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what is an oral anticoagulant?
oral antiplatelet agents?
aspirin, clopidogrel (Plavix) and dipyridamole (Persantine, Aggranox- includes aspirin)
a blood viscosity reducing agent?
antidote for heparin?
antidote for warfarin?
does Hep dissolve clots?
- NO, prevents formation
- prevents thrombin from converting fibrinogen to fibrin
therapeutic range for Hep?
- PTT - 20-36 secs
- therapeutic is up to 2.5 times normal
therapeutic level for coumadin?
- PT 11-13, therapeutic is 1.5-2 times
- over 20 needs to be looked at
- INR is 2-3
main SE of antiplatelet meds?
GI bleeding, bruising, hematuria, tarry stools
what are interventions for antiplatelet meds?
determine sensativity before admin, VS take w/food if GI upset, monitor bleeding time, and for SE of bleeding
HIT or HAT?
- heparin induced thrombocytopenia, may develop on 8th day of therapy
- may reduce platelet count to 5,000
name 3 arterial disorders
- arteriosclerosis- arteries
- atherosclerosis- intema of large and medium arteries- lipid accumulation
- Plaque or atheromas- injuries
name 2 types of atherosclerotic lesions
- fatty streaks
- fibrous plaque
what is collateral circulation?
growin more blood vessels around the structure involved
pathophys of atherosclerosis?
due to damage of the vessal wall, caused by sheering stresses and turbulent flow, there is injury to the endothelium.
high risk factors for an arterial disorder?
- high fat diet
- hereditary & sedentary lifestyle
what are medical treatments for arterial disorders?
- Angioplasty PTA
- vascular stents- balloon on femoral artery, blown up, backed out-leg, kidney, lungs
- pharmacological managment- aspirin, coumadin, heprain, Plavix, trental
- Alertation of peripheral tissue perfusion
- risk for impaired skin integrity
- knowledge deficit
Nursing interventions for arterial disorders?
- (cautiously) apply warmth
- avoid cold
- stop smoking
- avoid constrictive clothing
- relief of pain
- avoid trauma to extremities
- lower cholesterol, increase protein
S/S of intermittent claudication?
- pain, ache, fatigue, burning, discomfort to muscles of feet, calves or thighs
- symptoms start during exercise and go away with rest
what is intermittent claudication?
narrowing or blocking the main artery taking blood to the leg due to hardening of the arteries (atherosclerosis)
what is a bruit, a thrill?
- bruit- sound made over a narrowing
- thrill- feel of the turbulence
what are the med/surg managments for peripheral arterial occlusive disease?
- exercise- start slow
- weight reduction
- stop smoking
- vascular grafting- anastomosis (artificial of one of their own)
- eddarterectomy- cleaning out
- femoral/popliteal graft-own autogolous graft best
nursing interventions Post op?
- VS Q 15 min 1st hr, Q 30 min 2nd hr the Q hr for 24 hrs
- check distal circulation!
- dopplers signal checks Q at least 2 hrs
- notify surgeon immidiatley if loss of pulse, change in color-pale, temp-cold, bleeding
- BP management, pain
what is Thromboangitis Obliterans or Burger's disease?
recurring inflammation of the intermediate and small arteries
S/S of buerger's disease?
pain, cold sensativity, digital rest pain constantly present rubur (reddish-blue discoloration of the feet
what is treatment for Burgers disease?
same as atherosclerotic peripheral disease
what are aortitis and aortaliliac diseases?
inflammation of the aorta
what is an aortic aneurysm?
loacalized sac or dilation involving an artery formed at a weak point in the vessel wall
who does the aortic aneurysm most often affect? what part of the aorta and how many die?
- Men 40-70
- the thoracic segment
- and 1/3 die from rupture
S/S of an aortic aneurysm?
- pain- constant and boring to back
- dyspnea, hoarseness, loss of voice from pressure of the sac against trachea, main bronchus or lung
- pulsatile mass of the abdomen
signs of an impending ruptire of aortic aneurysm includes
severe back or abdominal pain
nursing considerations for pt with an aortic aneurysm?
dont palpate, you can hear systolic bruit over the mass, the aneurysm will be reassessed Q 6 monthsif it is 5-7 cm
what are the signs of a dissecting aorta?
- Unrelievable PAIN
- pt will show signs of shock
Dx of dissecting aorta?
angiogram, CT scan, transesophageal echocardiography, duplex ultrasound, MRI
Medical treatment of arterial embolism?
- embolectomy- stent to pull clot out
- thrombolytic therapy- to dissolve clot, cant use if pt has had surgery within past 6 months
what are the 5 P's / symptoms of an arterial embolism?
what are risk factors for getting an arterial embolism?
- atrial fibrillation (should be on anticoagulants)
- trauma- DIC, crush injury
what is the medical managment for arterial embolism or thrombosis?
heparin therapy w/inital bolus of 5000 to 10,000 U followed by continous drip at 1000 U per hr. a PTT. Heparin prevents further clotting
intermittent arteriolar vasoconstriction due to stress or cold
S/S of Raynaud's disease?
coldness, pain, pallor of the fingertips, toes and ears
who does Raynaud's disease most commonly occur in?
women 16-40 years old
Mngmnt of Raynauds disease includes?
- avoid cold, no smoking
- Ca channel blockers
- use hot mitts to get ice trays
Venous disorders can cause?
thrombophlebitis, DVT, leg ulcers, varicose veins
treatment for venous disorders?
exercise, anticoagulant therapy- coumadin
what lab test will be ordered to monitor therapy for DVT?
CBC coagulation panel, aPTT, D-Dimer