Peripheral Arterial Disease (PAD)

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Questions and Answers

Which of the following is the primary mechanism behind the signs and symptoms of peripheral arterial disease (PAD)?

  • Increased venous pressure in the peripheral limbs.
  • Inflammation of the endothelial lining of peripheral veins.
  • Narrowing of arteries, reducing blood flow to peripheral limbs. (correct)
  • Increased lymphatic drainage in the lower extremities.

Which of the following physiological processes is initially disrupted in the development of arteriosclerosis, a key factor in PAD?

  • Enhanced lymphatic absorption in arterial walls.
  • Increased production of red blood cells.
  • Endothelial dysfunction due to damaging factors. (correct)
  • Reduced elasticity of venous valves.

A patient with peripheral arterial disease (PAD) reports experiencing leg pain that is relieved by sitting and dangling their legs. What physiological principle explains this?

  • Sitting decreases metabolic demand of leg muscles.
  • Dangling the legs decreases hydrostatic pressure, improving arterial flow. (correct)
  • Lying flat increases collateral circulation to the legs.
  • Elevation of the legs promotes venous return, reducing pain.

A patient with peripheral arterial disease (PAD) reports experiencing increased leg pain at night. Which of the following best explains this phenomenon?

<p>Horizontal positioning reduces arterial blood flow to the legs. (D)</p> Signup and view all the answers

A patient with PAD experiences severe pain in the calf muscle during exercise, which is relieved by rest. Which term accurately describes this symptom?

<p>Intermittent claudication (B)</p> Signup and view all the answers

During a physical examination of a patient with suspected PAD, what clinical finding is most indicative of chronic arterial insufficiency?

<p>Dependent rubor. (A)</p> Signup and view all the answers

An ankle-brachial index (ABI) is ordered for a patient with suspected PAD. If the ankle systolic blood pressure is 90 mmHg and the brachial systolic blood pressure is 120 mmHg, what does this ABI suggest?

<p>Significant arterial blockage. (B)</p> Signup and view all the answers

When educating a patient diagnosed with PAD about lifestyle modifications, which intervention should be given the highest priority?

<p>Smoking cessation. (D)</p> Signup and view all the answers

What is the primary goal of managing intermittent claudication in patients with peripheral arterial disease (PAD)?

<p>Reestablishing perfusion to prevent limb loss. (C)</p> Signup and view all the answers

Which medication is commonly prescribed to reduce the risk of thrombotic events in patients with peripheral arterial disease (PAD)?

<p>Clopidogrel. (B)</p> Signup and view all the answers

Which statement best explains the pathophysiology of heart failure (HF)?

<p>Impaired cardiac pumping or filling, leading to inadequate oxygen delivery. (D)</p> Signup and view all the answers

What is the significance of ejection fraction (EF) in the context of heart failure (HF)?

<p>It distinguishes between systolic and diastolic heart failure. (B)</p> Signup and view all the answers

Which of the following is a key distinction between heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF)?

<p>HFrEF involves impaired contractile function; HFpEF involves impaired ventricular relaxation. (D)</p> Signup and view all the answers

Why does left-sided heart failure often lead to pulmonary congestion and edema?

<p>Backflow of blood into the pulmonary veins. (A)</p> Signup and view all the answers

Which clinical manifestation is specifically characteristic of acute decompensated heart failure (ADHF) and requires immediate intervention?

<p>Pulmonary edema. (C)</p> Signup and view all the answers

A patient with heart failure reports paroxysmal nocturnal dyspnea. What physiological mechanism explains this?

<p>Increased venous return and fluid redistribution when lying flat. (D)</p> Signup and view all the answers

Why is monitoring daily weight important for patients with chronic heart failure?

<p>To detect early signs of fluid retention. (B)</p> Signup and view all the answers

What dietary recommendation is typically included in the management plan for chronic heart failure (HF)?

<p>Sodium restriction. (B)</p> Signup and view all the answers

What is the rationale for using diuretics in the management of heart failure (HF)?

<p>To decrease preload and reduce pulmonary congestion. (C)</p> Signup and view all the answers

Which classification of medications may be used in heart failure patients who cannot tolerate ACE inhibitors?

<p>Angiotensin II receptor blockers (ARBs). (B)</p> Signup and view all the answers

A 76-year-old male is two days post-op from an open reduction and internal fixation (ORIF) of a right femur fracture. Which of his medications increases his risk of developing a pulmonary embolism?

