NSG210 Week 08 Summary: Alterations in Perfusion (PVD) and Alterations in Activity and Rest
Week 08 (October 12-16, 2026): Exam 2 on Oct 12, then two lectures - Alterations in Perfusion / Peripheral Vascular Diseases, and the Oct 14 Alterations in Activity and Rest (inflammatory rheumatic diseases). Clinical Oct 15 and 16. All Week 08 content is on Exam 3.
Chapter numbering: the syllabus lists Hinkle 27, 35, 36 and the course outline lists Ch. 27 (PAD/DVT/PE), 35 (RA/SLE/gout), 37 (OA/arthroplasty), 38 (amputation). Those are older-edition numbers. In the 15th edition the matching chapters are Ch. 26, 34, 36, and 37 (see nsg210-textbook-chapter-crosswalk).
Lecture Notes
| Lecture | Deck (raw/) |
Notes |
|---|---|---|
| Peripheral Vascular Diseases: PAD, bypass, amputation, Buerger, Raynaud, DVT, anticoagulation, PE | nsg210_PeripheralVascularDiseases2026.ppt |
nsg210-week-08-peripheral-vascular-diseases-lecture |
| Inflammatory Rheumatic Diseases: RA, lupus, gout, joint replacement; SLE and gout case studies | nsg210_AlterationActivityRestRheumaticDiseases2026.pptm |
nsg210-week-08-rheumatic-diseases-lecture |
Chapter Outlines and Quizzes
| Hinkle 15e chapter | Topics | Outline |
|---|---|---|
| Ch. 26 | PAD, aneurysm, acute arterial occlusion, Raynaud, VTE/DVT, PE, venous insufficiency, ulcers, varicose veins, lymphedema, cellulitis | nsg210-hinkle-ch26-vascular-disorders |
| Ch. 34 | RA, SLE, gout, other rheumatic disorders | nsg210-hinkle-ch34-inflammatory-rheumatic-disorders |
| Ch. 35 | Musculoskeletal assessment | not yet written |
| Ch. 36 | Osteoarthritis, arthroplasty, osteoporosis | nsg210-hinkle-ch36-musculoskeletal-disorders |
| Ch. 37 | Fractures, casts, traction, compartment syndrome, amputation | nsg210-hinkle-ch37-musculoskeletal-trauma |
Slide vs Textbook Differences
Full list: nsg210-exam-3-lecture-vs-textbook. The ones most likely to matter:
| Item | Slides | Textbook |
|---|---|---|
| ABI claudication | 0.95-0.50 | 0.90-0.50 |
| ABI severe ischemia | Under 0.25 | Under 0.40 |
| Heparin aPTT | 1.5 times control | 1.5-2 times control |
| Hyperuricemia | Over 7 mg/dL | Over 6.8 mg/dL |
| SLE diagnosis | 4 of 11 ACR criteria | No criteria list; ANA, anti-dsDNA, anti-Sm |
Week 08 Key Points
Perfusion (PVD lecture):
- PVD vs PAD chart (skin temperature, skin color, pulses, edema, pain, skin changes, ulcer location) is in nsg210-week-08-peripheral-vascular-diseases-lecture. On an exam, PVD means venous and PAD means arterial. PAD = pale, cool, weak or absent pulses, little edema, claudication, ulcers on toes and pressure points. Venous = red or brown, warm in DVT, pulses present, edema, aching relieved by elevation, ulcers at the medial malleolus
- Arterial = legs DOWN, keep warm (no direct heat above body temperature), no nicotine, no leg crossing; venous = legs UP
- Claudication (reproducible exercise pain relieved by rest) vs rest pain (critical ischemia); absent pulse = blockage proximal
- ABI = highest ankle / highest arm systolic
- Cilostazol for claudication (not in heart failure); antiplatelets and statins for all PAD
- After bypass, a pulse that disappears = call the surgeon now
- Amputation: tourniquet at bedside; pillow under residual limb first 24 hours only; prone positioning; figure-eight compression wrap to a cone; no oils or creams; phantom pain is real
- VTE = DVT plus PE; superficial thrombophlebitis rarely embolizes (warm compresses, elevation, NSAIDs) while DVT can become a PE - comparison table in nsg210-week-08-peripheral-vascular-diseases-lecture
- DVT/PE risk factors: Virchow triad (stasis, vessel wall injury, altered coagulation). Slide list: immobility or bed rest, recent surgery or hospitalization, major trauma, prior DVT or PE, cancer, pregnancy and postpartum, estrogen, obesity, smoking, thrombophilia, increasing age. Also ask about varicose veins, hypercoagulation, and cardiovascular disease. Full note in nsg210-week-08-peripheral-vascular-diseases-lecture
- DVT: Homans sign unreliable; duplex ultrasound and D-dimer; heparin (protamine reversal), warfarin INR 2-3 (vitamin K reversal), LMWH; HIT at platelets under 100,000 or a 25% drop
- Thrombocytopenia: under 100,000; HIT on heparin = under 100,000 or 25% drop (LMWH lower risk, argatroban for HIT); petechiae and bruising first; bleeding precautions - note in nsg210-week-08-peripheral-vascular-diseases-lecture
- PE: sudden dyspnea, tachycardia, pleuritic chest pain, anxiety, low SpO2 - oxygen, anticoagulation
- PE ECG (textbook; not described on the slides): sinus tachycardia and nonspecific ST-T changes. These do not diagnose PE; CT pulmonary angiography is the standard. Classic right-heart strain pattern (S in lead I, Q and inverted T in lead III) is not in the slides or Ch. 26. Full note in nsg210-week-08-peripheral-vascular-diseases-lecture
Activity and rest (rheumatic lecture):
- RA: symmetric, small joints first, morning stiffness over 1 hour, RF and anti-CCP; early aggressive DMARDs
- Drug cautions: NSAIDs (GI bleeding, BP), COX-2 (MI, stroke), hydroxychloroquine (eye exams), methotrexate (teratogenic, CBC, LFTs), TNF blockers (TB test first, infection), steroids (lowest dose, never stop abruptly)
- SLE: butterfly rash, photosensitivity, nephritis (urine output, creatinine, daily weight, BP); avoid sun; infection risk with low WBC
- Gout: big toe, uric acid, tophi; low-purine diet, no alcohol; colchicine for acute attacks (diarrhea = toxicity, hold and notify); allopurinol long term; thiazides raise uric acid
Musculoskeletal trauma (Ch. 37 reading):
- Compartment syndrome: pain out of proportion and on passive stretch; loosen cast; keep at HEART level; fasciotomy
- Fat embolism 24-72 hours after long-bone fracture: hypoxemia, confusion, petechiae
- Hip fracture: leg shortened, adducted, externally rotated
Related
- nsg210-week-06-summary - previous perfusion lecture (valves, dysrhythmias)
- nsg210-dvt-simulation-prep
- INDEX
- nsg210-exam-3-lecture-vs-textbook