Transcript Cardiovascular and Peripheral Vascular Disorders

Nursing of Adults
with
Medical & Surgical Conditions
Disorders
of the
Peripheral Vascular System
Risk Factors
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Similar to risk factors for heart disorders
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Age
Gender
Smoking
Hypertension
Hyperlipidemia
Obesity
Lack of exercise
Emotional stress
Diabetes Mellitus
Family History
Assessment of Vascular Disorders
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Arterial Assessment
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First symptom is usually pain
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Occurs due to arterial insufficiency and ischemia
Dull ache in calf muscles
Leg fatigue and cramping
Intermittent claudication
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Later symptoms of pain
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Pain brought on by exercise
Pain at rest
Burning, tingling, and numbness at night even lying down
Pulses
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May be weak, thready, or absent
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Scale for documentation
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0 – absent
• +1 – barely palpable, intermittent
• +2 – weak , possibly thready, but constantly palpable
• +3 – normal strength and quality
• +4 – bounding, easily palpable, may be visible
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Assessment and Documentation
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PATCHES
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P for Pulses
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Absence of pulses in generally a medical emergency
• Compare with previous findings
• Look for other symptoms – may just be hard to feel
• Use Doppler device if necessary
A for Appearance
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Pale, mottled, cyanotic or discolored (red, black, brown)
Necrosis or bleeding (ulcers)
• Size, depth, and location
• Edges jagged or smooth
• Painful to touch
Shiny or dull
• Shiny may indicate edema
• Dull may indicate inadequate arterial blood supply
Superficial veins, erythema, or inflammation
Varicosities
• Have patient to stand
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T for Temperature
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Cool
Possible arterial problem
Warm
• Possible venous problem
Temperature changes may be caused by other problems as well
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C for Capillary refill
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H for Hardness
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Less than 2 seconds
Supple or hard and inelastic
• Hardness may indicate chronic problems
E for Edema
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Pitting edema
• Usually acute problem
• Assessment: Press on skin for 5 seconds and release
(Page 317 --Figure 8-17 and Table 8-3)
Non-pittting
• May be chronic condition
• Assessment: Measure circumference of the extremity
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for Sensation
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Patient states extremity FEELS:
• Numbness
• Tingling
• Hot
• Cold
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Venous Assessment
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First symptom is usually edema
Dark pigmentation
Dryness and scaling
Ulcerations
Pain, aching, and cramping
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Usually relieved by rest or elevation
Comparison of Arterial and Venous Disorders
Page 331 – Table 8-5
Diagnostic Tests
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Noninvasive Procedures
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Treadmill Test
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Plethysmography
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Assesses blood volume in the veins
Digital Subtraction Angiography (DSA)
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Exercise to determine blood flow to extremities
IV contrast is administered
Blood vessels are visualized by radiography using an image
intensifier video system and monitor
Doppler Ultrasound
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Measures blood flow in arteries or veins
Diagnostic Tests
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Invasive Procedures
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Phlebography or venography
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125 I-fibrinogen Uptake Test
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Radiographic visualization of veins
IV contrast is administered in a foot vein
X-rays are taken to detect filling defects
Assesses for condition of deep veins and to diagnose deep vein
thrombosis
Assesses for acute calf vein thrombosis
Fibrinogen is tagged with iodine 125 and given IV - it can
then be detected in the blood stream by a gamma ray detector
Angiography
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IV contrast is administered
X-ray to visualize arteries
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D-dimer Serum Test
 D-dimer
forms when fibrin is broken down
 When a thrombus is present D-dimer levels are
elevated – usually greater than 1591 ng/ml
 Normal value: 68-494 ng/ml
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Duplex Scanning
 Combination
of ultrasound imaging and Doppler
 Determines location and extent of thrombus within
veins
Arteriosclerosis & Atherosclerosis
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Arteriosclerosis
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thickening, loss of elasticity, and calcification
of arterial walls, resulting in a decreased blood
supply
Atherosclerosis
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narrowing of the artery due to yellowish
plaques of cholesterol, lipids, and cellular
debris in the inner layers of the walls of large
and medium sized arteries
a type of arteriosclerosis
Atherosclerosis
Hypertension
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Etiology/Pathophysiology
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A sustained elevated systolic blood pressure
greater than 140 mm Hg and /or a sustained
elevated diastolic blood pressure greater than
90 mm Hg.
