3. introduction
Conditions of vascular system include arterial
disorders, venous disorders, lymphatic
disorders & cellulites. Nursing management
depends on a understanding of vascular
systems. Adequate blood flow depends on the
efficiency of heart as a pump, the patency &
responsiveness of the blood vessels
characteristics all peripheral vascular
disease.
6. definition
Reynaud’s phenomenon is a form of
intermittent arteries vasoconstriction that
results in coolness, pain and pallor of the
fingertips or toes.
OR
Raynaud's disease causes some areas of your
body — such as your fingers and toes — to feel
numb and cold in response to cold
temperatures or stress. In Raynaud's disease,
smaller arteries that supply blood to your skin
narrow, limiting blood circulation to affected
areas (vasospasm).
7. Risk factors
Risk factors for primary Raynaud's include:
Sex
Age
Climate
Family history
Risk factors for secondary Raynaud's include:
Associated diseases
Certain occupations
Exposure to certain substances
8. causes
Blood vessels in spasm
With Raynaud's, arteries to your fingers and toes go
into vasospasm when exposed to cold or stress,
narrowing your vessels and temporarily limiting blood
supply. Over time, these small arteries can thicken
slightly, further limiting blood flow.
Reynaud’s disease has no identifiable cause , whereas
Reynaud’s phenomenon occurs secondarily to
another disease.
9. Contd…
Causes of secondary Raynaud’s include:
1. Connective tissue diseases.
2. Diseases of the arteries.
3. Carpal tunnel syndrome.
4. Repetitive action or vibration.
5. Smoking.
6. Injuries to the hands or feet
7. Certain medications. These include beta blockers, used to treat high
blood pressure; migraine medications; attention-
disorder medications; certain chemotherapy agents; and drugs that
cause blood vessels to narrow, such as some over-the-counter cold
medications.
10. Clinical manifestations
Signs and symptoms of Raynaud's disease
include:
Cold fingers or toes.
Color changes in your skin in response to cold or stress.
Numb, prickly feeling or stinging pain upon warming or stress relief.
During an attack of Raynaud's, affected areas of your skin usually first
turn white. Then, they often turn blue and feel cold and numb. As
you warm and circulation improves, the affected areas may turn red,
throb, tingle or swell.
14. DIAGNOSIS
To distinguish between primary and
secondary Raynaud's, your doctor
might perform a test called nail
fold capillaroscopy.
If your doctor suspects that
another condition, such as an
autoimmune or connective tissue
disease, underlies Raynaud's, he or
she will likely order blood tests,
such as:
Antinuclear antibodies test.
Erythrocyte sedimentation rate.
15. COMPLICATIONS
Manifestations for at least 2 years.
Intermittent attacks of pallor or
cyanosis of the digits by exposure to
cold or from emotional stimuli.
Scleroderma
No evidence of occlusive disease in the
digital arteries or of any systemic
disease that might be the cause of
chnages.
Gangrene, whicha (which it occurs) is
limited to the skin of lips of the digits.
16. ASSESSMENT
(1)History and evaluation: The nurse obtains an in depth description from the pt of any
pain and its precipitating factors by assessing the following :-
Intermittent claudication-
Any previous peripheral vascular disorder occurrence-
Patient’s occupations and local guide
(2)PHYSICAL ASSESSMENT
Inspection of the skin
Palpation of pulse
(3)COLD STIMULATION TEST
This is performed to detect Reynaud’s disease .In this test the nurse tapes a
temperature measuring device to each of the fingers and records the
temperature afterwards submerge the hands in the water for 20 seconds
as soon as the hands are removed the nurse records the temperature of
finger immediately and every 5 min .thereafter until the temperature
to the pretest level.
(4)ERTHROCYTE SEDTIMENTATIONRATE(ESK)test
17. MEDICAL MANAGEMENT
Treatment
Dressing for the cold in layers and wearing gloves or heavy socks usually are effective in
with mild symptoms of Raynaud's. Medications are available to treat more-severe forms of
condition. The goals of treatment are to:
Reduce the number and severity of attacks
Prevent tissue damage
Treat the underlying disease or condition
Medications
Calcium channel blockers. These drugs relax and open small blood vessels in your hands
and feet, decreasing the frequency and severity of attacks in most people with Raynaud's.
