Vascular disorder Flashcards by Diane M.

Age-Related Changes

Arteriosclerosis

Stiffening of the vessel walls results in compromised delivery of oxygen and nutrients to tissues; buildup of waste products in tissue
Decrease production of hemoglobin results in a decline in the oxygen-carrying capacity of the blood
Slowing or
ineffective heart
rate
Decrease in
stroke volume

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Chief Complaint and History of Present Illness

Focuses on the six classical “Ps” of peripheral vascular disease: pain, pulselessness, poikilothermy, pallor, paresthesia, and paralysis

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Past Medical History

Document a history of hypertension, coronary artery disease, myocardial infarction, or atheroscleros

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Family History

Relevant diseases: hypertension, coronary artery disease, myocardial infarction, atherosclerosis, aneurysm, and diabetes

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an organism (as a frog) with a variable body temperature that tends to fluctuate with and is similar to or slightly higher than the temperature of its environment:a cold-blooded organism

POIKILOTHERM

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Changes associated with PVD:

Review of systems

thick, brittle nails; shiny, taut, scaly, dry skin; skin temperature variations; skin ulcerations; muscle atrophy; localized redness and hardness; and hair loss on the extremities

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Review of systems

Assess for symptoms of aneurysms:

hoarseness, dysphagia, dyspnea, abdominal or back pain, or swelling of the head and arms

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Functional assessment PVD

Determines the effect of the disease on the patient’s life

Pain of PVD can interfere with the ability to perform activity leading to a more sedimentary lifestyle

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Assessment of the Vascular System
Physical examination
PVD

Inspect the skin for color and lesions
Capillary refill time in the nail beds
Palpate affected areas to evaluate temperature, detect edema, and assess peripheral pulses
Allen test: clench fist, occlude radial/ulnar arteries, open hand, and release ulnar artery. Color return?

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Diagnostic Tests and Procedures PVD

Ultrasonography
Pressure measurements
Plethysmography 
Segmental plethysmography 
Exercise (treadmill) test
Angiography
Tomographic angiography
Magnetic resonance angiography 
Arteriography
Venography

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Therapeutic Measures PVD

Exercise programs
Stress management
Pain management
Smoking cessation
Elastic stockings (TED)
Intermittent pneumatic compression (SCD)
Positioning
Thermotherapy
Protection 
Patient teaching

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is used to measure changes in volume in different parts of the body. This can help checkblood. The test may be done to check for blood clots in the arms and legs, or to measure how much air you can hold in your lungs.
Penile pulse volume recording is a type this test that is done on the penis to check for causes oferectile dysfunction.

Plethysmography

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Surgical procedures PVD

Embolectomy 
Percutaneous transluminal angioplasty 
Endarterectomy 
Sympathectomy
Vein ligation and stripping 
Sclerotherapy

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Preoperative nursing care PVD

Patient with severe cardiovascular disease may have activity restrictions to reduce demands on circulatory system until the surgical procedure is done
Affected extremity should be maintained in a level or slightly dependent position as ordered
Optimize peripheral circulation: keep extremity warm

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angiographic procedure for elimination of areas of narrowing in blood vessels.

angioplasty

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in which aballooncatheteris inflated inside an artery, stretching the intima and leaving a ragged interior surface after deflation, which triggers a healing response and breaking up of plaque.

balloon angioplasty

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a type ofballoon angioplastyin which the catheter is inserted through the skin and through the lumen of the vessel to the site of the narrowing.

percutaneous transluminal angioplasty

percutaneous transluminal angioplasty to enlarge the lumen of a sclerotic coronary artery (see accompanying illustration). This provides an alternative to cardiacbypasssurgery for selected patients with ischemic heart diseas

percutaneous transluminal coronary angioplasty(PTCA)

is asurgical procedureto remove theatheromatousplaquematerial, or blockage, in the lining of anarteryconstricted by the buildup of soft/hardening deposits. It is carried out by separating the plaque from the arterial wall.

