Professional Documents
Culture Documents
Alterations
Chapter 30
Interventions for
Clients with Vascular
Problems
Arteriosclerosis and
Atherosclerosis
Arteriosclerosis: thickening or hardening of the
arterial wall
Atherosclerosis: type of arteriosclerosis involving
the formation of plaque within the arterial wall
Etiology ( exact cause unknown) genetic
predisposition
Factors related to atherosclerosis include
obesity, lack of exercise, smoking, and stress.
Usually occurs between ages 60-80, more
Diagnostics
Lipid level, including cholesterol and
Secondary Goals:
Total cholesterol Less than 200mg/dL and
Triglycerides less than 150 mg/dL
HDL > 40mg/dL
Clinical Manifestations
Depends on organ or tissue affected:
Angina
MI
CVA
TIA
Anuerysm
Renal Stenosis
Extremities with atherosclerotic lesions
Medical Management
Surgery
Femoral-popliteal bypass
(fempop)
Radiological Interventions
Percutaneous Transluminal
angioplasty (PTA)
Nursing Dx
Altered Tissue perfusion
Impaired Skin Integrity
Knowledge Deficit
Alteration in Comfort
Activity Intolerance
Potential for injury/infection
Peripheral Arterial
Disease
Physical Assessment
Intermittent claudication ( to limp)
Physical Assessment
(Continued)
Thin, shiny, taunt skin
Hair loss and thickened toenails ( no hair
Diagnostic Test
Segmental systolic blood pressure
Pharmacological agents
and Treatments
Exercise. 30 min 3x/week minimum
Positioning( dont cross legs)
Promoting vasodilation ( warm
Surgical Management
Preoperative care( same as others
(Continued)
Surgical Management
(Continued)
Postoperative care
Assessment for graft occlusion (check
Buergers Disease
(Thromboangiitis obliterans):
Assessment
First clinical manifestation is usually
Raynauds Phenomenon
and Raynauds Disease
Caused by vasospasm of the arterioles
Raynauds cont
Clinical signs/symptoms:
Color changes in fingers, toes, ears, nose (white,
blue, or red)
Usually last only a few minutes
Symptoms precipitated by cold, caffeine, tobacco,
or emotional upset
Dx: based on symptoms
TX: avoid temperature extremes (wear coverings),
Venous Thromboembolism
Thrombus: a blood clot
Thrombophlebitis( refers to a thrombus
Assessment
classic S/S Calf or groin tenderness or
pain and
Sudden onset of unilateral swelling of
the leg
Positive Homans sign( in only about
10% of cases and false positives are
common)
Localized edema( measure and compare
each leg)
Venous flow studies may be done to
confirm
Nonsurgical Management
Rest (Dorsal flex foot and rotate
heparin( Lovenox)
Warfarin therapy( coumadin)
Thrombolytic therapy( TPA)
Surgical Management
Thrombectomy( removes clot)
Inferior vena caval interruption
Ligation or external clips
impaired return/inflammation
Ineffective health maintenance r/t lack of
knowledge about disorder/tx
Risk for impaired skin integrity r/t altered
tissue perfusion
Potential complication: bleeding r/t
anticoagulant therapy
Potential complication: PE r/t embolization
of thrombus, dehydration and immobility
Goals of tx
Relief of pain
Decreased edema
No skin ulceration
No complications from anticoagulant therapy
No evidence of pulmonary emboli
Discharge teaching:
SS of PE
Side effect of anticoagulant therapy/follow up labs
Proper hydration
Exercise program
Venous Insufficiency
Result of prolonged venous
debrided)
Teach proper foot care/monitoring
Varicose Veins
Distended, protruding veins that
veins
Phlebitis
Inflammation of the superficial veins
Aneurysms
A permanent localized dilation of an artery,
Continue Anyeurysms
Thoracic account for 25% they are frequently
misdiagnosed
Aneurysms can cause symptoms by exerting
pressure on surrounding organs or by
rupturing
Rupture is life threatening and is the most
frequent complication
Atherosclerosis is the most common cause of
all aneurysms.
The goal of management is to prevent
aneurysm from rupturing
Surgical repair
Surgical repair of AAA involves:
Incising the diseased segment of the aorta
Removing intraluminal thrombus or plaque
Inserting a synthetic graft
Suturing the native aortic around the graft
Preoperative is monitoring the patient for rupture
Overall goals : Normal tissue perfusion, intact
Cond AAA
Postoperative surgery:
Patient will be monitored in CC unit, be mechanically
Expected outcomes
Patent arterial graft with adequate distal
perfusion
Adequate urine output
Normal body temperature
No S/S of infection