<p>Heparin. (A)</p> Signup and view all the answers

A 76-year-old male is two days post-op from an open reduction and internal fixation (ORIF) of a right femur fracture. The patient is complaining of right sided chest pain. He states that he is short of breath. His vital signs are: BP 98/60; P 120; R 24; Pulse oximeter reads 86%, so you start him on 6L 02 by nasal cannula (NC). You identify faint crackles in the posterior bases bilaterally. The heart monitor on lead II shows nonspecific T wave changes. What order should take priority?

<p>STAT chest x-ray (CXR). (D)</p> Signup and view all the answers

A 76-year-old male is two days post-op from an open reduction and internal fixation (ORIF) of a right femur fracture. He has a spiral CT scan of the lungs. The interpretation of the results read "strongly suggestive of a pulmonary embolus (PE)." Which of the follow symptoms is unique to fat embolisms?

<p>Petechiae. (D)</p> Signup and view all the answers

A 76-year-old male is two days post-op from an open reduction and internal fixation (ORIF) of a right femur fracture. He has a spiral CT scan of the lungs. The interpretation of the results read "strongly suggestive of a pulmonary embolus (PE)." Which is the best explanation for his risk of developing a Pulmonary Embolism?

<p>He has an extended period of inactivity. (D)</p> Signup and view all the answers

A 76-year-old male is two days post-op from an open reduction and internal fixation (ORIF) of a right femur fracture. He has a spiral CT scan of the lungs. The interpretation of the results read "strongly suggestive of a pulmonary embolus (PE)." You are the nurse caring for the patient and you are monitoring his lab values. What lab value should you monitor closely as a result of his receiving heparin?

<p>aPTT. (C)</p> Signup and view all the answers

Which statement accurately describes a similarity between fat embolisms and blood clot embolisms in the lungs?

<p>They both cause altered mental status. (A)</p> Signup and view all the answers

Which anticoagulant medication is most commonly administered initially in acute pulmonary embolism cases due to its rapid onset of action?

<p>Heparin (D)</p> Signup and view all the answers

After the patient is stable, the physician plans to switch the patient 76-year-old male is two days post-op from an open reduction and internal fixation (ORIF) of a right femur fracture from heparin to an oral anticoagulant. Which of the following requires patient education?

<p>To be cautious of nose bleeds. (B)</p> Signup and view all the answers

A 68-year-old retired painter, S.P., presents with right leg calf pain that began approximately 2 years ago, worsening in the last 4 months. The pain is exercise-induced and relieved by rest. Based on this information, what is the most likely initial diagnosis?

<p>Peripheral Artery Disease (PAD) (B)</p> Signup and view all the answers

S.P., a 68-year-old with PAD, has smoked 2-3 packs of cigarettes per day for 45 years. How does smoking contribute to the pathophysiology of S.P.'s PAD?

<p>Smoking damages the endothelial lining of arteries and promotes clot formation. (A)</p> Signup and view all the answers

S.P., a 68-year-old with PAD, has a history of coronary artery disease (CAD), hypertension (HTN), peripheral artery disease (PAD), and osteoarthritis. Which combination of these conditions most directly contributes to the development of PAD?

<p>CAD and HTN (A)</p> Signup and view all the answers

S.P., a 68-year-old with PAD, reports increased hip pain with exercise that is not promptly relieved by rest and is sometimes worse than other days; which risk factor would the nurse attribute to these symptom?

<p>Exacerbation of hip osteoarthritis. (B)</p> Signup and view all the answers

Which of the following signs would the nurse expect to find during an assessment of S.P.'s lower extremities, consistent with his diagnosis of PAD?

<p>Thick, brittle nails and cool extremity. (C)</p> Signup and view all the answers

S.P. is scheduled for an ankle-brachial index (ABI) test. What instructions should the nurse provide to a patient, S.P., prior to an ABI test?

<p>Wear loose-fitting clothing and avoid smoking for at least 1 hour before the test. (A)</p> Signup and view all the answers

Which aspect of patient teaching is most important to emphasize to a hypertensive patient, S.P., being switched from aspirin to clopidogrel?

<p>Reporting any signs of unusual bleeding or bruising. (D)</p> Signup and view all the answers

A client had quadruple coronary artery bypass graft (CABG x4) three years ago. What medication is best for management?

<p>Simvastatin (B)</p> Signup and view all the answers

Select the three conditions best supported by the information presented about the 68-year-old painter being evaluated in the clinic.

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Identify three priorities for a nurse responding to a client who is restless and complaining of chest pain

<p>A and C (C)</p> Signup and view all the answers

A 76-year-old male is two days post-op from an open reduction and internal fixation (ORIF) of a right femur fracture. The interpretation of the results read "strongly suggestive of a pulmonary embolus (PE)." In what situation a thrombolytics such as alteplase (Activase) be beneficial for this patient

<p>More testing is needed. (D)</p> Signup and view all the answers

S.P., a 68-year-old retired painter with known PAD, reports that he still smokes 2 packs a day. How does smoking contribute to the progression of S.P.'s PAD?

