Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.
Nursing Care of Clients with
Peripheral Vascular Disorders
Overview of Disorders
PERIPHERAL ARTERIAL OCCLUSIVE
DISEASE
 Upper extremity arterial occlusive disease
 Arterial embolism; Arterial thrombosis
...
VENOUS DISORDERS
Venous Thrombosis, Deep Vein Thrombosis (DVT),
Thrombophlebitis, and Phlebothrombosis
Chronic Venous Insu...
LYMPHATIC DISORDERS
 Lymphangitis and Lymphadenitis
 Lymphedema and Elephantiasis
Peripheral vascular disease (PVD)
 includes disorders that alter the natural flow of blood
 through the arteries and veins...
Peripheral Arterial/ Venous Disease
 A chronic disorder in which partial or total occlusion
 deprives the lower extremitie...
PERIPHERAL ARTERIAL OCCLUSIVE
DISEASE
Peripheral Arterial Disorders (PAD)
 Aka: Peripheral arterial occlusive disease
   Arterial Occlusive Disorders
   Lower e...
Assessment
 intermittent claudication: hallmark of the disease
 rest pain: severe
   is a numbness or burning, often descr...
Assessment
 Coldness or cold sensitivity – Coldness in the feet with
 exposure to a cold environment, associated with blan...
Assessment
 Ulceration and gangrene. May be due to ischemia ot
 trauma. Impaired tissue perfusion inhibits healing
 proces...
Assessment
 peripheral pulses: important part of assessing arterial
 occlusive disease.
 Unequal pulses between extremitie...
Diagnostic Findings
 CW Doppler and ankle-brachial indices (ABIs)
 Treadmill testing for claudication
 duplex ultrasonogra...
Medical Management
 Control hypertension
 Reduce risk factors:
   Control serum lipids
   Weight reduction
   Low fat low ...
PHARMACOLOGIC THERAPY
hemorheologic and antiplatelet agents
Vasodilators
Antihyperlipidemics
hemorheologic agent
 Pentoxifylline (Trental)
   Increase flexibility of RBCs
   decreases blood viscosity by inhibiting p...
Antiplatelet agents
 aspirin (acetylsalicylic acid, Ancasal) : 325 or 81
 mg/day
 clopidogrel (Plavix)
 ticlopidine (Ticli...
Surgical Management
 Percutaneous transluminal angioplasty
 Balloon angioplasty
 Laser angioplasty
 Stent insertion
 Ather...
SURGICAL MANAGEMENT

choice of the surgical procedure depends on the
  degree and location of the stenosis or occlusion.
 ...
vascular grafting or endarterectomy
  For patients, severe intermittent claudication and disabling or
  when the limb is a...
Endarterectomy
 an incision is made into the artery
 atheromatous obstruction is removed.
 artery is then sutured closed t...
Bypass grafts
 are performed to reroute the blood flow around the stenosis
 or occlusion.
 Before bypass grafting, the sur...
femoral-to-popliteal graft
surgical procedure of choice if atherosclerotic occlusion is
below the inguinal ligament in the...
Bypass grafts may be synthetic or autologous vein.
  Native vein or autologous vein
    greater or lesser saphenous vein o...
Nursing Management
 Maintaining circulation
 Maintain skin integrity and prevent infection
 Monitoring and managing potent...
Maintaining circulation: Post op care
 Monitor the ff q hour for first 8 hours and then every 2 hours
 for 24 hours
 Pulse...
Disappearance of a pulse that was present may
indicate thrombotic occlusion of the graft
 Notify surgeon STAT
Maintain circulation
 Warm environmental temperature
 Place legs in slight dependency to promote arterial flow
 Avoid pres...
Exercise
 may improve arterial blood flow to the affected limb through
 buildup of the collateral circulation.
 is individ...
Positioning
 To promote circulation
 Still controversial
 Some have swelling in extremities
 Because swelling prevents art...
Maintain skin integrity and prevent
infection
 Examine skin on a daily basis
 Take daily bath and dry the skin gently
 App...
Monitoring and managing potential
complications
 UO
 central venous pressure
 mental status
 pulse rate and volume
 permit...
Monitoring and managing potential
complications
 Bleeding / Hematoma
   can result from the heparin administered during su...
Promoting home and community-based
care
 Assess patient’s ability to manage independently.
 Determine if patient has a net...
Promote activity
 Regular aerobic exercises such as walking, swimming,
 jogging , bicycling
 Do exercises 30-45 minutes 3-...
Prevention
 Primary – provide info on the effects of the following:
   Cigarrete smoking. Nicotene causes vaso-constrictio...
Hyperlipidemia. Contribute to atherosclerotic plaques in vessels
Obesity. Added burden on the heart and blood vessels
Phys...
Secondary prevention
  Encourage clients with early symptoms to seek medical care to
  prevent complications