These drugs can also help heal skin ulcers on your fingers or toes. Examples include
(Afeditab CR, Procardia, others), amlodipine (Norvasc), felodipine and isradipine.
Vasodilators. These drugs, which relax blood vessels, include nitroglycerin cream applied to
the base of your fingers to help heal skin ulcers. Other vasodilators include the high blood
pressure drug losartan (Cozaar), the erectile dysfunction medication sildenafil (Viagra,
the antidepressant fluoxetine (Prozac, Sarafem, others) and a class of medications called
prostaglandins.
alpha adrenergic block : prazosin (minipress ) reduce the frequency and severity of attacks.
18. SURGICAL MANAGEMENT
Nerve surgery. Sympathetic nerves in your hands and feet control
the opening and narrowing of blood vessels in your skin. Cutting
these nerves interrupts their exaggerated responses.
Through small incisions in the affected hands or feet, a doctor strips
these tiny nerves around the blood vessels. This surgery
(sympathectomy), if successful, might reduce the frequency and
duration of attacks.
Chemical injection. Doctors can inject chemicals such as local
anesthetics or onabotulinumtoxin type A (Botox) to block
sympathetic nerves in affected hands or feet. You might need to
the procedure repeated if symptoms return or persist.
Arterial bypass surgery : It is a surgery to reroute the blood
supply around a blocked artery by replacing the blocked artery
prosthetic material or the patient’s artery or vein.
Amputation : Removal of a body extremity by surgery to save the
pt’s life. Toes are the most amputated part of the body .
19.
20. 1.NURSING DIAGNOSIS : Ineffective peripheral tissue perfusion lack of
blood relates to supply to extremities.
Goal-increased arterial blood circulation ,color and sensation at the
extremities.
Nursing Intervention-
Asses the patient for the blood circulation, color and sensation at the
extremities.
Apply warm compress at the affected areas.
Administer the medication as prescribed by doctor such as vasodilator
,calcium channels blockers and alpha blockers .
Monitor the blood circulation to the extremities every two hourly
(circulation chart).
Encourage patient to perform extremities exercises while sitting or during
works.
Evaluation- Patient’s extremities are warm to touch, improve in color & no
complain of numbness.
21. 2.NURSING DIAGNOSIS: Anxiety related to disease process.
Goal: to reduce the anxiety related level of patients
Nursing Intervention –
Asses the patients anxiety level by observing clients behavior eg crying,
expression and anxious
Reinforce doctor’s explanations to patients by using the non- medical term
Provide moral and emotional support to patients
Encourage diversional therapy eg: watching t.v, listening songs
Evaluation- Patient’s anxiety level decreases & client is more clear about the
disease.
22. 3.NURSING DIAGNOSIS- Deficient knowledge regarding self –care
activities. activities.
Goal : The patients will able to carry out daily activity by understanding
the health education given by nurse based on the disease.
Nursing intervention
1.Asses clients knowledge level.
2. Encourage patients to perform extremities exercises.
3.Advise pt to place the fingers or toe under the warm water duringthe
attack.
4. Advise pt to stop smoking.
5.Advise patient not to wear tight wrist band or watch and clothings.
6. Patients should be cautioned to handle sharp objects carefully to avoid
injury to their fingers.
7. Avoid using tools that vibrate the hands.
Evaluation- Client is able to carry out the daily activities by implementing
the health education was given.
26. DEFINITION
An aneurysm is an abnormal dilation of a blood
vessel, commonly at a site of weakness or tear in
the vessel wall it commonly affect the aorta and
peripheral arteries , because of high pressure in
these vessels .it is more common in man of
age,>50 Years
OR
An aneurysm refers to a weakening of an artery
wall that creates a bulge, or distention, of the
artery.
