Peripheral Vascular System Additions to Notes Dr. Brown April 6, 2009 See peripheral vascular stuff in chapter 30 Blood vessels ? p.1085 Blue toe syndrome Discoloration to toes as a result of tissue ischemia The syndrome is cased by the blockage of small vessels that lead to the toes Pulses If you can?t feel it, you can listen with a Doppler stethoscope Need gel Listening for a swishing sound Thrill ? feel by touch Bruit ? listen Invasive diagnostic testing Give Acetylcysteine (Mucomyst) Tastes like rotten eggs Prevent contrast nephrotoxicity This is a respiratory drug (decreases thickness of secretions, put it in an inhaler), but if patients drink it, this prevention of nephrotoxicity is an off-label use Need to know what patients renal condition is before you do any invasive diagnostic testing If BUN is up, call physician and tell him/her any changes that have occurred before patient is sent to surgery HTN Hypertensive crisis or emergency SBP 180 mmHg or greater DBP 120 mmHg or greater This is different from slide! When you?re bringing a blood pressure down, you don?t want to do it too fast or else it will cause cerebral edema Resistant hypertension ? resistant to treatment/lifestyle changes Risk factors No control over first 4 ? family history, gender, age, ethnic group High sodium or high fat diets ? these need more attention for some people than others Drug therapy responsibility ? Know this slide!! Angioedema evidenced by ? ?my tongue is thick,? voice changes, swelling in neck ? medical emergency! Nursing implementation Important bullets: assess client?s understanding of treatment reginmen, monitor compliance with medications IV meds p. 1169 Question: Long-term complication with HTN: renal failure Question: the nurse understands that a priority nursing diagnosis for the pt with HTN would be: Risk for immobility Ineffective health maintenance Impaired skin integrity Fluid volume excess Case study: Mr. K is a 72YO male admitted for abdominal discomfort the past week. A CT scan is ordered and shows a 6 cm fusiform AAA. Mr. K is previous smoker, but quit ten years ago ? Question: a pt is admitted to ER complaining of abdominal pain. A CT reveals a large non ruptured abdominal aortic aneurysm ? priority nursing goal is to prepare patient for emergency surgery Case study ? 67 YO male admitted with complaints of severe lower left leg pain after walking out to the mailbox. Pain eases with rest. Assessment of lower extremietis reveals left lower leg from mild calf to toes cool, dusky red, pain with exercise, DP/PT non palpable, audible with +1 doppler. Hx of smoking 1 ppd for 30 yrs and has been treated for chronic HTN for 10 years, has diabetes, high cholesterol? Memorize signs of acute arterial occlusion! Pain, pulselessness, pallor, paresthesias, paralysis, polar sensation? Arterial disease question: if a nurse can?t palpate the patient?s left pedal pulse, she should use the Doppler ultrasound device Buerger?s Disease ? see page 1183 Same page for Raynaud?s Disease Meds: remember that #1 side effect with nitroglycerin is a headache (you can get a headache if you?re putting the topical nitro on pt) Memorize Virchow?s triad: stasis of blood, endothelial damage, inflammation, hypercoagulability 80% of DVT?s start in calf Learn slide 103 about DVT causes ? see page 1186 Not good to massage patient?s calves ? See page 1189 for anticoagulant therapy Heparin is very short-acting, and you can give it with coumadin because the coumadin will take several days DVT nursing interventions ? p. 1191-1193 Question: DVT in right leg, loading dose of heparin given in ER and IV heparin has been started ? must monitor the activated partial throboplastin time IVs in feet increase risk of DVT
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