Tertiary pr...
Acute Peripheral Arterial Occlusion
ACUTE PERIPHERAL ARTERIAL
OCCLUSION
 Aka: Arterial embolism and arterial thrombosis
 arterial occlusions : sudden and dram...
Assessment
 severe pain below level of the occlusion
 occurs even at rest.
 affected extremity : cool or cold, pulseless, ...
Interventions
 initiate treatment promptly to avoid permanent damage or
 loss of an extremity.
 Anticoagulant therapy with...
Surgical treatment
 Emergencysurgical thrombectomy or embolectomy
 with local anesthesia
  to remove the occlusion.
  phys...
Fogarty catheter
Preop nursing care
 bed rest with extremity level or slightly dependent (15
 degrees).
 affected part is kept at room temp...
PostopNursing care
  Monitor affected extremity for improvement in color,
 temperature, and pulse, other extremities for s...
Buerger’s disease
Buerger’s disease
 Inflammatory, non-lipid occlusive condition of small to medium
 arteries followed by vein that impairs ...
Cause
 Unknown
 believed to be autoimmune disease (autoimmune vasculitis)
 Linked to smoking or chewing of tobacco (sugges...
Pathophy
 characterized by recurring inflammation of the intermediate and
 small arteries and veins of the lower and (in r...
Clinical Manifestations
 intermittent claudication
  Most characteristic manifestation
  foot cramps, especially of the ar...
Clinical Manifestations
 intense rubor (reddish blue discoloration) of the foot
 absence of pedal pulse but normal femoral...
The feet of a patient with Buerger
       disease.
           Note the ischemic ulcers
           on the distal portion of...
Superficial
                                                thrombophlebitis of the
                                      ...
The tobacco smoke–
           stained fingers of this
           patient suggested the man's
           diagnosis (Buerger...
This lower extremity
           arteriogram of the
           peroneal and tibial arteries
           of a patient with Bu...
Diagnostic Findings
 Allen's test
 Segmental limb blood pressures
  Demonstrate distal location of the lesions or occlusio...
Management
main objectives: improve circulation to extremities,
prevent progression of disease, and protect extremities
fr...
Management
Exercise programs that         Avoid injury to the
us gravity to fill and drain   extremities
the blood vessels...
Other treatments
 Other treatment approaches exist but are less effective.
 Intermittent compression of the arms and legs ...
SURGICAL MANAGEMENT OF
COMPLICATIONS
 Amputations
   If gangrene of a toe develops as a result of arterial occlusive
   di...
NURSING MANAGEMENT OF
COMPLICATIONS
 Postop care amputation
  Elevate stump for first 24 hours to promote venous return an...
NURSING MANAGEMENT
grief, fear, or anxiety r/t loss of limb.
  Encourage discuss his or her feelings.
  Spiritual advisors...
Discharge planning
 Assess ability to manage independently.
 Assist in developing a plan to stop using tobacco and to
 man...
Lifestyle and home remedies
        Take care of fingers and toes
        Check the skin on arms and legs daily for cuts a...
AORTIC ANEURYSM
AORTIC ANEURYSM
Abnormal dilatation of
the arterial wall caused
by localized weakness
and stretching in the
medial layer o...
Classification
classified by shape or form
  saccular aneurysm
    projects from one side of
    the vessel only
  fusifor...
What is the diference between true
and false aneurysm?
True anuerysm                  false aneurysms
 all three tunica la...
Classification
                 By location
                   Abdominal
                   Thoracic
                   Ce...
Etiologic Classification of Arterial
Aneurysms
 atherosclerotic changes in the aorta
 Congenital: Primary connective tissu...
Etiologic Classification of Arterial
Aneurysms
 Infectious (mycotic): Bacterial, fungal, spirochetal
 infections
 Pregnanc...
Risk factors
 Genetic predisposition
 smoking (or other tobacco use)
 Hypertension
 Obesity
 Stress
 Hypercholesterolemia
Aortitis
Aortitis
 is inflammation of the aorta, particularly of the aortic arch.
 Two types
   Takayasu’s disease
     occlusive t...
Aorta
 main trunk of arterial system
 divided into
   (1) ascending aorta (5 cm [2 inches] in diameter, contained in
   th...
Thoracic aorta is above diaphragm
Abdominal aorta is below the diaphragm.
  further divided as
    suprarenal (above renal...
Takayasu’s disease
 chronic inflammatory disease of the aortic arch and its branches
 affects young or middle-aged women; ...
Takayasu’s disease: Diagnostic exams
 diagnose and evaluate the lesions
 Magnetic resonance angiography
 CT
 Duplex ultras...
Takayasu’s disease Management
 early stage
   Corticosteroids
   cytotoxic immunosuppressive agents.
 Selective PTA & Surg...
Aortoiliac disease
AORTOILIAC DISEASE
 If collateral circulation has developed, patients with a stenosis
 or occlusion of the aortoiliac segm...
Medical Management
 Treatment same as that for atherosclerotic peripheral arterial
 occlusive disease.
 aortobi iliac graf...
Nursing Management
 Preoperative assessment
 brachial, radial, ulnar, femoral, posterior tibial, and dorsalis
 pedis pulse...
Nursing Management
 Postoperative care
   monitoring for signs of thrombosis in arteries distal to the
   surgical site.
 ...
Nursing Management
 Postoperative care
 Monitor UO
   Renal function may be impaired as a result of hypoperfusion
   from ...
Nursing Management
 Abdominal assessment
   bowel sounds and paralytic ileus is performed at least q 8 hrs.
   BS may not ...
THORACIC AORTIC ANEURYSM
THORACIC AORTIC ANEURYSM
 Atherosclerosis: most
 common cause
 occur most frequently in
 men, 40 and 70 years.
 thoracic a...
Clinical Manifestations
 Symptoms are variable and depend on how rapidly the
 aneurysm dilates and how the pulsating mass ...
Clinical Manifestations
1.   Dyspnea                1. result of pressure of the
                               sac agains...
Clinical Manifestations
4.   Dysphagia           4. due to impingement on
                            the esophagus by the...
Diagnostic Findings
 chest x-ray
 transesophageal echocardiography
 CT
ABDOMINAL AORTIC ANEURYSM
(AAA)
ABDOMINAL AORTIC ANEURYSM
Atherosclerosis: most common cause
common among Caucasians; affects men four times more
often th...
Pathophysiology
 All aneurysms involve a
 damaged media layer of the
 vessel.
 After an aneurysm
 develops, it tends to
 e...
Clinical Manifestations
 feel heart beating in their   If associated with
 abdomen when lying down       thrombus, a major...
Atheroemboli from small
                                                AAAA produce livedo
                              ...
Diagnostic Findings
 Duplex ultrasonography or CT
   used to determine the size, length, and location of the aneurysm
 Ult...
Conventional angiography
 Angiography is used to diagnose the renal area. In this
 instance, an endoleak represented conti...
Gerontologic Considerations
 Most occur ages of 60 and 90 years.
 Rupture is likely with coexisting hypertension and with
...
MANAGEMENT: Aneursyms
MANAGEMENT: Aneursyms
 Goals
  Limit progression
  Control BP
  Recognizing early symptoms
  Prevent rupture
Management
   Size- <5cm and asymptomatic- follow up with serial
   ultrasound every 3-12 months
      >5cm elective repai...
SURGICAL MANAGEMENT
Surgery : treatment of choice for abdominal aneurysms wider than
5 cm (2 inches) wide or those that ar...
standard preoperative care
         Type and crossmatch blood
         Administer prophylactic antibiotics (cefazolin, 1 g...
Post Surgical Complications
   Post op Renal failure
   Ischemic colitis
   Acute leg ischemia
   Spinal cord ischemia- li...
Post Op Nursing Interventions
 Thoracic Aneurysm Repair
   Thoracotomy or median sternotomy approach is used
   Aneurysm i...
Monitor for signs of hemorrhage
Monitor chest tubes for an increase in chest drainage
Assess sensation and motion of all e...
Monitor for dysrhythmias
Monitor respiratory status
Encourage coughing and deep breathing
No lifting of heavy objects for ...
SURGICAL MANAGEMENT:
Endovascular grafting
 placement of endovascular stents
 alternative for treating an infrarenal abdom...
SURGICAL MANAGEMENT:
Endovascular grafting
 Potential complications
   bleeding
   hematoma, or wound infection at the fem...
Nursing Management
 Preop
   Anticipate rupture
   Recognize that patient may have cardiovascular,
   cerebral, pulmonary,...
Nursing Management
                                      Indications of a rupturing
Signs of impending rupture            ...
Rupture into peritoneal cavity : rapidly fatal
Retroperitoneal rupture of an aneurysm
  May result in hematomas in the scr...
Possible complications of
Postoperative care             surgery
  intense monitoring of          arterial occlusion
  pul...
DISSECTING AORTA
DISSECTING AORTA
 Occasionally, in an aorta diseased by arteriosclerosis, a tear
 develops in the intima or the media dege...
Pathophysiology
 Arterial dissections (separations) are commonly associated with poorly
 controlled hypertension;
 three t...
Clinical Manifestations
 Onset of symptoms - usually sudden.
 Severe and persistent pain
   tearing or ripping
   anterior...
Clinical Manifestations
 Cardiovascular, neurologic, and gastrointestinal symptoms are
 responsible for other clinical man...
Diagnostic Findings
 Arteriography
 CT
 transesophageal echocardiography
 Duplex ultrasonography
 magnetic resonance imagi...
Management
Medical Management             Nursing Management
 Medical or surgical            same nursing care with an
 tr...
OTHER ANEURYSMS
OTHER ANEURYSMS
peripheral vessels: subclavian artery, renal artery, femoral
artery, or popliteal artery
most often result...
OTHER ANEURYSMS
Diagnostic exam
  Duplex ultrasonography and CT to determine the size, length,
  and extent of the aneurys...
OTHER ANEURYSMS
Surgical repair
  replacement grafts or endovascular repair using a stent-graft or
  wall graft, which is ...
Nursing Management: endovascular
repair postop care
 Supine 6 hours; head of bed elevated up to 45 degrees after 2
 hours....
Nursing Management: endovascular
repair postop care
 Assess bleeding, swelling, pain, and hematoma formation.
 Any changes...
RAYNAUD’S DISEASE
Raynaud’s disease
 is a form of intermittent arteriolar vasoconstriction that
 results in coldness, pain, and pallor of th...
Raynaud's phenomenon           Raynaud's disease
 usually unilaterally.          occurs bilaterally.
 occurs in people old...
The pathophysiology is the same for
both entities.
 Clients often have an associated systemic connective tissue
 disease, ...
Cause
 The etiology is unknown.
 many have immunologic disorders (scleroderma, systemic
 lupus erythematosus, rheumatoid a...
Prognosis
 Varies
 some patients slowly improve, some become progressively
 worse, and others show no change.
 Ulceration ...
Clinical Manifestations
   Classic clinical picture - Triphasic color changes in the
   hands
      Blanching (pallor or w...
Symptoms
Numbness, tingling, and burning pain occur as the color change
bilateral and symmetric
may result from defect in ...
Diagnostics
 ANA titer
 Arteriography
 Doppler ultrasound
Medical Management
 Avoid trigggers (e.g., cold, tobacco, stress) that provoke
 vasoconstriction
 Medications
 Sympathecto...
Vasodilating agents
 Commonly prescribed drugs are
   nifedipine (Procardia)
   cyclandelate (Cyclospasmol)
   phenoxybenz...
Sympathectomy
 For severe symptoms that cannot be alleviated by drugs
 lumbar sympathectomy
   physician cuts sympathetic ...
Education of client is important in
prevention of complications.
 Minimize exposure to cold
  remain indoors as much as po...
Methods to prevent vasoconstriction
 Avoid all forms of nicotine; Smoking cessation, nicotine gum
 or patches used to help...
Nursing Management
 decrease stress
   help the client to identify stressors and provides suggestions for
   reducing them...
Complications
 serious but uncommon
 Gangrene
 Amputation
THORACIC OUTLET SYNDROME
Thoracic outlet syndrome
 is a compression of the subclavian artery at thoracic outlet by
 anatomic structures, such as a ...
more common in females
people whose occupations require holding their arms up or
leaning over, such as baseball players, g...
s/s
 neck, shoulder, and arm pain : may be intermittent.
 numbness and moderate edema of extremity.
 pain and numbness wor...
COLLABORATIVE MANAGEMENT
PT
Exercises
Avoiding aggravating positions, such as elevating the arms.

