Interventions for Clients with Vascular Problems.

Interventions for Clients Interventions for Clients with Vascular Problemswith Vascular Problems

Arteriosclerosis and Arteriosclerosis and AtherosclerosisAtherosclerosis

Arteriosclerosis: thickening or hardening of the Arteriosclerosis: thickening or hardening of the arterial wallarterial wall

Atherosclerosis: type of arteriosclerosis involving Atherosclerosis: type of arteriosclerosis involving the formation of plaque within the arterial wallthe formation of plaque within the arterial wall

Etiology and genetic predispositionEtiology and genetic predisposition– Factors related to atherosclerosis include obesity, Factors related to atherosclerosis include obesity,

lack of exercise, smoking, and stress.lack of exercise, smoking, and stress.

Laboratory AssessmentLaboratory Assessment

Lipid level, including cholesterol Lipid level, including cholesterol and triglycerides, is elevated in and triglycerides, is elevated in atherosclerosis clients. atherosclerosis clients.

High serum levels of High serum levels of homocysteine can allow cell homocysteine can allow cell walls to become vulnerable to walls to become vulnerable to plaque buildup.plaque buildup.

Interventions Interventions

Evaluation of total serum Evaluation of total serum cholesterol levels and lifestyle cholesterol levels and lifestyle changeschanges

Diet therapyDiet therapy Smoking cessationSmoking cessation ExerciseExercise Drug therapyDrug therapy

Hypertension Hypertension Hypertension: systolic blood pressure Hypertension: systolic blood pressure ≥≥ 140 mm Hg 140 mm Hg

and/or diastolic blood pressure and/or diastolic blood pressure ≥≥ to 90 mm Hg (not to 90 mm Hg (not including diabetics)including diabetics)

Malignant hypertension: elevated blood pressure Malignant hypertension: elevated blood pressure that progresses rapidly to systolic pressure > 200 that progresses rapidly to systolic pressure > 200 mm Hg and diastolic pressure > 130 mm Hgmm Hg and diastolic pressure > 130 mm Hg

DiseasesDiseases Diseases that commonly cause secondary Diseases that commonly cause secondary

hypertension:hypertension:– Renal vascularRenal vascular– Renal parenchymalRenal parenchymal– Dysfunction of the adrenal medulla or the adrenal Dysfunction of the adrenal medulla or the adrenal

cortexcortex– Primary aldosteronismPrimary aldosteronism– PheochromocytomasPheochromocytomas– Cushing’s syndromeCushing’s syndrome– Coarctation of the aortaCoarctation of the aorta– Neurogenic disturbances, such as brain tumors, Neurogenic disturbances, such as brain tumors,

encephalitis, and psychiatric disturbancesencephalitis, and psychiatric disturbances

Drug Therapy Drug Therapy DiureticsDiuretics Calcium channel-blocking agentsCalcium channel-blocking agents ACE inhibitorsACE inhibitors Angiotensin II receptor antagonistsAngiotensin II receptor antagonists Aldosterone receptor antagonistsAldosterone receptor antagonists Beta-adrenergic blockersBeta-adrenergic blockers Central alpha agonistsCentral alpha agonists Alpha-adrenergic agonistsAlpha-adrenergic agonists

Peripheral Arterial Peripheral Arterial Disease Disease

Disorders that alter the natural flow of blood Disorders that alter the natural flow of blood through the arteries and veins of the peripheral through the arteries and veins of the peripheral circulationcirculation

Manifestation of systemic atherosclerosis: a chronic Manifestation of systemic atherosclerosis: a chronic condition in which partial or total arterial occlusion condition in which partial or total arterial occlusion deprives the lower extremities of oxygen and deprives the lower extremities of oxygen and nutrientsnutrients

Physical AssessmentPhysical Assessment Intermittent claudicationIntermittent claudication Pain that occurs even while at rest; numbness and Pain that occurs even while at rest; numbness and

burningburning Inflow disease affecting the lower back, buttocks, or Inflow disease affecting the lower back, buttocks, or

thighsthighs Outflow disease causing cramping in calves, ankles, Outflow disease causing cramping in calves, ankles,

and feetand feet Hair loss and dry, scaly, mottled skin and thickened Hair loss and dry, scaly, mottled skin and thickened

toenailstoenails Ulcers: arterial ulcers, diabetic ulcers, venous stasis Ulcers: arterial ulcers, diabetic ulcers, venous stasis

ulcersulcers

Diagnostic AssessmentsDiagnostic Assessments AngiographyAngiography Segmental systolic blood pressure measurementsSegmental systolic blood pressure measurements Exercise tolerance testingExercise tolerance testing PlethysmographyPlethysmography

Nonsurgical Nonsurgical ManagementManagement

ExerciseExercise PositioningPositioning Promoting vasodilationPromoting vasodilation Drug therapyDrug therapy Percutaneous transluminal Percutaneous transluminal

angioplastyangioplasty Laser-assisted angioplastyLaser-assisted angioplasty Atherectomy Atherectomy

Surgical ManagementSurgical Management Preoperative carePreoperative care Operative procedures (bypass Operative procedures (bypass

surgery)surgery) Postoperative carePostoperative care

– Assessment for graft occlusionAssessment for graft occlusion– Promotion of graft patencyPromotion of graft patency– Treatment of graft occlusionTreatment of graft occlusion– Monitoring for compartment Monitoring for compartment

syndromesyndrome– Assessment for infectionAssessment for infection

Acute Peripheral Arterial Acute Peripheral Arterial OcclusionOcclusion

Embolus: the most common cause of occlusions, Embolus: the most common cause of occlusions, although local thrombus may be the causealthough local thrombus may be the cause

