chapter 48 care of the patient with a cardiovascular or a peripheral vascular disorder
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Chapter 48 Care of the Patient with a Cardiovascular or a Peripheral Vascular Disorder. Overview ofAnatomy and Physiology. Heart Four-chambered, hollow, muscular organ, not much bigger than a fist Lies in the mediastinum Lower border is called the apex Heart wall: three layers - PowerPoint PPT PresentationTRANSCRIPT
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 1
Chapter 48
Care of the Patient with a Cardiovascular or a Peripheral Vascular Disorder
Chapter 48
Care of the Patient with a Cardiovascular or a Peripheral Vascular Disorder
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 2
Overview ofAnatomy and PhysiologyOverview ofAnatomy and Physiology
• Heart Four-chambered, hollow, muscular organ, not much
bigger than a fist Lies in the mediastinum Lower border is called the apex Heart wall: three layers
• Epicardium: serous membrane on the outside of the heart
• Myocardium: constructed of cardiac muscle
• Endocardium: lines the inner surface of the chambers of the heart
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 3
Figure 48-1Figure 48-1
Heart and major blood vessels viewed from front (anterior).
(From Thibodeau, G.A., Patton, K.T. [1987]. Anatomy and physiology. St. Louis: Mosby.)
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 4
Overview of Anatomy and PhysiologyOverview of Anatomy and Physiology
• Heart chambers Right atrium—receives deoxygenated blood Left atrium—receives oxygenated blood Right ventricle—pumps deoxygenated blood Left ventricle—pumps oxygenated blood
• Heart valves Atrioventricular valves ( AV) valves
• Tricuspid and bicuspid valves Semilunar valves
• Pulmonary and aortic semilunar valves
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 5
Figure 48-2Figure 48-2
Interior of the heart.
(From Thibodeau, G.A., Patton, K.T. [1987]. Anatomy and physiology. St. Louis: Mosby.)
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 6
Overview of Anatomy and PhysiologyNew Slide
Overview of Anatomy and PhysiologyNew Slide
1. Identify the four main types of
tissues which make up the
body’s major organs.
2. How does skeletal, smooth ( visceral) and
cardiac muscle cells differ in ref:
appearance, movement and
location?
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 7
• Electrical conduction system Automaticity
• An inherent ability of the heart muscle tissue to contract in a rhythmic pattern
Irritability• The ability to respond to a stimulus
Impulse pattern• Sinoatrial node to AV node to bundle of His to right and
left bundle branches to Purkinje fibers
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 8
Figure 48-3 (new)Figure 48-3 (new)
Identify the Conduction system structures
1.
2.
3.
4.
5.
Conduction system of the heart.
(From Thibodeau, G.A., Patton, K.T. [1987]. Anatomy and physiology. St. Louis: Mosby.)
Located w/in the walls
of the heart & septum
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 9
Overview of Anatomy and PhysiologyOverview of Anatomy and Physiology
• Cardiac cycle A complete heartbeat
• Atria contract while ventricles relax
• Ventricles contract while atria relax Systole
• Phase of contraction Diastole
• Phase of relaxation
• Period between contraction of the atria or ventricles during which the blood enters the relaxed chambers
• A complete cycle takes an average of 0.8 second
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 10
Figure 48-4Figure 48-4
Blood flow during systole.
(From Canobbio, M. [1990]. Cardiovascular disorders, Mosby’s clinical nursing series. St. Louis: Mosby.)
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 11
Figure 48-5Figure 48-5
Blood flow during diastole.
(From Canobbio, M. [1990]. Cardiovascular disorders, Mosby’s clinical nursing series. St. Louis: Mosby.)
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 12
Figure 48-7Figure 48-7
Normal ECG deflections.
Review ElectrocardiographyTrue or False Atrial
repolarization is captured on the EKG? Explain.
So what causes cardiac impulse to occur?
