Vascular disorder Flashcards
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
Chief Complaint and History of Present Illness
Focuses on the six classical “Ps” of peripheral vascular disease: pain, pulselessness, poikilothermy, pallor, paresthesia, and paralysis
Past Medical History
Document a history of hypertension, coronary artery disease, myocardial infarction, or atheroscleros
Family History
Relevant diseases: hypertension, coronary artery disease, myocardial infarction, atherosclerosis, aneurysm, and diabetes
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
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
Review of systems
Assess for symptoms of aneurysms:
hoarseness, dysphagia, dyspnea, abdominal or back pain, or swelling of the head and arms
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
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?
Diagnostic Tests and Procedures PVD
Ultrasonography Pressure measurements Plethysmography Segmental plethysmography Exercise (treadmill) test Angiography Tomographic angiography Magnetic resonance angiography Arteriography Venography
Therapeutic Measures PVD
Exercise programs Stress management Pain management Smoking cessation Elastic stockings (TED) Intermittent pneumatic compression (SCD) Positioning Thermotherapy Protection Patient teaching
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
Surgical procedures PVD
Embolectomy Percutaneous transluminal angioplasty Endarterectomy Sympathectomy Vein ligation and stripping Sclerotherapy
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
angiographic procedure for elimination of areas of narrowing in blood vessels.
angioplasty
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
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.
Thisconditionmostly affects young men ages 20- 40, whoare heavy smokers or chew tobacco.
Thromboangiitis obliterans (Buerger disease
Thromboangiitis obliterans (Buerger disease signs and symptoms
Fingersortoes canbe 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 onfingers 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
