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Vascular DisordersMedical Surgical Nursing

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Arterial or Venous Ulcer? Skin is warm
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Venous
What is the goal blood pressure for a patient with an aortic dissection?
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Systolic BP between 110-120 mm Hg
What are the classes of drugs currently used to treat PAD?
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Antiplatelets like aspirin, Plavix ACE inhibitors Trental or Pletal to treat intermittent claudication Carnitine is being investigated to improve quality of life
What is the primary nonpharmacological treatment of PAD?
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Exercise (walking). Patient should walk 30-60 minutes a day for 3-5 days a week. They should walk until the feel pain, stop until it subsides, then resume
__________ is a chronic condition characterized by ischemic pain, arterial leg ulcers and/or gangrene of the leg due to advanced PAD.
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Critical limb ischemia
What is an endarterectomy?
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It is the opening of an artery to remove an obstructing plaque. It is used to treat advance PAD
What are signs/symptoms of a worsening of PAD?
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Pain at rest or in the night
What are factors that could reduce circulation that a patient with PAD should avoid?
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Smoking, restrictive clothing, exposure to cold temps., crossing the legs or feet
What are the important aspects of wound care related to critical limb ischemia?
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DRY care, dry dressings, careful cleaning and lubrication, keep the heel free of pressure, avoid chemicals, heat and cold
What are the nursing considerations following a surgical or radiologic intervention for a patient with PAD?
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Monitor for bleeding, emboli, hematomas and compartment syndrome by conducting frequent pulse measurements. Avoid knee-flexed positions, get the patient up frequently even if it's to walk a step or two. Discourage prolonged sitting.
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What nursing interventions can help a patient who has swelling in their legs after a surgical or radiological intervention for PAD?
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Place them in a reclining position with the legs elevated above the heart
What foot problems are (aside from an ulceration)considered potentially serious in patients with PAD or diabetes and therefore require health care provider attention?
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Thickened toenails or calluses
What is the most common cause of acute arterial ischemia?
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Embolization of thrombi from the heart or an aneurysm
What are the six Ps of the clinical presentation of acute arterial ischemia?
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Pain, pallor, pulselessness, paresthesia, paralysis and poikilothermia (adaptation of the ischemic limb to the environmental temperature)
What is the traditional anticoagulant of choice for treating acute arterial ischemia?
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IV unfractionated heparin
_________ is a rare, non-atherosclerotic inflammatory vasoocclusive disorder of the small and medium sized arteries, veins and nerves of the upper and lower extremities.
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Thromboangiitis obliterans (Buerger's Disease)
What can be used to guide differentiation of a diagnosis of Buerger's disease from PAD?
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The s/s are essentially the same, research has shown that Buerger's often has a higher hematocrit, blood viscosity and RBC rigidity than patients with PAD.
How is Buerger's disease treated?
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Absolute cessation of smoking, second-hand smoke exposure and NO nicotine replacement products. Areas of necrosis are amputated
_________ is a procedure where the nerve, ganglion and/or plexus of the SNS is transected to improve distal blood flow, reduce pain and facilitate healing of ulcerations in a patient with Buerger's disease.
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Sympathectomy
__________ is an episodic vasospasm of the small cutaneous arteries, usually in the fingers and toes. It is characterized by color changes in the fingers, toes, ears and nose (red, white or blue)caused by exposure to cold, emotional upset, caffeine or tobacco.
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Raynaud's phenomenon
What are the causes of secondary Raynaud's phenomenon?
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Autoimmune conditions like SLE, RA, or scleroderma
  
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