Your SlideShare is downloading. ×
0
Last Lecture<br />Cardiovascular Diseases<br />
Alterations inBlood Flow in the Systemic Circulation<br />
ANEURYSM<br />Dilation involving an artery formed at a weak point in the vessel wall<br />
ANEURYSM<br />Saccular= when one side of the vessel is affected<br />Fusiform= when the entire segment becomes dilated<br />
ANEURYSM<br />RISK FACTORS<br />Atherosclerosis<br />Infection= syphilis<br />Connective tissue disorder<br />Genetic diso...
ANEURYSM<br />PATHOPHYSIOLOGY<br />Damage to the intima and media  weakness  outpouching<br />Dissecting aneurysm  tear...
ANEURYSM<br />ASSESSMENT<br />Asymptomatic<br />Pulsatile sensation on the abdomen<br />Palpable bruit<br />
ANEURYSM<br /><ul><li>LABORATORY:
CT scan
Ultrasound
X-ray
Aortography</li></li></ul><li>ANEURYSM<br /><ul><li>Medical Management:
Anti-hypertensives
Synthetic graft</li></li></ul><li>ANEURYSM<br /><ul><li>Nursing Management:
Administer medications
Emphasize the need to avoid increased abdominal pressure
No deep abdominal palpation
Remind patient the need for serial ultrasound to detect diameter changes</li></li></ul><li>PERIPHERAL ARTERIAL OCCLUSIVE D...
Usually found in males age 50 and above
The legs are most often affected</li></li></ul><li>PERIPHERAL ARTERIAL OCCLUSIVE DISEASE<br /><ul><li>Risk factors for Per...
Non-Modifiable
1. Age
2. gender
3. family predisposition</li></li></ul><li>PERIPHERAL ARTERIAL OCCLUSIVE DISEASE<br /><ul><li>Risk factors for Peripheral ...
Modifiable
1. Smoking
2. HPN
3. Obesity
4. Sedentary lifestyle
5. DM
6. Stress</li></li></ul><li>
PERIPHERAL ARTERIAL OCCLUSIVE DISEASE<br /><ul><li>ASSESSMENT FINDINGS
1. INTERMITTENT CLAUDICATION- the hallmark of PAOD
This is PAIN described as aching, cramping or fatiguing discomfort consistently reproduced with the same degree of exercis...
1. INTERMITTENT CLAUDICATION- the hallmark of PAOD
Upcoming SlideShare
Loading in...5
×

Cv

1,395

Published on

Published in: Health & Medicine
0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total Views
1,395
On Slideshare
0
From Embeds
0
Number of Embeds
0
Actions
Shares
0
Downloads
13
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide

Transcript of " Cv"