Ch. 15 & ch. 10A&P book
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 13
Overview of Anatomy and PhysiologyOverview of Anatomy and Physiology
• Blood vessels ( 3 main types) Capillaries
• Tiny blood vessels joining arterioles and venules
• How are capillaries able to produce gas exchange? Arteries
• Large vessels carrying blood away from the heart Veins
• Vessels that convey blood from the capillaries to the heart
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 14
CirculationCirculation
• Coronary blood supply Right and left coronary arteries
• Branch off of the aorta
• Encircle the heart like a crown
• Supply the myocardium with blood
Coronary veins• Return the unoxygenated blood to the coronary sinus,
then to the right atrium
When might collateral circulation become necessary?
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 15
Figure 48-6Figure 48-6
Arterial coronary circulation (anterior).
(From Canobbio, M. [1990]. Cardiovascular disorders, Mosby’s clinical nursing series. St. Louis: Mosby.)
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 16
CirculationCirculation
• Systemic circulation Circulates blood from the left ventricle to all parts of
the body and back to the right atrium Carries oxygen and nutritive materials to all body
tissues and removes products of metabolism
• Pulmonary circulation Circulates blood from the right ventricle to the lungs
and back to the left atrium of the heart Carries deoxygenated blood to the lungs to be
reoxygenated and removes the metabolic waste product, carbon dioxide
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 17
Laboratory and Diagnostic ExaminationsLaboratory and Diagnostic Examinations
• Diagnostic imaging Fluoroscopy Angiogram Aortogram
• Cardiac catheterization and angiography
• Electrocardiography
• Cardiac monitors
• Thallium scanning
• Laboratory tests: CBC, blood cultures, coagulation studies, ESR electrolytes, lipids, arterial blood gases, cardiac markers
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 18
Disorders of the Cardiovascular SystemDisorders of the Cardiovascular System
• Risk factors Non-modifiable factors
• Family history
• Age
• Sex (gender)
• Race
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 19
Disorders of the Cardiovascular SystemDisorders of the Cardiovascular System
• Risk factors (continued) Modifiable factors
• Smoking
• Hyperlipidemia
• Hypertension
• Diabetes mellitus
• Obesity
• Sedentary lifestyle
• Stress
• Oral contraceptives
• Psychosocial factors
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 20
Disorders of the Cardiovascular SystemDisorders of the Cardiovascular System
• Cardiac dysrhythmias Any cardiac rhythm that deviates from normal sinus
rhythm• Sinus tachycardia
• Sinus bradycardia
• Supraventricular tachycardia
• Atrial fibrillation
• Atrioventricular block
• Premature ventricular contractions
• Ventricular tachycardia
• Ventricular fibrillation
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 21
Disorders of the Cardiovascular SystemDisorders of the Cardiovascular System
• Cardiac Arrest The sudden cessation of cardiac output and
circulatory process Cause: ventricular tachycardia, ventricular
fibrillation, and ventricular asystole S/S: abrupt loss of consciousness with no response
to stimuli; gasping respirations followed by apnea; absence of pulse and blood pressure; pupil dilation; pallor and cyanosis
Tx: • Immediate CPR ( CAB) no longer ABCs
• ACLS Review Medications for Cardiac Dysrhythmias
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 22
Disorders of the HeartDisorders of the Heart
• Coronary atherosclerotic heart disease Coronary artery disease (CAD)
• A variety of conditions that obstruct blood flow in the coronary arteries
Atherosclerosis• A common arterial disorder characterized by yellowish
plaques of cholesterol, lipids, and cellular debris in the inner layers of the walls of the arteries; the primary cause of atherosclerotic heart disease (ASHD)
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 23
Figure 48-10Figure 48-10
Progressive development of coronary atherosclerosis.
(From Lewis, S.M., Heitkemper, M.M., Dirksen, S.R. [2004]. Medical-surgical nursing: assessment and management of clinical problems. [6th ed.]. St. Louis: Mosby.)
