CHAPTER 33

ARTERIOSCLEROSIS & ARTHEROSCLEROSIS Arteriosclerosis – refers to loss of

elasticity or hardening of the arteries. Atherosclerosis- refers to accumulation

of fat deposits in the lumen of the arteries, called plaque.

Hyperlipidemia –high levels of blood fats. Factors: Heredity- diet – sex-

OCCLUSIVE DISORDER OF CORONARY BLOOD VESSELS Coronary occlusion- closing of a coronary artery

which results in total interruption in blood supply to the muscle area.

Coronary Artery Disease (CAD) – refers to atherosclerotic & arteriosclerotic changes in the coronary arteries supplying the myocardium.

Risk factors: Inherited behavioral male sex smoking DM obesity increased lipid levels competitive, aggressive hypertension high- fat diet genetic predisposition sedentary lifestyle

ASSESSMENT FINDINGS

SIGNS AND SYMPTOMS:FatigueChest pain( angina)Pain radiating to shoulders,

arms,especially on the left side,

jaw, neck or TeethSqueezing, burning, crushing

tightness in chest & throat

HyperlipidemiaAcrus senilisxanthelisma

Diagnostic findingsTotal serum cholesterol &

triglycerides – elevatedLDL (bad cholesterol)- higher

ratio of cholesterol than protein

HDL (good Cholesterol)- lower than desired

Apolipoproteins-low or absent

ECGCoronary arteriographyElectron- beam computed

tomography

MEDICAL AND SURGICAL MANAGEMENT DRUG THERAPHYnitrates- nitroglycerin,

isorbide dinitrateBeta adrenergic blocking

agentsCalcium channel blocking

agentsAntibiotic – AzithromycinNicotinic acids- niacinVit. B6 and B12- Aspirin

Surgiacal TheraphyPercutaneous transluminalcoronary angioplasty (PTCA)Coronary Stent-Atherectomy- 4 types1. Directional Coronary Atherectomy2. Transluminal extraction3. Percutaneous transluminal

Cath.4. Laser angioplastyCoronary Artery Bypass

Graft

NURSING MANAGEMENT Asess character of pain AdministerPrescribed medication Encouraged client to rest & administerO2

Notify physician ifpain does not relieve Low fat diet & anerobic exercise

MYOCARDIAL INFARCTION It occurs whenthere is totalocclusion Of coronaryarterial blood flow. Coronary Thrombosis Most common cause of MI3 zones of tissue damage Central area of

necrotic death of myocardial cells

Injured cells, sorround the 1st zone

Ischemic area

COMPLICATIONSDysrhythmias Cardiogenic shockVentricular ruptureVentricular aneurysmArterial embolismVenous thrombosis Pulmonary EmbolismPericarditisMitral insufficiency

ASSESMENT FINDINGS

S & Sx, Severe chest painSame signs &Symptoms Withangina, Client appear pale And diaphoreticSqueezing & crushingPainHypotensive and faint

DIAGNOSTIC FINDINGSCreatinine kinase &Lactate dehydrogenase-

all elevatedWBC, C- reactive protein,Erythrocytesedimentation rate-inc.Blood glucose- elevatedECG- ST segment elev. , T- wave inversion, and QWave.

MEDICAL AND SURGICAL MANAGEMENT DRUG THERAPHYVasodilators – nitroglycerineBeta-adrenergic blockers-

propanolol(inderal)Thrombolytics – alteplase

(Activase); Anticougalants – heparin

sodium(Hepalaen)Calcuim channel blockers-

diltiazine(cardizem)Diuretics- furosimide (Lasix)

SURGICAL MANAGEMENTCardiac rehabilitation Nursing ManagementAsses character of painVital signs every 30 min.

until stablePresence of N&V,

diaphoresis, anxietyO2 saturation level by

oximeterECG for cardiac rhythmDrug Hx (OTC),herbs.Hx of DM, Hypertension,

allergy to drugs,

NURSING DIAGNOSIS

Acute pain related to diminished myocardial oxygenation

Hemorrhage related to thrombolytic therapy

Dysrhythmias related to reperfusion of myocardium with thrombolytic therapy and instability of the conduction system.

OCCLUSIVE DISORDERS OF PERIPHERAL BLOOD VESSELS Peripheral vascular

disorder –affect blood vessels.

RAYNAUDS DISEASE- periodic constriction of arteries that supply extremeties.

