Carotid Artery Disease
How is carotid artery disease defined?
Atherosclerosis disease similar to PAD, stenosis (narrowing) greatest at the carotid bifurcation (carotid bulb)
When carotid artery disease is asymptomatic, what is the treatment plan for these patients?
lifestyle modifications
- diet changes - weight management - smoking cessation - limit alcohol - control co-morbidities and atherosclerosis disease
What diagnostic test can be used to confirm an acute peripheral arterial occlusion?
angiography
MRA (magnetic resonance angiography)
Where are the common areas to find a DVT?
iliac, femoral, popliteal, and veins of the calves
What labs might a physician order to help diagnose a DVT?
D-Dimer, coagulation studies (aPTT, ACT, PT, INR), platelet count, hemoglobin and hematocrit
How do you assess for a bruit?
what are the steps?
listen to the carotid artery
- bell of stethoscope on carotid artery
- patient turn head away
- patient hold breath
Are there surgical procedures to remove or lessen the blockage?
carotid endarterectomy
carotid angioplasty and stent
anticoagulant medications
What medical treatment options are available for acute peripheral arterial occlusion?
anticoagulant therapy
thrombolytic therapy
What are the common causes of DVTs?
post surgery complication and trauma patients
*some medical conditions*
What are the diagnostic tests a physician might order to diagnose a DVT?
venous compression ultrasound, color flow duplex venous ultrasonography, CT and MRI venography, ascending contrast venography
What are the risk factors for carotid artery disease? Men and women are more at risk at different ages, when are they more at risk?
begins around age 40, progresses with age
more common in caucasians and native americans
similar to PAD risk factors
men more at risk before 75 yo
women more at risk after 75 yo
What is the most common cause of an acute peripheral arterial occlusion?
embolus
What procedures are used to treat acute peripheral arterial occlusion?
PTA
Laser artherectomy
rotational artherectomy
thrombectomy or embolectomy
surgical arterial revascularization
amputation
Virchow's Triad is a combination of events that can lead to a thrombus. What three factors are in Virchow's Traid?
Venous stasis (decreased blood flow)
Endothelial damage (damage to blood vessels)
Hypercoagulability (increased clotting)
As a nurse, what non-pharmacological measures can you take to ensure a DVT does not develop?
early mobilization, leg exercises, graded elastic compression (TED hose), intermittent compression devices (SCD)
Carotid Artery Disease can be asymptomatic or symptomatic. What are some symptoms seen with carotid artery disease?
sudden weakness, loss of coordination, dizziness
facial droop, difficulty talking, vision problems
sudden severe headache, confusion
What history puts a person at risk of an acute peripheral arterial occlusion?
recent acute MI and/or atrial fibrillation
What is thromboangiitis obliterans (buerger's disease) and who is most to develop this disease?
inflammatory disorder of the small arteries, veins, and nerves of the extremities, causing spasms and clots
young males who smoke.
There are many risk factors associated with DVTs, list as many as you can. (15)
surgery - cancer - cardiovascular disorders (a.fib.) - obesity - respiratory failure - elderly - immobilization - inflammation/infection - ICU admission - trauma - thrombophlebitis - thromboembolism (history) - pregnancy and delivery - hormone therapy - coagulation disorders
What medications might a physician order to help prevent the development of DVTs?
prophylactic anticoagulation, anticoagulation for DVT
What diagnostic tests can be used to confirm carotid artery disease?
carotid duplex ultrasonography (most common)
CTA (computed tomography angiography)
MRA (magnetic resonance angiography)
carotid angiography
What extremities are most commonly affected by acute peripheral arterial occlusion?
lower extremities more than upper
What is Raynauds disease or phenomenon? who does it show up in more commonly? can also be associated with collagen vascular diseases and long term exposure to _____ or _______.
vasospasm in small arteries of the fingers
young women, triggered by emotional stress and exposure to cold
cold or machinery
DVTs may appear asymptomatic at first but if present may appear clinically as...
dull, aching pain in affected extremity (pelvis and deep veins of legs, calves)
tenderness
edema (unilaterally)
warmth
erythema (redness)
The patient has a confirmed DVT, the physician will order medications (Unfractionated heparin, and low molecular weight heparin), name the med, how its given, and anything else you should know about it.
Unfractionated Heparin: (no name given), prophylactic is SQ BID-TID and treatment is continuous IV infusion, labs aPTT or anti-factor Xa/platelets/risk of bleeding
Low Molecular Weight Heparin: Enoxaparin or Dalteparin, SQ (most likely BID - this is a guess), less bleeding risk