Surgical treatment
  re...
References
 Brunner
 Ignatavicius
 http://www.mayoclinic.com/health/buergers-
 disease/DS00807/METHOD=print&DSECTION=all
Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3
Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3
Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3
Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3
Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3
Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3
Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3
Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3
Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3
Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3
Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3
Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3
Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3
Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3
Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3
Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3
Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3
Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3
Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3
Upcoming SlideShare
Loading in …5
×

of

Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 1 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 2 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 3 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 4 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 5 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 6 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 7 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 8 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 9 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 10 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 11 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 12 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 13 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 14 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 15 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 16 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 17 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 18 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 19 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 20 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 21 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 22 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 23 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 24 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 25 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 26 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 27 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 28 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 29 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 30 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 31 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 32 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 33 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 34 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 35 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 36 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 37 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 38 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 39 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 40 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 41 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 42 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 43 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 44 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 45 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 46 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 47 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 48 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 49 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 50 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 51 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 52 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 53 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 54 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 55 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 56 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 57 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 58 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 59 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 60 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 61 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 62 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 63 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 64 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 65 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 66 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 67 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 68 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 69 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 70 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 71 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 72 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 73 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 74 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 75 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 76 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 77 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 78 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 79 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 80 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 81 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 82 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 83 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 84 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 85 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 86 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 87 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 88 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 89 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 90 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 91 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 92 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 93 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 94 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 95 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 96 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 97 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 98 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 99 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 100 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 101 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 102 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 103 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 104 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 105 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 106 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 107 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 108 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 109 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 110 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 111 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 112 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 113 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 114 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 115 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 116 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 117 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 118 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 119 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 120 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 121 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 122 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 123 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 124 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 125 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 126 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 127 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 128 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 129 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 130 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 131 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 132 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 133 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 134 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 135 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 136 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 137 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 138 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 139 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 140 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 141 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 142 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 143 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 144 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 145 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 146 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 147 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 148 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 149 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 150 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 151 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 152 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 153 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 154 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 155 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 156 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 157 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 158 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 159 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 160 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 161 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 162 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 163 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 164 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 165 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 166 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 167 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 168 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 169 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 170 Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3   Slide 171
Upcoming SlideShare
Cardiac A&P Review - BMH/Tele
Next
Download to read offline and view in fullscreen.

61 Likes

Share

Download to read offline

Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3

Download to read offline

Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3: Arterial disorders such as Arterial occlusive disease, Arterial embolism, Arterial thrombosis, Thromboangiitis obliterans (Buerger’s disease), Aortitis, Aortoiliac disease, Aneurysms, Raynaud’s disease, and Thoracic outlet syndrome

