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Chapter 33

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OBSTRUCTION IN THE CORONARY ARTERY AND PERIPHERAL VEINS

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Chapter 33

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

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