OXY Gastransport

8/12/2019 OXY Gastransport

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CONCEPT ON OXYGENATION

GAS TRANSPORT


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CARDIOVASCULAR SYSTEM


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Efficient pumping system

Transports cellular wasteproducts to the appropriateorgans for removal from the

body.

Supplies all body tissues withoxygen and nutrients.
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Blood cells play important rolesin the immune system.

Efficient pumping system

Blood cells play important rolesin the endocrine system.
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HEART

BLOOD

BLOODVESSELS


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HEART

Located between thelungs

Above the diaphragmFurnishes the powerto maintain blood flow

throughout both thepulmonary andsystemic circulatorysystems.

Hollow muscular organ
http://catalog.nucleusinc.com/enlargeexhibit.php?ID=10406


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HEART

Weight: between 7 and 15 ounces(200 425 grams)

Size: A little larger than the size of fist.

Average total heart beats per day:100,000

Lifetime average heartbeat: 3.5 billiontimes


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Double-walledmembrane sacthat encloses theheart.

Pericardialfluid between the

layers of thepericardium toprevent frictionwhen the heart

beats.


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EPICARDIUM

external layerof the heart; part of theinner layer of pericardial sac.

ENDOCARDIUMlining ofthe heart; inner surface thatcomes in direct contact withblood being pumped throughthe heart.

MYOCARDIUMmiddle andthickest of the three layers;

consists of cardiac muscle.


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Must have:- continuous supply ofoxygen and nutrients- prompt removal ofwaste

If blood supply isdisrupted, the myocardiumin the affected area dies.

Highly specialized muscle

that beats constantly.

Coronary artery & veins

supply the blood needs ofthe myocardium.


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Atria- upper chamber of the heart- receiving chamber

- separated by interatrial septum

Ventriclelower chamber- all vessels leavingthe heart emergefrom

the ventricles-separated by

interventricularseptum

Cardiac Apex:

narrow tip ofthe heart


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Flow of blood is

controlled by the

following valves:


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Flow of blood is controlled by the following valves:


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Valve: A membranous structure in ahollow organ or passage that folds orcloses to prevent the return flow of thebody fluid passing through it.

If any of the heart valves is not workingproperly, blood does not flow properlythrough the heart and cannot be pumpedeffectively throughout the body.


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Tricuspid (TV)Controls theopening

between theright atriumand right

ventricle.


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Tricuspid:Having 3

points orcusps


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Pulmonarysemilunar valve:

located betweenright ventricleand pulmonaryartery.Semilunar:half-moon


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MitralValve (MV):located

betweenleft atriumand left

ventricle.


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Mitral Valve (MV):Bicuspid valveValve is shaped

with two points


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AorticSemilunar

Valve:

locatedbetween the

left ventricle

and theaorta.


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Valves

Atrioventricular valvesclosure of AV valves = S1 or first heart sound

LUB

tricuspid

mitral Semilunar valvesclosure of SVS2 or second heart sound DUB

pulmonic

aortic

EXTRA HEART SOUNDS

S3ventricular gallop CHF

S4atrial gallop MI, HPN


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Systemicand

PulmonaryCirculation

Makes possiblethe importantfunction of blood:

Bringing oxygento the cells andremoving waste

products.


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SYSTEMIC CIRCULATION

Includes blood flow to all

parts of the body except thelungs.

Oxygen-rich blood flows out

of the heart from the leftventricle into arterial

circulation.

Oxygen-poor blood returnsto the heart through the

veins and flows into the right

atrium.

PULMONARY CIRCULATION


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PULMONARY CIRCULATION

Flow of blood between the heart and lungs.

Blood flows out of the heart from the right ventricle

and through the pulmonary arteriesto the lungs.

This is the only place in the body where arteries

carry oxygen-poor blood.

In the lungs, waste material (CO2)from the body is exchanged for oxygen

from the inhaled air.

The pulmonary veinscarry the

oxygen-rich blood into the left atriumof the heart.

This is the only place in the body

where veins carry oxygen-rich

blood.


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To pump blood effectively

throughout the body, thecontraction and relaxation (beating)of the heart must occur in exactlythe correct sequence.


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The rate and regularity of the

heartbeat is determined byelectrical impulses from nervesthat stimulates the myocardium ofthe chambers of the heart.


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CONDUCTION

SYSTEM:

Bundle of His

atrioventricular(A-V) node

sinoatrial node(S-A node)

Bundle of His


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Bundle of His

Sinoatrial Node(S-A node)

Located in theposterior wall of theright atrium near theentrance of thesuperior vena cava.

Establishes the

basic rhythm of theheartbeat.

NATURAL

PACEMAKER


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Bundle of His

Sinoatrial Node Electrical impulsesfrom the S-A node start

each wave of musclecontraction in the heart.

Impulse in the right

atrium spreads over themuscles of both atria,causing them to contractsimultaneously.

The contractionforces blood into theventricles.