DIAGNOSTIC FINDINGSDiagnosis Hx of the Sx Laboratory examination

S & SxAfter exposure to coldHands becomes cold, blanched, wet with perspirationNumbness & tinglingCyanotic & begins to AcheIschemiaPainSlow healing of minor lesions

MEDICAL AND SURGICAL MANAGEMENT

Avoid smokingIsoxsupirine(Vasodilan)Nifidipine ( Procardia)IV infusion of prostaglandin ESympathectomy(cutting of per.Symphatitic nerves

NURSING MANAGEMENTEncourages client to Imagine warming Hands by holding Them together near aFire.Snow skiers (McIntyre manueversHealth teachings about the

dis.Instuct client to avoid

smokingNail care

THROMBOSIS, PHLEBOTHROMBOSIS AND EMBOLISM Thrombosis- a clot

forms in the blood vessels

Phlebothrombosis- dev. Of clot within a vein without inflammation

Embolus- a moving mass (clot) of particles, either solid or gas, in the bloodstream.

S &SxIschemiaExtremities becomes pale,Cold,& extremely painfulArterial pulsation is absentNumbness, tingling, CrampingMild fever & pain, HomansSign

MEDICAL AND SURGICAL MANAGEMENT ARTERIAL OCCLUSIVE

DISEASEImmediate inject. OfHeparin,Administeringvasodilation drugsNarcoticsThrombolytic agentThrombectomy,embolectoMy, endarterectomy,CABG

VENOUS OCCLUSIVE DISEASEBed restElevation of the ExtremetiesLocal heatAnalgesic for painContinues heparin therapyOral coagulants once

heparin achieved therapeutic effect

thrombectomy

VENOUS INSUFFICIENCY A peripheral disorder in

which venous blood is impaired through deep or superficial

veins .Varicose, valvular damage, S & SxSwollen foot, dilatedSuperficail veins, not uniform skin color, lesionDrainage color opaque,Moderate pain, pedal & tibial difficult to palpate

DIAGNOSTIC FINNDINGS Doopler ultrasoundPhotoplethysmographyAir photoplethysmography NURSING MANAGEMENTAssess appearance of the

extremitiesIf ulcer is present measure

and describe apperanceRate pain & admin.

AnalgesicsMeasure calf,ankle, length of

legs for stockingsimplements wound care

MEDICAL AND SURGICAL MANAGEMENT NON-SURGICAL

THERAPHYApply elastic compression stockingMild analgesicsClean wound by soap

& water or disinfectant

Topical hyperbaric oxygen

SURGICAL THERAPHY

Vascular therapyNecrotic tissue

debridement

DIORDERS OF BLOOD VESSEL WALLS VARICOSE VEINSDilated varicose that may

occur in the other parts, such as rectum, & esophagus.

Prolonged standing, obesity, pressure on blood vessels from an enlarging fetus, liver, or abdominal tumor, thrombophlebitis.

ASSESSMENT FINDING S & SxLegs feels heavy and

tired, leg veins distended which appears to be dark blue or purple, snakelike, elevations.

Swollen feet, ankles, & legs

Diagnostic findingsBrodie-trendelenburg testUltrasonography &

venography

MEDICAL, SURGICAL AND NURSING MANAGEMENT MEDICAL MNGT.exercising( walking or

swimming), losing weight if needed, wearing elastic support stockings, avoid prolong standing.

SURGICAL MAN.Vein ligationVein stripping

NURSING MNGT.Assess skin, distal

circulation, peripheral edema.

Monitor for swelling in the operative legs & its affect in circulation

Rewrapped bandage to facilitate blood flow.

Inspect dressing for active bleeding

ANUERYSMS Stretching and bulging of

an arterial wall. Arterosclesoris,

hypertension, trauma, or congenital weakness affects the tunica media, causing the part of the vessels to buldge.

When the blood flow decreases or stops, tissue necrosis.

S & SxPain, discomfort, dysphagia,

dyspnea, Nausea and vommiting,

pulsating mass around the umbilicus. Bruit ( blowing or purring sound

Difference in BP on the Left arm & right arm maybe different, and so is in both legs.

DIAGNOSTIC FINDINGSRadiographsaortagraphs

MEDICAL, SURGICAL AND NURSING MANAGEMENT MEDICAL TREAT.Administering anti-

hypertensive drugs SURGCAL TREAT.Bypass or grafting. NURSING INTER.Minimize activityInstruct client to avoid

straining during bowel movement, coughing, & holding breaths when positioning.

Monitor BP, PR, hourly urine output, skin color, LOC, and chatheristic of pain.

Monitor client for possible shock and adequate tissue perffusion.