UNIT 6 BUERGERS DISEASE, VARICOSE VEINS AND RAYNAUDS DISEASE CHAPTER 33

Question 1

What is Varicose veins?

Answer 1

Varicose veins are distended, protruding veins that appear darkened and tortuous. They can occur in anyone, but they are common in adults older than 30 years whose occupations require prolonged standing or heavy physical activity.

Question 2

What is the pathophysiology of varicose veins

Answer 2

The valves in the veins which help bring blood back up to the heart become incompetent. Therefore there is a decrease in venous return

As the vein wall weakens and dilates, venous pressure increases, and the valves become incompetent (defective), causing venous reflux. The incompetent valves enhance the vessel dilation, and the veins become tortuous and distended. The severity of the disease depends on the extent of the distention and reflux. Telangiectasias (spider veins) are dilated intradermal veins less than 1 to 3 mm in diameter that are visible on the skin surface. Most patients are not bothered by them but may consider them una ractive. Most telangiectasias do not develop into the more severe varicose vein disease.

Question 3

Risk factors/ causes of Varicose Veins

Answer 3

Varicose veins are also frequently seen in patients with *systemic problems
*(e.g., heart disease),
*obesity,
*high estrogen states, and a
*family history of varicose veins.

Question 4

What would improve venous return in a pt with Varicose veins?

Answer 4

Treatment: Improve venous return using the 3 E’s
* Elastic compression stockings, Exercise, Elevation
* If necessary: Medical procedures:
* Ligation, stripping, injecting vein and laser surgery

Graduated compression stockings (GCSs) rely on graduated external pressure to improve venous return by applying pressure to the muscles. They are available in many grades or strengths, ranging from 8 to 50 mm Hg pressure.

Exercise increases venous return by helping the muscles pump blood back to the heart. Teach patients to avoid high-impact exercises such as horseback riding and running. Daily walks and ankle flexion exercises while si tting are common exercises that are helpful in promoting circulation.

Elevating the extremities as much as possible allows gravity to work with the valves in promoting venous return and preventing reflux.

Question 5

Which of the following terms is associated with Raynaud’s Disease?

A. Venous spasm
B. arterial occlusion
C. edema
D. vasodilation

Answer 5

A. Venous spasm

The disruption of blood flow with Raynaud’s disease is due to spasms in the vessels.

Question 6

Should you apply Vasoconstriction for a patient with Raynaud’s disease?

A. NO
B. Yes

Answer 6

A. NO

You should avoid all VASOCONSTRICTION FOR A PATIENT WITH RAYNAUDS DISEASE

Anything that causes vasoconstriction
Cold weather, nicotine, chocolate, caffein

NO SCD
NO ELASTIC STOCKINGS
NO BENDING OF THEKNEE
NO CROSSING LEGS

Question 7

Patient teaching for Raynauds disease

Answer 7

• Keep your feet clean by washing them with a mild soap in room- temperature water.
• Keep your feet dry, especially the ankles and between the toes.
• Avoid injury to your feet and ankles. Wear comfortable, well-fi ing shoes. Never go without shoes.
• Keep your toenails clean and filed. Have someone cut them if you cannot see them clearly. Cut your toenails straight across.
• To prevent dry, cracked skin, apply a lubricating lotion to your feet.
• Prevent exposure to extreme heat or cold. Never use a heating pad on your feet.
• Avoid constricting garments.
• Avoid extended pressure on your feet or ankles, such as occurs when you lean against something.
• Inspect your feet daily for injuries.
• See your health care provider at the first sign of a sore or injury to your skin.

Question 8

Which of the following terms are related to Buergers Disease

A. Inflammation and swelling of the vessels
B. Spider legs
C. venous spasms
D. discoloration of lower leg

Answer 8

A. Inflammation and swelling of the vessels

Disruption of blood flow is due to swelling and inflammation of vessels, thus causing a decrease in vascular space allowing blood flow.

Question 9

What are the Risk Factors of Burgers Disease?

Answer 9

Smoking
Nicotine use

Advise patients to completely stop smoking

Question 10

Patients who have recently been diagnosed with Buergers disease should avoid _____ weather because they should avoid all things that cause vasoconstriction

A. Cold
B. Warm
C. Hot
D. Timid

Answer 10

A. Cold

They should also avoid…

caffiene
chocalte
and nicotine use

Question 11

Treatment for Buergers disease?

Answer 11

Vasodilating drugs, such as nifedipine (Procardia);
management of ulceration and gangrene; chronic pain management modalities.

Question 12

Venous Insufficiency Patient Educations

Answer 12

Graduated Compression Stockings (GCSs)
* Wear stockings as prescribed, usually during the day and evening.
* Put the stockings on upon awakening and before ge ing out of bed.
* When applying the stockings, do not “bunch up” and apply like socks. Instead, place your hand inside the stocking and pull out the heel. Then place the foot of the stocking over your foot and slide the rest of the stocking up. Be sure that rough seams on the stocking are on the outside, not next to your skin.
* Do not push stockings down for comfort because they may function like a tourniquet and further impair venous return.
* Put on a clean pair of stockings each day. Wash them by hand (not in a washing machine) with a gentle detergent and warm water.
* If the stockings seem to be “stretched out,” replace them with a new pair.
* Be sure to assess sizing if the patient has gained or lost weight. Dos and Don’ts
* Elevate your legs for at least 20 minutes 4 or 5 times a day. When in bed, elevate your legs above the level of your heart.
* Avoid prolonged sitting or standing.
* Do not cross your legs. Crossing at the ankles is acceptable for short periods.
* Do not wear tight, restrictive pants. Avoid girdles and garters.