STUDENT LEARNING GUIDE – PERIPHERAL VASCULAR DISEASES
1. Explain how each of the following risk factors contributes to the occurrence of peripheral
vascular diseases:
a) cigarette smoking
b) diabetes
c) sedentary lifestyle
2. Match the following pathological processes with the corresponding disease process:
____ Thrombotic occlusion of upper or lower extremities,
occurring only in smokers
____ Vasospasms of small arteries in fingers and toes
____ Progressive narrowing of vessels due to
artherosclerotic plaques
____ An embolism blocks blood flow
a.
b.
c.
d.
Acute arterial
occlusive
Buerger’s disease
Raynaud’s disease
Chronic arterial
occlusive disorder
3. State 3 complications of arterial vascular disorders and explain why each occurs.
4. Manifestations of Acute Arterial Occlusive Disorder includes the 6 P’s. State each of these and
explain how each occurs.
5. Pain in the extremity which begins on exercise and goes away with rest is called
___________________________.
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6. You are conducting an assessment on a client with chronic arterial occlusion. Check all of the
following manifestations that you would expect to find.
___
___
___
___
___
___
___
___
Severe and constant pain, not relieved by rest
Intermittent claudication
Poikilolthermia
Thickened, brittle nails
Paralysis
Decreased or absent peripheral pulse
Red rubor
Ischemic muscle ache
7. Indicate whether the following manifestations are characteristic of Buerger’s disease or Rayaud’s
phenomenon?
___
___
___
___
___
___
___
___
___
___
Involves cutaneous arteries of the fingers and toes
Inflammation of midsized arteries and veins
Treated with calcium-channel blockers, especially Procardia
Strongly associated with smoking
Predominant in young females
Episodes involve white, blue, and red color changes of the fingertips
Amputation of digits or legs below the knee may be done due to ulceration and
gangrene
Precipitated by exposure to cold, caffeine, and tobacco
Intermittent claudication of feet, arms, and hands may be present
Frequently associated with autoimmune disorders
8. A client with Raynaud’s disease may present with extremities that turn red, white and blue. In
what order due these colors occur and why?
9. Describe the following tests for diagnosis of peripheral arterial disease.
a)
b)
c)
d)
Angiography
Segmental Pressure Readings
Stress Testing Treadmill
Doppler Ultrasonography
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e) Duplex Doppler Ultrasonography
f) Transuctaneous Oximetry
10. Below is a list of nursing diagnoses. Some, but not all of them apply to a client with Arterial
Vascular Disorders. Place a number in the blank indicating the priority for all of the diagnoses
that apply.
_____
_____
_____
_____
_____
_____
Pain r/t vascular pooling
Activity intolerance r/t imbalance between oxygen supply and demand
Impaired skin integrity r/t decreased perfusion and decreased sensation
Pain r/t ischemia
Altered tissue perfusion: peripheral r/t effects of arterial spasm or
arterial occlusion flow
Impaired skin integrity r/t valve incompetence
11. Indicate whether the following treatments apply to peripheral arterial or venous disorders?
___________
___________
___________
___________
___________
___________
a)
b)
c)
d)
e)
f)
Sympathectomy
Bypass graft
Thrombectomy
Insertion of a Greenfield filter
Vein ligation
Sclerotherapy
12. State 5 appropriate goals for a client with Arterial Vascular Disease.
13. Match the following descriptions with the appropriate surgical therapy:
_____
_____
_____
Used to decrease neurological
stimulation to vessel
Cage expanded in the vessel
Catheter inserted with a balloon
a. Embolectomy
b. Endarectomy
c. Arterial bypass
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_____
_____
Graft to replace an occluded artery
Vessel dissected to remove clot
d. Sympathectomy
e. Intravascular stent
f. Percutaneous translulminal
angioplasty
14. You are caring for a client who has just had a stent placement in the left femoral artery.
What should you assess during the first 48 hours post-op?
What complications should you assess for?
15. Match the following items with the appropriate medication:
_____
_____
_____
_____
_____
_____
_____
Interferes with vitamin K
Increases erythrocyte flexibility
Acts directly on the intrinsic pathway
Low molecular weight heparin
Prevents aggregation of platelets
Breaks down existing clots
Enhances blood flow by increasing
vessel lumen size
a.
b.
c.
d.
e.
f.
g.
