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PERIPHERAL VASCULAR DISEASE (PVD) (anything that alters the FLOW of blood,…

- - - - ischemia
      - necrosis
- - - - claudication? after walking abt 1-2 blocks
      - rest pain may be present
        
        when at rest, extremities are in pain
      - pain at ulcer site
      - risk factors:
        
        valve incompetence
        
        obesity
        
        advanged age
      - location:
        
        end of toes
        
        between the toes
      - ulcer bed that is pale, with even edges
        
        no new tissue growth (granulation) to arterial ulcers
      - S/S
        
        cool/cold extremities
        
        absent pulse
        
        hair loss
        
        pallor with elevation
        
        no blood flow
        
        rubor (dark reddish/bluish color)
        
        eschar/blackened tissue
        
        depending on severity
        
        gangrene
        
        depending on infection
        
        neuro deficit
      - treatment
        
        underlying cause
        
        surgery may be needed to improve blood flow
        
        prevent trauma and infection to area
        
        stress good foot care
  - - - no complaint of rest pain
      - may be discomfort in or around ulcer
      - swelling around ankle/foot area
      - risk factors:
        
        PVD
        
        age
        
        diabetes (huge one)
      - location
        
        ankle area
      - stages of healing vary
      - usually superficial
      - granulation visible
      - edges are uneven, irregular
      - treatment:
        
        long time wound care
        
        damp to dry dressings
        
        unna boot - made of cotton, has zince oxide paste
        
        educate to elevate extremity
        
        prevention of infection
        
        keep blood sugar under control : diabetics
    - - shiny legs
      - hair loss
      - edema
      - discoloration around leg and foot
      - present pulses
      - no neuro deficit
      - may see scarring from previous ulcers
- - - - compare and dopple
    - - paled/moddled
  - - - removal of the thrombus
  - - - shortness of breath
      - chest pain
      - confusion
      - edema
- - - - aortic dissection is life-threatening
        
        HTN is a factor
      - AAA - survival rate drops 1% per minute
        
        50% dont make it to surgery
        
        pain is sharp and "tearing", stabbing, diaphoresis, n&v, BP increases and then it crashes, altered LOC, decreased peripheral pulses, death
  - - - may see pulsation associated with it
      - do NOT PALPATE; ITLL RUPTURE!
      - monitor lower extremties
      - auscultate for bruits
    - - uneffected by movement
      - may last for hrs or days
  - - - dopple if necessary
- - - - wear warm gloves
- - - - may occur from limited mobility
      - faulty valves
    - - caused by damage inside vessel
  - - - promotes venous return
    - - ensure they're correct size
    - - do heel pumps while sitting
  - - - NOT ACCURATE!
  - - - measuring for DVT
      - highly sensitive but not specific
    - - xray involving dye injection
  - - - lovenox
      - warfarin
      - heparin
    - - may do greenfield filter that prevents clot from going into lungs or brain
    - - most of the time bedrest wins!
- - - - increasing fluids
        
        if not contraindicated
        
        avoiding temp. extremes
        
        dont cross legs
        
        avoid rigorous massage of area
        
        educate about medications
- - - - may have to provide lifestyle changes
        
        to increase blood flow
        
        medications can be used
        
        most times, antiplatelet
        
        asprinin/plavix
        
        used to reduce cardiovascular risks
        
        long-term treatment
        
        not used together / one or the other
- - - - rooter router the veins
      - surgery
- - - - lovenox
        
        thrombolytics
        
        actually breakup clots
        
        streptoclynase
        
        aspirin/plavix
        
        depends on HCP and pt wgt.
        
        1mg/kg
        
        NO specific LAB
        
        monitor PT and INR
      - INR
        
        PT (maybe)
      - vitamin K is antedote
        
        limit foods high in vitamin K
    - - PTT
  - - - PTT
        
        INR
        
        CBC
        
        platelet count
        
        creatinine
        
        ensure kidneys are good
      - 1 1/2x to 2 1/2x value
  - - - occult blood
        
        check stool to see if pt is bleeding along GI tract