Download Peripheral Vascular Disorders and Amputation Care and more Exams Nursing in PDF only on Docsity!
Adult health 1- PAD, PVD, and venous disorders Questions & Answers
What is PVD (peripheral vascular disease)? - ANS-slow and progressive circulation disorder that includes disorders of the arteries, veins, and lymphatic vessels.
What is PAD? - ANS-thickening of artery walls which results in progressive narrowing of the arteries in the upper and lower extremities. This can result in a number of arterial diseases
What are some venous disorders? - ANS-Chronic Venous Insufficiency (CVI) occurs when the leg veins do not allow blood flow back up to the heart. The acute disorders we will study in this module are venous thromboembolism (VTE) and pulmonary embolism.
What are the clinical manifestations of PAD? - ANS-- Intermittent claudication/pain with walking
- Diminished pulses in affected extremity
Burning
Heaviness
Pressure
Soreness
Tightness
Weakness
What would the limb appearance of PAD? - ANS-Skin becomes thin, shiny, and taut.
Legs lose their hair.
Pulses may be decreased or absent.
Pallor occurs when the limb is elevated.
Redness occurs when the limb is in a dependent position.
What are some complications of PAD? - ANS-Atrophy of skin and muscles.
Minor trauma to foot can cause delayed healing, wound infection, tissue necrosis.
Non-healing arterial ulcers and gangrene are the most serious complications.
Amputation.
Gender differences with PAD? - ANS-Women have faster functional decline and greater mobility loss than men do.
How do you reduce risk factors of PAD? - ANS-exercise, the DASH diet, taking prescribed medications (e.g., cholesterol meds, antihypertension meds if patient has hypertension, medications for diabetes if the patient has type 1 or type 2 diabetes as directed), smoking cessation, and having patients with diabetes maintain an A1C level within normal range (i.e., below 7%, ideally 6%).
What is Buerger's disease? (Thromboagiitis obliterans) - ANS-Thromboagiitis obliterans is a nonatherosclerotic inflammatory disorder of the small and medium arteries and veins of the arms and legs. The blood vessels swell, preventing blood flow, causing clots to form. This can result in tissue death. This disease does not involve other organs—just the limbs.
Buergers disease manifestations? - ANS-Intermittent claudication of feet, hands, or arms.
Rest pain.
Ischemic (lack of blood flow) ulceration.
Color changes of limbs.
Paresthesia.
Cold sensitivity.
Superficial vein thrombosis.
Buergers diseases complications? - ANS-Amputation
What would the care for buergers disease be? - ANS-encourage the patient to stop smoking.
What are some clinical manifestations of Raynauds phenomenon? - ANS-Pallor of limbs, followed by cyanosis, followed by redness as the blood flow returns.
Pain.
Paresthesia. (Pins and needles)
Tingling.
What are some complications for Raynaud's disease - ANS-Skin may become thickened and nails brittle. May get small holes in fingertips.
What are some gender differences with rauynauds? - ANS-Women are affected more often than men are.
What would be the care for the patient? - ANS-Teach the patient to avoid temperature extremes and to wear mittens (mittens are better than gloves, as the fingers "buddy" together to create warmth), socks, and hats to keep fingers, toes, and ears warm. Teach the patient ways to reduce stress and to avoid tobacco and caffeine. Patients may be on calcium channel blockers.
What would be some symptoms for chronic venous insufficiency? (CVI) - ANS-Varicose veins
darkened, hard, leathery skin
swelling
pain and heaviness
leg cramps and spasms
restless leg syndrome
itchy skin
What would be some complications for venous insufficiency - ANS-The main complication is venous ulcer. Ulcers occur at the ankle or above.
What would be the care for CVI? - ANS-Compression stockings are encouraged as they assist with blood flow back to the heart. Remember, veins bring blood back to the heart passively; therefore, compression stockings will help
Sequential Compression Devices or SCDs.
Care for CVI also involves teaching patients to avoid standing or sitting for long periods of time. Teach patients to elevate legs whenever possible to assist with the blood return. Teach patients to moisturize dry, flaky skin associated with CVI. For those with venous ulcers, wound care teaching is essential. Patients also need education on proper nutrition for wound healing.
What type of food should be encouraged for wound healing? - ANS-Protein
What is an amputation? - ANS-Amputation is the removal of a body extremity by trauma or surgery.
What is the goal for amputation surgery? - ANS-The goal of surgery is to preserve the greatest extremity length and function while removing the pathologic or ischemic area.
What are the goals for a patient that has an amputation? - ANS-The goals for a patient with an amputation are to have relief from the underlying health problem, have pain relief, reach maximum rehabilitation of the affected limb, cope with body image change, and have satisfying lifestyle adjustments.
is phantom limb pain real? - ANS-Yes
What treatment has been found to help with phantom limb pain? - ANS-Mirror therapy
Use prescribed pain management techniques.
Perform ROM to all joints daily.
Perform general strengthening exercises (including for upper extremities) daily.
Do not elevate residual limb on a pillow.
Lay prone with hip in extension for 30 minutes three or four times daily.
Geriatric considerations for amputations? - ANS-An older person with a limb amputation may have great difficulty with mobility post-op. Many do not have the upper strength for crutch walking and may also have difficulty with prosthetic walking. It is vital to have a collaborative approach before the surgery to set realistic post-op goals.
What is a VTE? - ANS-VTE involves a thrombus in a deep vein which occurs most often in the legs but can be found in the arms, pelvis, vena cava, and pulmonary system. The biggest concern is the movement of the VTE into the lungs, resulting in a pulmonary embolism.