  1. 1. Last Lecture<br />Cardiovascular Diseases<br />
  2. 2. Alterations inBlood Flow in the Systemic Circulation<br />
  3. 3. ANEURYSM<br />Dilation involving an artery formed at a weak point in the vessel wall<br />
  4. 4. ANEURYSM<br />Saccular= when one side of the vessel is affected<br />Fusiform= when the entire segment becomes dilated<br />
  5. 5. ANEURYSM<br />RISK FACTORS<br />Atherosclerosis<br />Infection= syphilis<br />Connective tissue disorder<br />Genetic disorder= Marfan’s Syndrome<br />
  6. 6. ANEURYSM<br />PATHOPHYSIOLOGY<br />Damage to the intima and media  weakness  outpouching<br />Dissecting aneurysm  tear in the intima and media with dissection of blood through the layers<br />
  7. 7. ANEURYSM<br />ASSESSMENT<br />Asymptomatic<br />Pulsatile sensation on the abdomen<br />Palpable bruit<br />
  8. 8. ANEURYSM<br /><ul><li>LABORATORY:
  9. 9. CT scan
  10. 10. Ultrasound
  11. 11. X-ray
  12. 12. Aortography</li></li></ul><li>ANEURYSM<br /><ul><li>Medical Management:
  13. 13. Anti-hypertensives
  14. 14. Synthetic graft</li></li></ul><li>ANEURYSM<br /><ul><li>Nursing Management:
  15. 15. Administer medications
  16. 16. Emphasize the need to avoid increased abdominal pressure
  17. 17. No deep abdominal palpation
  18. 18. Remind patient the need for serial ultrasound to detect diameter changes</li></li></ul><li>PERIPHERAL ARTERIAL OCCLUSIVE DISEASE<br /><ul><li>Refers to arterial insufficiency of the extremities usually secondary to peripheral atherosclerosis.
  19. 19. Usually found in males age 50 and above
  20. 20. The legs are most often affected</li></li></ul><li>PERIPHERAL ARTERIAL OCCLUSIVE DISEASE<br /><ul><li>Risk factors for Peripheral Arterial occlusive disease
  21. 21. Non-Modifiable
  22. 22. 1. Age
  23. 23. 2. gender
  24. 24. 3. family predisposition</li></li></ul><li>PERIPHERAL ARTERIAL OCCLUSIVE DISEASE<br /><ul><li>Risk factors for Peripheral Arterial occlusive disease
  25. 25. Modifiable
  26. 26. 1. Smoking
  27. 27. 2. HPN
  28. 28. 3. Obesity
  29. 29. 4. Sedentary lifestyle
  30. 30. 5. DM
  31. 31. 6. Stress</li></li></ul><li>
  32. 32. PERIPHERAL ARTERIAL OCCLUSIVE DISEASE<br /><ul><li>ASSESSMENT FINDINGS
  33. 33. 1. INTERMITTENT CLAUDICATION- the hallmark of PAOD
  34. 34. This is PAIN described as aching, cramping or fatiguing discomfort consistently reproduced with the same degree of exercise or activity</li></li></ul><li>PERIPHERAL ARTERIAL OCCLUSIVE DISEASE<br /><ul><li>ASSESSMENT FINDINGS
  35. 35. 1. INTERMITTENT CLAUDICATION- the hallmark of PAOD
  36. 36. This pain is RELIEVED by REST
  37. 37. This commonly affects the muscle group below the arterial occlusion</li></li></ul><li>PERIPHERAL ARTERIAL OCCLUSIVE DISEASE<br /><ul><li>Assessment Findings
  38. 38. 2. Progressive pain on the extremity as the disease advances
  39. 39. 3. Sensation of cold and numbness of the extremities</li></li></ul><li>PERIPHERAL ARTERIAL OCCLUSIVE DISEASE<br /><ul><li>Assessment Findings
  40. 40. 4. Skin is pale when elevated and cyanotic/ruddy when placed on a dependent position
  41. 41. 5. Muscle atrophy, leg ulceration and gangrene</li></li></ul><li>PERIPHERAL ARTERIAL OCCLUSIVE DISEASE<br /><ul><li>Diagnostic Findings
  42. 42. 1. Unequal pulses between the extremities
  43. 43. 2. Duplex ultrasonography
  44. 44. 3. Doppler flow studies</li></li></ul><li>PAOD<br /><ul><li>Medical Management
  45. 45. 1. Drug therapy
  46. 46. Pentoxyfylline (Trental) reduces blood viscosity and improves supply of O2 blood to muscles
  47. 47. Cilostazol (Pletaal) inhibits platelet aggregation and increases vasodilatation
  48. 48. 2. Surgery- Bypass graft and anastomoses</li></li></ul><li>PERIPHERAL ARTERIAL OCCLUSIVE DISEASE<br /><ul><li>Nursing Interventions
  49. 49. 1. Maintain Circulation to the extremity
  50. 50. Evaluate regularly peripheral pulses, temperature, sensation, motor function and capillary refill time
  51. 51. Administer post-operative care to patient who underwent surgery</li></li></ul><li>PERIPHERAL ARTERIAL OCCLUSIVE DISEASE<br /><ul><li>Nursing Interventions
  52. 52. 2. Monitor and manage complications
  53. 53. Note for bleeding, hematoma, decreased urine output
  54. 54. Elevate the legs to diminish edema
  55. 55. Encourage exercise of the extremity while on bed