27. RISK FACTORS
RISK FACTORS
Older age
Cigarette smoking
High blood pressure (hypertension)
Drug abuse, particularly the use of cocaine
Heavy alcohol consumption
Risk factors present at birth
These include:
Inherited connective tissue disorders, such as Ehlers-Danlos syndrome, that
weaken blood vessels
Polycystic kidney disease, an inherited disorder that results in fluid-filled sacs in
the kidneys and usually increases blood pressure.
28. CAUSES
Aortic dissection
Atherosleroisis.
High cholesterol.
Hypertension weakness and damages aorta wall
Damage to the artery wall of metalloproteinase infection
,congenital weakning of the connective tissue component
the artery wall (eg mafan syndrome ) , myotic infections or
rarely by trauma.
Cigarette smoking
Diabetes mellitus
Genetic factors
29. TYPES OF
ANEURYSM
1.
• Thoracic aortic aneurysm
2.
• Abdominal aortic aneurysm
3.
• Intracranial aneurysm
4.
• Peripheral aneurysm
ON THE BASIS OF
LOCATION
30. TYPES ON THE BASIS OF
SHAPES & FORMS
False aneurysm
True aneurysm
Fusiform
Saccular
aneurysm
Dissecting
aneurysm
31. PATHOPHYSIOLOGY
Aorta supplies blood.
Etiological factors such as degenerative disease and destruction of elastin and collagen fibers.
Inflammatory mechanism trauma
Factors weakening the vessels wall + forceful turbulent blood flow.
Dilate the wall.
35. complications
Most people living with an aneurysm do not experience any complications.
However, in addition to thrombo embolism and rupture of the aorta,
complications can include:
Severe chest or back pain: Severe chest or back pain may arise
following the rupture of an aortic aneurysm in the chest.
Angina: Certain types of aneurysm can lead to angina, another type of
chest pain. Angina can lead to myocardial ischemia and heart attack.
A sudden extreme headache: If a brain aneurysm leads to SAH, the
main symptom is a sudden, severe headache.
Any rupture of an aneurysm may cause pain, low blood pressure, a rapid heart
rate, and lightheadedness. Most people with an aneurysm will not experience
any complications.
36. assessment
Subjective and objective data:
Initially , clients are often asymptomatic
Abdominal aortic aneurysm (AAA)-
most common related to artherosclerosis
Constant gnawing feeling in abdomen , flank or back pain
Pulsating abdominal mass (do not palpate ; may cause rupture)
Bruit
Elevated blood pressure (unless in cardiac tamponade or rupture of aneurysm)
Aortic dissection (often associated with marfan’s syndrome)
sudden onset of tearing , ‘ripping’ and stabbing abdominal or back pain
Hypovolemic shock
Diaphoresis , nausea , vomiting , faintness apprehension
Neurological deficits
Hypotension and tachycardia(initial)
Thoracic aortic aneurism –
severe back pain (most common)
Hoarseness , cough ,shortness of breath and difficulty swallowing
37. Medical management
The priority intervention is to reduce systolic BP b/w 100 and 120 mm Hg during emergency . long
term goal includes maintaining systolic blood pressure at or less than 130 to 140 mm Hg.
Pain relievers, such as acetaminophen (Tylenol, others), may be used to treat headache pain.
Calcium channel blockers prevent calcium from entering cells of the blood vessel walls. These
medications may lessen the erratic narrowing of blood vessels (vasospasm) that may be a
complication of a ruptured aneurysm.
One of these medications, nimodipine (Nymalize, Nimotop), has been shown to reduce the risk of
delayed brain injury caused by insufficient blood flow after subarachnoid hemorrhage from a
ruptured aneurysm.
Interventions to prevent stroke from insufficient blood flow include intravenous injections of a
drug called a vasopressor, which elevates blood pressure to overcome the resistance of narrowed
blood vessels.
An alternative intervention to prevent stroke is angioplasty.
Anti-seizure medications may be used to treat seizures related to a ruptured aneurysm. These
medications include levetiracetam (Keppra), phenytoin (Dilantin, Phenytek, others), valproic acid
(Depakene) and others. Their use has been debated by several experts, and is generally subject to
caregiver discretion, based on the medical needs of each patient.
