care | Abd CT Scans is necessary to detect an endoleak
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| Aneurysm Repair | Endovascular stent grafts; Open surgical procedure
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| Aneurysm Interdisciplinary Care | Most found on routine physical exam,history. Chest x-ray, ultrasound,angiography, tranesophageal for thoracic. Surgery, EVSG (Stent graphs), anticoagulant therapy
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| Aneurysm Meds | beta-blockers, keep heart rate 60, Nipride, keep systolic at 120
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| Aneurysm Nursing Care | Risk for ineffective tissue perfusion; Assess for increase in pain, change in pulses; prevent straining; provide calm environment; measure abd girth, assess the abd, monitor all pulses, and urinary output.
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| Aneurysm Labs/Assessment | Ecchymosis of the scrotum, perineum or new expanding hematoma; decrease in motor function or sensation; decrease in H&H; decrease in LOC
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| Arterial Disorders Pathologic Changes Results In | Decreased blood supply to tissues, PVD ; progressive obstruction & decrease blood flow, tissue hypoxia or anoxia. Develops collateral circulation. Effects found primarily abd aorta & LE with 60% occlusion or more
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| Arterial Disorders Risk Factors | Smoker; HTN; Obesity
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| Arterial Disorders Manifestations | Intermittent claudication; pain experienced during activity, elevation aggravates the pain; pulses may be diminished or absent; legs feels cold, or numb; skin pale if elevated or dark red if dependent; Hair loss, toenails thickened; line of demarcation
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| Intermittent Claudication | cramping or aching, calves, thighs, buttocks occurs with predictable level of activity
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| Arterial Disorders Lab & Diagnostics | Angiography, contrast medium, using fluoroscopy; Doppler ultra sound, sound waves reflected off RBSc; transcutaneous oximetry
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| Arterial Disorders Pharm | Beta blockers, control heart rate and BP, Nipride; Low dose aspirin, inhibit platelet aggregation; Plavix, low-weight heparin, inhibits clotting cascade; Thrombolitic therapy, breaks up the clot; Trental; Pletal, platelet inhibitor
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| Beta Blockers – Action | Blocks beta receptors in the heart causing: decreased heart rate; decrease force of contractions; decreases rate of A-V conduction
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| Beta Blockers – Side Effects | Bradycardia; Lethargy; GI disturbance; CHF; decrease BP; Depression; Dry hacking cough
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| Arterial Disorders – Treatments | Conservative-walking, weight loss, no smoking (blockage 60% or less); Surgery-arterial bypass grafting, endartectomy (clean out)
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| Arterial Disorders – Nursing Care | Altered Tissue Perfusion; assess the extremities; keep extremities dependent; keep-extremities warm; change position; meticulous foot care; close monitoring
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| Why Plagues are formed | Tissue is torn or damaged & the body forms the plagues in a response in fixing it
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| Arterial Disorders-Nursing Care | Pain-pain scale; changes in degree of obstruction, increase in pain; stress reduction; Impaired Skin Integrity
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| Arterial Thrombosis | Blood clot-adheres to vessel wall, occlusion of arterial blood flow
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| Arterial Thrombosis Mainfestations | pain in affected region; numbness; pallor, mottling, muscle spasm; collateral circulation; risk for necrosis and gangrene; loss of perfusion; pulselessness; possible paralysis
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| Pain | Indicates change in status
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| Arterial Embolism | Occlusion of blood flow by a foreign object, air bubbles, bacteria, fat, cancer cells
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| Arterial Embolism S/SX | pain; numbness; coldness; tingling
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| Arterial Embolism Treatment | Embolism-immd surgery, percutaneous transluminal angioplasty (PTA); stent placement; artherectomy; balloon angioplasty; line of demarcation
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| Arterial Embolism Nursing Care | Anxiety; Altered tissue perfusion, assess peripheral pulses, skin temp, color cap refill, movement and sensation, unrelieved pain; Impaired Physical Mobility; Monitor PTT, PT, INR
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| Venous Thrombosis | Blood clots form on the wall of the vein, may partially or completely occlude flow
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| Venous Thrombosis Pathologic Factors | Virchow's Triad--Statis of blood; increase coagulability; injury to vessel wall
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| Venous Thrombosis S/SX | Dull aching pain; severe pain when walking;cyanosis; elevated temp; general malaise; edema
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| Venous Thrombosis Collaborative Care | Treatment of the inflammatory process; prevent further clotting; restoration of venous blood flow
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| Venous Thrombosis Lab & Diagnostics | Blood cultures; Doppler ultrasound, plethysmography, measure changes in blood flow; ascending contrast venography; MRI; Duplex venous ultrasonography, visualize the vein measure velocity of blood flow
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| Venous Thrombosis Pharm | Anti-inflammatory; anticoagulants, heparin, Coumadin, thrombolytics; surgery-venous thrombectomy
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| Coumadin lab test | PT/INR
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| Heparin lab test | PTT & APTT
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| Venous Thrombosis Nursing Care | Pain; Ineffective tissue perfusion; Impaired physical mobility
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