Nursing Assessment for Stent Graft Procedures

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Questions and Answers

Which of the following is a potential complication of a fully deployed bifurcated stent graft?

Rapid weight loss

Elevated blood pressure

Increased heart rate

Endoleak (correct)

What should be established during pre-operative nursing assessment?

Immediate post-op medication needs

Family history of surgery complications

Baseline data for post-operative comparison (correct)

Patient's history of smoking

Which assessment should be performed post-operatively to monitor for renal perfusion?

Temperature and pulse assessment

Foley catheter insertion site

Chest X-ray results

Urine output and creatinine levels (correct)

During the nursing assessment, which of the following should be documented on the lower extremities?

Skin lesions and pedal pulse sites Signup and view all the answers

Which complication requires emergency intervention post-operatively?

Graft thrombosis Signup and view all the answers

What is an important post-op instruction for patients regarding lifting?

Avoid lifting heavy objects Signup and view all the answers

Which of the following is NOT included in the post-operative nursing assessment?

Palpating large masses Signup and view all the answers

What should be monitored to assess neurological status after the procedure?

Facial symmetry and speech quality Signup and view all the answers

What is the primary reversal agent for dabigatran (Pradaxa)?

Idarucizumab Signup and view all the answers

Which of the following is commonly associated with venous insufficiency?

Chronic leg edema Signup and view all the answers

What management approach is recommended for venous insufficiency complications?

Compression and elevation Signup and view all the answers

What condition results from an immune reaction to heparin and increases the risk of clots?

Heparin-induced thrombocytopenia (HIT) Signup and view all the answers

In the treatment of venous insufficiency, which of the following is emphasized?

High-protein diet Signup and view all the answers

What is a primary management priority for patients with Buerger Disease?

Initiate vasodilating drugs Signup and view all the answers

Which symptom is characteristic of Raynaud Phenomenon?

Skin color changes to red and white Signup and view all the answers

In the case of Subclavian Steal Syndrome, what is the most appropriate intervention for unrelenting symptoms?

Surgical intervention Signup and view all the answers

What is a recommended nursing priority for thoracic outlet syndrome?

Advise avoiding aggravating positions Signup and view all the answers

Which of the following conditions is more commonly associated with women?

Raynaud Phenomenon Signup and view all the answers

What is the primary cause of peripheral artery disease (PAD) in most cases?

Tobacco Abuse Signup and view all the answers

At what percentage of arterial blockage do clinical symptoms of peripheral artery disease typically occur?

60% to 75% Signup and view all the answers

Which of the following is NOT a commonly recognized risk factor for developing peripheral artery disease?

Excessive exercise Signup and view all the answers

What stage of peripheral artery disease is characterized by intermittent claudication?

Claudication Signup and view all the answers

Why is peripheral artery disease often underdiagnosed and undertreated?

Symptoms are often overlooked Signup and view all the answers

What nursing process step involves establishing health promotion priorities for clients with vascular alterations?

Planning Signup and view all the answers

Which of the following is a classic symptom of peripheral artery disease?

Intermittent claudication Signup and view all the answers

What nursing implication is crucial when managing patients with peripheral artery disease?

Educate on the importance of tobacco cessation Signup and view all the answers

What is the primary characteristic of Critical Limb Ischemia (CLI)?

Rest pain lasting longer than 2 weeks Signup and view all the answers

What is a common method patients use to alleviate rest pain in their legs?

Dangling legs over the bedside Signup and view all the answers

Which diagnostic study is used to assess vascular status non-invasively?

Ankle-Brachial Index (ABI) Signup and view all the answers

When does rest pain most often occur in patients with CLI?

At night while trying to sleep Signup and view all the answers

What may be required if extensive tissue necrosis occurs in a limb affected by CLI?

Amputation Signup and view all the answers

Which condition indicates a need for immediate revascularization therapy?

Non-healing arterial leg ulcers Signup and view all the answers

Which of the following is not a complication associated with CLI?

Increased appetite Signup and view all the answers

How is the Ankle-Brachial Index (ABI) calculated?

Dividing the ankle systolic BP by the higher of the left and right brachial systolic BP Signup and view all the answers

Study Notes

Fully Deployed Bifurcated Stent Graft

Potential complications include:
- Endoleak
- Aneurysm growth, rupture, or dissection
- Bleeding
- Stent migration leading to renal artery occlusion
- Graft thrombosis (medical emergency)
- Site infection
- Graft dysfunction requiring traditional surgical repair

Nursing Assessment Pre-op

Establish baseline data for post-op comparison
Note peripheral pulse quality, character, and neurologic status
Mark and document pedal pulse sites and any skin lesions on lower extremities (pre and post-op)
Avoid palpating large masses
Insert two large-bore IV catheters
Administer 0.9% sodium chloride and prescribed medications
Insert an indwelling catheter
Administer pre-op antibiotics as ordered