Rehabilitative therapy. Damage to the brain from a subarachnoid hemorrhage may result in the
need for physical, speech and occupational therapy to relearn skills.
38. Surgical management
Abdominal aortic aneurysm resection –
Percutaneous aneurysm repair –
Brain aneurysm surgery
There are two common treatment options for a
ruptured brain aneurysm.
Surgical clipping
Endovascular coiling
39.
40. Nursing DiagnosisI. – Risk for tissue perfusion related to defect in the vessel
wall, leading to risk for dissection.
Goal : To reduce risk for complications from progressive dissection or rupture as
result of early detection of symptoms and appropriate intervention.
Nursing interventions-
Assess and monitor the location and characteristic of pain.
Thoracic: pain in the neck, low back, shoulders, or abdomen.
Abdominal: pain in the abdomen or back, flank, or groin caused by the pressure
on adjacent structures.
Obtain a thorough history regarding risk factors for dissection or rupture.
Monitor for signs and symptoms indicating progressive dissection.
For abdominal aneurysms:
Assess the lower extremities for signs of peripheral ischemia and insufficiency
(such as paralysis, pain, paresthesia, pallor, pulselessness, and poikilothermia
[decreased temperature, coolness]).
Monitor for abdominal distention, diarrhea, or severe abdominal pain
and/or fever.
Gently palpate the abdomen for a midline mass or pulsation.
Monitor urine output.
41. Contd……
For thoracic aneurysms:
Assess the quality of peripheral pulses.
Assess for respiratory compromise.
Assess for hemoptysis.
Assess for disphagia.
Assess for upper-extremity and head swelling with cyanosis.
Provide nonpharmacological measures to alleviate pain:
Relaxation techniques
Physical comfort (such as cold towel application, hand-holding)
Position of comfort (e.g, place clients exhibiting back pain in a side-lying position)
Administer antihypertensive medications as indicated: angiotensin-converting enzyme (ACE)
inhibitor, beta-blocker.
Administer pain medication as indicated.
For type A dissections (involving ascending aorta or transverse arch), prepare the client for
intervention.
For type B dissection (involving descending thoracic aorta), anticipate chronic medical treatment
which consists of the following long-term measures
Administer sedatives as indicated.
42. Nursingdiagnosis II -Risk for decreased cardiac output related to rupture of
the aorta.
Goal: To maintain normal cardiac output.
Nursing interventions-
Asess for signs of myocardial ischemia: chest pain, tachycardia, or ST-
segment and T-wave changes on electrocardiogram (ECG).
Assess the client’s hemodynamic status. Monitor for signs of decreasing
cardiac output, such as tachycardia, decreased urine output, and
restlessness.
Administer medications, intravenous fluids, and blood as order.
Send a blood specimen for type and crossmatch and other routine
preoperative blood work.
If decreased cardiac output is drug induced, anticipate the following:
For beta-blocker: May stop the drug or reduce the dose.
For vasodilators: Stop the drug and administer isotonic solution
(0.9% normal saline solution) or plasma expanders.
43. NursingDiagnosisIII. Anxiety related to sudden onset of
illness.
Goal – To reduce the level of anxiety.
Nursing Intervention-
Assess the client’s anxiety level (mild, severe). Note
signs and symptoms, especially non verbal
communication.
Acknowledge awareness of the client’s anxiety.
Provide a quiet, private place for significant others
to wait.
Reduce unnecessary external stimuli.
Explain all procedures as appropriate, using
simple, concrete words.
44. NursingDiagnosisIV. Deficient Knowledge related to new medical problem
&unfamiliarity with surgical procedure and hospital care.
GOAL - The patient will be understand about disease process, treatment &
medications given.
Nursing Interventions-
• Assess the client’s knowledge of the disease and treatment options.