Assessment: pain, pallor, pulselessness, paresthesia, Assessment: pain, pallor, pulselessness, paresthesia, paralysis, poikilothermiaparalysis, poikilothermia

Drug therapyDrug therapy Surgical therapySurgical therapy Nursing careNursing care

Aneurysms of Central Aneurysms of Central ArteriesArteries

Aneurysm: a permanent localized dilation of an Aneurysm: a permanent localized dilation of an artery, enlarging the artery to twice its normal artery, enlarging the artery to twice its normal diameterdiameter

Fusiform aneurysmFusiform aneurysm Saccular aneurysmSaccular aneurysm Dissecting aneurysm (aortic dissections)Dissecting aneurysm (aortic dissections) Thoracic aortic aneurysmsThoracic aortic aneurysms

Assessment of Assessment of Abdominal Aortic Abdominal Aortic Aneurysm (AAA)Aneurysm (AAA) Pain related to AAA is usually steady with a gnawing Pain related to AAA is usually steady with a gnawing

quality, is unaffected by movement, and may last for quality, is unaffected by movement, and may last for hours or days.hours or days.

Pain is in the abdomen, flank, or back.Pain is in the abdomen, flank, or back. Abdominal mass is pulsatile.Abdominal mass is pulsatile. Rupture is the most frequent complication and is life Rupture is the most frequent complication and is life

threatening.threatening.

Assessment of Thoracic Assessment of Thoracic Aortic AneurysmAortic Aneurysm

Assess for back pain and manifestation of Assess for back pain and manifestation of compression of the aneurysm on adjacent compression of the aneurysm on adjacent structures.structures.

Assess for shortness of breath, hoarseness, and Assess for shortness of breath, hoarseness, and difficulty swallowing.difficulty swallowing.

Occasionally a mass may be visible above the Occasionally a mass may be visible above the suprasternal notch.suprasternal notch.

Sudden excruciating back or chest pain is Sudden excruciating back or chest pain is symptomatic of thoracic rupture.symptomatic of thoracic rupture.

Diagnosis and Diagnosis and ManagementManagement

X-raysX-rays Computed tomography scan to Computed tomography scan to

assess size and location of assess size and location of aneurysmaneurysm

Aortic angiographyAortic angiography UltrasonographyUltrasonography Goal of nonsurgical Goal of nonsurgical

management: monitor growth management: monitor growth of the aneurysm and maintain of the aneurysm and maintain blood pressure at normal levelblood pressure at normal level

Aneurysms of the Peripheral Aneurysms of the Peripheral ArteriesArteries

Femoral and popliteal aneurysmsFemoral and popliteal aneurysms Symptoms: limb ischemia, diminished or absent Symptoms: limb ischemia, diminished or absent

pulses, cool to cold skin, and painpulses, cool to cold skin, and pain Treatment: surgeryTreatment: surgery Postoperative care: monitor for painPostoperative care: monitor for pain

Buerger’s Disease Buerger’s Disease Thromboangiitis obliterans: relatively uncommon Thromboangiitis obliterans: relatively uncommon

occlusive disease limited to the medium and small occlusive disease limited to the medium and small arteries and veinsarteries and veins

Often identified with tobacco smoking Often identified with tobacco smoking Nursing interventions to prevent progression of Nursing interventions to prevent progression of

diseasedisease

Raynaud’s PhenomenonRaynaud’s Phenomenon Caused by vasospasm of the arterioles and arteries Caused by vasospasm of the arterioles and arteries

of the upper and lower extremitiesof the upper and lower extremities Drug therapy: Procardia, Cyclospasmol, and Drug therapy: Procardia, Cyclospasmol, and

DibenzylineDibenzyline Lumbar sympathectomyLumbar sympathectomy Reinforcement of client education; restriction of cold Reinforcement of client education; restriction of cold

exposureexposure

Venous Venous Thromboembolism Thromboembolism

Thrombus: a blood clotThrombus: a blood clot ThrombophlebitisThrombophlebitis Deep vein thrombosisDeep vein thrombosis Pulmonary embolismPulmonary embolism High rate of deathHigh rate of death

Assessment Assessment Calf or groin tenderness or painCalf or groin tenderness or pain Sudden onset of unilateral swelling of the legSudden onset of unilateral swelling of the leg Positive Homans’ signPositive Homans’ sign Localized edemaLocalized edema Venous flow studiesVenous flow studies

Venous Insufficiency Venous Insufficiency

Result of prolonged venous Result of prolonged venous hypertension, stretching veins and hypertension, stretching veins and damaging valvesdamaging valves

Stasis dermatitis, stasis ulcersStasis dermatitis, stasis ulcers Management of edemaManagement of edema Management of venous stasis Management of venous stasis

ulcersulcers Drug therapyDrug therapy Surgical managementSurgical management

Varicose VeinsVaricose Veins

Distended, protruding veins that Distended, protruding veins that appear darkened and tortuousappear darkened and tortuous

Collaborative management includes:Collaborative management includes:– Elastic stockingsElastic stockings– Elevation of extremitiesElevation of extremities– SclerotherapySclerotherapy– Surgical removal of veinsSurgical removal of veins– Radio frequency energy to heat the Radio frequency energy to heat the

veinsveins

PhlebitisPhlebitis

Inflammation of the superficial Inflammation of the superficial veinsveins

Management: warm, moist soaks Management: warm, moist soaks and elastic stockingand elastic stocking

Complications: tissue necrosis, Complications: tissue necrosis, infection, or pulmonary embolusinfection, or pulmonary embolus