Related Books

Free with a 30 day trial from Scribd

See all

Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3

  1. 1. Nursing Care of Clients with Peripheral Vascular Disorders
  2. 2. Overview of Disorders
  3. 3. PERIPHERAL ARTERIAL OCCLUSIVE DISEASE Upper extremity arterial occlusive disease Arterial embolism; Arterial thrombosis Thromboangiitis obliterans (buerger’s disease) Aortitis Aortoiliac disease Aneurysms Aortic aneurysm Thoracic aortic aneurysm Abdominal aortic aneurysm Dissecting aorta Other aneurysms Raynaud’s disease Thoracic outlet syndrome
  4. 4. VENOUS DISORDERS Venous Thrombosis, Deep Vein Thrombosis (DVT), Thrombophlebitis, and Phlebothrombosis Chronic Venous Insufficiency Leg Ulcers Varicose Veins Cellulitis
  5. 5. LYMPHATIC DISORDERS Lymphangitis and Lymphadenitis Lymphedema and Elephantiasis
  6. 6. Peripheral vascular disease (PVD) includes disorders that alter the natural flow of blood through the arteries and veins of the peripheral circulation. affects the lower extremities much more frequently than the upper extremities. Generally, a client with a diagnosis of PVD has arterial disease (peripheral arterial disease [PAD]) rather than venous involvement. Some clients have both arterial and venous disease.
  7. 7. Peripheral Arterial/ Venous Disease A chronic disorder in which partial or total occlusion deprives the lower extremities of oxygen and nutrients Tissue damage occurs below the level of the arterial occlusion Atherosclerosis - most common cause of peripheral arterial disease
  8. 8. PERIPHERAL ARTERIAL OCCLUSIVE DISEASE
  9. 9. Peripheral Arterial Disorders (PAD) Aka: Peripheral arterial occlusive disease Arterial Occlusive Disorders Lower extremity arterial disease (LEAD) Is the arterial insufficiency of the extremities most common cause is Arteriosclerosis Obliterans (ASO) lower extremities are more commonly affected. More prevalent among men 50-70 years old
  10. 10. Assessment intermittent claudication: hallmark of the disease rest pain: severe is a numbness or burning, often described as feeling like a toothache, that is severe enough to awaken clients at night. it may be so excruciating that it is unrelieved by opioids. elevating the extremity or placing it in a horizontal position increases the pain, whereas placing the extremity in a dependent position reduces the pain. In bed, some sleep with affected leg hanging over the side of the bed. Some patients sleep in a reclining chair in an attempt to relieve the pain.
  11. 11. Assessment Coldness or cold sensitivity – Coldness in the feet with exposure to a cold environment, associated with blanching or cyanosis due to ischemia extremity Cold and pale when elevated or ruddy and cyanotic when placed in a dependent position nails : thickened and opaque Skin: shiny, atrophic, and dry, with sparse hair growth. comparison of the right and left extremities. Bruits may be auscultated with a stethoscope
  12. 12. Assessment Ulceration and gangrene. May be due to ischemia ot trauma. Impaired tissue perfusion inhibits healing process Edema. Due to severe obstruction Sexual dysfunction. Occlusion of terminal aorta decreases blood supply to the penile arteries Gangrene muscle atrophy
  13. 13. Assessment peripheral pulses: important part of assessing arterial occlusive disease. Unequal pulses between extremities or the absence of a normally palpable pulse is a sign of peripheral arterial disease. The femoral pulse in the groin and the posterior tibial pulse beside the medial malleolus are most easily palpated.
  14. 14. Diagnostic Findings CW Doppler and ankle-brachial indices (ABIs) Treadmill testing for claudication duplex ultrasonography
  15. 15. Medical Management Control hypertension Reduce risk factors: Control serum lipids Weight reduction Low fat low cholesterol diet Daily walking Cessation of tobacco use Note: Patients should not be promised that their symptoms will be relieved if they stop tobacco use, because claudication may persist, and they may lose their motivation to stop using tobacco Skin and foot care
  16. 16. PHARMACOLOGIC THERAPY hemorheologic and antiplatelet agents Vasodilators Antihyperlipidemics
  17. 17. hemorheologic agent Pentoxifylline (Trental) Increase flexibility of RBCs decreases blood viscosity by inhibiting platelet aggregation and decreasing fibrinogen and thus increases blood flow in the extremities.
  18. 18. Antiplatelet agents aspirin (acetylsalicylic acid, Ancasal) : 325 or 81 mg/day clopidogrel (Plavix) ticlopidine (Ticlid) Cilostazol (Pletal) : inhibit platelet aggregation, inhibit smooth muscle cell proliferation, and increase vasodilation.
  19. 19. Surgical Management Percutaneous transluminal angioplasty Balloon angioplasty Laser angioplasty Stent insertion Atherectomy Arterial revascularization : Arterial bypass; vascular grafting Endarterectomy Endovascular surgery Amputation
  20. 20. SURGICAL MANAGEMENT choice of the surgical procedure depends on the degree and location of the stenosis or occlusion. overall health of patient and length of procedure that can be tolerated.
  21. 21. vascular grafting or endarterectomy For patients, severe intermittent claudication and disabling or when the limb is at risk for amputation because of tissue loss palliative therapy of primary amputation rather than an arterial bypass.
  22. 22. Endarterectomy an incision is made into the artery atheromatous obstruction is removed. artery is then sutured closed to restore vascular integrity
  23. 23. Bypass grafts are performed to reroute the blood flow around the stenosis or occlusion. Before bypass grafting, the surgeon determines where the distal anastomosis (site where the vessels are surgically joined) will be placed. The distal outflow vessel must be at least 50% patent for the graft to remain patent. A higher bypass graft patency rate is associated with keeping the length of the bypass as short as possible.
  24. 24. femoral-to-popliteal graft surgical procedure of choice if atherosclerotic occlusion is below the inguinal ligament in the superficial femoral artery Class. based on location of distal anastomosis above-knee below-knee grafts
  25. 25. Bypass grafts may be synthetic or autologous vein. Native vein or autologous vein greater or lesser saphenous vein or a combination of one of the saphenous veins and an upper extremity vein such as the cephalic vein are used to meet the required length. woven or knitted Dacron, expanded polytetrafluoroethylene (ePTFE, such as Gore- Tex or Impra), collagen-impregnated, and umbilical vein.
  26. 26. Nursing Management Maintaining circulation Maintain skin integrity and prevent infection Monitoring and managing potential complications Promoting home and community-based care
  27. 27. Maintaining circulation: Post op care Monitor the ff q hour for first 8 hours and then every 2 hours for 24 hours Pulses color and temperature of the extremity capillary refill Sensory and motor function of the affected extremities Note: Compare extremities Doppler evaluation ABI : at least once q 8 hrs for 1st 24 hrs and then OD until discharge (not usually assessed for pedal artery bypasses).
  28. 28. Disappearance of a pulse that was present may indicate thrombotic occlusion of the graft Notify surgeon STAT
  29. 29. Maintain circulation Warm environmental temperature Place legs in slight dependency to promote arterial flow Avoid pressure on affected extremity; use padding for support Avoid vigorous massage of extremities Avoid Chilling and exposure to cold Avoid contrictive clothing Crossing legs Quit smoking Do not go barefootd Trim toenails straight Avoid scratching or rubbing feet
  30. 30. Exercise may improve arterial blood flow to the affected limb through buildup of the collateral circulation. is individualized for each client Contrindicated: severe rest pain, venous ulcers, or gangrene Initiate gradually and is slowly increased nurse instructs the client to walk until the point of claudication, stop and rest, and then walk a little farther. Eventually, clients are able to walk longer distances as collateral circulation develops.
  31. 31. Positioning To promote circulation Still controversial Some have swelling in extremities Because swelling prevents arterial flow, should elevate feet at rest, but shld be taught to refrain raising legs above heart level. Extreme elevation slows arterial blood flow to the feet. In severe cases, clients with PAD and swelling may sleep with the affected limb hanging from the bed, or they may sit upright in a chair for comfort. avoid crossing their legs, which may interfere with blood flow.
  32. 32. Maintain skin integrity and prevent infection Examine skin on a daily basis Take daily bath and dry the skin gently Apply moisturizing cream/lotion in the skin. Avoid using alcohol Foot care Wear comfortable, well fitted pair of shoes Avoid direct heat application over the extremities
  33. 33. Monitoring and managing potential complications UO central venous pressure mental status pulse rate and volume permit early recognition and treatment of fluid imbalances.
  34. 34. Monitoring and managing potential complications Bleeding / Hematoma can result from the heparin administered during surgery or from an anastomotic leak. Avoid leg crossing and prolonged extremity dependency to prevent thrombosis. Edema normal postoperative finding elevating the extremities and encouraging the patient to exercise the extremities while in bed reduces edema. Elastic compression stockings care must be taken to avoid compressing distal vessel bypass grafts. Severe edema of the extremity, pain, and decreased sensation of toes or fingers can be an indication of compartment syndrome.
  35. 35. Promoting home and community-based care Assess patient’s ability to manage independently. Determine if patient has a network of family and friends to assist with ADL Encourage to make the lifestyle changes necessary with a chronic disease, including pain management and modifications in diet, activity, and hygiene (skin care). Ensure has knowledge and ability to assess for any postop complications such as infection, occlusion of the artery or graft, and decreased blood flow. Assists in developing a plan to stop using tobacco.
  36. 36. Promote activity Regular aerobic exercises such as walking, swimming, jogging , bicycling Do exercises 30-45 minutes 3-4 times a week
  37. 37. Prevention Primary – provide info on the effects of the following: Cigarrete smoking. Nicotene causes vaso-constriction, spasms of the arteries, reduced circulation to the extremities. CO2 reduces O2 transport to the tissues Hypertension. Cause elastic tissue in the arteries to be replaced by fibrous collagen tissue reducing arterial elasticity and increases resistance.
  38. 38. Hyperlipidemia. Contribute to atherosclerotic plaques in vessels Obesity. Added burden on the heart and blood vessels Physical inactivity. Compromises circulation Emotional stress. Stimulates the sympathetic response which results to vasocontriction DM. Changes in glucose and fat metabolism enhances atherosclerosis
  39. 39. Secondary prevention Encourage clients with early symptoms to seek medical care to prevent complications Tertiary prevention Rehabilitation . Exercises to develop collateral circulation.
  40. 40. Acute Peripheral Arterial Occlusion
  41. 41. ACUTE PERIPHERAL ARTERIAL OCCLUSION Aka: Arterial embolism and arterial thrombosis arterial occlusions : sudden and dramatic. Occlusion may affect the upper extremities, but it is more common in the lower extremities. most common cause : embolus or local thrombus Emboli originating from heart: are most common Risk factors AMI within the preceding weeks atrial fibrillation infective endocarditis chronic heart failure
