Vasculular disorder 2 Flashcards
A dilated segment of an artery caused by weakness and stretching of the arterial wall; can be congenital or acquired
Aneurysms
s/s Aneurysms
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
complications
Rupture, thrombus formation that obstructs blood flow, emboli, pressure on surrounding structures
Medical and surgical treatment
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
Preoperative nursing care
It is important to document chronic conditions, such as emphysema or heart disease, that increase the risk of postoperative complications
Postoperative Nursing Care
Assessment
Monitor vital signs, hemodynamic status, renal function, and fluid balance. Inspect and palpate the extremities for color, warmth, and peripheral pulses
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
Aortic Dissection
Thoracic Ascending: most common, most fatal Aortic Dissection
s/s
Signs & Symptoms: pain, unequal intensities of Rt carotid and Lt radial pulses, bradycardia, pericardial friction rub
Descending Thoracic:
s/s
Signs & Symptoms: pain (sharp, tearing b/w shoulder blades)
Transverse:Aortic Dissection
s/s
Signs & Symptoms: pain (sharp, radiating to shoulders), dyspnea, dry
cough, dysphagia, hoarseness
Pain described as
Aortic Dissection
“tearing” or “ripping” pain and will have
syncope spells
Generally Medical treatment
Aortic Dissection
immediate surgery
If no complications, patient managed with
Aortic Dissection
antihypertensives
and drugs to decrease the strength of cardiac contraction
Otherwise, affected area is replaced with a synthetic graft
A key aspect of postoperative care
Aortic Dissection
: keep blood pressure at lowest
possible level
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
Varicose Vein Disease
Signs and symptoms Varicose Vein Disease
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
Medical diagnosis
Varicose Vein Disease
Based on their appearance and duplex ultrasonography
Medical and surgical treatment
Varicose Vein Disease
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
Assessment
Varicose Vein Disease
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
Inflammation of the vein wall
Phlebitis
Clot has formed at the site of inflammation within a vein
Thrombophlebitis:
Presence of a thrombus in a vein as a result of stasis, deviation of the intima, or hypercoagulability
Phlebothrombosis
Clot in a deep vein rather than in superficial
Deep vein thrombosis
Risk factors
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
Deep vein
Signs and symptoms
Edema, warmth, and tenderness at the area of compromise; positive Homans’ sign
Superficial vessels
Signs and symptoms
Pain, redness, warmth, or tenderness in the affected area
Medical and surgical treatment
Venous Thrombosis
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
Culmination of long-standing pressure that stretches the
veins and damages the valves
Chronic Venous Insufficiency
s/s Chronic Venous Insufficiency
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
Medical and surgical treatment
Chronic Venous Insufficiency
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
Assessment
Chronic Venous Insufficiency
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
Acute inflammation of the lymphatic channels
The inflammation is the result of an infectious
process, usually caused by streptococcus
Lymphangitis
s/s
Lymphangitis
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
Medical and surgical treatment
Lymphangitis
Antimicrobials
Abscess is incised to drain the suppurative material
Rest and elevation of the limb; warm, wet dressings; and elastic support hose
Assessment
Lymphangitis
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
Interventions
Lymphangitis
Analgesics, antimicrobials, and elevation of the extremity to reduce lymphedema
Application of warm, moist soaks to the infected areas
Elastic support hose
