NUR 146 - WEEK 11 - Arterial Vascular disorders Flashcards
Arterial dysfunction:
Causes
- Atherosclerotic plaque
- Thromboembolism
- Mechanical trauma
- Infections
- Vasospastic conditions
Venous dysfunction:
Causes
- Incompetent valves
- Thromboembolism
Lymphatic dysfunction:
Causes
- Mechanical trauma
- Tumor
Vascular disorders:
Labs / Diagnostics
Preferred Tests:
Duplex ultrasonography
- Looks for blood clots in a vein (like DVT)
Doppler ultrasound / Ankle-brachial index
- Compares upper and lower peripheral blood flow
Exercise testing (like stress testing)
- How far can you walk without pain (?)
Not preferred tests:
CT scan
Angiography
MRA (Magnetic Resonance Angiography)
Lymphoscintigraphy
Peripheral Artery Disease (PAD):
What is it?
Characterized by partially obstructed arteries, typically in lower half of the body
-Symptoms occur with activity and are relieved with rest (like stable angina!)
Clinical Manifestations:
- Aching, cramping
- Fatigue, weakness
- “Rest pain” in advanced disease
Pain may be debilitating and difficult to manage –> pain may wake patient from sleep
Peripheral Artery Disease:
Assessment findings
- Intermittent claudication
- Rest pain
- Ask for location of pain
- Ask distance patient can walk
Peripheral Artery Disease:
Physical Assessment
Skin color:
- Pallor, cyanosis
- Rubor (advanced disease)
Skin temp
Hair loss (of peripheries)
Dry skin
Peripheral Arterial Disease:
Six P’s / Five P’s and a T
Pain - d/t ischemia
pallor - d/t ischemia
Paresthesia - numbness/tingling
Poikilothermia - cold d/t lack of circulation
pulselessness
Paralysis - late finding
Arteriosclerosis and atherosclerosis:
What is it?
What does it result in?
Hardening of the arteries
Arteriosclerosis = General term, “hardening of arteries”
Atherosclerosis = type of arteriosclerosis, Buildup of plaques inside artery wall
Result:
- Narrowed lumen
- Decrease blood supply to target tissue may stimulate development of collateral circulation (new connections made
PAD & Arteriosclerosis:
Risk factors
Prevention
Similar to other cardiac conditions
Modifiable:
- Nicotine
- diabetes
- htn
- hyperlipidemia
-diet
- stress
Non-modifiable:
- age
- genetics
Prevention:
- similar to cardiac
PAD:
Pharmacologic
Antiplatelet agents: Prevent buildup/blockages
- Aspirin
- Clopidogrel
Statins:
- Atorvastatin, pravastatin
Arteriosclerosis:
Endovascular therapy
Complications of Endovascular therapy
Angioplasty:
Balloon-tipped catheter brought to stenosed area –> stretched lumen of artery –> increased blood flow
Atherectomy:
- Laser to remove plaque within an artery
Stent placement:
- Mesh tube placement to support vessel wall
Complication:
- Embolus formation
- Dissection of vessel
- Bleeding
- Stent dislodgment
PAD:
Surgical Management
Highly complex and invasive; only for severe cases which would otherwise require amputation!!
- Bypass grafting technique (make an alternate route)
Arteriosclerosis:
Nursing Management
Improve peripheral arterial circulation:
- Position body part below heart level
- Gentle exercise (pain will guide limits)
Promoting vasodilation and prevention of vascular compression:
- Avoid cold exposure, stay warm
- Stop smoking
- Stress reduction
Maintain Tissue Integrity:
- Poorly oxygenated tissue = greater risk for damage + infection
- Wounds heal slow
- Prevent injury
- Adequate nutrition & protein
Aneurysm:
What is it?
Classification
Localized sac or dilation at a weak point in wall of an artery
- Can be fatal: rupture –> hemorrhage –> death
Classification:
Saccular - Protrude from one side of the vessel
Fusiform - Circumferential bulging
Thoracic Aortic Aneurysm:
What is it?
Clinical manifestations
Portion of Aorta within the thorax
- Often asymptomatic
- Symptoms are locally related
Clinical manifestations:
- dyspnea
- cough, hoarseness
- stridor
- aphonia
If aneurysm compresses neck veins:
- JVD
- Upper extremity edema
Diagnostics:
- CXR (Chest x ray)
- CTA
- TEE
- MRA
Abdominal Aortic Aneurysm:
What is it?
Clinical manifestations
Diagnostics
Portion of aorta below diaphragm
Clinical Manifestations:
- * Pulsatile abdominal mass * = “It only feels like patient has a mass, but it is the dilated aorta”
- Abdominal throbbing pain
- Bruit
- Severe lower back pain, hypotension = if ruptured aneurysm
Diagnostics:
- CTA
- Ultrasound
Aneurysms:
Medical Management
Non surgical approach:
- Monitor size
- Control blood pressure (beta blockers, ARBs)
- Frequent CT scan
Surgical Repair:
- Endograft
- Open surgery
- Potential complications: bleeding, distal ischemia, infection, paralysis
Post-Endovascular Surgery:
Nursing Care Post op
Similar to cardiac cath
Supine position for 6 hours
Assess peripheral pulses q15min until stable
Check for bleeding
Aortic Dissection:
What is it?
Tear in the lining of the aorta
- Potentially fatal
- Requires surgical
Cause:
- Atherosclerosis
- HTN
Clinical manifestations:
- Severe pain in chest, epigastrium or back (wherever tear is)
- Ripping/tearing sensation
- Diaphoresis, pallor
- Tachycardia, hypertension
Raynaud’s Phrenomenon:
What is it?
Clinical manifestations
Intermittent arteriolar vasoconstriction (typically in hands)
- Common in young women
Cause:
- Cold exposure
- Stress
Clinical manifestations:
- Coolness, pallor or pain in fingers/toes
Raynaud’s disease: primary (occurs on its own)
Raynaud’s syndrome: Associated with another disease process
Raynaud’s disease:
Management
Management is prevention
- Avoid cold exposure and stress
- Avoid injury to hands
- Avoid vasoconstrictors