  42. 42. Assessment severe pain below level of the occlusion occurs even at rest. affected extremity : cool or cold, pulseless, and mottled. Minute areas on the toes may be blackened or gangrenous. "six P's" of ischemia: pain, pallor, pulselessness, paresthesia, paralysis, and poikilothermia (coolness) of the involved extremity.
  43. 43. Interventions initiate treatment promptly to avoid permanent damage or loss of an extremity. Anticoagulant therapy with unfractionated heparin (UFH; Hepalean*) is usually the first intervention to prevent further clot formation. bolus of up to 10,000 units angiography
  44. 44. Surgical treatment Emergencysurgical thrombectomy or embolectomy with local anesthesia to remove the occlusion. physician makes an incision, which is followed by an arteriotomy (a surgical opening into an artery). then inserts a Fogarty catheter into artery and retrieves embolus. may be necessary to close artery with patch graft.
  45. 45. Fogarty catheter
  46. 46. Preop nursing care bed rest with extremity level or slightly dependent (15 degrees). affected part is kept at room temperature and protected from trauma. Heating and cooling pads are contraindicated ischemic extremities are easily traumatized by alterations in temperature. If possible, tape and electrocardiogram electrodes should not be used on the extremity sheepskin and foot cradles are used to protect the leg from mechanical trauma.
  47. 47. PostopNursing care Monitor affected extremity for improvement in color, temperature, and pulse, other extremities for s/s of new thrombi or emboli. mild incisional pain is normal Watch closely for complications caused by reperfusing the artery after thrombectomy or embolectomy spasms and swelling of the skeletal muscle. Swelling of the skeletal muscles is characterized by edema, pain on passive movement, poor capillary refill, numbness, and muscle tenseness. Fasciotomy (surgical opening into the tissues) may be necessary to prevent further injury and save the limb.
  48. 48. Buerger’s disease
  49. 49. Buerger’s disease Inflammatory, non-lipid occlusive condition of small to medium arteries followed by vein that impairs circulation to the legs, feet and occasionally hands Rare, occurs most often in men, ages of 20 and 35 years, all races
  50. 50. Cause Unknown believed to be autoimmune disease (autoimmune vasculitis) Linked to smoking or chewing of tobacco (suggesting a hypersensitivity reaction to nicotine)
  51. 51. Pathophy characterized by recurring inflammation of the intermediate and small arteries and veins of the lower and (in rare cases) upper extremities. Polymorphonuclear leukocytes infiltrate the walls of small and medium sized arteries and veins Thrombus formation and occlusion of vessels Diminished blood flow produces ulceration and later on gangrene lower extremities; upper extremities or viscera can also be involved Generally bilateral and symmetric with focal lesions. Superficial thrombophlebitis may be present.
  52. 52. Clinical Manifestations intermittent claudication Most characteristic manifestation foot cramps, especially of the arch (instep claudication), after exercise. relieved by rest often, a burning pain is aggravated by emotional disturbances, nicotine, or chilling. Cold sensitivity of the Raynaud type is found in one half the patients and is frequently confined to the hands. Digital rest pain is constant, and the characteristics of the pain do not change between activity and rest.
  53. 53. Clinical Manifestations intense rubor (reddish blue discoloration) of the foot absence of pedal pulse but normal femoral and popliteal pulses. absent or diminished radial and ulnar artery pulses Various types of paresthesia may develop. As the disease progresses, definite redness or cyanosis of the part appears when the extremity is in a dependent position. generally bilateral, but color changes may affect only one extremity or only certain digits. Color changes may progress to ulceration, and ulceration with gangrene eventually occurs.
  54. 54. The feet of a patient with Buerger disease. Note the ischemic ulcers on the distal portion of the left great, second, and fifth toes. Though the patient's right foot is normal in gross appearance, angiography demonstrated compromised arterial flow to both feet. http://emedicine.medscape.com/article/460027- overview#showall
  55. 55. Superficial thrombophlebitis of the great toe in a patient with Buerger disease. http://emedicine.medscape.com/article/460027- overview#showall
  56. 56. The tobacco smoke– stained fingers of this patient suggested the man's diagnosis (Buerger disease). The patient presented with small, painful ulcers on the tips of his thumb and ring finger. http://emedicine.medscape.com/article/460027- overview#showall
  57. 57. This lower extremity arteriogram of the peroneal and tibial arteries of a patient with Buerger disease demonstrates the classic findings of multiple small- and medium-sized arterial occlusions with formation of compensatory "corkscrew collaterals." http://emedicine.medscape.com/article/460027- overview#showall
  58. 58. Diagnostic Findings Allen's test Segmental limb blood pressures Demonstrate distal location of the lesions or occlusions. Duplex ultrasonography/ Doppler ultrasonography used to document patency of the proximal vessels and to visualize the extent of distal disease. Contrast angiography Demonstrate diseased portion of anatomy. Arteriography Plethysmography Venography
  59. 59. Management main objectives: improve circulation to extremities, prevent progression of disease, and protect extremities from trauma and infection. Treatment same as that for atherosclerotic peripheral arterial disease.
  60. 60. Management Exercise programs that Avoid injury to the us gravity to fill and drain extremities the blood vessels to Antibiotics , analgesics promote adequate débridement of necrotic circulation tissue: Minimize infection Monitor pulses Regional sympathetic Stop smoking block or Absolute discontinuation ganglionectomy of tobacco use is the only produce vasodilation and strategy proven to prevent increase blood flow. the progression of Buerger disease. Amputation
  61. 61. Other treatments Other treatment approaches exist but are less effective. Intermittent compression of the arms and legs to increase blood flow to extremities Spinal cord stimulation therapeutic angiogenesis Medications to stimulate growth of new blood vessels Vasodilators: rarely prescribed Lumbar sympathetectomy cut nerves to affected area to control pain and increase blood flow; controversial
  62. 62. SURGICAL MANAGEMENT OF COMPLICATIONS Amputations If gangrene of a toe develops as a result of arterial occlusive disease in the leg, below-knee amputation (BKA) or above-knee amputation toe amputation or even transmetatarsal amputation Indications worsening gangrene, especially if the infected area is moist, severe rest pain, or fulminating sepsis.
  63. 63. NURSING MANAGEMENT OF COMPLICATIONS Postop care amputation Elevate stump for first 24 hours to promote venous return and minimize edema. The incision is monitored for signs of hematoma (unapproximated suture line, discoloration or ruddy color changes of the skin along the suture line, tenderness with palpation, or oozing of dark blood from the suture line). Assess fit of elastic bandages and ensures integrity of wrap and continued ability to fit two fingers between layers of wrap. Distal skin color and warmth are assessed, if accessible, and recorded. Elastic bandages are removed and reapplied as prescribed by the surgeon (eg, every 6 hours using figure-of-eight turns).
  64. 64. NURSING MANAGEMENT grief, fear, or anxiety r/t loss of limb. Encourage discuss his or her feelings. Spiritual advisors and other health care team members are consulted Recovery and rehabilitation require multidisciplinary care (e.g., physicians, physical and occupational therapists, prosthetists, dietitians, nurses, discharge coordinators). prosthetic device fitting
  65. 65. Discharge planning Assess ability to manage independently. Assist in developing a plan to stop using tobacco and to manage pain. Encourage to make the lifestyle changes necessary with a chronic disease, including modifications in diet, activity, and hygiene (skin care). Determine whether patient has a network of family and friends to assist with ADL. Ensure that patient has knowledge and ability to assess for any postoperative complications such as infection and decreased blood flow.
  66. 66. Lifestyle and home remedies Take care of fingers and toes Check the skin on arms and legs daily for cuts and scrapes, keep in mind that if lost feeling to a finger or toe may not feel, for example, a cut when it happens. Keep your fingers and toes protected and avoid exposing them to cold. Low blood flow to extremities means body can't resist infection as easily. Small cuts and scrapes can easily turn into serious infections. Clean any cut with water, apply antibiotic ointment and cover it with a clean bandage. Keep an eye on any cuts or scrapes to make sure they're healing. If they get worse or heal slowly, see doctor promptly. Visit your dentist regularly to keep gums and teeth in good health and avoid gum disease, which in its chronic form is associated with Buerger's disease. http://www.mayoclinic.com/health/buergers- disease/DS00807/METHOD=print&DSECTION=all
  67. 67. AORTIC ANEURYSM
  68. 68. AORTIC ANEURYSM Abnormal dilatation of the arterial wall caused by localized weakness and stretching in the medial layer or wall of an artery An aneurysm is a localized sac or dilation formed at a weak point in wall of aorta Can be located anywhere along the aorta
  69. 69. Classification classified by shape or form saccular aneurysm projects from one side of the vessel only fusiform aneurysm If an entire arterial segment becomes dilated mycotic aneurysms very small aneurysms due to localized infection
  70. 70. What is the diference between true and false aneurysm? True anuerysm false aneurysms all three tunica layers are or pseudoaneurysm one in which the entire wall is involved injured blood escapes between tunica layers and they separate. the blood is contained by the surrounding tissues, with eventual formation of a sac communicating with the artery (or heart). If the separation continues, a clot may form, resulting in a dissecting aneurysm.
  71. 71. Classification By location Abdominal Thoracic Cerebral , etc
  72. 72. Etiologic Classification of Arterial Aneurysms atherosclerotic changes in the aorta Congenital: Primary connective tissue disorders (Marfan’s syndrome, Ehlers-Danlos syndrome) and other diseases (focal medial agenesis, tuberous sclerosis, Turner’s syndrome, Menkes’ syndrome) Mechanical (hemodynamic): Poststenotic and arteriovenous fistula and amputation-related Traumatic (pseudoaneurysms): Penetrating arterial injuries, blunt arterial injuries, pseudoaneurysms Inflammatory (noninfectious): Associated with arteritis (Takayasu’s disease, giant cell arteritis, systemic lupus erythematosus, Behçet’s syndrome, Kawasaki’s disease) and periarterial inflammation (ie, pancreatitis)
  73. 73. Etiologic Classification of Arterial Aneurysms Infectious (mycotic): Bacterial, fungal, spirochetal infections Pregnancy-related degenerative: Nonspecific, inflammatory variant Anastomotic (postarteriotomy) and graft aneurysms: Infection, arterial wall failure, suture failure, graft failure
  74. 74. Risk factors Genetic predisposition smoking (or other tobacco use) Hypertension Obesity Stress Hypercholesterolemia
  75. 75. Aortitis
  76. 76. Aortitis is inflammation of the aorta, particularly of the aortic arch. Two types Takayasu’s disease occlusive thromboaortopathy is uncommon syphilitic aortitis Rare
