Vasculular disorder 2

Question 1

A dilated segment of an artery caused by weakness and stretching of the arterial wall; can be congenital or acquired

Answer 1

Aneurysms

Question 2

s/s Aneurysms

Answer 2

Thoracic aneurysms usually have no symptoms, though some report deep, diffuse chest pain
If aneurysm puts pressure on the recurrent laryngeal nerve, patient may complain of hoarseness
Pressure on the esophagus may cause dysphagia
If superior vena cava compressed, edema of the head and arms
Signs of airway obstruction may be present if the aneurysm presses against pulmonary structures
Abdominal aneurysms may be palpated as a pulsating mass in the area slightly left of the umbilicus

Question 3

complications

Answer 3

Rupture, thrombus formation that obstructs blood flow, emboli, pressure on surrounding structures

Question 4

Medical and surgical treatment

Answer 4

Repair of aneurysms done by replacing the dilated segment of the artery with synthetic graft or, in some cases, by suturing or patching the defective area

Question 5

Preoperative nursing care

Answer 5

It is important to document chronic conditions, such as emphysema or heart disease, that increase the risk of postoperative complications

Question 6

Postoperative Nursing Care

Assessment

Answer 6

Monitor vital signs, hemodynamic status, renal function, and fluid balance. Inspect and palpate the extremities for color, warmth, and peripheral pulses

Question 7

Acute, life threatening hemorrhage into vessel wall
A small tear in the intima permits blood to escape into the space between the intima and the media
Blood accumulates between the layers, causing the media to split lengthwise
The split may extend up and down the aorta, where it can occlude major arteries

Answer 7

Aortic Dissection

Question 8

Thoracic Ascending: most common, most fatal Aortic Dissection
s/s

Answer 8

Signs & Symptoms: pain, unequal intensities of Rt carotid and Lt radial pulses, bradycardia, pericardial friction rub

Question 9

Descending Thoracic:

s/s

Answer 9

Signs & Symptoms: pain (sharp, tearing b/w shoulder blades)

Question 10

Transverse:Aortic Dissection

s/s

Answer 10

Signs & Symptoms: pain (sharp, radiating to shoulders), dyspnea, dry
cough, dysphagia, hoarseness

Question 11

Pain described as

Aortic Dissection

Answer 11

“tearing” or “ripping” pain and will have

syncope spells

Question 12

Generally Medical treatment

Aortic Dissection

Answer 12

immediate surgery

Question 13

If no complications, patient managed with

Aortic Dissection

Answer 13

antihypertensives
and drugs to decrease the strength of cardiac contraction
Otherwise, affected area is replaced with a synthetic graft

Question 14

A key aspect of postoperative care

Aortic Dissection

Answer 14

: keep blood pressure at lowest

possible level

Question 15

Varicosities are dilated, tortuous, superficial veins, often the saphenous veins in the lower extremities
Dilation of the vessels results from incompetent valves in the veins
Classified as primary (only superficial veins affected) and secondary (characterized by deep vein obstruction

Answer 15

Varicose Vein Disease

Question 16

Signs and symptoms Varicose Vein Disease

Answer 16

Oversized, discolored (purplish), and tortuous veins
Dull aching sensations when standing or walking; a feeling of heaviness in the affected legs; muscle cramps, especially at night; increased muscular fatigue in the affected area; and ankle edema

Question 17

Medical diagnosis

Varicose Vein Disease

Answer 17

Based on their appearance and duplex ultrasonography

Question 18

Medical and surgical treatment

Varicose Vein Disease

Answer 18

Avoid restrictive garments, prolonged standing or sitting, crossing the legs or knees, and injury to compromised areas 
Weight reduction
Support stockings
Sclerotherapy or laser therapy
Ligation and stripping

Question 19

Assessment

Varicose Vein Disease

Answer 19

Health history determines pain, edema, cramps, and muscle fatigue
Note family history of varicose veins
Patient’s occupation and usual activities
Physical examination: inspect the legs for color, edema, turgor, and capillary refill
Palpate the legs for tenderness

Question 20

Inflammation of the vein wall

Answer 20

Phlebitis

Question 21

Clot has formed at the site of inflammation within a vein

Answer 21

Thrombophlebitis:

Question 22

Presence of a thrombus in a vein as a result of stasis, deviation of the intima, or hypercoagulability

Answer 22

Phlebothrombosis

Question 23

Clot in a deep vein rather than in superficial

Answer 23

Deep vein thrombosis

Question 24

Risk factors

Answer 24

Prescribed bed rest
Surgery for people older than 40 years of age
Leg trauma resulting in immobilization from casts or traction
Previous venous insufficiency
Obesity
Use of oral contraceptives
Virchow’s Triad: 3 factors that contributes to venous thrombus formation 1.) stasis if of the blood; 2.) Damage to the vessel walls, and
3.) hypercoagulability… 2 of 3 must be present for thrombus formation

Question 25

Deep vein | Signs and symptoms

Answer 25

Edema, warmth, and tenderness at the area of compromise; positive Homans’ sign

Question 26

Superficial vessels | Signs and symptoms

Answer 26

Pain, redness, warmth, or tenderness in the affected area

Question 27

Medical and surgical treatment | Venous Thrombosis

Answer 27

Anticoagulant or thrombolytic therapy, or both Patient teaching about the disease; ongoing assessment for pulmonary emboli; bed rest; elevation of the extremity; warm, moist soaks to the affected area; and antiembolism hose Surgery considered when patient cannot receive anticoagulants or thrombolytic therapy or when high possibility of pulmonary emboli

Question 28

Culmination of long-standing pressure that stretches the | veins and damages the valves

Answer 28

Chronic Venous Insufficiency

Question 29

s/s Chronic Venous Insufficiency

Answer 29

Edema around the lower legs, pain, brownish skin discoloration (stasis dermatitis), and stasis ulcerations Heaviness or dull ache in the calf or thigh Skin temperature is cool, and nails are normal Feet and ankles often cyanotic when in a dependent position

Question 30

Medical and surgical treatment | Chronic Venous Insufficiency

Answer 30

Compression Elastic or compression stockings and pneumatic compression device If patient has an ulcer, special dressings, systemic antibiotics, topical débriding agents such as Elase, and Unna boots Hyperbaric oxygen therapy

Question 31

Assessment Chronic Venous Insufficiency

Answer 31

``` Inspect the lower extremities for rubor and stasis dermatitis, palpate skin temperature, and determine the presence of pain in the affected extremityInterventions Ineffective Tissue Perfusion Disturbed Body Image Risk for Infection Impaired Skin Integrity ```

Question 32

Acute inflammation of the lymphatic channels The inflammation is the result of an infectious process, usually caused by streptococcus

Answer 32

Lymphangitis

Question 33

s/s | Lymphangitis

Answer 33

Enlargement of the lymph nodes along the lymphatic channel Tenderness as these nodes are assessed Red streak from the infected wound extends up the extremity along the path of the lymphatics Elevated temperature and chills

Question 34

Medical and surgical treatment | Lymphangitis

Answer 34

Antimicrobials Abscess is incised to drain the suppurative material Rest and elevation of the limb; warm, wet dressings; and elastic support hose

Question 35

Assessment | Lymphangitis

Answer 35

Inspect skin for open wounds, inflammation, and red streaks along the paths of lymphatic channels Palpate lymph nodes in groin and underarm areas for enlargement

Question 36

Interventions | Lymphangitis

Answer 36

Analgesics, antimicrobials, and elevation of the extremity to reduce lymphedema Application of warm, moist soaks to the infected areas Elastic support hose