Varicose Veins
Name two factors that contributed to the development of Mrs. Henry's varicose veins.
Prolonged standing
Obesity
Pregnancy
Female
Name two risk factors for the development of a DVT in Mr. Johnson.
Any of the following: Age, orthopedic procedure, immobility, hip fracture, MI, anesthesia, heart failure, operating room time >2hours
Name two signs or symptoms of chronic venous insufficiency.
Any of the following: edema, pain, brownish discoloration along the medial ankle, superficial veins may be dilated, warm and red skin
Mr. VanHandel has intermittent claudication. Name two differences between intermittent claudication and rest pain.
Intermittent Claudication: Pain occurs with exercise. It is relieved by rest. The pain is reproducible. The pain is described as crampy or achy muscle pain and is most commonly in the calves and ankles. It is NOT relieved by a change in position.
Rest Pain: Pain is more severe and is located in the toes or foot. The pain is described as paresthesias or a burning sensation. The pain is increased when the legs are elevated. It is relieved by a dependent position.
Mr. Eichman presented to the Emergency Room complaining of a sudden onset of severe abdominal pain. On his abdominal X-Ray a 7cm abdominal aortic aneurysm is seen. What is your interpretation of these findings?
The aneurysm may be expanding or may be about to rupture.
Name two other signs or symptoms that Mrs. Henry may be experiencing.
Muscle cramps
Muscle fatigue
Heaviness
Aching legs
Edema
Name two possible signs or symptoms of a DVT.
Edema
Difference in leg size
Red, warm, painful, swollen and tense extremity
Pulmonary embolus (may be first sign or symptom of a DVT!)
Name two signs and symptoms of a venous ulcer that differ from an arterial ulcer.
Any of the following: ankle or leg swelling, ulcer at the medial ankle, brown discoloration at the medial ankle, edema, pulse present, no claudication, or superficial wound with uneven edges. Wound is typically large and exudative. Skin is warm, dry and pink. No neurologic deficit.
Part of Mr. VanHandel's workup is a diagnostic test called an ankle-brachial index. Mr. VanHandel's brachial SBP=154 and his ankle SBP=116. Determine his ankle-brachial index. What is his value? Does he has PAD?
The ankle pressure (116) is divided by the brachial pressure (154) . ABI= 0.75
He DOES have PAD.
What is the number one risk factor for the development of an abdominal aortic aneurysm?
Atherosclerosis
Mrs. Henry asks you what she can do to treat her condition. Name two independent nursing interventions that you can recommend.
Elevating the feet when sitting or lying
Wearing support hose
Weight reduction
When sitting – avoid crossing of the legs (impedes venous return)
Avoid prolonged sitting or standing
Walk 1-2 miles/day
Name two ways in which a DVT may be prevented from developing in Mr. Johnson.
Medications: lovenox or heparin SC
Compression stockings
Aspirin
TEDS
Elevating the foot of the bed
Adequate hydration
Early ambulation
Active and passive leg exercises
Deep breathing exercises
Miss Casey is scheduled for a debridement of her ulcer. What is the purpose of debridement?
Debridement is removing dead tissue. The removal of this tissue promotes wound healing and prevents (or corrects) infection.
Mr. VanHandel is prescribed Trental. How will this drug help to treat his peripheral arterial disease?
Trental alters the membrane flexibility of the RBCs so they fit into smaller blood vessels. However, it only changes the reticulocytes -- NOT the mature RBC (erythrocyte).
Name two other diagnostic tests that may have been used to diagnosis Mr. Eichman's aneurysm.
Any of the following: ultrasound, TEE, CT, angiography, MRI, MRA
Mrs. Henry's veins can BEST be assessed while she is in the ___________________ position.
Dependent
Despite your best efforts, Mr. Johnson develops a DVT. During the course of his hospital stay, Mr. Johnson is given a heparin bolus and placed on a heparin drip. He is now ready for discharge and will be taking Coumadin at home. Name two signs or symptoms that Mr. Johnson will need to report to his physician.
Any of the following: bleeding that does not stop,abdominal pain, red or pink-tinged urine, red or black stools, fainting, weakness, headaches, bruises, high heart rate, low blood pressure, family observation of altered LOC
When should Miss Casey's graduated compression stockings be applied?
You should put them on after the legs have been elevated for a period of time. Rationale: the amount of blood in the leg veins is at its lowest.
Mr. VanHandel is diagnosed with a graft occlusion. Name two interventions that you may do or that you may prepare the patient for.
Return to OR for: Emergency thrombectomy or graft revision
Possible Meds: Thrombolytic or an antiplatelet drug
Mr. Eichman asks you if he should measure his waist circumference once a week. Is this important to monitor? Why or why not?
The patient does NOT need to do this. If his waist circumference were to increase, he would be actively and profusely bleeding. You would not see a change as the abdomen can hold large volumes of fluid.
Will Mrs. Henry's pedal pulses be normal, diminished or absent?
Mrs. Henry’s pedal pulses will be normal as her disorder is not an arterial one.
Name the three identified pathophysiologic factors that may have lead to the development of a thrombus.
1. Venous stasis
2. Endothelial injury
3. Altered coagulation
Describe the pathophysiologic changes involved in the development of chronic venous insufficiency.
"Prolonged venous hypertension stretches the veins and damages the valves. Valvular damage can lead to a backup of blood and further venous hypertension, resulting in edema."
Mr. VanHandel is diagnosed with a graft occlusion. Name two signs or symptoms of a graft occlusion.
Any of the six "Ps": polar, pain, paresthesia, paralysis, pulselessness, or pallor
After Mr. Eichman's surgery, you monitor him for potential complications. Name two potential complications that may occur (specific to this procedure).
Any of the following: MI, heart failure, CVA, renal damage, graft occlusion, graft rupture, shock, paralytic ileus, bleeding, perforated bowel, ischemic colitis, spinal cord ischemia, thrombi/emboli, infection, dehiscence, evisceration