  77. 77. Aorta main trunk of arterial system divided into (1) ascending aorta (5 cm [2 inches] in diameter, contained in the pericardium) (2) aortic arch (extending upward, backward, and downward) (3) descending aorta
  78. 78. Thoracic aorta is above diaphragm Abdominal aorta is below the diaphragm. further divided as suprarenal (above renal artery level) perirenal level (at renal artery level) infrarenal (below renal artery level).
  79. 79. Takayasu’s disease chronic inflammatory disease of the aortic arch and its branches affects young or middle-aged women; Asian descent Cause nonatherosclerotic exact pathologic mechanism is unknown thought to be immune complex mediated progresses from a systemic inflammation with localized arteritis to end-organ ischemia bcoz of large vessel stenosis or obstruction. Lesions are typically long, smooth areas of narrowing with or without aneurysms
  80. 80. Takayasu’s disease: Diagnostic exams diagnose and evaluate the lesions Magnetic resonance angiography CT Duplex ultrasonography Arteriography
  81. 81. Takayasu’s disease Management early stage Corticosteroids cytotoxic immunosuppressive agents. Selective PTA & Surgical revascularization performed after suppression of the systemic vascular inflammation.
  82. 82. Aortoiliac disease
  83. 83. AORTOILIAC DISEASE If collateral circulation has developed, patients with a stenosis or occlusion of the aortoiliac segment may be asymptomatic, or they may complain of buttock or low back discomfort associated with walking. Men may experience impotence. decreased or absent femoral pulses.
  84. 84. Medical Management Treatment same as that for atherosclerotic peripheral arterial occlusive disease. aortobi iliac graft distal anastomosis is made to iliac artery, and entire surgical procedure can be performed within abdomen. aortobifemoral graft if iliac vessels are diseased distal anastomosis is made to femoral arteries Bifurcated woven or knitted Dacron grafts are preferred for this surgical procedure.
  85. 85. Nursing Management Preoperative assessment brachial, radial, ulnar, femoral, posterior tibial, and dorsalis pedis pulses ; establish baseline for follow-up after arterial lines are placed
  86. 86. Nursing Management Postoperative care monitoring for signs of thrombosis in arteries distal to the surgical site. Assess color and temperature of the extremity, capillary refill time, sensory and motor function, and pulses by palpation and Doppler q 1 hr for 1st first 8 hrs and then q 2 hrs for 1st 24 hrs. Report STAT to physician Any dusky or bluish discoloration, coolness, capillary refill time greater than 3 seconds, decrease in sensory or motor function, or decrease in pulse quality
  87. 87. Nursing Management Postoperative care Monitor UO Renal function may be impaired as a result of hypoperfusion from hypotension, involvement of the renal arteries during the surgical procedure, hypovolemia, or embolization of the renal artery or renal parenchyma. V VS, pain, and intake and output are monitored with the pulse and extremity assessments. Lab results monitored and reported Ischemic bowel usually causes increased pain and elevated white blood cell count (20,000 to 30,000 cells/mm3).
  88. 88. Nursing Management Abdominal assessment bowel sounds and paralytic ileus is performed at least q 8 hrs. BS may not return b4 third postop day (normal) (-) bowel sounds, (-) flatus, and (+) abdominal distention: indicates of paralytic ileus. Manual manipulation of the bowel during surgery may have caused bruising, resulting in decreased peristalsis. Nasogastric suction may be necessary to decompress bowel until peristalsis returns. liquid bowel movement b4 3rd postop day may indicate bowel ischemia may occur when mesenteric blood supply (celiac, superior mesenteric, or inferior mesenteric arteries) is occluded.
  89. 89. THORACIC AORTIC ANEURYSM
  90. 90. THORACIC AORTIC ANEURYSM Atherosclerosis: most common cause occur most frequently in men, 40 and 70 years. thoracic area - most common site for a dissecting aneurysm. About one third of patients with thoracic aneurysms die of rupture of the aneurysm
  91. 91. Clinical Manifestations Symptoms are variable and depend on how rapidly the aneurysm dilates and how the pulsating mass affects surrounding intrathoracic structures. Some :asymptomatic. chest pain- most prominent symptom usually constant and boring but may occur only when the person is supine unequal pulses and arterial pressure in upper extremities, tracheal deviation, cyanosis, weakness
  92. 92. Clinical Manifestations 1. Dyspnea 1. result of pressure of the sac against the trachea, a main bronchus, or the lung itself 2. Cough 2. frequently paroxysmal and with a brassy quality 3. Hoarseness, stridor, 3. resulting from pressure or weakness or against the left recurrent complete aphonia laryngeal nerve
  93. 93. Clinical Manifestations 4. Dysphagia 4. due to impingement on the esophagus by the aneurysm. 5. Dilated superficial 5. when large veins in chest veins of the chest, are compressed by the neck, or arms aneurysm 6. Unequal pupils 6. Pressure against the cervical sympathetic chain
  94. 94. Diagnostic Findings chest x-ray transesophageal echocardiography CT
  95. 95. ABDOMINAL AORTIC ANEURYSM (AAA)
  96. 96. ABDOMINAL AORTIC ANEURYSM Atherosclerosis: most common cause common among Caucasians; affects men four times more often than women; most prevalent in elderly patients Most occur below the renal arteries (infrarenal aneurysms). Untreated, the eventual outcome may be rupture and death.
  97. 97. Pathophysiology All aneurysms involve a damaged media layer of the vessel. After an aneurysm develops, it tends to enlarge.
  98. 98. Clinical Manifestations feel heart beating in their If associated with abdomen when lying down thrombus, a major vessel feel abdominal mass or may be occluded or smaller abdominal throbbing distal occlusions may result pulsatile mass in from emboli. middle and upper A small cholesterol, abdomen platelet, or fibrin emboli most important diagnostic may lodge in the indication interosseous or digital systolic bruit over mass arteries, causing blue toes
  99. 99. Atheroemboli from small AAAA produce livedo reticularis of the feet (ie, blue toe syndrome). http://emedicine.medscape.com/article/756735- overview#showall
  100. 100. Diagnostic Findings Duplex ultrasonography or CT used to determine the size, length, and location of the aneurysm Ultrasonography Watchful Waiting Period For sml aneurysm conducted at 6-month intervals until aneurysm reaches a size at which surgery to prevent rupture is of more benefit than the possible complications of a surgical procedure. Some aneurysms remain stable over many years of observation.
  101. 101. Conventional angiography Angiography is used to diagnose the renal area. In this instance, an endoleak represented continued pressurization of the sac.
  102. 102. Gerontologic Considerations Most occur ages of 60 and 90 years. Rupture is likely with coexisting hypertension and with aneurysms wider than 6 cm. In most cases at this point, the chances of rupture are greater than the chance of death during surgical repair. If the elderly patient is considered at moderate risk for complications related to surgery or anesthesia, the aneurysm is not repaired until it is at least 5 cm (2 inches) wide.
  103. 103. MANAGEMENT: Aneursyms
  104. 104. MANAGEMENT: Aneursyms Goals Limit progression Control BP Recognizing early symptoms Prevent rupture
  105. 105. Management Size- <5cm and asymptomatic- follow up with serial ultrasound every 3-12 months >5cm elective repair Growth rate- normally 2-8mm/year, if > 4mm/year consider elective surgery Symptomatic – mandates repair control blood pressure Systolic pressure is maintained at about 100 to 120 mm Hg with antihypertensive medications Correct risk factors Pulsatile flow is reduced by medications that reduce cardiac contractility (eg, propranolol [Inderal]).
  106. 106. SURGICAL MANAGEMENT Surgery : treatment of choice for abdominal aneurysms wider than 5 cm (2 inches) wide or those that are enlarging Endoaneurysmorrhaphy- opening the sac and suturing a prosthetic graft to the normal aorta within the aneurysm (Teflon/Dacron/Gortex) Endovascular repair Elective aneurysm repair Via traditional open laparotomy standard treatment open surgical repair of the aneurysm by resecting the vessel and sewing a bypass graft in place.
  107. 107. standard preoperative care Type and crossmatch blood Administer prophylactic antibiotics (cefazolin, 1 g intravenous piggyback) Insert a Foley catheter Establish large-bore intravenous access Monitor central venous pressure or establish Swan-Ganz catheterization (if indicated) Prepare the skin from the nipples to the mid thigh Administer general anesthesia (with or without epidural anesthesia) Cell Saver use has become popular Insert a nasogastric tube http://emedicine.medscape.com/article/756735-overview#a11
  108. 108. Post Surgical Complications Post op Renal failure Ischemic colitis Acute leg ischemia Spinal cord ischemia- ligation of the artery of Adamkiewicz which supplies the spinal cord anterior spinal artery syndrome-paraplegia, rectal and urinary incontinence, loss of pain and vibratory sense with preservation of vibratory and proprioception Aortic Graft infection Sexual Dysfunction
  109. 109. Post Op Nursing Interventions Thoracic Aneurysm Repair Thoracotomy or median sternotomy approach is used Aneurysm is exposed and excised and a graft or prosthesis is sewn onto the aorta Total cardiopulmonary bypass is necessary for excision of aneurysms in the ascending and arch of the aorta Partial cardiopulmonary bypass for descending aneurysms
  110. 110. Monitor for signs of hemorrhage Monitor chest tubes for an increase in chest drainage Assess sensation and motion of all extremities and notify physician for deficits Monitor serum creatinine, BUN and hourly outputs
  111. 111. Monitor for dysrhythmias Monitor respiratory status Encourage coughing and deep breathing No lifting of heavy objects for 6-12 weeks Avoid straining
  112. 112. SURGICAL MANAGEMENT: Endovascular grafting placement of endovascular stents alternative for treating an infrarenal abdominal aortic aneurysm Involves transluminal placement and attachment of a sutureless aortic graft prosthesis across an aneurysm can be performed under local or regional anesthesia. performed if abdominal aorta and iliac arteries are not extremely tortuous and if the aneurysm does not begin at the level of the renal arteries.
  113. 113. SURGICAL MANAGEMENT: Endovascular grafting Potential complications bleeding hematoma, or wound infection at the femoral insertion site Distal ischemia or embolization dissection or perforation of the aorta graft thrombosis graft infection break of the attachment system graft migration proximal or distal graft leaks delayed rupture bowel ischemia
  114. 114. Nursing Management Preop Anticipate rupture Recognize that patient may have cardiovascular, cerebral, pulmonary, and renal impairment from atherosclerosis. Assess functional capacity of all organ systems Medical therapies designed to stabilize physiologic function should be promptly implemented.
  115. 115. Nursing Management Indications of a rupturing Signs of impending rupture AAA severe back pain or abdominal constant, intense back pain pain may be persistent or falling BP intermittent localized in the middle or lower abdomen to left decreasing hematocrit of midline Low back pain because of pressure of the aneurysm on the lumbar nerves. a serious symptom, usually indicating that the aneurysm is expanding rapidly and is about to rupture.