Nursing Assessment Post-op

Monitor for infection
Monitor for bowel ischemia
Assess pulses
Assess neurologic status
Maintain NPO/NG tube
Administer pain medication
Monitor for signs of renal perfusion

Post-op Discharge Teaching

Avoid lifting heavy objects
Maintain HTN control
Follow wound care instructions
Be aware of signs and symptoms of rupture/dissection
Limit stair climbing
Avoid pulling, pushing, or straining until cleared by a physician

Peripheral Artery Disease (PAD)

Thickening of artery walls leading to narrowed arteries in upper and lower extremities
Prevalence increases with age, symptoms typically occur between ages 50-70
People with diabetes show symptoms earlier
Strong correlation with other cardiovascular diseases
Higher risk of general mortality
PAD remains underdiagnosed and undertreated

Causes of PAD

Progressive narrowing and degeneration of arteries in the extremities
Atherosclerosis (gradual thickening of the innermost layer of the arterial wall)
Tobacco abuse is the #1 cause
Other causes:
- Hypercholesterolemia
- Chronic kidney disease
- Hypertension
- Diabetes mellitus
- Age

Stages of PAD

Asymptomatic
Claudication (pain with exertion)
Rest pain
Necrosis/gangrene

Signs and Symptoms of PAD

Classic symptoms:
- Intermittent claudication (pain with exertion)
- Rest pain (most often in feet/toes)
Occurs when blood flow does not meet the metabolic needs of distal tissues
Rest pain often occurs at night due to decreased cardiac output during sleep
Patients may dangle their legs or sleep in a chair to relieve pain
Critical Limb Ischemia (CLI):
- Characterized by rest pain lasting >2 weeks
- non-healing arterial leg ulcers or gangrene

PAD Complications

Atrophy of skin and underlying muscles
Delayed healing
Arterial ulcers (most often on toes, feet, and lower legs)
Gangrene:
- Critical Limb Ischemia
- Chronic ischemic rest pain (>2 weeks)
- Arterial leg ulcers or gangrene
- Optimal therapy for CLI is revascularization
Amputation:
- May be necessary if tissue necrosis, gangrene, osteomyelitis, or blocked major arteries preclude successful surgery

PAD Diagnostic Studies

Health history and physical examination
Doppler Ultrasound Studies
Segmental Blood Pressures
Ankle-Brachial Index (ABI)
- Measured using a hand-held Doppler
- Ratio of ankle systolic BP to higher of left or right brachial systolic BP
- Normal ABI: 0.91 to 1.30
- Indicates adequate blood pressure in the extremities

Deep Vein Thrombosis (DVT)

Blood clot that forms in a deep vein, usually in the legs
Can travel to the lungs (pulmonary embolism)
Risk factors:
- Prolonged immobility
- Surgery
- Cancer
- Pregnancy
- Obesity
- Hormonal therapy
Signs and symptoms:
- Swelling
- Pain
- Redness
- Warmth
- Tenderness

DVT Treatment

Anticoagulants
- Heparin: IV or subcutaneous
  - INR goal: 2-3
  - Reversal agent: Vitamin K, avoid green leafy vegetables
- Novel Oral Anticoagulants (NOACs)
  - Dabigatran (Pradaxa), rivaroxaban (Xarelto), apixaban (Eliquis)
  - No lab monitoring, renally dose
  - Reversal agent: FDA approved only for dabigatran (Pradaxa)
- All NOACs: treat for 3 months or longer and monitor for bleeding
IVC Filter: for recurrent DVTs or inability to tolerate NOACs
Heparin-induced Thrombocytopenia (HIT): Immune reaction to heparin resulting in decreased platelets and increased risk of clots
- Measure circulating heparin antibodies
- Lovenox: less likely to cause HIT
- Multiple co-morbidities or large VTE: inpatient treatment necessary

Venous Insufficiency

Result of prolonged venous hypertension stretching veins and damaging valves
Causes:
- Leg edema
- Stasis dermatitis
- Stasis ulcers
Management: Non-surgical unless complicated by stasis ulcers

Venous Insufficiency Signs and Symptoms

Brownish, thick skin (leathery)
Itching
Eczema
Painful
Chronic

Venous Insufficiency Complications

Rare: Osteomyelitis, which may lead to amputation

Venous Insufficiency Treatment

Compression and elevation
Moist dressings
Diet high in protein and calories
Control diabetes
If signs of infection confirmed by wound culture:
- Wound debridement and oral antibiotics (do not use topical antibiotics)

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Description

This quiz focuses on the nursing assessment and care related to fully deployed bifurcated stent graft procedures, covering both pre-operative and post-operative protocols. It highlights potential complications, essential monitoring techniques, and patient management strategies to ensure optimal outcomes. Test your knowledge on effective nursing interventions in vascular surgery.