• Instruct medically treated clients about the following:
• Goals of therapy (avoidance of excess BP and strain on the disease arterial
wall)
• Importance of follow-up computed tomography scanning
• Signs and symptoms to report
• Side effects of the drug
• Use of antihypertensive medications as prescribed; importance of
compliance
• Instruct surgical clients about the following:
• Avoidance activities that are isometric or abruptly can raise BP (e.g., lifting
and carrying of heavy objects, straining for bowel movements)
• Signs and symptoms to report
• Wound care
• Instruct endograft clients about the need for follow-up CT scans at 1 and 6
months and yearly for the rest of their lives.
45. Health education
However, some lifestyle choices can affect the risk:
Smoking is a risk factor for both aortic aneurysms and the rupture of an aneurysm anywhere in
in the body. Quitting smokingcan reduce the risk of a severe aneurysm.
Managing blood pressure can also minimize the risk of an aneurysm. Healthful blood pressure
can be achieved through dietary measures, regular exercise, and medications.
Obesity can put extra pressure on the heart, so taking these steps is important for
reducing stress on the artery walls.
A healthful diet can also reduce cholesterol and decrease the risk of atherosclerosis . Fusiform
aneurysms are often linked to atherosclerosis.
Prevent infection (good hand hygiene, wound care management). Report evidence of infection.
infection. (wound redness, edema, drainage ; elevated temperature).
Encourage proper diet (low fat, high protein, vitamin A&C, Zinc to promote wound healing)
Review manifestation of aneurysm rupture (abdominal fullness or pain, chest of back pain,
shortness of breath, cough, difficulty swallowing hoarseness) Instruct client to report these
immediately.
Avoid strenuous activity & restrict heavy lifting to less than 15 Lb (Surgical client).
47. definition
Peripheral artery disease (also called peripheral arterial
disease) is a common circulatory problem in which
narrowed arteries reduce blood flow to your limbs.
OR
A circulatory condition in which narrowed blood vessels
reduce blood flow to the limbs.
Peripheral vascular disease is a sign of fatty deposits
and calcium building up in the walls of the arteries
(atherosclerosis).
48.
49. etiology
Arthero sclerosis.
Blood clots.
Diabetes.
Inflammation of the arteries or veins.
Infection.
Structural defects
50.
51. Diagnostic evaluation
Segmental pressure measurements
Stress Testing
Doppler ultrasound :
Transcutaneous oximetry:
Angiography or Magnetic resonance angiography
MRI
Lipid profile test
52. Clinical manifestations
Painful cramping in one or both of your hips, thighs or calf muscles after certain
activities, such as walking or climbing stairs (claudication)
Leg numbness or weakness
Coldness in your lower leg or foot, especially when compared with the other side
Sores on your toes, feet or legs that won't heal
A change in the color of your legs
Hair loss or slower hair growth on your feet and legs
Slower growth of your toenails
Shiny skin on your legs
No pulse or a weak pulse in your legs or feet
Erectile dysfunction in men
If peripheral artery disease progresses, pain may even occur when you're at rest or
when you're lying down (ischemic rest pain). It may be intense enough to disrupt
sleep. Hanging your legs over the edge of your bed or walking around your room
may temporarily relieve the pain.
54. assessment
History : Complaints of pain, its relationship to exercise or
rest, timing, associated symptoms and relief measures,
of Coronary Heart Disease & activity pattern.
Physical Examination : Vital signs; strength & equality of
peripheral pulses of all extremities, capillary refill, skin colour,
temperature, hair distribution, presence of any discolouration
or lesion, movement & sensation of lower extremities.
55. Medical management
Cholesterol-lowering medications.
High blood pressure medications. Medication to control
blood sugar.
Medications to prevent blood clots:
Symptom-relief medications.
58. Nursing diagnosisI : Ineffective peripheral tissue perfusion related to compromised circulation.
Goal : Increased arterial blood supply to extremities.
Intervention :
Lower the extremities below the level of the heart (if condition is arterial in nature).
Encourage moderate amount of walking or graded extremity exercises if no
contraindications exist.
Goal : Decrease in venous congestion.
Intervention :
Elevate extremities above heart level (if condition is venous in nature)
Discourage standing still or sitting for prolonged periods
Encourage walking
Goal : Promotion of vasodilatation & prevention of vascular compression.
