Peripheral Vascular Disorders Flashcards
Pathophysiology of Disorders of Peripheral Vascular System
Related to inefficiency of the heart, blood vessels, incompetent valves, lymphatic obstruction
Normal aging: inner walls of blood vessels become thick and less flexible, which increases vascular resistance
Risk Factors of Disorders of the Peripheral Vascular System
Age, gender, heredity, race, diet, exercise, smoking, stress, hyperlipidemia, obesity, diabetes (increased blood glucose)
Arterial Assessment
First symptom of decreased arterial circulation is pain
Ischemia
Caused by lack of oxygen-rich blood getting to the muscles
Pain frequently in lower extremities, dull ache in calf muscles, occurs even with rest
Accompanied by fatigue and cramping
Precipitated by exercise
Alleviating factor is rest (initially)
Intermittent Claudication
Weakness and cramp-like pain in the calves related to poor circulation of the arterial blood
Arterial/Venous Assessment
Pulses Appearance Temperature Capillary refill Hardness Edema Sensation
Venous Assessment
First symptom is edema
Dark pigmentation, dryness, and scaling due to chronic venous insufficiency
Chronic edema and stasis leads to stasis ulcerations caused by the pooling of blood
Achy pain and cramps
Alleviated by activity or raising the legs above heart level
Noninvasive Tests of Vascular Insufficiency
Treadmill test (taking blood pressures in extremities and monitoring for pain)
Plethysmography (measures changes in volume in different parts of the body)
Doppler ultrasound (continuous recording, color flow, used for looking at claudication and obstruction)
Invasive Tests of Vascular Insufficiency
Phebography or venography (injection of dye into an IV)
Angiography (dye in an IV)
Doppler/Duplex Scanning Tests (combines ultrasound and doppler)
D-Dimer (looks for blood clots, thrombus present if test shows > 1591 ng/mL of D-Dimer)
Characteristics of Arterial Insufficiency
Pulses decreased or absent
Color is pale, dusky rubor present
Temperature is cool
No edema
Skin is shiny and has absence of hair, ulcers on the toes
Pain aggravated with exercise and relieved with rest
Characteristics of Venous Insufficiency
Pulses are present
Color is pink to cyanotic with brown pigmentation at ankles
Temperature is warm
Edema is present
Skin shows ulcers on ankles
Pain is aggravated by long standing or sitting and is alleviated by elevation of legs, lying down, or walking
Pathophysiology of Hypertension
Sustained elevated systolic blood pressure greater than 140 mmHg and sustained elevated diastolic blood pressure greater than 90 mmHg
Increases vascular resistance, hastens atherosclerosis and arteriosclerosis, and makes the heart work harder
Essential Hypertension
No exact cause, makes up 90-95% of all diagnosed cases
Includes malignant hypertension
Malignant Hypertension
Severe, rapidly progressive elevation of blood pressure of over 250/120 mmHg
Medical emergency
Symptoms include headache, visual disturbances, nosebleeds
Can lead to heart attack, stroke, renal failure, or problems with the eyes
Secondary Hypertension
Related to something else and can be fixed by fixing the root issue
Examples are hyperthyroidism, fluid overload, kidney problems
Risk Factors for Hypertension
Age/Gender (older than 30 increases risk for hypertension; men are more likely to be at risk)
Race/Heredity (higher risk for African Americans)
Smoking/Obesity
High sodium/Elevated cholesterol
Oral contraceptives or estrogen
Alcohol (increases catecholamines that lead to vasoconstriction)
Emotional stress/Sedentary lifestyle
Signs and Symptoms of Hypertension
Headache (especially upon awakening)
Blurred vision, spots before eyes
Epistaxis
Complications can occur in the heart, brain, eyes, and kidneys
Pharmacological Management of Hypertension
Patients should report signs and symptoms and should not stop taking abruptly
Antihypertensive medications (teach about taking as ordered, teach about side effects such as hypotension, drowsiness, erectile dysfunction)
Diuretics (help to get rid of the extra fluid in the body)
Medical Management of Hypertension
Diet (low sodium, reduction of saturated fats, reduce alcohol)
Exercise (30-45 minutes, 3-4 times a week)
No smoking
Relaxation techniques/Stress management
Peripheral Arterial Disease
Narrowing or occlusion of the blood vessels
Common sites are iliac, common femoral arteries and superficial femoral arteries
Signs and Symptoms include pain, pulselessness, pallor, paresthesia, paralysis
Diagnosis of Peripheral Artery Disease
Ankle Brachial Index (blood pressure taken in both arms and one in the legs; ABI < 0.9 is abnormal)
Treatment of Peripheral Artery Disease
Anticoagulants/Fibrinolytics/ACE Inhibitors
Embolectomy, Endarterectomy, Arterial Bypass, Percutaneous Transluminal Angioplasty, Amputation
Arterial Embolism Signs and Symptoms
Pain
Absent distal pulses
Pale, cool, and numb extremity
Necrosis
Management of Arterial Embolism
Anticoagulants and fibrinolytics
Endarterectomy
Embolectomy
Risk Facters for Arterial Aneurysm
