cardiovascular

1. CAROTID STENOSIS
GROUP 2 MEDICAL SURGICAL NURSING PRESANTATION

2. OBJECTIVES
BY THE END OF THIS PRESANTATION IT IS OUR EXPECTATION EACH
STUDENT TO
• Define carotid stenosis and the prevalence
• The pathophysiology of carotid stenosis
• The prognosis of carotid stenosis
• How to comprehessively asses the patient with carotid stenosis
• The major signs and symptoms of carotid stenosis
• Complications of carotid stenosis
• The treatment, management and complication of carotid stenosis
• Nursing education

3. INTRODUCTION
Carotid stenosis is a cerebral vascular disease in which the carotid
arteries which supply oxygenated blood to the brain becomes
narrowed or blocked
This narrowing may be caused by a build up of plaques or
atherosclerosis which eventually reduces the oxygen supply to the
brain
The brain need constant supply of oxygen to work. Even a brief pause
of oxygen supply may cause catastrophically damaging problems to the
brain cells which may lead to fatal condition and early death

4. CONT…..
• If the arteries are completely blocked can prevent oxygen supply to
the brain which may lead to stroke
• Also if a piece of plaque breaks and enters the brain may lead to
stroke
• Plaque are mostly composed of solidified fats and cholesterol
minerals like calcium and waste body products

5. DEFINITION OF TERMS
• Atherosclerosis can be defined as a condition in which fatty deposits,
inflammation and scar tissue build up in the inner walls of arteries .
• This can lead to blockage of arteries in thus reducing blood supply to
vital organs
• Carotid stenosis is a condition in which the carotid arteris are
narrowed or blocked due to atherosclerosis which leads to shortage
of oxygenated blood to the brain

6. PREVALENCE OF CAROTID STENOSIS
• Prevalence of carotid stenosis varies around the world with higher
rates on more developed countries this may be accounted by
sedentary lifestyle of habitant of these countries also high cholesterol
diet intake due to fast food chains of food
• In Africa the prevalence of carotid stenosis is not well documented
but it believed to be lower than in the more developed countries
• It is estimated that 1%to 2% of the world population have carotid
stenosis

7. CONT…
• In terms of age the elderly are at higher prevalence than the youths
this may be due to lowering of body functions with age also maybe
due to lifetime of unhealthy living
• But recently there has been an increase in the middle class group
prevalence to CS due to habits like alcoholism and ciggarate smoking
• Males are at higher prevalence than women to have CS this maybe
due to lifestyle choices and occupation

9. RISK FACTOERS OF CAROTID STENOSIS
• Risk factors related to carotid stenosis include
• Age
• Male
• Family history
• Race
• Genetic factors
• High blood pressure
• High blood cholesterol level
• Smoking
• Diabetes
• Lack of exercise
• obesity

10. PATHOPHYSIOLOGY OF CAROTID STENOSIS
• Involves the gradual build up of fatty deposits, cholesterol and wastes
around the inner walls of the arteries leading to narrowing of arteries and
restriction of blood supply to the brain
• The narrowing of arteries may cause formation of blood clots around the
arteries that may lead to partial or fully blockage of the blood vessels
leading to father damage to the brain
• Also the plaque formation may lead to turbulent flow in thw blood vessels
that increases the blood pressure in the vessels that may cause bursting or
rupture of the arteries

11. CONT…
• The pathophysiology of carotid stenosis does not only involve the
physical narrowing of the arteries but also the possibility of formation
of blood clots and embolization which may lead to ischemic stroke
• The reduced blood may lead to depravation of oxygen and other
nutrients to the brain cells which may cause neurological symptoms
and permanent damage of brain cells

12. PROGNOSIS OF CAROTID STENOSIS
• The prognosis of CS depends on the degree of blockage of arteries
and presence or absence of other risk factor of stroke
• The degree of stenosis depends on the width of the artery compared
to the width of the normal artery
• Mild stenosis is considered on the narrowing less than 50%
• Moderate stenosis is considered if the vessel is 50-60% lwss than a
normal artery

14. CONT….
• For severe stenosis is seen if the artery is less than 70% of the width
of the normal artery

15. ASSESMENT OF PATIENTS WITH CAROTID
STENOSIS
• When a nurse in clinical setting wants to asses a patient with carotid
stenosis the following steps are recommended to follow in odder to
know the proper diagnosis and management of the patient also aid in
easy diagnosis

