P2.2: VASCULAR: BUERGER'S DISEASE

Question 1

An occlusive vascular disease in which small and midsize peripheral arteries become inflamed and spastic causing clots to form

Answer 1

BUERGER’S DISEASE/THROMBOANGIITIS OBLITERANS

Question 2

An inflammatory, nonatheromatous occlusive condition that impairs circulation to the legs, feet and, occasionally, hands

Answer 2

BUERGER’S DISEASE/THROMBOANGIITIS OBLITERANS

Question 3

Inflammatory thrombotic disorder of the medium–sized arteries of the lower extremities. Distal arteries are usually involved but veins could also be affected.

Answer 3

BUERGER’S DISEASE/THROMBOANGIITIS OBLITERANS

The cause is unknown but maybe attributed to hypersensitivity reaction to tobacco products.

Question 4

CLINICAL MANIFESTATIONS:

Answer 4

• Intermittent claudication
• Cold, cyanotic and numbness of feet after exposure to cold
• Paresthesia
• Diminished hair growth and thickened nails of the affected extremity
• Muscle atrophy, ulceration and gangrene
• Pulsations in the posterior tibial and dorsalis pedis arteries are weak or absent
• Edema of the legs

Question 5

CLINICAL MANIFESTATIONS:

Pain on calves after period of walking and is relieved by rest

Answer 5

Intermittent Claudication

Pain- the most outstanding symptom

Question 6

CLINICAL MANIFESTATIONS:

Frequent complications and may occur early in the course of the disease

Answer 6

Muscle atrophy, ulceration and gangrene

Question 6

DIAGNOSTIC PROCEDURES

Answer 6

• X-ray examination
• Doppler ultrasonography
• Arteriography
• Plethysmography
• Allen’s test results

Question 7

DIAGNOSTIC PROCEDURES

Locates lesions and rules out atherosclerosis

Answer 7

Arteriography

Question 7

DIAGNOSTIC PROCEDURES

Shows diminished circulation in the peripheral vessels

Answer 7

Doppler ultrasonography

Question 8

DIAGNOSTIC PROCEDURES

Helps detect decreased circulation in the peripheral vessels

Answer 8

Plethysmography

Question 9

CLINICAL MANIFESTATIONS

Answer 9

• Pain
• Tenderness
• Rubor
• Cyanosis
• Malformed Nai;s
• Abnormal Hair Growth

Question 9

MANAGEMENT

Answer 9

1. Cessation of smoking
2. Avoidance of injury/trauma to extremity
3. Avoid precipitating factors such as emotional stress, trauma and exposure to cold
4. For the presence of gangrene and ulcers- gentle washing with soap and tepid water, rinse thoroughly, pat dry with soft towel
5. Use of anticoagulant
6. Embolectomy
7. Vasodilator/ Calcium channel blockers
8. Amputation if conservative interventions have failed

Question 10

DIAGNOSTIC ASSESSMENT

5 CRITERIA

Answer 10

1. Onset before age 50
2. History of tobacco use
3. Ischemia of the digits
4. Typical anteriographic findings
5. Exclusion of autoimmune disease

Question 10

NURSING MANAGEMENT

Answer 10

1. Smoking Cessation
2. Improve Circulation
3. Prevent Vasoconstriction
4. Prevent Complications

Question 11

Assessment before Amputation:

Answer 11

1. Client’s physical condition
2. Type of amputation to be performed
3. Level of amputation required
4. Peripheral vascular function test
5. Client’s attitude toward amputation
6. Client’s rehabilitative potential
7. Post-operative prosthetic fitting and rehabilitative team

Question 11

TYPES OF AMPUTATION:

Answer 11

1. Open/Guillotine amputation
2. Flap amputation

Question 11

It is the removal of all or part of an extremity by surgery; done for peripheral vascular disease if medical management is ineffective

Answer 11

AMPUTATION

Question 12

TYPE OF AMPUTATION:

Done by closing of covering of the stump with a flap of skin sutured over the end of the stump when there is no evidence of infection however drains may be inserted to promote wound healing

Answer 12

Flap amputation

Question 13

TYPE OF AMPUTATION:

• Major indication for infection
• No immediate closure of the stump with skin flap but leaves it open allowing the wound to drain freely

Answer 13

Open/Guillotine amputation

Question 13

How is the Level of amputation should be?

Answer 13

The level of amputation for any extremity should be as distal as possible

Question 13

• Feeling of pain in the amputated extremity
• Used to describe the normal perception of the missing extremity
• This perception is due to intact peripheral nerves proximal to the amputation site that used to carry messages between the brain and now the amputated part

Answer 13

Phantom pain

When the leg is amputated, the client will feel the presence of missing foot for many weeks