Perfusion
What condition causes the arteries to harden, causing impaired tissue perfusion?
Atherosclerosis
What is the morphology of RBC in Iron-deficiency anemia?
Microcytic and hypochromic
(small and pale)
Name two modifiable risk factors for PAD and 2 non-modifiable.
Modifiable: smoking, HTN, HLD, DMT2, diet, sedentary lifestyle, obesity
Non-modifiable: Age, men, ethnicity
In chronic venous insufficiency the problem lies with pushing blood flow from the heart to the limbs OR pulling blood flow from the limbs to the heart?
Limb to the heart: Vacuum problem
You are taking care of a patient who starts displaying signs of a myocardial infarction. What labs and diagnostic tests do you expect the doctor to order?
CK-MB, troponin, EKG, chest X-ray, D-dimmer, ABG, CRP, cardiac cath
What are some modifiable risk factors for impaired perfusion? Name 4
smoking, high cholesterol, obesity, and hypertension, uncontrolled glucose levels
Name 3 risk factors to iron-def. anemia
Pregnancy, heavy menses, drinking to much milk, genetics, trauma/bleeding, GI bleed
How can we educate the patient with PAD on preventing further tissue damage
Avoid heating pad and Hot water bottles- risk for burns
Do not cross the legs
Different from PAD, what are risk factors for venous insufficiency? name 3
HF, immobility, females, older, obesity, pregnancy, NURSES, standing for long periods,
You are working in the OBGYN clinic and you are seeing a female who is 20 wks pregnant. She complains the prenatal vitamin with ferrous sulfate she takes is causing stomach upset. What do you tell her?
Take with vit C, take at night (slowed gastric movement), take with a small amount of food,
What are some surgical interventions to prevent impaired local tissue perfusion? Name 3
angioplasty, bypass or graft surgery, stent, endarterectomy (surgical removal of plaque)
Name 6 signs and symptoms of Iron-deficiency anemia
Spoon-shaped nails, Cheilitis (fissures on the corners of the mouth), dry brittle nails, fatigue, SOA, activity intolerance, dry and pale mucous membranes, Pica, pallor
Describe the ulcers seen on patients with PAD. Give 5 descriptions
Ulcer: pale, even edges, toe, feet, dry, deeper,
What are the signs and symptoms of venous insufficiency? Name 5
Dark pigmentation- brown, venous stasis, Weeping, distended veins (varicose veins), dull pain/discomfort with standing- Need to elevate leg, Thick fibrous subq tissue, itchy skin
You are taking report on a patient coming up from the emergency department with complaints of burning and prinking sensation in their legs and pain with walking. What types of treatment and interventions will you expect to start on this client? What is the patients diagnosis?
Cardiopulmonary program, walking program, skin inspection with wound dressing changes, added nutrients to diet, O2 therapy possibly,
What are some nonmodifiable risk factors for impaired perfusion? name 3
age (increases with age), gender (men > women), and genetics/family history.
What are four medication education topics for the patient taking iron supplementation?
Side effects include constipation, green dark stools, staining teeth
Take on an empty stomach
Take with vitamin C
Rinse mouth after taking liquid form and take with a straw
iron toxicity S&S include N&V, diarrhea, and fatigue
Name 3 interventions for clients with PAD
walking program increases collateral circulation (walk until pain- rest- and then walk again)- forms new arterial pathways; avoid tight restrictive clothing, revascularization surgery
What are interventions or treatments for venous insufficiency? Name 5
compression stocking, elevation, Zinc oxide, ACE wrap, thrombectomy (clot removal), surgical ligation (stripping of the veins)
You are caring for a pregnant client in her third trimester. She reports having large veins in her legs that are painful. What education do you give this client.
Those are varicose veins caused by the increased pressure of the increased blood volume and cardiac output asserting pressure on the veins. You should prop your legs up when you can, avoid sitting or standing for long periods of time, wear compression stockings
What populations are at increased risk for impaired perfusion? Name 4
Middle-age and Older Adults, Men, African-Americans and Hispanics; Infants (with congenital heart defects); Children and Young Adults (due to trauma).
What should the patient include in their diet if low on iron? Name 4.
Organ meats, green veggies, red meats, egg, liver, avoid milk products= decreases absorption
List 6 specific signs and symptoms of PAD
Coldness in lower extremity, Shiny hairless skin, thicken toenails, diminished pulses (Doppler), REST Pain- sit on side of bed, Paresthesia (burning AND PRICKLING SENSATIONS), dry wound, NO Edema, GANGRENE, amputations, Infections, Intermittent claudication (pain/cramping with walking), cool feet
Rubor (red coloration with dangling),
*** Paralysis, pallor and coldness is consistent with complete arterial obstruction
What will the ulcers present with in clients with venous insufficiency? Give 4 descriptions
Ulcers: uneven wounds, more drainage, EDEMA, medial ankle (malleolus), more shallow/superficial,
Roy Price, a 68-year-old is seen at the Emergency Department with increasing symptoms of dyspnea, fatigue, lightheadedness, dizziness, difficulty sleeping at night, and unexplained weight loss. Roy's wife brought him to the Emergency Department because she was concerned with his unexplained periods of confusion. Roy retired from the Paper Making company 2-years ago after 35 years of service. He has a history of high blood pressure, sleep apnea, and smoking 1.5 packs of cigarettes a day. Roy quit smoking cigarettes 15 years ago. Assessment findings reveal BP 158/94 (115) mmHg; HR 82 beats/min; SpO2 94%; Temperature 98.7°F (37.0°C); Respirations 18; and 2+ pitting edema noted in both feet. Explain and Identify 3 intra-related concepts that apply to Roy’s situation. For example: Gas exchange, reproduction, sexuality, mobility, F&E ect.
Gas exchange=dyspnea & OSA, clotting=smoking, cognition= confusion, F&E= edema, nutrition/ digestion= weight loss