Adults med-surg 1 cardiac

Adults med-surg 1 cardiac Types of PVD (peripheral vascular disease) - Arterial occlusive disease - Venous Insufficency Arterial Occlusive Disease A common circulation problem; arteries that carry blood to the legs or arms becomenarrow and get clogged Main cause of AOD Atherosclerosis Risk factors of AOD - smoking - diabetes - BMI over 30 - high blood pressure 140/90 - increasing age - family history Effects of AOD It is 6-7 times of a greater risk of a heart attack and stroke Symptoms of AOD - intermittent claudication - painful cramping in hip, thigh or calf muscles after activity - leg numbness or weakness - coldness in your lower leg or foot especially with comparison - hair loss or slower hair growth on your feet/legs - slower growth of toenails - shiny skin on legs - weak or absent pulse in legs or feet - ED in men Treatment of AOD non-surgical, lifestyle changes medications: - Cholesterol lowering agents - BP medication Diagnostic tests: AOD Ankle- Brachial Index Doppler ultrasound Angiography PCD surgical treatments - Angioplasty - Endarterectomy - Stenting - Surgical bypass Venous Insufficency - caused by incompetent or obstructed veins = most common cause of lower extremity swelling Risk factors of VI age obesity trauma history of DVT/phlebitis surgical complications (orthopedic) tight fitting garments prolonged sitting or standing family history How it works:VI A clot will block blood flow through the vein and cause pressure to build up Upgrade to remove ads Only $3.99/month Leg injury of surgery injury or surgery that blocks the flow of blood through a vein can increase pressure Excess weight or weight gain The added weight of pregnancy or obesity can increase pressure in the veins of the legs and damage the veins and valves Standing or sitting for too long Prolonged periods without walking can decrease the movement of blood out of the legs and lead to increased pressure in the veins and pooling of blood -- thats because the muscles in the legs play an important role in circulation of blood, acting like a pump to move blood from the legs back to the heart. Signs and symptoms of VI - less pain than arterial disease - brawy skin discoloration (reddish brown) - edema (improves with elevation) - warm skin - itching/stasis dermatitis -stasis ulcers -veins visible (or not) Diagnostics of VI - venous dopller to rule out DVT - otherwise no tests - clinical diagnosis of exclusion VI treatment - no oral medication has yet been proven useful for the treatment of venous disease - graduated compression - surgery reserved for those with discomfort or ulcers refractory to medical management VI: Chronic disease - dialated (or swollen) veins - swelling (edema in the ankles and lower extremities usually at end of the day can be permanent - may be less prominent in the morning - skin changes (tan-reddish usually at ankle or over shins, iritated itchy dry skin thats oozing fluid and scabbing or crusting) Venous ulcers in chronic disease VI - open non healing sores in the inner or outer ankle - ulcers above the knee are usually secondary to injury - venous ulcers can take a long time (months or years) to heal - healing is a gradual process and the resulting scar is usually shiny pink or red with distinct white marks - venous ulcers can come back even after they heal Nursing measures of AOD - dependent position - progressive exercise - decrease risk factors - foot care - pulse checks Nursing measures of VID - avoid prolonged sitting or standing -elevated position - diuretics of limited value - graded compression stockings -meticulous skin care - analgesics as needed - education about poor circulation Upgrade to remove ads Only $3.99/month Abdominal Aortic Aneurysm - permanent localized dilation of aorta within the abdomen - 90% result from atherosclerosis and worsen from HTN - most common location below the bifurcation of the renal arteries (incidence is 3-4% of population, 15,800 die annually) Treatment of abdominal aortic aneurysm Nonsurgical: - if not leaking will monitor size - Manage BP - smoking cessation Surgical: - Indicated for aneurysm >4.5 cm wide Nursing care for abd - monitor vital signs - S/S infection - urine output - lower extremity circulation - abdmonial distension Venous thromboembolism (VTE) a disease that includes deep vein thrombosis (DVT) and pulmonary embolism - the third most common cardiovascular disease after heart attack and stroke DVT + PE = VTE! If not prevented or caught early a DVT can progress with the blood clot breaking away and traveling to your lungs and becoming a potentially deadly PE, which required immediate medical attention Pathogenesis of VTE - Virchow's triad - hypercoagable state - intimal injury (endothelial injury) - stasis of blood flow venous stasis and vascular wall damage + activation of clotting factors + decrease of clot lysing mechanism --> thrombus Initial site often calf veins (less serious than proximal thrombi) S&S of DVT - unilateral edema - pain and tenderness - palpable cord - erythema, warmth along venous system -proximal veins often asymptomatic -common sites: iliac, common femoral, deep femoral and popliteal pulmonary embolus obstruction of pulmonary artery or branch by blood clot, air, fat, amniotic fluid or septic thrombus "blood clot to lungs" most thrombuses are blood clots from leg veins Presentation of PE can be large or small accounts fro 90% of all acute pulmonary conditions Clinical manifestations of PE - DYSPNEA/pleuretic chest pain - low grade fever - apprehension/restlessness - feeling of impending doom - cough hemoptytsis (coughing blood) Upgrade to remove ads Only $3.99/month Risk factors of PE venous stasis hypercoagablity venous endothelial disease certain disease state: heart disease, trauma, post op/postpartum, DM, COPD Other conditions: pregnancy, obesity, oral contraceptive use, constrictive clothing, previous history of thrombophlebitis PE Obstructed area has diminished or absent blood flow - although area is ventilated, no gas exchange occurs - ventilation perfusion imbalance, right ventricular failure, shock occur - can be fatal 1 hr after symptoms start Diagnosis test of PE Chest CT or pulmonary angiogram PE exam finding - tachypnea - lung crackles -pleural friction rub - tachycardia -diaphoresis -low grade fever - decreased O2 stat PE test: - ABG's - CXR - TEE - V/Q scan - spiral CT - pulmonary angiography Prevention of PE - exercises to avoid venous stasis - early ambulation - anticoagulant therapy - sequential compression devices (SCDs) Treatment of PE - measures to improve resp, CV status - Anticoagulation, thrombolytic therapy PE non surgical treatment - O2 - Telemetry monitor - anticoagulation - heparin PE surgical treatment - embolectomy - vena cava filter placement Anticoagulant drug actions: interferes with cagulation process by interferring with clotting cascade and thrombin formation -- examples: coumadin (warfarin sodium) and heparin Upgrade to remove ads Only $3.99/month Heparin Prevention of thrombus formation: IV HEPARIN: - always administered on an infusion pump - therapeutic effect 45 mins - monitory PTT (goal is 60-80 sec) - reverse with protamine sulfate Lovenox ( low molecular weight heparin) - subcutaneous heparin BID Coumadin - individual dose adjustment - based on INR (test that measures how long it takes for blood to clot) - oral administration - can take up to 3-5 days to see therapeutic effect - vitamin K antidote Novel anticoagulants Direct Xa Inhibiotrs: Rivaroxban (Xarelto), Apixaban (Eliquis) Direct Thrombin Inhibitors Dabigatran (pradaxa) Antiplatelet drugs Alter formation of platelets by decreasing responsiveness of platelets to stimuli that would cause them to stick and aggregate on a vessel wall Example of antiplatelet Asprin: Reduction of risk of recurrent TIA's or strokes -- P2Y12 Inhibitors: Clopiodgrel (Plavix) Thrombolytic Agents - Activate the natural anti clotting system, conversion of plasminogen to plasmin - Activation of this system breaks down fibrin threads and dissolves any formed clot Example: TPA & Strept