Congenital issue, hypertension, arteriosclerosis, atherosclerosis
Signs and Symptoms of Arterial Embolism
Large pulsating mass inside of the abdomen
Pain
Thoracic Aorta: pain in the neck, shoulders, lower back, abdomen, syncope, dyspnea, increased pulse, color changes, weakness, hoarseness, difficulty swallowing
Abdominal Aorta: bruit, tenderness with deep palpation, lower abdominal and back pain
Management of Arterial Aneurysm
Goal is to limit the progression and prevent straining of the body
Assess pain, color changes
Pre-Op: teach how to splint, educate on how to get out of bed, give pain medication, check lab work, teach about incentive spirometry, mark the pulses
Post-Op: monitor pulses, vital signs, restrict HOB to less than 45 degrees, watch intake and output, NG tube, manage pain
Pathophysiology of Thromboangitis Obliterans (Buerger’s Disease)
Occlusive disease of the medium and small arteries and veins that affects the distal portions of the upper and lower limbs
Men between 35-40 years of age who smoke are most affected
Signs and Symptoms of Thromboangitis Obliterans
Pain, sensitivity to cold
Skin cold and pale
Ulcerations on feet or hands; gangrene
Superficial thrombophlebitis
Treatment of Thromboangitis Obliterans
Goal is to prevent progression
NO SMOKING
Exercise to develop collateral circulation
Amputation of gangrenous extremities
Sympathectomy: cutting into the SNS by interrupting nerve pathways in order to eliminate pain and vasospasms
Educate, prevent necrosis, hydrate, clean infected areas, encourage well-fitting shoes and socks
Pathophysiology of Raynaud’s Disease
Intermittent arterial spasms in the lower and upper extremities related to exposure to cold
Mostly affects the ears, toes, fingers, and nose
Women more likely to have this
Signs and Symptoms of Raynaud’s Disease
Chronically cold hands and feet
Pallor, coldness, numbness, cyanosis, and pain during spasms
Erythema following a spasm
Ulcerations on the fingers and toes
Diaphoresis, numb and prickly sensations
Pharmacological Management of Raynaud’s Disease
Vasodilators/Calcium antagonists
Sympathectomy
No smoking
Avoid exposure to cold, add warmth
Amputation for gangrene
Thrombophlebitis
Inflammation of the vein caused by venous stasis, trauma to a blood vessel, immobilization, dehydration, and/or childbirth
Phlebothrombosis
Clots in the vein
Signs and Symptoms of Thrombophlebitis
Pain
Edema
Positive Homan’s sign
Erythema, warmth, tenderness along the vein
Management of Superficial Thrombophlebitis
NSAIDs/Anticoagulants
Bedrest to keep clot where it is
Moist heat
Elevate extremity
Never massage or rub area
Management of Deep Thrombophlebitis
Anticoagulants/Fibrinolytics
Bed rest, elevate extremity
Anti-embolism stockings
Thrombectomy
Vena cava umbrella (Greenfield filter)
Varicose Veins
Dilated veins with incompetent valves
Blood collects in the veins and is not returned to the heart in an efficient manner
People with prolonged standing have an increased risk
Signs and Symptoms of Varicose Veins
Dark, raised, tortuous veins
Fatigue, dull aches
Cramping of the muscles
Heaviness or pressure of extremity, tired legs
Edema, pain, changes in skin color
Slow healing/ulcerations
Management of Varicose Veins
Elastic stockings
Rest
Elevate legs
Sclerotherapy: injection of a solution in a vein that leads vein to collapse and scar so that the body reroutes the blood deeper into the muscles instead
Vein ligation and stripping
Post-Op Care for Ligation and Stripping
Monitor for pain, bleeding
Vital signs
Elevate foot of bed
ACE wraps
Early ambulation
Avoid prolonged standing, walk as much as possible, do not strain
Venous Stasis Ulcers
Caused by varicose veins, burns, trauma, sickle cell anemia, diabetes mellitus, neurogenic disorders, hereditary factors
Signs and Symptoms of Venous Stasis Ulcers
Pain
Ulceration with dark pigmentation
Edema
Management of Venous Stasis Ulcers
Increased protein, vitamins A and C, and zinc
Debridement of necrotic tissue
Antibiotics
Unna boot
Function of Lymphatic System
Maintenance of fluid balance
Production of lymphocytes
Absorption and transportation of lipids from the intestine to the bloodstream
Lymph
Specialized fluid that is transported through the lymphatic vessels
Lymph Nodes
Act as a filter, keeping particulate matter such as bacteria from entering the bloodstream
Lymphangitis
Inflammation of the lymphatic vessels, usually after a staph or strep infection of an extremity
Signs and Symptoms of Lymphangitis
Local pain
Chills, fever
Red streaks from the affected area
Edema, enlarged lymph nodes
Headache, myalgia
Treatment of Lymphangitis
Penicillin
Moist heat
Elevate extremity
Lymphedema
Accumulation of lymph in the soft tissue
Primary: cause unknown, could be malformed lymphatic system
Secondary: usually related to cancer
Signs and Symptoms of Lymphedema
Massive edema and tightness of affected extremity
Pain
Treatment of Lymphedema
Antibiotics
Special massage
Compression pump, elastic stocking or sleeve
Restrict sodium, maintain a healthy weight, exercise regularly, avoid constrictive clothing, avoid trauma
