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Ischemic pain that is precipitated by exercise, which resolves with rest, and is reproducible. The pain associated with this arises when cellular oxygen demand exceeds supply. It occurs early in the disease course of peripheral vascular disease, and is typically the initial reason clients who have PAD seek medical attention.
What is intermittent claudication?
To test capillary refill, a nurse presses on the client's nail beds to produce blanching and then measures the time it takes for the color to return. With adequate arterial capillary perfusion, the color should return within 3 seconds. If the skin color takes longer than 3 seconds to return to normal, this indicates this problem.
What is impaired arterial blood flow to the extremity, or arterial insufficiency?
What is extremity pain at rest?
In the initial stages of PAD, clients might experience intermittent claudication. As the disease progresses, the client will experience pain even at rest due to ischemia of the distal extremities. The client might describe this pain as a persistent burning or aching pain that often awakens the client at night.
This should be measured when treating heart failure with diuretics.
What is monitor urine output and blood pressure?
The nurse should monitor urinary output and blood pressure because the administration of furosemide should result in diuresis/increased urinary output and might lower blood pressure.
An increase in venous hydrostatic pressure, which develops when fluid accumulates in the veins, causes fluid to leak out into the tissues resulting in this.
What is edema?
Pulse pressure devices require the presence of optimal arterial waveforms in order to capture accurate data. Therefore, this will compromise the readings.
What is an arrhythmia or dysrhythmia?
These are the signs and symptoms of right sided heart failure.
What are fluid retention causing swelling in the ankles, legs, feet and/or abdomen with or without hepatomegaly, awakening at night with shortness of breath/shortness of breath laying flat/shortness of breath with exertion, coughing, wheezing, dizziness, fatigue, lack of appetite and nausea, difficulty exercising, and sudden weight gain (fluid retention)?
What is constant coughing, shortness of breath with walking or bending over, waking up short of breath or unable to lie flat at night, weight gain (fluid retention), swelling in the ankles, legs, or abdomen?
Over time, these complications may occur: cardiogenic shock, enlarged heart (cardiomegaly), and abnormal heart rates and rhythms.
What is to help determine the degree of damage to the heart tissue?
Cardiac enzyme studies are obtained because the degree of enzyme elevation reflects the degree of damage to the myocardium. The enzymes most commonly measured are CPK and troponin. These enzymes have a characteristic rise and fall pattern after an MI. It may take 4 hr or more after the onset of manifestations for the test to become abnormal and up to 24 hr for the level to peak. Eventually, the levels in the blood fall back to normal. Consequently, serial blood tests must be taken from the client to document and evaluate enzyme levels.
This is a key physical finding for cardiac tamponade.
What is muffled heart sounds?
Muffled heart sounds are a key indicator of cardiac tamponade because of the excess amount of fluid surrounding the heart.
This is an intervention a nurse should perform with a patient who has a DVT and is receiving anticoagulation therapy.
What is encourage a patient to walk?
Patients with DVTs should avoid sitting or standing for long periods of time. After the patient begins anticoagulant therapy, the nurse should encourage the client to walk.
These are the triad of risk factors for DVT, also called Virchow's Triad.
What are venous stasis, vascular injury, and hypercoagulability.
You should know what can cause these things, such as lack of movement, injury or surgery, pregnancy, birth control pills (especially combined with smoking), cancer, etc.
This should be the priority for assessing when a patient has infective endocarditis.
What is dyspnea?
Dyspnea can be an indication of left-sided heart failure, or a pulmonary infarction due to embolization.
This should be done if you suspect swelling (edema) above a PICC insertion site.
What is should measure the arm and compare the result with the circumference of the other arm?
If the arm is swollen, the nurse should notify the provider who inserted the PICC line. Swelling could indicate formation of a clot above the site or even catheter rupture.
When a patient with heart failure complains of not being able to do the activities they normally are able to do, for example walk to the mailbox, or describe being so exhausted the following day and cannot do hardly any activities, this is demonstrating this.
What is activity intolerance?
Heart failure patients should be encouraged to do something like walk to their mailbox, or exercise at least three times a weeks to help with knowing if they are having activity intolerance versus deconditioning. Plus, patients who have heart failure and remain active appear to have improved outcomes. Regular exercise strengthens the heart and cardiovascular system, thereby improving circulation and lowering blood pressure.
Taking daily medications for Raynaud's disease (syndrome) prevents the onset of this.
What is vasoconstriction?
These symptoms can indicate fluid overload and should be watched for when giving any IV fluids with a patient who has heart failure.
What are dyspnea, confusion, and JVD?
Other symptoms of fluid overload include: tachycardia/increased heart rate; increased blood pressure; increased respiratory rate; edema.
This is a noninvasive diagnostic test that assess the flow of blood and is used to detect distal deep vein thrombosis.
What is a venous duplex ultrasound?
The Homan's sign is something you might hear older nurses use to help assess for DVT's, but due not being very reliable and therefore no longer useful and not advised, it is better to look for this for DVTs.
What is edema, warmth and redness in the calf and complaints of dull, aching calf pain?
This type of venous access device should be used/considered if access will need to remain in place for weeks or months.
What is a peripherally inserted central catheter (PICC) line?
A peripherally inserted central catheter (PICC) line is the venous access device commonly used when the client needs extended, but not permanent, intravenous access. PICC lines can also be used to draw blood samples without the need for additional venipunctures.
This is an acute inflammation of the deep connective tissue of the skin, caused by infection. Elevation of the affected area and frequent repositioning reduces dependent edema and assists in the healing process
What is cellulitis?
The edema of the inflammatory response puts the client at risk for skin breakdown. Elevation of the affected area and frequent repositioning reduces dependent edema and assists in the healing process.
Due to nitroglycerin causing vasodilation and increases blood flow to the head, this is a typical result of taking nitroglycerin.
What is a headache?
Because this medication reduces preload and afterload, it is considered the medication of choice for treating pain and anxiety of an acute MI.
What is morphine?
Besides cardiac enzymes, this is often used to determine if a patient is having an acute myocardial infarction.
What is an EKG or EEG?
The nurse should perform a 12-lead ECG when a client complains of chest pain to determine if the client is experiencing a myocardial infarction.
As a nurse and educator, educating your patients about these will help to prevent vascular disease.
What are modifiable risk factors?
You should know what are the modifiable risk factors as well as what are nonmodifiable risk factors for vascular disease (PAD and CAD).