Vasodilators
Urokinase
Coumadin
Heparin
Lovenox
Trental
Plavix
16. Create a teaching plan for clients with each of the following diagnoses:
a) Raynaud’s disease
b) Thromboangitis Obliterans (Buerger’s Disease)
c) Chronic Arterial Occlusive Disease (Atherosclerosis Obliterans)
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17. What exercises would you recommend to a client to help promote peripheral circulation?
18. Identify which of the following is true or false.
____
____
____
a) The most common cause of superficial
thrombophlebitis in the legs is IV therapy.
b) A tender, red, inflamed irritation along the course of a
peripheral vein is characteristic of a deep vein
thrombosis (DVT).
c) The method of prevention of DVT in hospitalized
patients that addresses all three parts of Virchow’s triad
is the use of elastic compression stockings.
19. State 3 factors that contribute to the occurrence of thrombophlebitis and give 2 examples of
conditions that could cause each factor. (Virchow’s triad)
20. What is Virchow’s triad?
21. How do you prevent embolization of a thrombus in the patient with a DVT?
22. Explain how venous stasis ulcers occur.
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23. How does each of the following contribute to the formation of varicose veins?
a) Obesity
b) Pregnancy
c) Prolonged standing
24. Describe the following tests for the diagnosis of peripheral venous disease.
a)
b)
c)
d)
Venous Ultrasonography
Plethysmography
MRI
Ascending Contrast Venography
25. Identify reasons to notify the physician immediately after a femoral-popliteal bypass?
26. List four nursing interventions for a post-op femoral-popliteal bypass patient.
27. Indicate whether the following findings are manifestations of arterial (A) or venous (V) disease.
_____
_____
_____
_____
_____
_____
_____
_____
_____
_____
_____
a.
b.
c.
d.
e.
f.
g.
h.
i.
j.
k.
Parathesia
Heavy ulcer drainage
Edema of the ankles
Gangrene over bony prominences on toes and feet
Decreased peripheral pulses
Brown pigmentation of the legs
Thickened, brittle nails
Pallor on elevation of the legs
Rubor when legs are dependent
Dull ache in calf or thigh
Pruritus
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28. You are providing care for a client with Deep Vein Thrombosis and are assessing for signs and
symptoms of pulmonary embolism. What signs or symptoms would occur first?
29. Describe the treatment for pulmonary embolism.
30. Which of the following clinical manifestations would you expect to find for a client with Deep
Vein Thrombosis?
______
______
______
______
______
______
Intermittent claudication – found in arterial disorders
Positive Homan’s sign
Ulceration of the toes – arterial disorders. Ulceration of ankles for venous
Swelling – around ankles and lower leg
Brown, leathery skin
Cyanosis of the extremity – if dependent
31. Complete the following table for each of the anticoagulants indicated:
Medication Coagulation Study Normal result without
treatment
Heparin
Expected therapeutic result with
treatment
Coumadin
Lovenox
32. Decide which of the anticoagulant drugs, unfractionated heparin, low molecular weight
heparin, or coumadin, applies to the following:
____________________________
____________________________
____________________________
____________________________
a)
b)
c)
d)
Vitamin K is the antidote
Is only administered subcutaneously
Routine coagulation tests are not usually required
Protamine sulfate is the antidote
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____________________________
____________________________
____________________________
____________________________
____________________________
e)
f)
g)
h)
i)
May be administered IV or subcutaneously
Is only administered orally
International normalized ratio is monitored
Partial Thromboplastin Time (PTT) is monitored
Prothrombin Time (PT) is monitored
33. The antidote for Heparin is _________________________.
34. The antidote for Coumadin is ________________________.
35. Why must the intake of leafy green vegetables be consistent for a client on Coumadin?
36. State 3 appropriate goals for a client with a venous disorder.
37. Beside each of the following nursing interventions indicate whether the intervention is
appropriate for either an arterial (A) or v (V) disorder.
______
______
______
______
a)
b)
c)
d)
Elastic compression stockings
Walk to the point of pain
Wear clothing to keep the extremity warm
Elevate the extremity
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