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 24
Disorders of the HeartDisorders of the Heart
• Angina pectoris Etiology/pathophysiology
• Cardiac muscle is deprived of oxygen
• Increased workload on the heart Clinical manifestations/assessment
• Pain (usually relieved by rest)
• Dyspnea
• Anxiety; apprehension
• Diaphoresis
• Nausea
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 25
Disorders of the HeartDisorders of the Heart
• Angina pectoris (continued) Medical management/nursing interventions
• Correct cardiovascular risk factors
• Avoid precipitating factors
• Medications Dilate coronary arteries and decrease workload of heart Nitroglycerin Beta-adrenergic blocking agents Calcium channel blockers
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 26
Disorders of the HeartDisorders of the Heart
• Angina pectoris (continued) Medical management/nursing interventions
• Surgical interventions Coronary artery bypass graft (CABG) Percutaneous transluminal coronary angioplasty (PTCA) Stent placement
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 27
Disorders of the HeartDisorders of the Heart
• Myocardial infarction Etiology/pathophysiology
• Occlusion of a major coronary artery or one of its branches with subsequent necrosis of myocardium
• Most common cause is atherosclerosis
• Ability of the cardiac muscle to contract and pump blood is impaired
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 28
Figure 48-16Figure 48-16
Four common locations where myocardial infarctions occur.
(From Lewis, S.M., Heitkemper, M.M., Dirksen, S.R. [2004]. Medical-surgical nursing: assessment and management of clinical problems. [6th ed.]. St. Louis: Mosby.)
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 29
Disorders of the HeartDisorders of the Heart
• Myocardial infarction (continued) Clinical manifestations/assessment
• Asymptomatic (silent MI)
• Pain (not relieved by rest, position, or nitroglycerin)
• Nausea
• SOB; dizziness; weakness
• Diaphoresis
• Pallor—ashen color
• Sense of impending doom
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 30
Figure 48-11Figure 48-11
Sites to which ischemic myocardial pain may be referred.
(From Lewis, S.M., Heitkemper, M.M., Dirksen, S.R. [2004]. Medical-surgical nursing: assessment and management of clinical problems. [6th ed.]. St. Louis: Mosby.)
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 31
Disorders of the HeartDisorders of the Heart
• Myocardial infarction (continued) Medical management/nursing interventions
• Oxygen
• Fibrinolytic agents
• Percutaneous transluminal coronary angioplasty (PTCA)
• Coronary artery bypass graft surgery
• Medications: vasopressors, analgesics, nitrates, beta-adrenergic blockers, calcium channel blockers, antidysrhythmics, diuretics, inotropic agents, diuretics, stool softeners
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 32
Figure 48-12Figure 48-12
A, Saphenous vein. B, Saphenous aortocoronary artery bypass.
(A, from Thelan, L., et al. [1998]. Critical care nursing. [3rd ed.]. St. Louis: Mosby. B, from Lewis, S.M., Heitkemper, M.M., Dirksen, S.R. [2004]. Medical-surgical nursing: assessment and management of clinical problems. [6th ed.].
St. Louis: Mosby.)
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 33
Figure 48-13Figure 48-13
Coronary artery bypass graft.
(From Phipps, W., et al. [1995]. Medical-surgical nursing: concepts and clinical practice. [5th ed.]. St. Louis: Mosby.)
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 34
Disorders of the HeartDisorders of the Heart
• Heart failure Etiology/pathophysiology
• Abnormal condition characterized by circulatory congestion resulting from the heart’s inability to act as an effective pump
• Left ventricular failure Most common
• Right ventricular failure Usually caused by left ventricular failure
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 35
Disorders of the HeartDisorders of the Heart
• Heart failure (continued) Clinical manifestations/assessment
• Decreased cardiac output Fatigue Angina Anxiety; restlessness Oliguria Decreased GI motility Pale, cool skin Weight gain
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 36
Disorders of the HeartDisorders of the Heart
• Heart failure (continued) Clinical manifestations/assessment (continued)
• Left ventricular failure Pulmonary congestion
o Dyspneao Paroxysmal nocturnal dyspneao Cough; frothy, blood-tinged sputumo Orthopneao Pulmonary crackleso Pleural effusion (x-ray)
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 37
Disorders of the HeartDisorders of the Heart
• Heart failure (continued) Clinical manifestations/assessment (continued)
• Right ventricular failure Distended jugular veins Anorexia, nausea, and abdominal distention Liver enlargement Ascites Edema in feet, ankles, sacrum; may progress up the legs
into thighs, external genitalia, and lower trunk
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 38
Disorders of the HeartDisorders of the Heart
• Heart failure (continued) Medical management/nursing interventions
• Increase cardiac efficiency Digitalis Vasodilators ACE inhibitors (decrease blood pressure)
• Bedrest, HOB elevated
• Oxygen
• Treat edema and pulmonary congestion
• Monitor fluid retention (weigh daily; strict I&O)
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 39
Disorders of the HeartDisorders of the Heart
• Pulmonary edema Etiology/pathophysiology
• Accumulation of fluid in lung tissues and alveoli
• Complication of congestive heart failure (CHF) Clinical manifestations/assessment
• Restlessness
• Agitation
• Disorientation
• Diaphoresis
• Dyspnea and tachypnea
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 40
Disorders of the HeartDisorders of the Heart
• Pulmonary edema (continued) Clinical manifestations/assessment (continued)
• Tachycardia
• Pallor or cyanosis
• Cough—large amounts of blood-tinged, frothy sputum
• Wheezing, crackles
• Cold extremities
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 41
Disorders of the HeartDisorders of the Heart
• Pulmonary edema (continued) Medical management/nursing interventions
• High Fowler’s or orthopnic position
• Morphine sulfate
• Oxygen
• Nitroglycerin
• Diuretics
• Inotropic agents
• Vasodilators
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 42
Disorders of the HeartDisorders of the Heart
• Valvular heart disease Etiology/pathophysiology
• Heart valves are compromised and do not open and close properly
Stenosis Insufficiency
• Causes may be: Congenital Rheumatic fever
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 43
Disorders of the HeartDisorders of the Heart
• Valvular heart disease (continued) Clinical manifestations/assessment
• Fatigue
• Angina
• Oliguria
• Pale, cool skin
• Weight gain
• Restlessness
• Abnormal breath sounds
• Edema
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 44
Disorders of the HeartDisorders of the Heart
• Valvular heart disease (continued) Medical management/nursing interventions
• Restrict activities
• Sodium-restricted diet
• Diuretics
• Digoxin
• Antidysrhythmics
• Surgery Open mitral commissurotomy Valve replacement
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 45
Disorders of the HeartDisorders of the Heart
• Rheumatic heart disease Etiology/pathophysiology
• Rheumatic fever Inflammatory disease which is a delayed childhood
reaction to inadequately treated childhood upper respiratory tract infection of beta-hemolytic streptococci
Causes scar tissue in the heart
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 46
Disorders of the HeartDisorders of the Heart
• Rheumatic heart disease (continued) Clinical manifestations/assessment
• Elevated temperature
• Elevated heart rate
• Epistaxis
• Anemia
• Joint pain and stiffness
• Nodules on the joints
• Specific to valve affected
• Heart murmur
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 47
Disorders of the HeartDisorders of the Heart
• Rheumatic heart disease (continued) Medical management/nursing interventions
• Prevention Treat infections rapidly and completely
• Bedrest
• NSAIDs
• Application of heat
• Well-balanced diet (supplement with vitamins B and C)
• Encourage fluids
• Commissurotomy or valve replacement
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 48
Disorders of the HeartDisorders of the Heart
• Pericarditis Etiology/pathophysiology
• Inflammation of the membranous sac surrounding the heart
• May be acute or chronic
• Bacterial, viral, or fungal
• Noninfectious conditions Azotemia, MI, neoplasms, scleroderma, trauma, systemic
lupus erythematosus (SLE), radiation, drugs
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 49
Disorders of the HeartDisorders of the Heart
• Pericarditis (continued) Clinical manifestations/assessment
• Debilitating pain
• Dyspnea
• Fever
• Chills
• Diaphoresis
• Leukocytosis
• Pericardial friction rub
• Pericardial effusion
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 50
Disorders of the HeartDisorders of the Heart
• Pericarditis (continued) Medical management/nursing interventions
• Analgesia
• Oxygen
• IV fluids
• Salicylates
• Antibiotics
• Antiinflammatory agents
• Corticosteroids
• Surgery: pericardial window, pericardial tap
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 51
Disorders of the HeartDisorders of the Heart
• Endocarditis Etiology/pathophysiology
• Infection or inflammation of the inner membranous lining of the heart
Clinical manifestations/assessment• Influenza-like symptoms
• Petechiae on the conjunctiva, mouth, and legs
• Anemia
• Splinter hemorrhages under nails
• Weight loss
• Heart murmur
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 52
Disorders of the HeartDisorders of the Heart
• Endocarditis (continued) Medical management/nursing interventions
• Bedrest
• Antibiotics IV for 1-2 months
• Prophylactic antibiotics for “high-risk” patients
• Surgical repair of diseased valves or valve replacement
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 53
Disorders of the HeartDisorders of the Heart
• Myocarditis Etiology/pathophysiology
• Inflammation of the myocardium
• Rheumatic heart disease
• Viral, bacterial, or fungal infection
• Endocarditis
• Pericarditis
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 54
Disorders of the HeartDisorders of the Heart
• Myocarditis (continued) Medical management/nursing interventions
• Bedrest
• Oxygen
• Antibiotics; antiinflammatory agents
• Assessment and correction of dysrhythmias Clinical manifestations/assessment
• Vary according to site of infection
• Cardiac enlargement
• Murmur; gallop; tachycardia
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 55
Disorders of the HeartDisorders of the Heart
• Cardiomyopathy Etiology/pathophysiology
• A group of heart muscle diseases that primarily affects the structural or functional ability of the myocardium
• Not associated with CAD, hypertension, vascular disease, or pulmonary disease
• Primary—unknown cause
• Secondary—Infective, metabolic, nutritional, alcohol, peripartum, drugs, radiation, SLE, rheumatoid arthritis
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 56
Disorders of the HeartDisorders of the Heart
• Cardiomyopathy (continued) Clinical manifestations/assessment
• Angina
• Syncope
• Fatigue
• Dyspnea on exertion
• Severe exercise intolerance
• Signs and symptoms of left- and right-sided CHF
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 57
Disorders of the HeartDisorders of the Heart
• Cardiomyopathy (continued) Medical management/nursing interventions
• Treat underlying cause
• Diuretics
• ACE inhibitors
• Beta-adrenergic blocking agents
• Internal defibrillator
• Cardiac transplant
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 58
• Arterial assessment PATCHES
• P = Pulses
• A = Appearance
• T = Temperature
• C = Capillary refill
• H = Hardness
• E = Edema
• S = Sensation
Disorders of the Peripheral Vascular System Disorders of the Peripheral Vascular System
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 59
• Venous assessment First symptom is usually edema Dark pigmentation Dryness and scaling Ulcerations Pain, aching, and cramping
• Usually relieved by rest or elevation
Disorders of the Peripheral Vascular System Disorders of the Peripheral Vascular System
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 60
• Diagnostic tests Noninvasive procedures
• Treadmill test
• Plethysmography
• Digital subtraction angiography (DSA)
• Doppler ultrasound Invasive procedures
• Phlebography or venography
• 125 i-fibrinogen uptake test
• Angiography
Disorders of the Peripheral Vascular System Disorders of the Peripheral Vascular System
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 61
• Arteriosclerosis Thickening, loss of elasticity, and calcification of
arterial walls, resulting in decreased blood supply
• Atherosclerosis Narrowing of the artery due to yellowish plaques of
cholesterol, lipids, and cellular debris in the inner layers of the walls of large- and medium-sized arteries
A type of arteriosclerosis
Disorders of the Peripheral Vascular System Disorders of the Peripheral Vascular System
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 62
• Hypertension Etiology/pathophysiology
• A sustained elevated systolic blood pressure greater than 140 mm Hg and/or a sustained elevated diastolic blood pressure greater than 90 mm Hg.
• Vasoconstriction (increases blood pressure )
• Essential (primary) hypertension 90-95% of all diagnosed cases
• Secondary hypertension Attributed to an identifiable medical diagnosis
Disorders of the Peripheral Vascular System Disorders of the Peripheral Vascular System
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 63
• Hypertension (continued) Clinical manifestations/assessment
• Headache; blurred vision
• Epistaxis
• Angina Medical management/nursing interventions
• Antihypertensive medications; diuretics
• Diet: weight control, reduction of saturated fats, and low sodium
• No smoking
Disorders of the Peripheral Vascular System Disorders of the Peripheral Vascular System
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 64
• Arteriosclerosis obliterans Etiology/pathophysiology
• Narrowing or occlusion of the blood vessel with plaque formation—little or no blood flow to the affected extremity
Clinical manifestations/assessment• Pain—intermittent claudication
• Pulselessness
• Pallor
• Paresthesia
• Paralysis
Disorders of the Peripheral Vascular System Disorders of the Peripheral Vascular System
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 65
• Arteriosclerosis obliterans (continued) Medical management/nursing interventions
• Anticoagulants
• Fibrinolytics
• Surgery Embolectomy Endarterectomy Arterial bypass Percutaneous transluminal angioplasty Amputation
Disorders of the Peripheral Vascular System Disorders of the Peripheral Vascular System
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 66
• Arterial embolism Etiology/pathophysiology
• Blood clots in the arterial bloodstream
• May originate in the heart
• Foreign substances Clinical manifestations/assessment
• Pain
• Absent distal pulses
• Pale, cool, and numb extremity
• Necrosis
Disorders of the Peripheral Vascular System Disorders of the Peripheral Vascular System
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 67
• Arterial embolism (continued) Medical management/nursing interventions
• Anticoagulants
• Fibrinolytics
• Endarterectomy
• Embolectomy
Disorders of the Peripheral Vascular System Disorders of the Peripheral Vascular System
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 68
• Arterial aneurysm Etiology/pathophysiology
• Enlarged, dilated portion of an artery
• Causes: arteriosclerosis; trauma; congenital Clinical manifestations/assessment
• Asymptomatic
• Large pulsating mass
• Pain, if large enough to press on other structures
Disorders of the Peripheral Vascular System Disorders of the Peripheral Vascular System
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 69
Figure 48-19Figure 48-19
Types of aneurysms. A, Fusiform. B, Saccular.
C, Dissecting.
(From Lewis, S.M., Heitkemper, M.M., Dirksen, S.R. [2004]. Medical-surgical nursing: assessment and management of clinical problems. [6th ed.]. St. Louis: Mosby.)