  56. 56. Teach patient to avoid leg-crossing</li></li></ul><li>PERIPHERAL ARTERIAL OCCLUSIVE DISEASE<br />Nursing Interventions<br />3. Promote Home management<br />Encourage lifestyle changes<br />Instruct to AVOID smoking<br />Instruct to avoid leg crossing<br />
  57. 57. Buerger’s Disease<br />Also known as Thromboangiitisobliterans<br />Usually a disease of heavy cigarette smoker/tobacco user men, 25-40y/o<br />Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins & nerves<br />
  58. 58. Affects medium-sized arteries (usually plantar & digital vessels in the foot or lower legs)<br />unknown pathogenesis but it had been suggested that:<br />tobacco may trigger an immune response or <br />unmask a clotting defect; <br />-> these 2 can incite an inflammatory reaction of the vessel wall<br />
  59. 59. Manifestations <br /><ul><li>Pain – predominant symptom; R/T distal arterial ischemia
  60. 60. Intermittent claudication in the arch of foot & digits
  61. 61. Increased sensitivity to cold (due to impaired circulation
  62. 62. Absent/diminished peripheral pulses</li></li></ul><li><ul><li>Color changes in extremity (cyanotic on dependent position; digits may turn reddish blue)
  63. 63. Thick malformed nails (chronic ischemia)
  64. 64. Disease progression ulcerate tissues & gangrenous changes may arise; may necessitate amputation </li></li></ul><li>Diagnosis & Treatment<br />Diagnostic methods – those that assess blood flow (Doppler ultrasound & MRI)<br />Tx: mandatory to stop smoking or using tobacco<br />Meds to increase blood flow to extremities<br />Surgery (surgical sympathectomy)<br />amputation<br />
  65. 65. Rynaud’s Disease<br /><ul><li>Mechanism: intensive vasospasm of arteries & arterioles in thefingers
  66. 66. Cause: unknown
  67. 67. Usually affects young women
  68. 68. Precipitated by exposure to cold & strong emotions
  69. 69. Raynaud’s phenomenon – associated with previous injury (i.e.. Frostbite, occupational trauma associated with use of heavy vibrating tools, collagen diseases, neuro d/o, chronic arterial occlusive d/o)</li></li></ul><li>Manifestations <br />Period of ischemia (ischemia due to vasospasm) <br />change in skin color = pallor to cyanotic<br />1st noticed at the fingertips later moving to distal phalanges<br />Cold sensation<br />Sensory perception changes (numbness & tingling)<br /> Period of hyperemia – intense redness<br />Throbbing<br />Paresthesia<br />
  70. 70. Return to normal color<br />Note: although all of the fingers are affected symmetrically, only 1-2digits may be involved<br />Severe cases: arthritis may arise (due to nutritional impairment)<br />Brittle nails<br />Thickening of the skin of fingertips<br />Ulceration & superficial gangrene of fingers (rare occasions)<br />
  71. 71. Diagnosis & Treatment<br /><ul><li>Dx: initial = based on Hx of vasospastic attacks
  72. 72. Immersion of hand in cold water to initiate attack aids in the Dx
  73. 73. Doppler flow velocimetry – used to quantify blood flow during temperature changes
  74. 74. Serial Computed thermography (finger skin temp) – for diagnosing the extent of disease</li></li></ul><li><ul><li>Tx: directed towards eliminating factors causing vasospasm & protecting fingers from injury during ischemic attacks
  75. 75. PRIORITIES: Abstinence in smoking & protection from cold
  76. 76. Avoidance of emotional stress (anxiety & stress may precipitate vascular spasm)
  77. 77. Meds: avoid vasoconstrictors (i.e.. Decongestants)</li></ul> -Calcium channel blockers (Diltiazem, Nifedipine, Nicardipine) – decrease episodes of attacks<br />
  78. 78. Care Plan for Clients with Altered Cardiovascular Oxygenation<br />Goals:<br />Relief of pain & symptoms<br />Prevention of further cardiac damage<br />Nursing Interventions:<br />Pain control<br />Proper medications<br />Decrease client’s anxiety<br />Health teachings (meds, activities, diet, exercise, etc)<br />Assessment:<br />Hx of symptoms (pain, esp. chest pain; palpitations; dyspnea)<br />v/s<br />Nursing Dx: <br />ineffective tissue perfusion (cardiopulmonary)<br />Impaired gas exchange<br />Anxiety due to fear of death (clients with MI or Angina)<br />
  79. 79. Thank you for listening!<br />
  1. A particular slide catching your eye?

    Clipping is a handy way to collect important slides you want to go back to later.

×