Aneurysm/Disections
What are risk factors for aortic aneurysm
Atherosclerosis
HTN
Blunt Trauma
Marfan Syndrome
Pregnancy
these 2 ca channel blockers have no effect on preload and are potent arterial dilators
Nicardipine
Clevidipine
what is the first symptom of PAD
Intermittent claudication
What is used to dx PAD
Ankle/Brachial Index (ABI):
Ankle SBP/Brachial SPB:
normal 0.9-1.0
mild 0.71-0.9
mod 0.41-0.7
severe <0.4
what is one complication of VTE and what are the s/s
pulmonary embolism- clot migrates through venous circ to pulmonary vascular bed
s/s: chest pain, sudden SOB, ALOC
What are the 2 types of aneurysms
fusiform
sacculated
this is an alpha adrenergic blocker with moderate dilation of arteries and veins
Labetolol
describe intermittent claudication
pain with activity and relieved by rest aka ischemic muscle pain
what is the medical management of PAD
-eliminate RF
-meds: anticoags, vasodilators, antiplatelets
-PTA/PCI= restore perfusion
-stent placement
-bypass sx
What is virchow's triad
stasis of blood
endothelial injury
hypercoagulability
When does an aortic aneurysm require surgical repair or stent placement
>5cm in diameter
This medication requires thiocyanate toxicity monitoring and is a smooth muscle relaxant, acting as a potent arterial dilator and moderate venous dilation
Nipride
What is required when PAD progresses to rest pain or continuous burning pain to lower extremity not relieved by rest
stat surgical catheter to save limb
nursing management of PAD
-monitoring pulses
-maintain skin integrity/preventing skin breakdown/injury
-pain control
-patient and family educ
-nursing management after angioplasty: s/p IR dysrhythmias, renal failure, hematoma
what are some PE dx and assessments
dx: US/D-dimer
assessment: most are asymptomatic
whole extremity swelling
positive homans sign(pain in calf with dorsiflexion)
what are the 3 s/s of aortic dissection that consider it emergent
acute/severe pain (chest/abdomen.back) Tearing
hypotension (hypertension initially, fleeting peripheral pulses, limb ischemia, aortic regurg-new murmur)
s/s of shock
what are the s/s of acute occlusion from thrombosis
5p's: pain, pallor, pulselessness, poikiothermia(cold), parasthesias
surgical intervention required immediately to open artery
Describe what a VTE (Venous Thromboembolism is)
Clot/Thrombus forms in large vein of leg, pelvis, arm
TX for VTE and what is monitored
monitor: CP, SOB, hemoptysis, tachypnea
medical management of aortic dissection
arterial line for bp monitoring
labetolol to decrease CO & Lower B/P
alpha blocking activity to vasodilate arteries and decrease bp
clevidipine rapid control of bp
What are atrophic changes seen in PAD
skin/nail changes
muscle wasting
ulcerations/gangrene
S/S of VTE
inflammation
pain/tenderness
Redness
how is PE dx'd and what is Tx
Dx: Chest CT. V/Q scan
Tx: thrombolytics, airway/intubation