Endarterectomy

Preoperative nursing care PVD

Protect the limb from further injury

Postoperative nursing care PVD

Primary goal of the postoperative period is to stimulate circulation by encouraging movement and preventing stasis within the extremity

Drugs PVD

Anticoagulants Thrombolytics
Platelet aggregation inhibitors Vasodilators
NSAIDS Analgesics

Dietary interventions PVD

Low-fat diets reduce serum cholesterol levels
Weight-reduction diet if the patient is obese
Adequate vitamin B, vitamin C, and protein needed to promote healing and improve tissue integrity

Usually forms in the heart, but a roughened atheromatous plaque in any artery also can lead to thrombus formation
If a thrombus breaks loose, it becomes an embolus and travels through the circulatory system until it lodges in a vessel, blocking blood flow distal to the occlusion

Arterial Embolism

Signs and symptoms | Arterial Embolism

Severe, acute pain Gradual loss of sensory and motor function in the affected areas Pain aggravated by movement or pressure Absent distal pulses Pallor and mottling (irregular discoloration) Sharp line of color and temperature demarcation: tissue beyond the obstruction is pale and cool

Medical and surgical treatment | Arterial Embolism

Intravenous anticoagulants and thrombolytic agents | Embolectomy

Atherosclerosis obliterans, arterial insufficiency, and peripheral vascular disease Pathologic changes in the arteries, typically plaque formations that arise where the arteries branch, veer, arch, or narrow Common sites for arterial occlusion are the distal superficial femoral and the popliteal arteries Occlusions prevent delivery of oxygen and nutrients to the tissues Hypoxia affects all tissues distal to the occlusion

Peripheral Arterial Occlusive Disease

Signs and symptoms | Peripheral Arterial Occlusive Disease

Intermittent claudication (aching,cramping, tiredness & weakness in leg when walking & relieved by rest) Absence of peripheral pulses below occlusive area Rest pain (persistent and aching pain developing during rest) Tingling or numbness or both in the toes Extremity is cold, numb, and pale Shiny, scaly skin; subcutaneous tissue loss; hairlessness on the affected extremity; and ulcers with a pale gray or yellowish hue, especially at ankles Eventually necrosis and gangrene

Medical diagnosis Peripheral Arterial Occlusive Disease

``` Duplex imaging (combines 2 types of ultrasonograpy…providing a 2-dimensional image of the blood vessels) Angiography ```

Medical and surgical treatment | Peripheral Arterial Occlusive Disease

Lifestyle changes Smoking cessation, exercise, weight management Treatment for hypertension, hyperlipidemia, or diabetes Drugs for claudication: cilostazol and pentoxifylline Surgical interventions Percutaneous transluminal angioplasty, atherectomy, and endarterectomy

Assessment | Peripheral Arterial Occlusive Disease

Assess the pulses distal to the surgical site and compare with the same pulses in the unaffected extremity Assess vital signs, color, and temperature of affected extremity, fluid intake and output, central venous pressure, and mental status

Also called Buerger’s disease Inflammatory thrombotic disorder of arteries and veins in lower and upper extremities Cause is unknown, but it occurs only in smokers

Thromboangiitis Obliterans

Signs and symptoms | Thromboangiitis Obliterans

intermittent claudication, rest pain, skin color/temperature changes in affected areas, cold sensitivity, abnormal sensation, ulceration, gangrene

Diagnosis/ treatment | Thromboangiitis Obliterans

Diagnosis based on physical findings and arteriography Most important treatment is smoking cessation Palliative treatments include sympathectomy and drugs, such as calcium channel blockers, antibiotics, and anticoagulants

is caused by small blood vessels that become inflamed and swollen. The blood vessels then narrow or become completely blocked by blood clots (thrombosis). Blood vessels of the hands and feet are especially affected. Arteries are more affected than veins. Average age when symptoms begin is around 35. Women and older adults are affected less often. This condition mostly affects young men ages 20 - 40, who are heavy smokers or chew tobacco.

Thromboangiitis obliterans (Buerger disease

``` Thromboangiitis obliterans (Buerger disease signs and symptoms ```

Fingers or toes can be pale, red, or bluish and feel cold Pain in the hands and feet Acute, severe Burning or tingling Often occurring at rest May be worse with cold exposure or with emotional stress Pain in the legs, ankles, or feet when walking (intermittent claudication), often located in the arch of the foot Skin changes or small painful ulcers on fingers or toes Usually two or more limbs are affected

Intermittent constriction of arterioles; affects hands primarily, but it can affect the toes and tip of the nose; Raynaud's Disease: the primary condition (has no identifiable cause) Raynaud's Phenomenon: vasospasm caused by other diseases

Raynaud’s Disease

Signs and symptoms | Raynaud’s Disease

Chronically cold hands, numbness, tingling, and pallor | During an arterial spasm, the skin color changes from pallor to cyanosis to redness with throbbing

Medical diagnosis | Raynaud’s Disease

Based on the signs and symptoms and on the absence of evidence of occlusive vascular disease

Medical and surgical treatment | Raynaud’s Disease

Drugs: calcium channel blockers, transdermal nitroglycerin, an endothelin receptor antagonist, phosphodiesterase inhibitors, and intravenous prostaglandins Sympathectomy