<p>By damaging the endothelial lining of blood vessels and promoting vasoconstriction. (D)</p> Signup and view all the answers

S.P., who does not have ankle edema, is scheduled for an ankle-brachial index (ABI) test. What should the nurse instruct S.P. to do to prepare for this test focusing on modifiable factors?

<p>Avoid smoking or consuming caffeine for at least 2 hours prior to the test. (D)</p> Signup and view all the answers

M.M. a 76 year old male is diagnosed with a pulmonary embolism (PE) and is being treated with heparin. Considering their age and post-operative status, what is the primary rationale for using heparin over other anticoagulants in the initial management of M.M.'s PE?

<p>Heparin can be easily reversed with protamine sulfate if bleeding complications arise. (D)</p> Signup and view all the answers

M.M. a 76 year old male is diagnosed with a pulmonary embolism (PE). The health care provider is considering using thrombolytics such as alteplase (Activase). What aspect of M.M.'s case would be most concerning regarding the use of thrombolytic therapy?

<p>M.M.'s recent (ORIF) which makes him at risk for a bleed. (B)</p> Signup and view all the answers

M.M. is started on Warfarin for management of the pulmonary embolism. Besides taking the medication at the same time each day and the importance of consistent blood work, what dietary education points are important to convey?

<p>Maintain a consistent intake of vitamin K-rich food. (B)</p> Signup and view all the answers

Flashcards

Peripheral Arterial Disease (PAD)

Narrowing of the arteries supplying peripheral limbs, reducing blood flow.

Endothelial dysfunction

Disruption of the endothelial muscle in the arteries, often due to damage from hypertension or other factors, leading to clot formation and stenosis.

Major cause of PAD

Building plaques in arteries, blood clots, or emboli.

Risk factors for PAD

Smoking, hyperlipidemia, hypertension, diabetes, and history of cardiac disease.

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Intermittent Claudication

Severe crampy pain during exercise, relieved with rest.

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Critical limb ischemia

Burning pain at night due to lack of blood flow.

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Dependent Rubor

Deep red color when the limb is lower than the rest of the body

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Arterial Brachial Index (ABI)

Compare blood pressure in the arm versus the leg. ABI= Ankle BP/Brachial BP <0.9 indicates PAD

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Acute Limb Ischemia Management

Urgent referral to vascular team for endovascular thrombolysis, thrombectomy, bypass surgery, or amputation.

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Critical Limb Ischemia Management

Analgesia, urgent revascularization, may lead to amputation.

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Intermittent Claudication Management

Relief symptoms, reestablish perfusion to prevent limb loss, by-pass blockages

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PAD Management - Surgical

Angioplasty and stenting is a surgical procedure used to manage PAD

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Heart Failure (HF)

An abnormal clinical syndrome involving impaired cardiac pumping and/or filling.

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HF Characterized by:

Ventricular dysfunction, reduced exercise tolerance, diminished quality of life, and shortened life expectancy

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Primary Risk Factors for Heart Failure

CAD and hypertension.

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Heart Failure Classification

Reduced ejection fraction (systolic) or preserved ejection fraction (diastolic).

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Heart Failure with Reduced Ejection Fraction (HF-REF)

Inability of the heart to pump blood effectively due to impaired contractile function, increased afterload, cardiomyopathy, and mechanical abnormalities.

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Heart Failure with Preserved Ejection Fraction (HF-PEF)

Inability of the ventricles to relax and fill during diastole.

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Decreased filling results in

Decreased stroke volume and cardiac output.

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HF Onset

HF can have an abrupt onset or it can be an insidious process resulting from slow, progressive changes. Compensatory mechanisms are activated to maintain adequate CO.

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Left-Sided Heart Failure

The most common form of initial HF, resulting from left ventricular dysfunction.

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Right-Sided Heart Failure

Backward blood flow to the right atrium and venous circulation.

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Acute Decompensated Heart Failure (ADHF)

An acute, life-threatening situation in which the lung alveoli become filled with serous or serosanguineous fluid.

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Pulmonary Edema Manifestations

Anxious, pale, and possibly cyanotic, clammy and cold, severe dyspnea, respiratory rate > 30, orthopnea, wheezing, coughing with frothy, blood-tinged sputum.

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Clinical Manifestations of Chronic HF

Fatigue, dyspnea, edema, nocturia, skin changes, behaviour changes, chest pain, and weight changes.