16. HISTORY
• The purpose of this is to know the patient cardiovascular system and
if there is any underlying condition that may cause the patient to have
the given condition
• The history involves different component that include

17. DEMOGRAPHIC DATA
• Include the name, sex, age, ethnicity, religion, race, beliefs and status
• These information may help in identifying to know the cause of the
carotid stenosis knowing which group is more vulnerable to getting
the condition
• This also helps to knowing the preferable treatment plan of the
patient according to his or her beliefs thus giving a holistic care

18. PERSONAL AND FAMILY HISTORY
• This helps to know if the patient has any underlying condition that
maybe causing this illness like kidney failure history of hypertension
and history of diabetic mellitus
• The family history allows us to speculate if the disease may be
hereditary and runs in the family
Also the history helps us to know previous snuggeries and medication
that may lead to increase risk factors of the disease
May also involve checking of patients past medical history

19. SOCIOECONOMIC STATUS
• The socioeconomic status helps us understand the understanding of
the patient on there condition
• Also the individual socioeconomic status helps us to deduce there life
• Style if there sedentary or active which all influence as the risk factors
of the carotid stenosis
• Obese inactive patients are at a greater risk of getting CS thus if the
patient has this characteristic may help draw hypothesis on CS

20. DIET HISTORY
• The diet of the patient that is high in cholesterol is more artist of
getting CS
• Thus the patient past meal and preferable meals and most consumed
meal help us build a picture of the patients who are at risk of getting
carotid stenosis

21. PHYSICALL ASSESMENT
• Physical assessment begins with the general appearance the nurse
asses the skin of the patient level of consciousness distress level and
breathing of the patient
• Basing on patient with Carotid stenosis the following are featured
expected to be observed when the nurse use the tools of inspection
palpation auscultation and percussion

22. INSPECTION
• GENERAL APPEARANCE OF PATIENT WITH CAROTID STENOSIS ARE
• Abnormal pulsations or thrills over the carotid arteries
• Visible or palpable pulsations in the neck
• Swelling or bulging of the carotid arteries
• Skin color changes on the affected area become reddish or discolored
• Visible nodule around the neck region
• Neurological signs like weakness fatigue and confussion

23. PALPATION
• Palatable carotid pulse
• Swelling and masses around the neck region
• Abnormal pulse of the carotid arteries

24. ASCULTATION
• On listening of the carotid arteries with statoscope to patients with
carotid stenosis abnormal sounds such as bruits are heard which may
indicate presence of atherosclerosis
• Also on measuring the blood pressure there is a big difference
between the right and left arms which may be due to blockage of
arteries in a particular side

25. PERCUSSION
• Tapping of carotid arteries ton patient with CS may cause abnormal
pulsation indicating presence of atherosclerosis

26. SIGNS AND SYMPTOM OF CAROTID STENOSIS
Most if the time carotid stenosis has no clinical symptoms .
Sometimes the first signs are transient ischemic attack (TIA) or mini
stroke
Transient ischemic attack or mini strokeis a temporary episode of
neurological dysfunction caused by a temporary loss of blood flow to
some parts of the brain

27. CONT…..
• Other symptoms associated with carotid stenosis are
• Cognitive impairment like memory problems or difficulty
concentrating and confusion
• Vision changes such as blurred vision or double vision
• Dizziness and imbalance
• Sudden weakness of an arm or leg on one side of the body
• Sudden paralysis of an arm or leg on one side of the body
• Inability to speak or slurred speech

28. CLINICAL DIAGNOSIS OF CAROTID STENOSIS
• Along with medical history and physical examination carotid stenosis can
be tested by
• LISTENING TO THE CAROTID ARTERIES. During this test a nurse or doctor
listen to the carotid arteries to her if there are bruit sound produced which
may indicate blood passing through a narrow artery
• CAROTID ARTERY DUPLEX SCAN. This is done by sending ultrasonic sound
above the vessel of the artery and the echo of the sound bounce back from
the walls of the arteries to be collected in an amplifier. The absence of
faintness sound may indicate blockage of the carotid artery

