AMS1

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Author:
alyn217
ID:
163111
Filename:
AMS1
Updated:
2012-07-19 13:24:48
Tags:
AMS1T1 PAD
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Description:
Periferal Artery Disease
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  1. General info about PAD
    • What?
    • --Progressive narrowing & degeneration of arteries
    • How?
    • --Atherosclerosis
    • Who?
    • --Cigarette smokers
    • --Hyperlipidemia
    • --Hypertension
    • --DM
  2. SnSs of PAD
    • Ischemic muscle ache or pain that is precipitated by a constant level of exercise
    • --Resolves within 10 minutes or less with rest (claudication)
    • Paresthesia
    • Thin, shiny, and taut skin
    • Loss of hair on the lower legs
    • Diminished/absent pedal, popliteal, or femoral pulses
    • Pallor
    • Reactive hyperemia
    • Rest pain
    • --Occurs in the fore
    • --foot or toes and is aggravated by limb elevation
    • --Occurs from insufficient blood flow
    • --Occurs more often at night
  3. Complications of PAD
    • Atrophy of the skin and underlying muscles
    • Delayed healing
    • Wound infection
    • Tissue necrosis
    • Arterial ulcers
  4. Diagnostics for PAD
    • Doppler ultrasound
    • --Segmental blood pressures
    • Ankle-brachial index (ABI)
    • --Done using a handheld Doppler
    • Duplex imaging
    • Angiogram
    • Magnetic resonance angiography (MRA)
    • H & P
    • Include palpation of peripheral pulses
  5. Rx therapy for PAD
    • Antiplatelet agents*
    • --aspirin
    • --ticlopidine (Ticlid)
    • --clopidogrel (Plavix)

    • Drugs prescribed for treatment of intermittent claudication:
    • pentoxifylline (Trental)
    • heparincilostazol (Pletal)
  6. Exercise therapy for PAD
    • Exercise improves oxygen extraction in the legs and skeletal metabolism
    • Walking is the most effective exercise for individuals with claudication
    • --30 to 40 minutes/day
    • --Will only work if PAD has not progressed to the point of occluding pulses.
  7. Nutritional Therapy for pt w/PAD
    • Dietary cholesterol less than 200 mg/day
    • Decrease intake of saturated fat
    • Soy products can be used in place of animal protein
  8. Alternative, Collaborative therapies for pt w/PAD
    • Gingko biloba
    • --Effective in increasing walking distance for patients with intermittent claudication
    • Folate, vitamin B6, cobalamin (B12)
    • --Lowers homocysteine levels
  9. Nursing care of an ischemic limb
    • Protect from trauma. Pt may not be able to feel feel and are therefore more prone to injury.
    • Decrease vasospasm. Use warm water, wear socks and shoes.
    • Prevent/control infection
    • Maximize arterial perfusion
  10. Intervensional, collaborative procedures
    • Percutaneous transluminal balloon angioplasty (radiological)
    • Peripheral-arterial bypass
    • Endarterectomy: surgical removal of plaque inside the artery.
    • Patch graft angioplasty
    • Amputation
  11. Acute Intervention for pt w/PAD
    • Knee-flexed positions should be avoided except for exercise
    • Turn and position frequently
    • What to call the MD for?
  12. 6 P's of acute and chronic PAD
    • *Pain
    • *Pallor
    • *Pulselessness
    • *Parasthesia
    • *Paralysis
    • *Poikilothermia (taking on temp of surrounding environment in affected extremety)

    Without intervension, pt may lose leg. Gangrene within hours.
  13. Nursing Intervensions for pt w/AAID
    • Continuous IV Heparin
    • Thrombolytics
    • Embolectomy
    • Bedrest
    • Determine potential cause
    • Monitor risks
  14. Thromboangiitis Obliterans
    AKA buerger's disease
    • Ischemia secondary to inflammatory thrombus, NOT fat!
    • Where?
    • Small arteries & veins in UE’s or LE’s
    • Who?--Smokers
    • Signs/Symptoms?
    • --Similar to PAD
    • --Cold sensitivities
  15. What is Raynaud's Syndrome?
    • Vasospasm secondary to exaggerated SNS response
    • Occupational related trauma?
    • Who?
    • --Young females
    • --Collagen diseases
    • S/S?
    • --Color changes to fingers, toes, ears & nose
    • --Episodic paresthesia/ coldness
  16. Management of Raynaud's
    • Protection from exacerbating factors
    • --Cold weather
    • --Cold objects
    • --Avoid caffeine
    • --Avoid tobacco products
    • --Avoid drugs with vasoconstrictive effects
    • --Stress reduction
    • Treatment
    • --Drug therapy
    • --Test for connective tissue or autoimmune disease
  17. Aoritic Aneurysms
    • What?
    • --Dilation of aortic arterial wall
    • How?
    • --atherosclerosis
    • Who?
    • --Family Hx
    • --Blunt trauma
    • --Acute infections
    • --Anastomotic disruption
  18. SnSs of TAA and AAA
  19. Aortic Aneurysm: NSG care
    • Pre-op & post-op care
    • ABG & F/E monitoring
    • ECG monitoring
    • Aseptic technique
    • Meticulous head-toe assessments
  20. DVT Collaborative Care
    • Nonpharmacologic
    • --Bedrest
    • --Elevation of extremity
    • --TED hose
    • --SCD’s
    • Pharmacologic
    • --Heparin
    • --Coumadin
    • Surgical
    • --Thrombectomy
    • --Greenfield Filter: filters DVTs if they travel before they enter the heart.

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