  116. 116. Rupture into peritoneal cavity : rapidly fatal Retroperitoneal rupture of an aneurysm May result in hematomas in the scrotum, perineum, flank, or penis. Rupture into vena cava Signs of heart failure or a loud bruit results in higher-pressure arterial blood entering the lower-pressure venous system and causing turbulence, which is heard as a bruit. high BP and increased blood volume returning to right heart from vena cava may cause R heart to fail. The overall surgical mortality rate associated with a ruptured aneurysm is 50% to 75%.
  117. 117. Possible complications of Postoperative care surgery intense monitoring of arterial occlusion pulmonary, cardiovascular, hemorrhage renal, and neurologic Infection status. ischemic bowel renal failure impotence
  118. 118. DISSECTING AORTA
  119. 119. DISSECTING AORTA Occasionally, in an aorta diseased by arteriosclerosis, a tear develops in the intima or the media degenerates, resulting in a dissection
  120. 120. Pathophysiology Arterial dissections (separations) are commonly associated with poorly controlled hypertension; three times more common in men than in women occur most commonly in the 50- to 70-year-old age group Dissection is caused by rupture in the intimal layer. A rupture may occur through adventitia or into the lumen through the intima, allowing blood to reenter the main channel and resulting in chronic dissection or occlusion of branches of the aorta. As the separation progresses, the arteries branching from the involved area of the aorta shear and occlude. The tear occurs most commonly in the region of the aortic arch, with the highest mortality rate associated with ascending aortic dissection. The dissection of the aorta may progress backward in the direction of the heart, obstructing the openings to the coronary arteries or producing hemopericardium (effusion of blood into the pericardial sac) or aortic insufficiency, or it may extend in the opposite direction, causing occlusion of the arteries supplying the gastrointestinal tract, kidneys, spinal cord, and legs.
  121. 121. Clinical Manifestations Onset of symptoms - usually sudden. Severe and persistent pain tearing or ripping anterior chest or back extends to shoulders, epigastric area, or abdomen. May be mistaken for an AMI
  122. 122. Clinical Manifestations Cardiovascular, neurologic, and gastrointestinal symptoms are responsible for other clinical manifestations, depending on the location and extent of the dissection. may appear pale Sweating and tachycardia elevated BP BP markedly different from one arm to the other if dissection involves the orifice of the subclavian artery on one side. early diagnosis is usually difficult because of the variable clinical picture associated with this condition
  123. 123. Diagnostic Findings Arteriography CT transesophageal echocardiography Duplex ultrasonography magnetic resonance imaging
  124. 124. Management Medical Management Nursing Management Medical or surgical same nursing care with an treatment depends on the aortic aneurysm requiring type of dissection present surgical intervention and follows the general principles outlined for the treatment of thoracic aortic aneurysms.
  125. 125. OTHER ANEURYSMS
  126. 126. OTHER ANEURYSMS peripheral vessels: subclavian artery, renal artery, femoral artery, or popliteal artery most often result of atherosclerosis s/s pulsating mass disturbs peripheral circulation distal to it. Pain and swelling develop because of pressure on adjacent nerves and veins.
  127. 127. OTHER ANEURYSMS Diagnostic exam Duplex ultrasonography and CT to determine the size, length, and extent of the aneurysm. Arteriography may be performed to evaluate the level of proximal and distal involvement.
  128. 128. OTHER ANEURYSMS Surgical repair replacement grafts or endovascular repair using a stent-graft or wall graft, which is a Dacron or PTFE (polytetrafluroethylene) graft with external structures made from a variety of materials (nitinol, titanium, stainless steel) for additional support.
  129. 129. Nursing Management: endovascular repair postop care Supine 6 hours; head of bed elevated up to 45 degrees after 2 hours. needs to use bedpan or urinal while on bed rest, or a Foley catheter may be used. VS and Doppler assessment of peripheral q 15 min four times, then q 30 min for four times, then q hour for four times, and then as directed by the physician or unit standards. catheterization site is assessed when vital signs and pulses are monitored.
  130. 130. Nursing Management: endovascular repair postop care Assess bleeding, swelling, pain, and hematoma formation. Any changes in vital signs, pulse quality, bleeding, swelling, pain, or hematoma are reported to the physician. also notify if persistent coughing, sneezing, vomiting, or systolic blood pressure above 180 mm Hg Coz of increased risk hemorrhage. If able to resume preprocedure diet encouraged drink fluids. IV infusion may be continued until able drink normally. Fluids are important to maintain blood flow through arterial repair site and assist kidneys excreting IV contrast agent and other medications used during procedure. 6 hrs post procedure may able roll side to side and may ambulate with assistance to bathroom.
  131. 131. RAYNAUD’S DISEASE
  132. 132. Raynaud’s disease is a form of intermittent arteriolar vasoconstriction that results in coldness, pain, and pallor of the fingertips or toes. Vasospasm of the arterioles and arteries of the upper and lower extremities; causes constriction of the cutaneous vessels occurs more frequently in cold climates and during winter
  133. 133. Raynaud's phenomenon Raynaud's disease usually unilaterally. occurs bilaterally. occurs in people older than occur between the ages of 30 years of age 17 and 50 years can occur in either sex more common in women
  134. 134. The pathophysiology is the same for both entities. Clients often have an associated systemic connective tissue disease, such as systemic lupus erythematosus or progressive systemic sclerosis. As a result of vasospasm, the cutaneous vessels are constricted and blanching of the extremity occurs, followed by cyanosis. When the vasospasm is relieved, the tissue becomes reddened or hyperemic. The client's extremities are numb and cold, and he or she may complain of pain and swelling. Ulcers may also be present. These attacks are intermittent and can be aggravated by cold or stress. In severe cases, the attack lasts longer and gangrene of the digits can occur.
  135. 135. Cause The etiology is unknown. many have immunologic disorders (scleroderma, systemic lupus erythematosus, rheumatoid arthritis), obstructive arterial disease, or trauma associated with smoking Rarely leads to gangrene
  136. 136. Prognosis Varies some patients slowly improve, some become progressively worse, and others show no change. Ulceration and gangrene are rare however, chronic disease may cause atrophy of the skin and muscles. With appropriate patient teaching and lifestyle modifications, the disorder is generally benign and self-limiting.
  137. 137. Clinical Manifestations Classic clinical picture - Triphasic color changes in the hands Blanching (pallor or white) of the fingers after exposure to cold or stress due to vasoconstriction and spasm Cyanosis (blue) follows because of oxygen deprivation of the tissues Red skin as exaggerated reflow (hyperemia) when oxygenated blood returns to the digits after the vasospasm stops. The characteristic sequence of color change of Raynaud’s phenomenon is described as white, blue, and red.
  138. 138. Symptoms Numbness, tingling, and burning pain occur as the color change bilateral and symmetric may result from defect in basal heat production that eventually decreases the ability of cutaneous vessels to dilate. Episodes may be triggered by emotional factors or by unusual sensitivity to cold. Generally unilateral and affecting only one or two digits, the phenomenon is always associated with underlying systemic disease. Attacks are intermittent and can occur with exposure to cold or stress Affects primarily the hands less commonly the feet
  139. 139. Diagnostics ANA titer Arteriography Doppler ultrasound
  140. 140. Medical Management Avoid trigggers (e.g., cold, tobacco, stress) that provoke vasoconstriction Medications Sympathectomy Amputation
  141. 141. Vasodilating agents Commonly prescribed drugs are nifedipine (Procardia) cyclandelate (Cyclospasmol) phenoxybenzamine (Dibenzyline) help to relieve the symptoms can cause uncomfortable S/E (facial flushing, headaches, hypotension, and dizziness)
  142. 142. Sympathectomy For severe symptoms that cannot be alleviated by drugs lumbar sympathectomy physician cuts sympathetic nerve fibers that cause vasoconstriction of blood vessels in the lower extremities. effective when experiencing foot symptoms. sympathetic ganglionectomy for upper extremities, a similar procedure may provide symptom relief. long-term effectiveness is questionable.
  143. 143. Education of client is important in prevention of complications. Minimize exposure to cold remain indoors as much as possible during cold weather wear layers of clothing when outdoors hats and mittens or gloves should be worn at all times when outside. Use fabrics specially designed for cold climates (e.g., Thinsulate) warm up vehicles before getting in To avoid touching cold steering wheel or door handle, which could elicit an attack. during summer, a sweater should be available when entering air- conditioned rooms. Maintain warm body temperature
  144. 144. Methods to prevent vasoconstriction Avoid all forms of nicotine; Smoking cessation, nicotine gum or patches used to help people quit smoking may induce attacks Avoid decongestants and caffeine
  145. 145. Nursing Management decrease stress help the client to identify stressors and provides suggestions for reducing them. Stress management classes Avoid situations that may be stressful or unsafe. Safety Handle sharp objects carefully to avoid injuring the fingers. Inform abt postural hypotension that may result from medications (ex: calcium channel blockers) safety precautions related to alcohol, exercise, and hot weather.
  146. 146. Complications serious but uncommon Gangrene Amputation
  147. 147. THORACIC OUTLET SYNDROME
  148. 148. Thoracic outlet syndrome is a compression of the subclavian artery at thoracic outlet by anatomic structures, such as a rib or muscle. arterial wall may be damaged, producing thrombosis or embolization to distal arteries of the arms. three common sites of compression in the thoracic outlet • The interscalene triangle • Between the coracoid process of the scapula and the pectoralis minor tendon • Most commonly, the costoclavicular space
  149. 149. more common in females people whose occupations require holding their arms up or leaning over, such as baseball players, golfers, or swimmers. trauma (whiplash or after clavicular fracture)
  150. 150. s/s neck, shoulder, and arm pain : may be intermittent. numbness and moderate edema of extremity. pain and numbness worse when arm is placed in certain positions, such as over head or out to side. Clients may have overdeveloped neck and shoulder muscles, and the affected arm may appear cyanotic.
  151. 151. COLLABORATIVE MANAGEMENT PT Exercises Avoiding aggravating positions, such as elevating the arms. Surgical treatment resection of anatomic structure that is compressing the artery. performed only if has severe pain, has lost hand function, or is responding poorly to conservative treatment.
  152. 152. References Brunner Ignatavicius http://www.mayoclinic.com/health/buergers- disease/DS00807/METHOD=print&DSECTION=all
  • PriyankaJoshi165