Vasoconstriction (increases B/P)
 caused
by stimulation of the sympathetic nervous
system and the release of epinephrine and/or
norepinephrine. Decreased blood flow to the
kidneys causes the release of renin and the
formation of angiotensin which is a vasoconstrictor.
Hypertension
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Essential (primary) hypertension
 90-95%
of all diagnosed cases
 Theories of causes:
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arteriolar changes, sympathetic nervous system activation,
hormonal influence, genetic factors, obesity, sedentary
lifestyle, increased sodium intake, excessive alcohol intake.
Secondary hypertension
 Attributed
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to an identifiable medical diagnosis
renal vascular disease
diseases of the adrenal cortex
coarctation of the aorta
head trauma or cranial tumor
pregnancy-induced hypertension
Hypertension
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Malignant hypertension
 severe,
rapidly progressive elevation in blood
pressure that causes damage to the small arterioles
in major organs (heart, kidneys, brain, eyes)
Hypertension
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Signs & Symptoms
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headache
blurred vision
epistaxis
angina
s/s of:
 MI,
CHF, renal failure, and stroke
Hypertension
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Treatment
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Antihypertensive medications
 Capoten,
Vasotec, Altace, Lotensin, Zestril,
Accupril, Monopril
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Diuretics
 Lasix,
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HCTZ, Aldactone
Diet
 weight
control, reduction of saturated fats, and low
sodium
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No smoking
Hypertension
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Decreased alcohol intake
Regular aerobic exercise
Relaxation techniques/stress management
Arteriosclerosis Obliterans
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Etiology/Pathophysiology
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narrowing or occlusion of the blood vessel with
plaque formation
little or no blood flow to the affected extremity
Arteriosclerosis Obliterans
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Signs & Symptoms
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Five P’s
 Pain
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intermittent claudication
 Pulselessness
 Pallor
 Paresthesia
 Paralysis
Arteriosclerosis Obliterans
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Treatment
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Anticoagulants
 Heparin
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and Coumadin
Fibrinolytics
 Urokinase
 administered
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directly into the thrombus
Surgery
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embolectomy- removal of the embloism
endarterectomy- removal of the lining of the artery
arterial bypass
percutaneous transluminal angioplasty
amputation
Percutaneous Transluminal
Angioplasty
Arterial Embolism
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Etiology/Pathophysiology
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Blood clots in the arterial bloodstream
May originate in the heart
 arterial
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dysrhythmia, MI, valvular heart disease, CHF
Foreign substances
 plaque,
tissue, etc.