What are some signs and symptoms of a DVT - ANS-Leg pain
swelling
erythema
warmth in the area of swelling
What are the clinical manifestations of VTE? - ANS-The affected limb may have unilateral edema, pain, erythema, and warmth. Most occur in the lower extremities, but 10% do occur in upper extremities.
Possible complications for VTE? - ANS-Pulmonary embolism
Care for patients for a VTE? - ANS-Every patient, unless comatose, should be up every day—even if only in a chair. Very few patients are on total bedrest. Even patients who have open-heart surgery are up in a chair the surgical day, or post on day 1! If a patient is on bedrest, they must be moved (turned) every two hours. Nurses need to assure all of their patients are moving! Most patients will have SCDs—even
when up in the chair. The nurse encourages the patient to flex and extend the feet, knees, and hips every 2-4 hours. Many protocols call for a prophylactic anticoagulant such as enoxaparin (Lovenox) to prevent VTEs.
What care can you delegate to an NAP for VTE prophylaxis? - ANS-Assist with repositioning.
Remind patient to exercise, taught by the RN.
Apply compression stockings and/or SCDs.
Assist with ambulation.
What is a pulmonary embolism - ANS-A PE is the blockage of one or more arteries in the lungs from a thrombus or from an air, from a central venous catheter, or fat embolus (we will learn about fat embolus next week). Most PEs come from VTEs.
What are some clinical manifestations of a PE? - ANS-Dyspnea is the most common symptom. Patients can also have hypoxemia, tachycardia, cough, chest pain, hemoptysis, crackles, wheezing, and fever. Massive PEs can cause mental status changes, hypotension, and sense of impending doom.
What are some complications for PE? - ANS-Death is a very real complication and occurs within an hour in 10% of those with a PE. Other complications include pulmonary infarction, meaning part of the lung tissue dies.
What is the priority assessment for a patient with a PE? - ANS-Cardiopulmonary assessment.
After the priority assessment, O2 is started and is based on an arterial blood gas (ABG) or initially with pulse ox. You will learn more about ABGs in NRS 411. For now, just know that an ABG may be performed for a patient with a PE. Patients may even been intubated if the oxygen status is extremely poor.
What is some teaching that can be given to a patient about PE's? - ANS-The nurse should teach the patient to cough, turn, and take deep breaths to prevent atelectasis. The patient will be kept on bedrest (one of the few times a patient is kept on bedrest!) in a semi-Fowler's position.
Heparin.
What is enoxaparin (Lovenox)? - ANS-A Low-Molecular Weight Heparin used to treat and prevent DVT, Unstable angina, MI, and Pulmonary embolism; Protamine sulfate is the antidote
Heparin injections (SQ) - ANS-The site most frequently recommended for heparin injections is the abdomen because it is a large subcutaneous site. The injection should be at least two inches from the umbilicus. The reason a nurse may not inject heparin into a person's abdomen is that the patient may have had major abdominal surgery, or the patient has severe ascites. The nurse should pinch the injection site and should not massage the area.
If giving low molecular weight heparin (Lovenox), do not expel the air bubble in the syringe before giving. Because the amount in the syringe is so small, the air bubble helps the medication get to the subcutaneous tissue.
What is heparin induced thrombocytopenia? - ANS-Platelets decreased by half within 24 hours after starting heparin
What is the normal range for platelets? - ANS-150-450 mcL
What do you teach patients on an anticoagulation therapy? - ANS-Give reasons for and action of the anticoagulant drug and how long therapy will last.
Take the drug at the same time each day (preferably in afternoon or evening).
Depending on the drug prescribed, obtain blood tests to assess the therapeutic effect of the drug and whether a change in dosage is needed.
Contact ERS immediately for any of the following adverse side effects of drug therapy:
Blood in urine or stool, or black, tarry stools
Vomiting blood, coffee-grounds emesis
Unusual bleeding from gums, skin, or nose, or heavy menstrual bleeding
Severe headaches or stomach pain
Chest pain, shortness of breath, palpitations (heart racing)
Weakness, dizziness, mental status changes
Cold, blue, or painful feet
Avoid any trauma or injury that may cause bleeding (e.g., vigorous brushing of teeth, contact sports, rollerblading, use of straight razor).
Avoid all aspirin-containing drugs and NSAIDs.
Limit alcohol intake to small to moderate amounts (12 oz beer, 4 oz wine, 1 oz hard liquor/day).
Wear a medical alert device saying what anticoagulant drug is being taken.
If taking warfarin (Coumadin), avoid frequent or dramatic changes in eating foods high in vitamin K (e.g., broccoli, spinach, kale, greens). Do not take supplemental vitamin K.
Consult with the HCP before beginning or stopping any drug, vitamin, mineral, or dietary or herbal supplement (see Complementary & Alternative Therapies box on p. 818).
Inform all HCPs, including the dentist, of anticoagulant therapy.
Correct dosing is essential. Provide supervision if patient has confusion or cognitive impairment.
Which lab test would the nurse monitor for a patient on a continuous heparin infusion? PT/INR or PTT? - ANS-PTT. An easy way to remember: Hold up ten fingers. When spelling HEPARIN, drop a finger for each letter. When done, you will have three fingers remaining—makes you think PTT. The PT/INR is monitored when a patient is on wafarin. Again, hold up ten fingers. When spelling WARFARIN, drop a finger for each letter. When done, you will have two fingers remaining—makes you think PT (which always goes with the INR).
What are the heparin injection sites? - ANS-Abdomen, left and right thigh
The nurse assesses a PT/INR for a patient on warfarin and the patient's INR and notes the INR is 6. The nurse will anticipate the health care provider will order which one of the following medications? - ANS- Vitamin K
An INR of 6 is very high which means the patient is at great risk for bleeding. Vitamin K is the antidote for warfarin