    Jul. 8, 2021
  • FLAMBEINT

    Feb. 9, 2021
  • SphatikaKalkura

    Feb. 5, 2021
  • ANGELSTEPHEN

    Feb. 4, 2021
  • nasrinmukhtaar

    Dec. 24, 2020
  • TsitsiMercyManyere

    Dec. 15, 2020
  • SreeniyaS

    Nov. 27, 2020
  • rubilynlumapas

    Oct. 2, 2020
  • AnanyaGupta105

    Aug. 29, 2020
  • ManjeetGill3

    Jul. 28, 2020
  • MaheshKumar1090

    Jul. 9, 2020
  • anuverma10

    Jun. 18, 2020
  • Rakeshkj

    May. 17, 2020
  • LakshmiSLux

    May. 8, 2020
  • vgipsyninan

    Apr. 29, 2020
  • PramodKhatri3

    Mar. 5, 2020
  • PushpaB7

    Mar. 5, 2020
  • abdellmohmmed

    Feb. 25, 2020
  • AishatIdowu

    Feb. 1, 2020
  • BosireOnchieku

    Feb. 1, 2020

Nursing Care of Clients with Peripheral Vascular Disorders Part 2 of 3: Arterial disorders such as Arterial occlusive disease, Arterial embolism, Arterial thrombosis, Thromboangiitis obliterans (Buerger’s disease), Aortitis, Aortoiliac disease, Aneurysms, Raynaud’s disease, and Thoracic outlet syndrome

Views

Total views

64,544

On Slideshare

0

From embeds

0

Number of embeds

16

Actions

Downloads

911

Shares

0

Comments

0

Likes

61

×