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  1. 1. Last LectureCardiovascular Diseases
  2. 2. Alterations in Blood Flow in the Systemic Circulation
  3. 3. ANEURYSM• Dilation involving an artery formed at a weak point in the vessel wall
  4. 4. ANEURYSM• Saccular= when one side of the vessel is affected• Fusiform= when the entire segment becomes dilated
  5. 5. ANEURYSM• RISK FACTORS• Atherosclerosis• Infection= syphilis• Connective tissue disorder• Genetic disorder= Marfan’s Syndrome
  6. 6. ANEURYSM• PATHOPHYSIOLOGY• Damage to the intima and media  weakness  outpouching• Dissecting aneurysm  tear in the intima and media with dissection of blood through the layers
  7. 7. ANEURYSM• ASSESSMENT• Asymptomatic• Pulsatile sensation on the abdomen• Palpable bruit
  8. 8. ANEURYSM• LABORATORY:• CT scan• Ultrasound• X-ray• Aortography
  9. 9. ANEURYSM• Medical Management:• Anti-hypertensives• Synthetic graft
  10. 10. ANEURYSM• 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
  11. 11. PERIPHERAL ARTERIAL OCCLUSIVE DISEASE• Refers to arterial insufficiency of the extremities usually secondary to peripheral atherosclerosis.• Usually found in males age 50 and above• The legs are most often affected
  12. 12. PERIPHERAL ARTERIAL OCCLUSIVE DISEASE• Risk factors for Peripheral Arterial occlusive disease• Non-Modifiable• 1. Age• 2. gender• 3. family predisposition
  13. 13. PERIPHERAL ARTERIAL OCCLUSIVE DISEASE• Risk factors for Peripheral Arterial occlusive disease• Modifiable• 1. Smoking• 2. HPN• 3. Obesity• 4. Sedentary lifestyle• 5. DM• 6. Stress
  14. 14. PERIPHERAL ARTERIAL OCCLUSIVE DISEASE• 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 exercise or activity
  15. 15. PERIPHERAL ARTERIAL OCCLUSIVE DISEASE• ASSESSMENT FINDINGS• 1. INTERMITTENT CLAUDICATION- the hallmark of PAOD• This pain is RELIEVED by REST• This commonly affects the muscle group below the arterial occlusion
  16. 16. PERIPHERAL ARTERIAL OCCLUSIVE DISEASE• Assessment Findings• 2. Progressive pain on the extremity as the disease advances• 3. Sensation of cold and numbness of the extremities
  17. 17. PERIPHERAL ARTERIAL OCCLUSIVE DISEASE• Assessment Findings• 4. Skin is pale when elevated and cyanotic/ruddy when placed on a dependent position• 5. Muscle atrophy, leg ulceration and gangrene
  18. 18. PERIPHERAL ARTERIAL OCCLUSIVE DISEASE• Diagnostic Findings• 1. Unequal pulses between the extremities• 2. Duplex ultrasonography• 3. Doppler flow studies
  19. 19. PAOD• Medical Management• 1. Drug therapy• Pentoxyfylline (Trental) reduces blood viscosity and improves supply of O2 blood to muscles• Cilostazol (Pletaal) inhibits platelet aggregation and increases vasodilatation• 2. Surgery- Bypass graft and anastomoses
  20. 20. PERIPHERAL ARTERIAL OCCLUSIVE DISEASE• Nursing Interventions• 1. Maintain Circulation to the extremity• Evaluate regularly peripheral pulses, temperature, sensation, motor function and capillary refill time• Administer post-operative care to patient who underwent surgery
  21. 21. PERIPHERAL ARTERIAL OCCLUSIVE DISEASE• Nursing Interventions• 2. Monitor and manage complications• Note for bleeding, hematoma, decreased urine output• Elevate the legs to diminish edema• Encourage exercise of the extremity while on bed• Teach patient to avoid leg-crossing
  22. 22. PERIPHERAL ARTERIAL OCCLUSIVE DISEASE• Nursing Interventions• 3. Promote Home management• Encourage lifestyle changes• Instruct to AVOID smoking• Instruct to avoid leg crossing
  23. 23. Buerger’s Disease• Also known as Thromboangiitis obliterans• Usually a disease of heavy cigarette smoker/tobacco user men, 25- 40y/o• Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins & nerves
  24. 24. • Affects medium-sized arteries (usually plantar & digital vessels in the foot or lower legs)• unknown pathogenesis but it had been suggested that: – tobacco may trigger an immune response or – unmask a clotting defect; → these 2 can incite an inflammatory reaction of the vessel wall
  25. 25. Manifestations Pain – predominant symptom; R/T distal arterial ischemia  Intermittent claudication in the arch of foot & digits Increased sensitivity to cold (due to impaired circulation Absent/diminished peripheral pulses
  26. 26.  Color changes in extremity (cyanotic on dependent position; digits may turn reddish blue) Thick malformed nails (chronic ischemia) Disease progression ulcerate tissues & gangrenous changes may arise; may necessitate amputation
  27. 27. Diagnosis & Treatment • Diagnostic methods – those that assess blood flow (Doppler ultrasound & MRI) • Tx: mandatory to stop smoking or using tobacco – Meds to increase blood flow to extremities – Surgery (surgical sympathectomy) – amputation
  28. 28. Rynaud’s Disease Mechanism: intensive vasospasm of arteries & arterioles in the fingers Cause: unknown Usually affects young women Precipitated by exposure to cold & strong emotions 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)
  29. 29. Manifestations• Period of ischemia (ischemia due to vasospasm) – change in skin color = pallor to cyanotic – 1st noticed at the fingertips later moving to distal phalanges – Cold sensation – Sensory perception changes (numbness & tingling)• Period of hyperemia – intense redness – Throbbing – Paresthesia
  30. 30. • Return to normal color• Note: although all of the fingers are affected symmetrically, only 1-2digits may be involved• Severe cases: arthritis may arise (due to nutritional impairment) – Brittle nails – Thickening of the skin of fingertips – Ulceration & superficial gangrene of fingers (rare occasions)
  31. 31. Diagnosis & Treatment Dx: initial = based on Hx of vasospastic attacks  Immersion of hand in cold water to initiate attack aids in the Dx  Doppler flow velocimetry – used to quantify blood flow during temperature changes  Serial Computed thermography (finger skin temp) – for diagnosing the extent of disease
  32. 32.  Tx: directed towards eliminating factors causing vasospasm & protecting fingers from injury during ischemic attacks  PRIORITIES: Abstinence in smoking & protection from cold  Avoidance of emotional stress (anxiety & stress may precipitate vascular spasm)  Meds: avoid vasoconstrictors (i.e.. Decongestants) -Calcium channel blockers (Diltiazem, Nifedipine, Nicardipine) – decrease episodes of attacks
  33. 33. Care Plan for Clients with Altered Cardiovascular OxygenationA. Assessment: C. Goals: 1. Hx of symptoms 1. Relief of pain & (pain, esp. chest pain; symptoms palpitations; dyspnea) 2. Prevention of further 2. v/s cardiac damageB. Nursing Dx: D. Nursing Interventions: 1. ineffective tissue 1. Pain control perfusion 2. Proper medications (cardiopulmonary) 2. Impaired gas exchange 3. Decrease client’s anxiety 3. Anxiety due to fear of 4. Health teachings death (clients with MI or (meds, activities, diet, ex Angina) ercise, etc)
  34. 34. Thank you for listening!