Podcast
Questions and Answers
Which of the following is a potential complication of a fully deployed bifurcated stent graft?
Which of the following is a potential complication of a fully deployed bifurcated stent graft?
What should be established during pre-operative nursing assessment?
What should be established during pre-operative nursing assessment?
Which assessment should be performed post-operatively to monitor for renal perfusion?
Which assessment should be performed post-operatively to monitor for renal perfusion?
During the nursing assessment, which of the following should be documented on the lower extremities?
During the nursing assessment, which of the following should be documented on the lower extremities?
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Which complication requires emergency intervention post-operatively?
Which complication requires emergency intervention post-operatively?
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What is an important post-op instruction for patients regarding lifting?
What is an important post-op instruction for patients regarding lifting?
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Which of the following is NOT included in the post-operative nursing assessment?
Which of the following is NOT included in the post-operative nursing assessment?
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What should be monitored to assess neurological status after the procedure?
What should be monitored to assess neurological status after the procedure?
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What is the primary reversal agent for dabigatran (Pradaxa)?
What is the primary reversal agent for dabigatran (Pradaxa)?
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Which of the following is commonly associated with venous insufficiency?
Which of the following is commonly associated with venous insufficiency?
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What management approach is recommended for venous insufficiency complications?
What management approach is recommended for venous insufficiency complications?
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What condition results from an immune reaction to heparin and increases the risk of clots?
What condition results from an immune reaction to heparin and increases the risk of clots?
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In the treatment of venous insufficiency, which of the following is emphasized?
In the treatment of venous insufficiency, which of the following is emphasized?
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What is a primary management priority for patients with Buerger Disease?
What is a primary management priority for patients with Buerger Disease?
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Which symptom is characteristic of Raynaud Phenomenon?
Which symptom is characteristic of Raynaud Phenomenon?
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In the case of Subclavian Steal Syndrome, what is the most appropriate intervention for unrelenting symptoms?
In the case of Subclavian Steal Syndrome, what is the most appropriate intervention for unrelenting symptoms?
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What is a recommended nursing priority for thoracic outlet syndrome?
What is a recommended nursing priority for thoracic outlet syndrome?
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Which of the following conditions is more commonly associated with women?
Which of the following conditions is more commonly associated with women?
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What is the primary cause of peripheral artery disease (PAD) in most cases?
What is the primary cause of peripheral artery disease (PAD) in most cases?
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At what percentage of arterial blockage do clinical symptoms of peripheral artery disease typically occur?
At what percentage of arterial blockage do clinical symptoms of peripheral artery disease typically occur?
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Which of the following is NOT a commonly recognized risk factor for developing peripheral artery disease?
Which of the following is NOT a commonly recognized risk factor for developing peripheral artery disease?
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What stage of peripheral artery disease is characterized by intermittent claudication?
What stage of peripheral artery disease is characterized by intermittent claudication?
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Why is peripheral artery disease often underdiagnosed and undertreated?
Why is peripheral artery disease often underdiagnosed and undertreated?
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What nursing process step involves establishing health promotion priorities for clients with vascular alterations?
What nursing process step involves establishing health promotion priorities for clients with vascular alterations?
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Which of the following is a classic symptom of peripheral artery disease?
Which of the following is a classic symptom of peripheral artery disease?
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What nursing implication is crucial when managing patients with peripheral artery disease?
What nursing implication is crucial when managing patients with peripheral artery disease?
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What is the primary characteristic of Critical Limb Ischemia (CLI)?
What is the primary characteristic of Critical Limb Ischemia (CLI)?
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What is a common method patients use to alleviate rest pain in their legs?
What is a common method patients use to alleviate rest pain in their legs?
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Which diagnostic study is used to assess vascular status non-invasively?
Which diagnostic study is used to assess vascular status non-invasively?
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When does rest pain most often occur in patients with CLI?
When does rest pain most often occur in patients with CLI?
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What may be required if extensive tissue necrosis occurs in a limb affected by CLI?
What may be required if extensive tissue necrosis occurs in a limb affected by CLI?
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Which condition indicates a need for immediate revascularization therapy?
Which condition indicates a need for immediate revascularization therapy?
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Which of the following is not a complication associated with CLI?
Which of the following is not a complication associated with CLI?
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How is the Ankle-Brachial Index (ABI) calculated?
How is the Ankle-Brachial Index (ABI) calculated?
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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
Other Arterial Health Problems
Buerger Disease
- Associated with smoking
- Claudication in feet and lower extremities, worse at night
- Causes ischemia and fibrosis of vessels
- Sensitivity to cold
- Gangrene ulcers
- Treatment: vasodilating drugs, chronic pain management, ulcer management
- Nursing priorities:
- Avoid cold
- Tobacco cessation
- Monitor medication side effects
- Avoid cold
Raynaud Phenomenon/Disease
- Possibly autoimmune trigger
- Causes painful vasospasms
- Red and white skin color changes with cold or stress
- More common in women
- Treatment: same as for Buerger Disease
- Nursing priorities: same as for Buerger disease
Subclavian Steal Syndrome
- Caused by subclavian artery occlusion
- Causes ischemia and pain in the arm, paresthesia, and numbness
- Different blood pressure in the arms
- Treatment: surgical intervention for unrelenting symptoms
- Nursing priorities:
- Monitor patient closely post-op
- Check pulses
- Watch for ischemic changes
- Monitor skin color and for severe pain
Thoracic Outlet Syndrome
- Caused by compression of subclavian artery by a rib or muscle
- Treatment:
- Physical therapy
- Avoid aggravating positions
- Surgery as a last resort for severe pain
- Nursing priorities:
- Health teaching
- Avoiding aggravating positions
- Neurovascular checks
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
- Heparin: IV or subcutaneous
- 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.
