Exam 23: Vascular Surgery

The perioperative nurse,with an understanding of the special surgical considerations for vascular procedures,will plan for the possibility of angiography studies being performed during the intraoperative or interventional procedure.An appropriate consideration when preparing the OR or interventional procedure room would be:

Varicose veins are enlarged and distended veins that are visible and palpable beneath the skin.Secondary varicose veins are believed to be a result of insufficiency of the deep venous system.The primary objective of varicose vein surgery,for the patient with secondary disease,is to prevent:

What statement regarding risk factors for developing vascular disease is true?

Vascular surgery patients are at risk for impaired skin integrity and ineffective tissue perfusion related to surgical positioning,presence of vascular disease,and vascular clamping.Positioning of the patient undergoing vascular surgery is of particular importance because of restricted circulation distal to the area of arterial obstruction and a generalized state of poor circulation.An appropriate protective intervention is reflected in which true statement about patient positioning for vascular surgery?

What drug is used to reverse the effects of heparin?

During the 4-hour vascular procedure,the circulating nurse,Karen,and the scrub person,Judy,have each had a coffee break and a lunch break.Judy has returned from lunch to find four medicine cups with clear fluid,each unlabeled.The outgoing relief scrub person,during her hand-off report to Judy,points to each cup and states;"The first one is contrast dye,the second cup is heparin,the third is heparinized saline and the fourth is papaverine;it's easy,they're in alphabetical order." Judy discarded all four medications and Karen replaced them into appropriately labeled medicine cups.After the procedure,Karen completed an unusual occurrence report.What recommendations should she include in her corrective action plan that the relief scrub person should have done? Select all that apply.

Assessing blood flow through diseased vessels by palpation is often difficult.Assessment of the patient's hemodynamic status during surgery can be further complicated by spasm of the vessel walls,the cool environment of the OR,and alterations in blood pressure caused by hemorrhage.Vascular monitoring during carotid endarterectomy (CEA)is critical to determine the quality of cerebral perfusion.What vascular monitoring device is employed during CEA and what important surgical need is determined by its results?

What properties enable arteries to compensate for changes in blood pressure and blood volume?

Identify the venous structure that prevents blood backflow.

Select the statement that best describes the comparative difference between open aortic aneurysm repair and endovascular aneurysm (EVAR)repair.

Arterial procedures,especially those that involve the aorta,may place the patient at risk for significant blood loss.A nursing diagnosis related to the care of patients undergoing vascular surgery is:Risk for Deficient Fluid Volume related to loss of body fluids,with a nursing outcome stated as:Fluid balance will be maintained as evidenced by postoperative pulses equivalent to preoperative level,hourly urine output of at least 30 mL,and good skin turgor.Select all the nursing interventions that are appropriate to this outcome.

Surgically created arteriovenous fistulas are also referred to as a(n)_ and are indicated for enabling __.

Myrtle Gruenwald is an 80-year-old relatively healthy woman with a 5-year history of cerebral ocular events,ultrasound-revealed irregular plaque formation in both carotid arteries,and several recent ischemic events.A risk reduction clinical decision strategy for Myrtle,based on best evidence and best practices,would be:

Karen Masterson,the perioperative nurse circulator,is preparing the OR for a vascular procedure where heparin will be used.She has obtained the heparin from the medication dispensing system and is preparing to mix the heparin in IV saline according to the dosage on the surgeon's preference/pick list.The scrub person,Judy Rothman,also a perioperative nurse,is preparing the sterile back table.What expected and appropriate risk reduction strategies related to the use of heparin would both Karen and Judy perform?

Substituting a cryo-preserved cadaveric vein or an in situ or reversed vein graft from the patient for an arterial bypass graft is an option for patients who have healthy,easily accessed saphenous veins.How does an in situ vein graft differ from a reversed vein graft?

A vena cava filter (Greenfield filter)maintains a patent vena cava but prevents pulmonary emboli (PE)by trapping the emboli at the apex of the device.This procedure may be performed in the OR,radiology suite,or ICU for critical patients.Select the statement that best describes the appropriate preferred insertion approaches.

The perioperative nurse with the vascular surgery service is preparing to discharge Mark Weston,a 51-year-old male who recently had endovascular surgery.He will be taking anticoagulation therapy for the next 12 weeks.What statement regarding anticoagulation therapy,that is relevant to Mark,is true?

When selecting a vascular graft for a vascular bypass or replacement procedure,what are the desirable characteristics that influence the surgeon's choice of graft? Select all that apply.

Why is the change in sound made by a passing train's whistle similar to the reason the pitch rises quickly in systole and drops quickly in early diastole when measuring arterial sounds?

Heparin sodium is an anticoagulant.The basic mechanism of heparin's action is best described as: