Vascular Disorders

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ittalks about the common disorders regarding Coronary arteries and peripheral blood vessels.

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  • they affect many blood vessels that supply body organs and tissue.they even contribute to several disorders such as MI,CVA, RENAL FAILURE.
  • CAD may result in angina pectoris, due to inadequate supply of oxygen in the myocardium. Death of heart muscle does not accompany angina.
  • Acrus senilis- opaque white ring about the periphery of cornea Xanthelisma- yellow plaque on the skin of the upper lower eyelids. Poteins transport lipids in the blood. LDL- bad c. because it sticks to arteries. HDL- it carries fats to the liver for removal. Cardiac risk can be estimated by dividing the TSC level by HDL level; a result greater than 5 suggest a potential for CAD. Apolipoproteins-low or absent among clients genetically prone to hyperlipidemia ECG- ST segemnt depression Coronary arteriography- shows narrowing of one or two C arteries Electron- beam computed tomography- detects calcified plaques in 1 or more CA in asymptomatic clients
  • Nitrates- helps dilates artery Beta adrenergic blocking agents- dec. consumption of O2 by reducing heart rate Calcium channel blocking agents- Antibiotic – Azithromycin Nicotinic acids- niacin - helps inc. HDL and lower LDL Vit. B 6 and B 12 - Aspirin Percutaneous transluminalcoronary angioplasty (PTCA)- baloon angioplasty use to compress the artherosclerotic plaque against the arterial wall. Coronary Stent-a smaal metal coil with meshlike openings placed in the coronary artery during PTCA. Atherectomy- removal of fatty plaque 4 types 1. Directional Coronary Atherectomy-shaves the plaque from the arterial wall and stores it in the catheter 2. Transluminal extraction- uses cardiac cath. With spinning blade 3. Percutaneous transluminal Cath.- uses rotating bur that spins at 200, 000 rev. per min. 4. Laser angioplasty- uses short pulses of light that vaporize plaque without creating heat.
  • Coronary Thrombosis – clot in the coronary artery Once an area of myocardium has been damaged cells in the area lose their special function.thus dysrhytmias and heart failure is the common consequences. Dysrhythmias Cardiogenic shock Ventricular rupture Ventricular aneurysm Arterial embolism Venous thrombosis Pulmonary Embolism Pericarditis Mitral insufficiency
  • the only diff.is that the pain cant be relieve with rest
  • RAYNAUDS DISEASE- coomon in young women. Most coomon site nose, ears, chin , toes,. Spasm last 15 min. And cause temp. ischemia of the tisue. Laboratory examination- to rule out accompanying tissue disorder. S& Sx Can be relieve by putting the handds in a warm water.
  • Uses stocking except when lying helps maintain 40 mmHg venous pressure
  • Anything that interferes with venous return .
  • Vein ligation- affected veins are tied off. Vein stripping- ligated veins are severed and removed. The Great saphenous veins may be removed.
  • Most common anuerysm in the aorta. Most aneurysm enlarge untill rupture. Loss of arterial blood volume may lead to shock and death. Some teras blood into sorrounding cavities, like the thorax ao abdomen.
  • Vascular Disorders

    1. 1. CHAPTER 33 Vascular Disorders Aubrey Gynn Gumapac
    2. 2. ARTERIOSCLEROSIS & ARTHEROSCLEROSIS <ul><li>Arteriosclerosis – refers to loss of elasticity or hardening of the arteries. </li></ul><ul><li>Atherosclerosis - refers to accumulation of fat deposits in the lumen of the arteries, called plaque. </li></ul><ul><li>Hyperlipidemia – high levels of blood fats. </li></ul><ul><li>Factors: </li></ul><ul><li>Heredity- </li></ul><ul><li>diet – </li></ul><ul><li>sex- </li></ul>
    3. 3. OCCLUSIVE DISORDER OF CORONARY BLOOD VESSELS <ul><li>Coronary occlusion- closing of a coronary artery which results in total interruption in blood supply to the muscle area. </li></ul><ul><li>Coronary Artery Disease (CAD) – refers to atherosclerotic & arteriosclerotic changes in the coronary arteries supplying the myocardium. </li></ul><ul><li>Risk factors: </li></ul><ul><li>Inherited behavioral </li></ul><ul><li>male sex smoking </li></ul><ul><li>DM obesity </li></ul><ul><li>increased lipid levels competitive, aggressive </li></ul><ul><li>hypertension high- fat diet </li></ul><ul><li>genetic predisposition sedentary lifestyle </li></ul>
    4. 4. ASSESSMENT FINDINGS <ul><li>SIGNS AND SYMPTOMS: </li></ul><ul><li>Fatigue </li></ul><ul><li>Chest pain( angina) </li></ul><ul><li>Pain radiating to shoulders, arms, </li></ul><ul><li>especially on the left side, jaw, neck or </li></ul><ul><li>Teeth </li></ul><ul><li>Squeezing, burning, crushing tightness in chest & throat </li></ul><ul><li>Hyperlipidemia </li></ul><ul><li>Acrus senilis </li></ul><ul><li>xanthelisma </li></ul><ul><li>Diagnostic findings </li></ul><ul><li>Total serum cholesterol & triglycerides – elevated </li></ul><ul><li>LDL (bad cholesterol)- higher ratio of cholesterol than protein </li></ul><ul><li>HDL (good Cholesterol)- lower than desired </li></ul><ul><li>Apolipoproteins-low or absent </li></ul><ul><li>ECG </li></ul><ul><li>Coronary arteriography </li></ul><ul><li>Electron- beam computed tomography </li></ul>
    5. 5. MEDICAL AND SURGICAL MANAGEMENT <ul><li>DRUG THERAPHY </li></ul><ul><li>nitrates- nitroglycerin, isorbide dinitrate </li></ul><ul><li>Beta adrenergic blocking agents </li></ul><ul><li>Calcium channel blocking agents </li></ul><ul><li>Antibiotic – Azithromycin </li></ul><ul><li>Nicotinic acids- niacin </li></ul><ul><li>Vit. B 6 and B 12 - </li></ul><ul><li>Aspirin </li></ul><ul><li>Surgiacal Theraphy </li></ul><ul><li>Percutaneous transluminal </li></ul><ul><li>coronary angioplasty (PTCA) </li></ul><ul><li>Coronary Stent- </li></ul><ul><li>Atherectomy- </li></ul><ul><li>4 types </li></ul><ul><li>1. Directional Coronary </li></ul><ul><li>Atherectomy </li></ul><ul><li>2. Transluminal extraction </li></ul><ul><li>3. Percutaneous transluminal Cath. </li></ul><ul><li>4. Laser angioplasty </li></ul><ul><li>Coronary Artery Bypass Graft </li></ul>
    6. 6. NURSING MANAGEMENT <ul><li>Asess character of pain </li></ul><ul><li>Administer </li></ul><ul><li>Prescribed medication </li></ul><ul><li>Encouraged client </li></ul><ul><li>to rest & administerO 2 </li></ul><ul><li>Notify physician if </li></ul><ul><li>pain does not relieve </li></ul><ul><li>Low fat diet & anerobic exercise </li></ul>
    7. 7. MYOCARDIAL INFARCTION <ul><li>It occurs when </li></ul><ul><li>there is total </li></ul><ul><li>occlusion Of coronary </li></ul><ul><li>arterial blood flow. </li></ul><ul><li>Coronary Thrombosis </li></ul><ul><li>Most common cause of MI </li></ul><ul><li>3 zones of tissue damage </li></ul><ul><li>Central area of necrotic death of myocardial cells </li></ul><ul><li>Injured cells, sorround the 1 st zone </li></ul><ul><li>Ischemic area </li></ul><ul><li>COMPLICATIONS </li></ul><ul><li>Dysrhythmias </li></ul><ul><li>Cardiogenic shock </li></ul><ul><li>Ventricular rupture </li></ul><ul><li>Ventricular aneurysm </li></ul><ul><li>Arterial embolism </li></ul><ul><li>Venous thrombosis </li></ul><ul><li>Pulmonary Embolism </li></ul><ul><li>Pericarditis </li></ul><ul><li>Mitral insufficiency </li></ul>
    8. 8. ASSESMENT FINDINGS <ul><li>S & Sx, </li></ul><ul><li>Severe chest pain </li></ul><ul><li>Same signs & </li></ul><ul><li>Symptoms With </li></ul><ul><li>angina, </li></ul><ul><li>Client appear pale </li></ul><ul><li>And diaphoretic </li></ul><ul><li>Squeezing & crushing </li></ul><ul><li>Pain </li></ul><ul><li>Hypotensive and faint </li></ul><ul><li>DIAGNOSTIC FINDINGS </li></ul><ul><li>Creatinine kinase & </li></ul><ul><li>Lactate dehydrogenase- all elevated </li></ul><ul><li>WBC, C- reactive protein, </li></ul><ul><li>Erythrocyte </li></ul><ul><li>sedimentation rate-inc. </li></ul><ul><li>Blood glucose- elevated </li></ul><ul><li>ECG- ST segment elev. , </li></ul><ul><li>T- wave inversion, and Q </li></ul><ul><li>Wave. </li></ul>
    9. 9. MEDICAL AND SURGICAL MANAGEMENT <ul><li>DRUG THERAPHY </li></ul><ul><li>Vasodilators – nitroglycerine </li></ul><ul><li>Beta-adrenergic blockers- propanolol(inderal) </li></ul><ul><li>Thrombolytics – alteplase (Activase); </li></ul><ul><li>Anticougalants – heparin sodium(Hepalaen) </li></ul><ul><li>Calcuim channel blockers- diltiazine(cardizem) </li></ul><ul><li>Diuretics- furosimide (Lasix) </li></ul><ul><li>SURGICAL MANAGEMENT </li></ul><ul><li>Cardiac rehabilitation </li></ul><ul><li>Nursing Management </li></ul><ul><li>Asses character of pain </li></ul><ul><li>Vital signs every 30 min. until stable </li></ul><ul><li>Presence of N&V, diaphoresis, anxiety </li></ul><ul><li>O2 saturation level by oximeter </li></ul><ul><li>ECG for cardiac rhythm </li></ul><ul><li>Drug Hx (OTC),herbs. </li></ul><ul><li>Hx of DM, Hypertension, allergy to drugs, </li></ul>
    10. 10. NURSING DIAGNOSIS <ul><li>Acute pain related to diminished myocardial oxygenation </li></ul><ul><li>Hemorrhage related to thrombolytic therapy </li></ul><ul><li>Dysrhythmias related to reperfusion of myocardium with thrombolytic therapy and instability of the conduction system. </li></ul>
    11. 11. OCCLUSIVE DISORDERS OF PERIPHERAL BLOOD VESSELS <ul><li>Peripheral vascular disorder –affect blood vessels. </li></ul><ul><li>RAYNAUDS DISEASE- periodic constriction of arteries that supply extremeties. </li></ul><ul><li>DIAGNOSTIC FINDINGS </li></ul><ul><li>Diagnosis Hx of the Sx </li></ul><ul><li>Laboratory examination </li></ul><ul><li>S & Sx </li></ul><ul><li>After exposure to cold </li></ul><ul><li>Hands becomes cold, </li></ul><ul><li>blanched, wet with </li></ul><ul><li>perspiration </li></ul><ul><li>Numbness & tingling </li></ul><ul><li>Cyanotic & begins to </li></ul><ul><li>Ache </li></ul><ul><li>Ischemia </li></ul><ul><li>Pain </li></ul><ul><li>Slow healing of minor </li></ul><ul><li>lesions </li></ul>
    12. 12. MEDICAL AND SURGICAL MANAGEMENT <ul><li>Avoid smoking </li></ul><ul><li>Isoxsupirine </li></ul><ul><li>(Vasodilan) </li></ul><ul><li>Nifidipine ( Procardia) </li></ul><ul><li>IV infusion of </li></ul><ul><li>prostaglandin E </li></ul><ul><li>Sympathectomy </li></ul><ul><li>(cutting of per. </li></ul><ul><li>Symphatitic nerves </li></ul><ul><li>NURSING MANAGEMENT </li></ul><ul><li>Encourages client to </li></ul><ul><li>Imagine warming </li></ul><ul><li>Hands by holding </li></ul><ul><li>Them together near a </li></ul><ul><li>Fire. </li></ul><ul><li>Snow skiers (McIntyre </li></ul><ul><li>manuevers </li></ul><ul><li>Health teachings about the dis. </li></ul><ul><li>Instuct client to avoid smoking </li></ul><ul><li>Nail care </li></ul>
    13. 13. THROMBOSIS, PHLEBOTHROMBOSIS AND EMBOLISM <ul><li>Thrombosis- a clot forms in the blood vessels </li></ul><ul><li>Phlebothrombosis- dev. Of clot within a vein without inflammation </li></ul><ul><li>Embolus- a moving mass (clot) of particles, either solid or gas, in the bloodstream. </li></ul><ul><li>S &Sx </li></ul><ul><li>Ischemia </li></ul><ul><li>Extremities becomes pale, </li></ul><ul><li>Cold,& extremely painful </li></ul><ul><li>Arterial pulsation is </li></ul><ul><li>absent </li></ul><ul><li>Numbness, tingling, </li></ul><ul><li>Cramping </li></ul><ul><li>Mild fever & pain, Homans </li></ul><ul><li>Sign </li></ul>
    14. 14. MEDICAL AND SURGICAL MANAGEMENT <ul><li>ARTERIAL OCCLUSIVE DISEASE </li></ul><ul><li>Immediate inject. Of </li></ul><ul><li>Heparin, </li></ul><ul><li>Administering </li></ul><ul><li>vasodilation drugs </li></ul><ul><li>Narcotics </li></ul><ul><li>Thrombolytic agent </li></ul><ul><li>Thrombectomy,embolecto </li></ul><ul><li>My, endarterectomy,CABG </li></ul><ul><li>VENOUS OCCLUSIVE </li></ul><ul><li>DISEASE </li></ul><ul><li>Bed rest </li></ul><ul><li>Elevation of the </li></ul><ul><li>Extremeties </li></ul><ul><li>Local heat </li></ul><ul><li>Analgesic for pain </li></ul><ul><li>Continues heparin therapy </li></ul><ul><li>Oral coagulants once heparin achieved therapeutic effect </li></ul><ul><li>thrombectomy </li></ul>
    15. 15. VENOUS INSUFFICIENCY <ul><li>A peripheral disorder in which venous blood is impaired through deep or superficial </li></ul><ul><li>veins . </li></ul><ul><li>Varicose, valvular </li></ul><ul><li>damage, </li></ul><ul><li>S & Sx </li></ul><ul><li>Swollen foot, dilated </li></ul><ul><li>Superficail veins, not </li></ul><ul><li>uniform skin color, lesion </li></ul><ul><li>Drainage color opaque, </li></ul><ul><li>Moderate pain, pedal & </li></ul><ul><li>tibial difficult to palpate </li></ul><ul><li>DIAGNOSTIC FINNDINGS </li></ul><ul><li>Doopler ultrasound </li></ul><ul><li>Photoplethysmography </li></ul><ul><li>Air photoplethysmography </li></ul><ul><li>NURSING MANAGEMENT </li></ul><ul><li>Assess appearance of the extremities </li></ul><ul><li>If ulcer is present measure and describe apperance </li></ul><ul><li>Rate pain & admin. Analgesics </li></ul><ul><li>Measure calf,ankle, length of legs for stockings </li></ul><ul><li>implements wound care </li></ul>
    16. 16. MEDICAL AND SURGICAL MANAGEMENT <ul><li>NON-SURGICAL THERAPHY </li></ul><ul><li>Apply elastic </li></ul><ul><li>compression stocking </li></ul><ul><li>Mild analgesics </li></ul><ul><li>Clean wound by soap & water or disinfectant </li></ul><ul><li>Topical hyperbaric oxygen </li></ul><ul><li>SURGICAL THERAPHY </li></ul><ul><li>Vascular therapy </li></ul><ul><li>Necrotic tissue debridement </li></ul>
    17. 17. DIORDERS OF BLOOD VESSEL WALLS <ul><li>VARICOSE VEINS </li></ul><ul><li>Dilated varicose that may occur in the other parts, such as rectum, & esophagus. </li></ul><ul><li>Prolonged standing, obesity, pressure on blood vessels from an enlarging fetus, liver, or abdominal tumor, thrombophlebitis. </li></ul><ul><li>ASSESSMENT FINDING </li></ul><ul><li>S & Sx </li></ul><ul><li>Legs feels heavy and tired, leg veins distended which appears to be dark blue or purple, snakelike, elevations. </li></ul><ul><li>Swollen feet, ankles, & legs </li></ul><ul><li>Diagnostic findings </li></ul><ul><li>Brodie-trendelenburg test </li></ul><ul><li>Ultrasonography & venography </li></ul>
    18. 18. MEDICAL, SURGICAL AND NURSING MANAGEMENT <ul><li>MEDICAL MNGT. </li></ul><ul><li>exercising( walking or swimming), losing weight if needed, wearing elastic support stockings, avoid prolong standing. </li></ul><ul><li>SURGICAL MAN. </li></ul><ul><li>Vein ligation </li></ul><ul><li>Vein stripping </li></ul><ul><li>NURSING MNGT. </li></ul><ul><li>Assess skin, distal circulation, peripheral edema. </li></ul><ul><li>Monitor for swelling in the operative legs & its affect in circulation </li></ul><ul><li>Rewrapped bandage to facilitate blood flow. </li></ul><ul><li>Inspect dressing for active bleeding </li></ul>
    19. 19. ANUERYSMS <ul><li>Stretching and bulging of an arterial wall. </li></ul><ul><li>Arterosclesoris, hypertension, trauma, or congenital weakness affects the tunica media, causing the part of the vessels to buldge. </li></ul><ul><li>When the blood flow decreases or stops, tissue necrosis. </li></ul><ul><li>S & Sx </li></ul><ul><li>Pain, discomfort, dysphagia, dyspnea, </li></ul><ul><li>Nausea and vommiting, pulsating mass around the umbilicus. Bruit ( blowing or purring sound </li></ul><ul><li>Difference in BP on the Left arm & right arm maybe different, and so is in both legs. </li></ul><ul><li>DIAGNOSTIC FINDINGS </li></ul><ul><li>Radiographs </li></ul><ul><li>aortagraphs </li></ul>
    20. 20. MEDICAL, SURGICAL AND NURSING MANAGEMENT <ul><li>MEDICAL TREAT. </li></ul><ul><li>Administering anti-hypertensive drugs </li></ul><ul><li>SURGCAL TREAT. </li></ul><ul><li>Bypass or grafting. </li></ul><ul><li>NURSING INTER. </li></ul><ul><li>Minimize activity </li></ul><ul><li>Instruct client to avoid straining during bowel movement, coughing, & holding breaths when positioning. </li></ul><ul><li>Monitor BP, PR, hourly urine output, skin color, LOC, and chatheristic of pain. </li></ul><ul><li>Monitor client for possible shock and adequate tissue perffusion. </li></ul>
    21. 21. Thank You For Listening!

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