nursing of adults with medical & surgical conditions
DESCRIPTION
Nursing of Adults with Medical & Surgical Conditions. Disorders of the Peripheral Vascular System. Risk Factors. Similar to risk factors for heart disorders Age Gender Smoking Hypertension Hyperlipidemia Obesity Lack of exercise Emotional stress Diabetes Mellitus Family History. - PowerPoint PPT PresentationTRANSCRIPT
Nursing of Adultswith
Medical & Surgical Conditions
Disorders
of the
Peripheral Vascular System
Risk Factors
Similar to risk factors for heart disorders– Age– Gender– Smoking– Hypertension– Hyperlipidemia– Obesity– Lack of exercise– Emotional stress– Diabetes Mellitus– Family History
Assessment of Vascular Disorders Arterial Assessment
– First symptom is usually pain Occurs due to arterial insufficiency and ischemia Dull ache in calf muscles Leg fatigue and cramping Intermittent claudication
– Pain brought on by exercise
– Later symptoms of pain Pain at rest Burning, tingling, and numbness at night even lying down
– Pulses May be weak, thready, or absent
– Scale for documentation• 0 – absent• +1 – barely palpable, intermittent• +2 – weak , possibly thready, but constantly palpable • +3 – normal strength and quality• +4 – bounding, easily palpable, may be visible
Assessment and Documentation– PATCHES
P for Pulses – Absence of pulses in generally a medical emergency
• Compare with previous findings• Look for other symptoms – may just be hard to feel• Use Doppler device if necessary
A for Appearance– Pale, mottled, cyanotic or discolored (red, black, brown)– Necrosis or bleeding (ulcers)
• Size, depth, and location• Edges jagged or smooth• Painful to touch
– Shiny or dull • Shiny may indicate edema• Dull may indicate inadequate arterial blood supply
– Superficial veins, erythema, or inflammation– Varicosities
• Have patient to stand
T for Temperature– Cool
• Possible arterial problem– Warm
• Possible venous problem– Temperature changes may be caused by other problems as well
C for Capillary refill– Less than 2 seconds
H for Hardness– Supple or hard and inelastic
• Hardness may indicate chronic problems E for Edema
– Pitting edema• Usually acute problem• Assessment: Press on skin for 5 seconds and release
(Page 317 --Figure 8-17 and Table 8-3)– Non-pittting
• May be chronic condition• Assessment: Measure circumference of the extremity
S for Sensation– Patient states extremity FEELS:
• Numbness• Tingling• Hot• Cold
Venous Assessment– First symptom is usually edema– Dark pigmentation– Dryness and scaling– Ulcerations– Pain, aching, and cramping
Usually relieved by rest or elevation
Comparison of Arterial and Venous DisordersPage 331 – Table 8-5
Diagnostic Tests
Noninvasive Procedures– Treadmill Test
Exercise to determine blood flow to extremities
– Plethysmography Assesses blood volume in the veins
– Digital Subtraction Angiography (DSA) IV contrast is administered Blood vessels are visualized by radiography using an image
intensifier video system and monitor
– Doppler Ultrasound Measures blood flow in arteries or veins
Diagnostic Tests
Invasive Procedures– Phlebography or venography
Radiographic visualization of veins IV contrast is administered in a foot vein X-rays are taken to detect filling defects Assesses for condition of deep veins and to diagnose deep vein thrombosis
– 125 I-fibrinogen Uptake Test Assesses for acute calf vein thrombosis Fibrinogen is tagged with iodine 125 and given IV - it can then be
detected in the blood stream by a gamma ray detector
– Angiography IV contrast is administered X-ray to visualize arteries
– D-dimer Serum Test D-dimer forms when fibrin is broken down When a thrombus is present D-dimer levels are
elevated – usually greater than 1591 ng/ml Normal value: 68-494 ng/ml
– Duplex Scanning Combination of ultrasound imaging and Doppler Determines location and extent of thrombus within
veins
Arteriosclerosis & Atherosclerosis Arteriosclerosis
– thickening, loss of elasticity, and calcification of arterial walls, resulting in a 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
Atherosclerosis
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 B/P) caused by stimulation of the sympathetic nervous system
and the release of epinephrine and/or norepinephrine. Decreased blood flow to the kidneys causes the release of renin and the formation of angiotensin which is a vasoconstrictor.
Hypertension– Essential (primary) hypertension
90-95% of all diagnosed cases Theories of causes:
– arteriolar changes, sympathetic nervous system activation, hormonal influence, genetic factors, obesity, sedentary lifestyle, increased sodium intake, excessive alcohol intake.
– Secondary hypertension Attributed to an identifiable medical diagnosis
– renal vascular disease– diseases of the adrenal cortex– coarctation of the aorta– head trauma or cranial tumor– pregnancy-induced hypertension
Hypertension
– Malignant hypertension severe, rapidly progressive elevation in blood
pressure that causes damage to the small arterioles in major organs (heart, kidneys, brain, eyes)
Hypertension
Signs & Symptoms– headache– blurred vision– epistaxis– angina– s/s of:
MI, CHF, renal failure, and stroke
Hypertension
Treatment– Antihypertensive medications
Capoten, Vasotec, Altace, Lotensin, Zestril, Accupril, Monopril
– Diuretics Lasix, HCTZ, Aldactone
– Diet weight control, reduction of saturated fats, and low sodium
– No smoking
Hypertension
– Decreased alcohol intake– Regular aerobic exercise– Relaxation techniques/stress management
Arteriosclerosis Obliterans
Etiology/Pathophysiology– narrowing or occlusion of the blood vessel with
plaque formation– little or no blood flow to the affected extremity
Arteriosclerosis Obliterans
Signs & Symptoms– Five P’s
Pain– intermittent claudication
Pulselessness Pallor Paresthesia Paralysis
Arteriosclerosis Obliterans Treatment
– Anticoagulants Heparin and Coumadin
– Fibrinolytics Urokinase administered directly into the thrombus
– Surgery embolectomy- removal of the embloism endarterectomy- removal of the lining of the artery arterial bypass percutaneous transluminal angioplasty amputation
Percutaneous Transluminal Angioplasty
Arterial Embolism
Etiology/Pathophysiology– Blood clots in the arterial bloodstream– May originate in the heart
arterial dysrhythmia, MI, valvular heart disease, CHF
– Foreign substances plaque, tissue, etc.
Arterial Embolism
Signs & Symptoms– Pain– Absent distal pulses– Pale, cool, and numb extremity– Necrosis– S/S of shock with occlusion of a major vessel
Arterial Embolism
Treatment– Anticoagulants
Heparin and Coumadin
– Fibrinolytics– Endarterectomy– Embolectomy
Arterial Aneurysm Etiology/Pathophysiology
– Enlarged, dilated portion of an artery– Causes:
arteriosclerosis trauma congenital defect
– Commonly affected arteries popliteal thoracic and abdominal aorta coronary cerebral
Arterial Aneurysm
Signs & Symptoms– Asymptomatic – Large pulating mass– Pain, if large enough to press on other
structures
Arterial Aneurysm
Treatment– Assess for s/s of rupture, thrombi, ischemia– Control hypertension– Surgery
Ligation Grafts
Surgical Repair of Arterial Aneurysm
Thromboangitis Obliterans(Buerger’s Disease) Etiology/Pathophysiology
– Occlusive vascular condition in which the small and medium size arteries become inflamed and thrombotic
affects the small arteries in the hands and feet
– Cause not known– Affects men 20-40 years old who smoke
Thromboangitis Obliterans(Buerger’s Disease) Signs & Symptoms
– Pain may be frequent and persistent
– Sensitivity to cold– Skin cold and pale– Ulcerations on feet or hands– Gangrene– Superficial thrombophlebitis
Thromboangitis Obliterans(Buerger’s Disease) Treatment
– No smoking– Exercise to develop collateral circulation– Surgery
amputation of gangrenous fingers and toes sympathectomy
– clip nerves to prevent pain and vasospasm
Raynaud’s Disease
Etiology/Pathophysiology– Intermittent arterial spasms– Primarily affects
fingers, toes, ears and nose
– Exposure to cold or emotional stress– Secondary:
scleroderma rheumatoid arthritis, SLE, drug intoxication, occupational
trauma
– Commonly affects women 20-40 years of age
Raynaud’s Disease
Signs & Symptoms– Chronically cold hands and feet– Pallor, coldness, numbness, cyanosis, and pain
during spasms– Erythema following a spasm– Ulcerations on the fingers and toes with chronic
disease
Raynaud’s Disease
Treatment– No smoking– Avoid exposure to cold– Medications
vasodilators calcium antagonists muscle relaxants
– Surgery sympathectomy amputation for gangrene
Thrombophlebitis
Etiology/Pathophysiology– Inflammation of a vein in conjunction with the
formation of a thrombus– More common in women– Risk factors
venous stasis hypercoagulability truama to the blood vessel immobilization after surgery
Thrombophlebitis Signs & Symptoms
– Pain– Edema– Positive Homan’s sign– Erythema, warmth, and tenderness along the vein
Thrombophlebitis
Treatment– Superficial
Bedrest Moist heat Elevate extremity NSAID’s
– Motrin– aspirin
Thrombophlebitis
– Deep Bedrest Anticoagulants
– Heparin & Coumadin
Fibrinolytics Elevate extremity Antiembolism stockings Surgery
– thrombectomy– vena cava umbrella (Greenfield filter)
Greenfield Filter
Varicose Veins
Etiology/Pathophysiology– Tortuous, dilated vein with incompetent valves– Most common in women 40-60 years of age– Caused by:
congenital defective valves, absent valve, valve that becomes incompetent
Pregnancy or obesity prolonged standing constrictive clothing
Varicose Veins
Varicose Veins
Signs & Symptoms– 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
Varicose Veins
Treatment– Elastic stockings– Rest– Elevate legs– Sclerotherapy
injection of sclerosing solution
– Surgery Vein ligation and stripping
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
Venous Stasis Ulcers Signs & Symptoms
– Pain– Ulceration with dark pigmentation– Edema
Venous Stasis Ulcers
Treatment– Diet
Increased protein Vitamin A & C and Zinc
– Debridement of necrotic tissue wet-to-dry dressings Elase cream surgical
– Antibiotics– Unna boot