Arterial Embolism
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Signs & Symptoms
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Pain
Absent distal pulses
Pale, cool, and numb extremity
Necrosis
S/S of shock with occlusion of a major vessel
Arterial Embolism
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Treatment
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Anticoagulants
 Heparin
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and Coumadin
Fibrinolytics
Endarterectomy
Embolectomy
Arterial Aneurysm
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Etiology/Pathophysiology
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Enlarged, dilated portion of an artery
Causes:
 arteriosclerosis
 trauma
 congenital
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defect
Commonly affected arteries
 popliteal
 thoracic
and abdominal aorta
 coronary
 cerebral
Arterial Aneurysm
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Signs & Symptoms
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Asymptomatic
Large pulating mass
Pain, if large enough to press on other
structures
Arterial Aneurysm
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Treatment
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Assess for s/s of rupture, thrombi, ischemia
Control hypertension
Surgery
 Ligation
 Grafts
Surgical Repair of
Arterial Aneurysm
Thromboangitis Obliterans
(Buerger’s Disease)
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Etiology/Pathophysiology
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Occlusive vascular condition in which the small
and medium size arteries become inflamed and
thrombotic
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the small arteries in the hands and feet
Cause not known
Affects men 20-40 years old who smoke
Thromboangitis Obliterans
(Buerger’s Disease)
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Signs & Symptoms
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Pain
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be frequent and persistent
Sensitivity to cold
Skin cold and pale
Ulcerations on feet or hands
Gangrene
Superficial thrombophlebitis
Thromboangitis Obliterans
(Buerger’s Disease)
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Treatment
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No smoking
Exercise to develop collateral circulation
Surgery
 amputation
of gangrenous fingers and toes
 sympathectomy
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clip nerves to prevent pain and vasospasm
Raynaud’s Disease
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Etiology/Pathophysiology
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Intermittent arterial spasms
Primarily affects
 fingers,
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toes, ears and nose
Exposure to cold or emotional stress
Secondary:
 scleroderma
 rheumatoid
arthritis, SLE, drug intoxication,
occupational trauma
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Commonly affects women 20-40 years of age
Raynaud’s Disease
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Signs & Symptoms
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Chronically cold hands and feet
Pallor, coldness, numbness, cyanosis, and pain
during spasms
Erythema following a spasm
Ulcerations on the fingers and toes with chronic
disease
Raynaud’s Disease
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Treatment
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No smoking
Avoid exposure to cold
Medications
 vasodilators
 calcium
antagonists
 muscle relaxants
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Surgery
 sympathectomy
 amputation
for gangrene
Thrombophlebitis
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Etiology/Pathophysiology
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Inflammation of a vein in conjunction with the
formation of a thrombus
More common in women
Risk factors
 venous
stasis
 hypercoagulability
 truama to the blood vessel
 immobilization after surgery
Thrombophlebitis
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Signs & Symptoms
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Pain
Edema
Positive Homan’s sign
Erythema, warmth, and tenderness along the vein
Thrombophlebitis
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Treatment
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Superficial
 Bedrest
 Moist
heat
 Elevate extremity
 NSAID’s
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Motrin
aspirin
Thrombophlebitis
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Deep
 Bedrest
 Anticoagulants
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Heparin & Coumadin
 Fibrinolytics
 Elevate
extremity
 Antiembolism stockings
 Surgery
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thrombectomy
vena cava umbrella (Greenfield filter)
Greenfield Filter
Varicose Veins
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Etiology/Pathophysiology
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Tortuous, dilated vein with incompetent valves
Most common in women 40-60 years of age
Caused by:
 congenital
defective valves, absent valve, valve that
becomes incompetent
 Pregnancy or obesity
 prolonged standing
 constrictive clothing
Varicose Veins
Varicose Veins
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Signs & Symptoms
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Dark, raised, tortuous veins
Fatigue
Dull aches
Cramping of the muscles
Heaviness or pressure of
extremity
Edema, pain, changes in
skin color, and ulcerations
with venous stasis
Varicose Veins
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Treatment
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Elastic stockings
Rest
Elevate legs
Sclerotherapy
 injection
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of sclerosing solution
Surgery
 Vein
ligation and stripping
Venous Stasis Ulcers
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Etiology/Pathophysiology
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Ulcerations of the legs from chronic deep vein
insufficiency and stasis of blood in the venous
system of the legs
Open necrotic lesion due to an inadequate
supply of oxygen-rich blood to the tissue
Causes
 varicose
veins, burns trauma, sickle cell anemia,
diabetes mellitus, neurogenic disorders, and
hereditary factors
Venous Stasis Ulcers
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Signs & Symptoms
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Pain
Ulceration with dark pigmentation
Edema
Venous Stasis Ulcers
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Treatment
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Diet
 Increased
protein
 Vitamin A & C and Zinc
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Debridement of necrotic tissue
 wet-to-dry
dressings
 Elase cream
 surgical
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Antibiotics
Unna boot