Intervention :
Maintain warm temperature & avoid chilling.
Discourage use of tobacco products.
Counsel in ways to avoid emotional upsets, Stress management.
Encourage avoidance of constrictive clothing & accessories.
Encourage avoidance of crossing the legs.
Administer vasodilator medications & adrenergic blocking agents as prescribed,
with appropriate nursing consideration.
59. NursingDiagnosisII : Chronic pain related to impaired ability of peripheral vessels to
supply tissues with oxygen.
Goal : Relief of pain.
Interventions :
Promote Increased circulation through exercise (example : walking program, upper
extremity exercises, water aerobics, using stationary bicycle)
Administer analgesic agents as prescribed, with appropriate Nursing
NursingDiagnosisIII: Risk for impaired skin integrity related to compromised circulation.
Goal : Attainment/ maintenance of tissue integrity.
Interventions :
Instruct in ways to avoid trauma to extremities.
Encourage wearing protective shoes & padding for pressure areas; wear new
for short period of time & then inspect feet for signs of injury.
Encourage meticulous hygiene, bathing with neutral soaps, applying lotions &
carefully trimming nails.
Caution to avoid scratching or vigorous rubbing.
Promote good nutrition, adequate intake of vitamins A & C, protein & Zinc &
control of obesity.
60. Health education
Stop smoking.
Exercise.
Eat a healthy diet.
Careful foot care
Wash your feet daily, dry them thoroughly and moisturize often to
prevent cracks that can lead to infection. Don't moisturize between
the toes, however, as this can encourage fungal growth.
Wear well-fitting shoes and thick, dry socks.
Promptly treat any fungal infections of the feet, such as athlete's
Take care when trimming your nails.
Inspect your feet daily for injuries.
Have a foot doctor (podiatrist) treat bunions, corns or calluses.
See your doctor at the first sign of a sore or injury to your skin.
61. research
TOPIC : Optimisation of botulinum toxin type a
treatment for the management of Raynaud's
phenomenon using a dorsal approach: a
prospective case series.
Abstract
Raynaud's phenomenon (RP) is a common condition and causes pain,
paraesthesia, ulceration and gangrene. Botulinum toxin A (Btx-A) is effective
when injected via a digital palmar approach, in the treatment of severe RP.
However, hand weakness resulting from lumbrical malfunction is a recognized
complication. This study aimed to determine the effect of Btx-A injected via a
dorsal approach.
Conclusions: Btx-A injected via a dorsal approach improves symptoms
and reduces the number of RP. We have shown an effective non-
surgical approach technique to treat RP.
62. summary
Today we have discussed about anatomy and physiology of
circulatory system. Definition of raynaud’s disease, Etiology,
Pathophysiology clinical manifestations, Diagnostic
Evaluation, Medical & Surgical management & Nursing
Management of Raynaud’s Disease, Definition of Aneurysm,
Etiology, Types of Aneurysm, Pathophysiology, Clinical
Manifestations & Nursing Management of Aneurysm,
Definition of Peripheral Vascular Disease, Etiology, Risk
factors, Clinical manifestations, complications, diagnostics
evaluation, Medical, Surgical & Nursing Management of PVD.
63. bibliography
Brunner & Suddarth’s, Text book of Medical surgical nursing, 13th edition,
published by Wolters Kluwer (India) Pvt. Ltd., New Delhi, Page No. : 832-845
RN Adult Medical Surgical Nursing Edition 9.0 Review Module, published by Ati
Nursing Educatin, Page No. 434-437.
Priscilla Lemone, Karen Burke, Medical surgical Nursing, 4th edition published by
Lemon Publications Page No. : 1331-1337.
Joyce M. Black, Medical Surgical Nursing Clinical Management for continuity of
care7th
edition, India published by W.B. Saunder’s Company Page No. : 1170-1183.
https://www.mayoclinic.org/diseases-conditions/raynauds-disease/symptoms-
causes/syc-20363571
https://www.medicalnewstoday.com/articles/156993#outlook
https://pubmed.ncbi.nlm.nih.gov/31482318/