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Complications of Heart Failure

Pleural effusion, dysrhythmias, left ventricular thrombus formation, hepatomegaly, and renal failure.

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Diagnostic studies for HF

Chest radiograph, electrocardiogram (ECG), laboratory data (cardiac enzymes, b-type natriuretic protein [BNP], serum chemistries, liver function studies, thyroid function studies, and complete blood count)

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ADHF Treatment goal

Improve ventricular function by decreasing intravascular volume, decreasing venous return (preload), decreasing afterload, improving gas exchange and oxygenation, and increasing CO.

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Decreasing Intravascular Volume in ADHF

Diuretics, ultrafiltration.

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Gas exchange improvement in ADHF

Administration of IV morphine sulphate and supplemental oxygen.

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Chronic HF Treatment goal

Treat the underlying cause and contributing factors, maximize CO, and alleviate symptoms.

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Chronic HF, Non-pharmacological: Oxygen

Administration of oxygen (if the O2 saturation is less than 95%).

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Drug management of chronic HF

Identification of the type of HF and underlying causes, (2) correction of sodium and water retention and volume overload, (3) reduction of cardiac workload, (4) improvement of myocardial contractility, and (5) control of precipitating and complicating factors.

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Diuretics used in HF

Used to mobilize edematous fluid, reduce pulmonary venous pressure, and reduce preload.

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Spironolactone (Aldactone)

Drug class: potassium-sparing diuretic that promotes sodium and water excretion but blocks potassium excretion by blocking the action of aldosterone.

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Eplerinone (Inspra)

Mineralocorticoid receptor antagonist, with similar effects similar to spironolactone.

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Administration of Oxygen

Improves tissue oxygen needs and helps relieve dyspnea and fatigue.

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What is a PE

A PE restricts blood flow to your lungs, lowers oxygen levels in your lungs and increases blood pressure in your pulmonary arteries.

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Manifestations of PE

Dyspnea, mild to moderate hypoxemia, tachypnea, cough, chest pain, hemoptysis, crackles, wheezing, diminished breath sounds, fever.

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Manifestations of PE

Tachycardia, and syncope.

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Manifestations of PE

Altered mental status, hypotension, and feelings of impending doom.

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PE Impact & Pathophysiology

A PE restricts blood flow to your lungs, lowers oxygen levels in your lungs and increases blood pressure in your pulmonary arteries.

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Anticoagulant in PE

Heparin

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Nursing Interventions for PE

Check VS, lung sounds, cardiac and respiratory status at least every 1 to 2 hours.

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Study Notes

Peripheral Arterial Disease (PAD)

  • PAD involves the narrowing of arteries that supply blood to peripheral limbs, resulting in reduced blood flow.
  • Endothelial dysfunction is the initial stage of arteriosclerosis and involves the disruption of the endothelial muscle in arteries due to damaging factors like hypertension or scratches.
  • Damage leads to clot formation and stenosis, causing blood vessels to lose distensibility.
  • The primary cause of PAD is the buildup of plaques in arteries, known as arteriosclerosis, as well as blood clots or emboli.

Risk Factors for PAD

  • Smoking
  • Hyperlipidemia
  • Hypertension
  • Diabetes
  • History of cardiac disease

Signs and Symptoms of PAD

  • Patients prefer to dangle their legs to alleviate ischemia, as blood flow improves when legs are dependent, while elevation causes pain due to impeded blood flow.
  • Sharp pain worsens at night due to the horizontal position affecting blood flow, alleviated by dangling the legs.
  • Intermittent claudication causes severe crampy pain during exercise, relieved by rest, commonly in the calf muscle but can occur in buttocks or thighs; advanced cases may experience pain even at rest.
  • Critical limb ischemia presents as burning pain at night.
  • Extremities are cold, with thin, dry, scaling skin, hairless toes, and thick toenails.
  • Pulses are weak on palpation or absent, requiring a handheld Doppler.
  • Dependent rubor causes a deep red color when the limb is lower than the rest of the body.
  • Lack of edema, paraesthesia.
  • Potential presence of leg ulcers at the end of feet, top of feet, or lateral malleolus.
  • Lesions appear deep with noticeable margins, minimal drainage, no tissue granulation, and can be pale, necrotic, or black due to impacted perfusion.

Diagnosis of PAD

  • Arterial Brachial Index (ABI) compares blood pressure in the arm versus the leg; a lower leg pressure indicates blockage, with ABI = Ankle BP/Brachial BP <0.9 indicating PAD.
  • Angiography
  • Duplex ultrasound

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