29. CONT….
• MRI SCAN . This test involves the use of large magnets radiofrequency
energy and a computer to produce a detailed image of organs and blood
vessels . This allows to see blockage of any arteries.
• COMPUTED TOMOGRAPHY ANGIOGRAPHY this is done by combination of
Xray technology and computer to make axial and lateral images of blood
vessels to see signs of narrowing or blockage
• ANGIOGRAPHY this is used to asses the degree of narrowing by taking x-ray
images with am object in the arteries to see the superiority of the plaque

30. COMPLICATIONS WITH CAROTID STENOSIS
• The major complication with carotid stenosis is stroke if the patient is
not identified or treated as soon as possible

31. MANAGEMENT AND TREATMENT PLAN
FOR PATIENTS WITH CAROTID STENOSIS
• The treatment plan for patients with carotid stenosis involves both lifestyle
modifications, medication and surgical interventions
• LIFESTYLE MODIFICATION : Patients are advised to change there lifestyles and
prevent themselves from risk behaviors that may cause more complications these
advise may include
Regular exercises
Improvement of diet and reduce consumption of food rich in saturated fat and
high in cholesterol
Quit smoking and alcohol use and if quitting is not ideal they should reduce the
amount consumed
Manage other conditions like hypertension and diabetis
Reduce weight from being obese

32. CONT….
• MEDICATIONS: Patients with carotid stenosis maybe prescribed
medicines that reduces the risk factors like high cholesterol and blood
pressure . Also they can be prescribed drugs that prevent clotting of
blood that reduce risk of plaques formation
Examples of groups of drugs that maybe prescribed include
Anticoagulants example rivaroxaban
Antiplatelet example aspirin
Statin to lower blood cholesterol level
Antihypertensive drugs according to the hypertension diagnosis

33. CONT…
• SURGICSL INTERVENTION: For [patients with severe carotid stenosis
surgical interventions may be considered these include
Carotid enterectomy. This is where the narrowed part of the artery is
surgically removed (cut off) this is after it is identified usually in small
portions or parts
Carotid artery stenting. This is a process where a stent is placed in the
blocked in odder to increase the blood flow to he parts of the brain
To be noted is that the method used depends on the severity and risk of
complication to the patient

34. CONT…
• EDUCATION SUPPORT: patients and their relatives need to be
educated on the condition of patient the importance of medication
and the symptoms of stroke . They should also be able to access
services for stroke preventions and support
• FOLLOW UP CHECKUPS: This allow to monitor the progress and any
change in patients conditions. This also helps to understand the
efficient and effectiveness of the care and treatment given. Thus
patients should be encourage to do follow up checks regularly to
monitor their improvement even if their not sick

35. NURSING EDUCATION
• Upon discharge and continue caring for patients with carotid stenosis it is
important for the nurse to educate the patients and there relatives this
may include
Importance of managing cardiovascular risk factors like hypertension and
diabetes
The signs and symptoms of stroke and the importance of seeking
immediate medical care
Should be provided with knowledge about carotid stenosis including its
causes, risk factor, management and complications
Also they are educated on the importance of adhering to medication,
follow ups and the education given at the hospital to reduce futher risks

36. CONCLUSION
• Carotid stenosis is a serious illness with no early symptoms that show
up and if not treated has fatal or may cause permanent damage to
patients life
• Untreated CS may cause fatal stroke or leave patients completely
paralyzed thus reducing the value of patients life
• We as nurses and other medical personnel we are obligated to advise
and educate the community on the whole knowledge about carotid
stenosis and encourage them to seek medical care

37. REFRENCES
• AMERICAN HEART ASSOSIATION
• NATIONAL INSTITUTE OF NEUROLOGICALDISODERS AND STROKE
• CENTER OF DISEASE CONTROL
• WORLD HEALTH ORGANAIZATION
• GUYTON 12th edition
• JOHN HOPKINS MECINE

38. LIST OF ABBREVIATIONS
• CS- CAROTID STENOSI
• TIA- TRANSIENT ISCHOHEMIC STROKE

39. PREPARED BY
• ABDULKARIM SHOMVI
• GODLISTEN SHIRIMA
• SALMA ABDALLAH
• ASHURA SHABAN
• JAMILA MANSOUR
• ARAFA ALLY
• GLADNESS MOLLA