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 70
• Arterial aneurysm (continued) Medical management/nursing interventions
• Assess for signs and symptoms of rupture, thrombi, ischemia
• Control hypertension
• Surgery Ligation Grafts
Disorders of the Peripheral Vascular System Disorders of the Peripheral Vascular System
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 71
• Thromboangitis obliterans (Buerger’s disease) Etiology/pathophysiology
• Occlusive vascular condition in which the small- and medium-sized arteries become inflamed and thrombotic
Clinical manifestations/assessment• Pain; sensitivity to cold
• Skin cold and pale
• Ulcerations on feet or hands; gangrene
• Superficial thrombophlebitis
Disorders of the Peripheral Vascular System Disorders of the Peripheral Vascular System
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 72
• Thromboangitis obliterans (Buerger’s disease) (continued) Medical management/nursing interventions
• No smoking
• Exercise to develop collateral circulation
• Surgery Amputation of gangrenous fingers and toes Sympathectomy
Disorders of the Peripheral Vascular System Disorders of the Peripheral Vascular System
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 73
• Raynaud’s disease Etiology/pathophysiology
• Intermittent arterial spasms
• Primarily affects fingers, toes, ears, and nose
• Exposure to cold or emotional stress Clinical manifestations/assessment
• Chronically cold hands and feet
• Pallor, coldness, numbness, cyanosis, and pain during spasms; erythema following a spasm
• Ulcerations on the fingers and toes
Disorders of the Peripheral Vascular System Disorders of the Peripheral Vascular System
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 74
• Raynaud’s disease (continued) Medical management/nursing interventions
• No smoking
• Avoid exposure to cold
• Medications Vasodilators Calcium antagonists Muscle relaxants
• Surgery: sympathectomy
• Amputation for gangrene
Disorders of the Peripheral Vascular System Disorders of the Peripheral Vascular System
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 75
• Thrombophlebitis Etiology/pathophysiology
• Inflammation of a vein in conjunction with the formation of a thrombus
• Risk factors: venous stasis, hypercoagulability, trauma of a blood vessel, immobilization after surgery
Clinical manifestations/assessment• Pain
• Edema
• Positive Homans’ sign
• Erythema, warmth, and tenderness along the vein
Disorders of the Peripheral Vascular System Disorders of the Peripheral Vascular System
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 76
Figure 48-22Figure 48-22
Deep vein thrombophlebitis.
(From Kamal, A., Brockelhurst, J.C. [1991]. Color atlas of geriatric medicine. [3rd ed.]. St. Louis: Mosby-Year Book —Europe.)
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 77
• Thrombophlebitis (continued) Medical management/nursing interventions
• Superficial Bedrest Moist heat Elevate extremity NSAIDs
o Motrino Aspirin
Disorders of the Peripheral Vascular System Disorders of the Peripheral Vascular System
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 78
• Thrombophlebitis (continued) Medical management/nursing interventions
• Deep Bedrest Anticoagulants Fibrinolytics Elevate extremity Antiembolism stockings Surgery: thrombectomy; vena cava umbrella (Greenfield
filter)
Disorders of the Peripheral Vascular System Disorders of the Peripheral Vascular System
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 79
• Varicose veins Etiology/pathophysiology
• Tortuous, dilated vein with incompetent valves Clinical manifestations/assessment
• Dark, raised, tortuous veins
• Fatigue; dull aches
• Cramping of the muscles
• Heaviness or pressure of extremity
• Edema, pain, changes in skin color, and ulcerations with venous stasis
Disorders of the Peripheral Vascular System Disorders of the Peripheral Vascular System
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 80
• Varicose veins (continued) Medical management/nursing interventions
• Elastic stockings
• Rest
• Elevate legs
• Sclerotherapy
• Surgery Vein ligation and stripping
Disorders of the Peripheral Vascular System Disorders of the Peripheral Vascular System
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 81
• Venous stasis ulcers Etiology/pathophysiology
• Ulcerations of the legs from chronic deep vein insufficiency and stasis of blood in the venous system of the legs
• Open necrotic lesion due to an inadequate supply of oxygen-rich blood to the tissue
• Causes Varicose veins, burns, trauma, sickle cell anemia,
diabetes mellitus, neurogenic disorders, and hereditary factors
Disorders of the Peripheral Vascular System Disorders of the Peripheral Vascular System
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 82
• Venous stasis ulcers (continued) Clinical manifestations/assessment
• Pain
• Ulceration with dark pigmentation
• Edema Medical management/nursing interventions
• Diet: increased protein; vitamins A and C and zinc
• Debridement of necrotic tissue
• Antibiotics
• Unna boot
Disorders of the Peripheral Vascular System Disorders of the Peripheral Vascular System
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 83
Figure 48-17Figure 48-17
Scale for pitting edema depth.
(From Canobbio, M. [1990]. Cardiovascular disorders, Mosby’s clinical nursing series. St. Louis: Mosby.)