(DIASTOLE)


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Bundle of His

Atrioventricular Node

Impulses from the S-Anode travel to the A-Vnode or atrioventricularnode.

It is located on the

floor of the right atriumnear the interatrialseptum.

The A-V node

transmits the electricalimpulses on to theBundle of His.


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Bundle of His

Bundle of His

Named for Wilhelm His, Jr.,

a 19thcentury Swiss physician.

Located within the

interventricular septum.

Branches of the Bundle of

His carry the impulse to the

right and left ventricles and the

Purkinje fibers.


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Bundle of His

Purkinje Fibers

Named for Johannes

Purkinje, a 19thcentury

physiologist.

Simulation of Purkinje

fibers causes the ventricles

to contract simultaneouslyforcing blood into the aorta

and pulmonary arteries.

SYSTOLE


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Activities of theelectrical conduction

system of the heart

can be visualized as

wave movements on amonitor or an

electrocardiogram.


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P waveis due to the

contraction (stimulation) of

the atria.

QRS complex shows the

contraction (stimulation) ofthe ventricles. The atria

relax as the ventricles

contract.

T waveis the relaxation

(recovery) of the ventricles.


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When a stethoscope is used to listen to the

hearbeat, two distinct sounds are heard. They arecalled the lubb-dupp sounds.

Lubb sound: Caused by the tricuspid and mitral

valves closing between the atria and the ventricles.

Dupp sound: Caused by the closing of thesemilunar valves in the aorta and pulmonary arteries

as blood is pumped out of the heart.

- Shorter and higher pitched sound.


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Arteries

Veins

Lumen: Opening within

the vessels through

which blood flows.

Capillaries

A t i


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Arteries

Large blood vessels that carry

blood away from the heart to allregions of the body.

High oxygen content: bright red

color of arterial blood

Endarterial: pertaining to the

interior or lining of an artery.

end: within arteri: artery

al: pertaining to

A t


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Aorta

Aorta: Maintrunk of the

arterial system

and begins fromthe left ventricle

of the heart

Coronary Artery


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Coronary Artery

Coronaryartery:branchesfrom the

aorta andsuppliesblood tothe

myocardium

A i l


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Arterioles Arterioles:Smaller,thin branches

of arteries.Carry bloodto the

capillaries.

Capillaries


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Capillaries Serve as the anatomic

units connecting the arterialand venous circulatory

systems.

Smallest vessel in the

body (thinner than hair).

Slower blood flow

through the capillaries

allows for the exchange of

oxygen, nutrients, andwaste materials between

tissue fluids and

surrounding cells.

V in


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VeinsForm a low-pressure collecting system to

return the waste-filled blood to the heart.Thinner walls and are less elastic thanarteries.

Have valves thatallow blood to flowtoward the heart but

prevent it from flowingaway from the heart.

Venules: small veins thatjoin to form the larger veins.

Th V C


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The Venae Cavae

Two large veins that enter theheart.

Superior vena cava (SVC) brings

blood from the upper portion of thebody.

Inferior vena cava (IVC) bringsblood from the lower portion of thebody.


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PULSE: Rhythmic expansion andcontraction of an artery

produced by the pressure of theblood moving through the artery.


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BLOOD

PRESSURE:Measurement ofthe amount of

pressure exertedagainst the wallsof the arteries.


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DIASTOLIC: Occurs whenthe ventricles

RELAX

LOWESTpressure againstthe walls of thevessels.


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SYSTOLIC:Occurs whenthe ventricles

CONTRACT

HIGHEST

pressure againstthe walls of thevessels.


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Normal seated adult: 134/84 mm Hg.


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Blood tests chapter 15Test for bloodoxygen levels can

be obtained througha monitor attachedto a finger

pulse oxymeterNormal value 95%

A i h


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- Radiographic study ofblood vessels after theinjection of a dye; resultingfilm is an angiogram.-Considered to be the most

accurate method of obtaininganatomic & pathologicvascular anatomy.-Performed through arterial

puncture, commonly, thefemoral artery

Angiography


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CoronaryAngiography:-performed todetect obstructionin the coronaryarteries of theheart.


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CARDIACCATHETERIZATION (CC)-catheter is passed into a vein orartery and guided to the heart(arm, neck, groin).-when catheter is in place,contrast medium is introduced to

produce an angiogram todetermine how well heart isworking (angiography)-Coronary arteries are viewed-O2 concentration can be

measured across all chambersand walls of the heart.


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CARDIACCATHETERIZATION(CC)

- Abnormal results will

mean1. presence of coronary

artery disease2. valvular heart disease3. ventricular aneurysm

4. ventricular enlargement.


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ANGIOCARDIOGRAPHY-uses contrast medium andchest x-rays to visualize thedimensions of the heart and

large blood vessels.-resulting film is anangiogram


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PHLEBOGRAPHY

- Venography-Technique of preparingan x-ray image of veinsinjected with a contrastmedium material.-Uses: diagnose deepvein thrombosis,distinguish blood clotsand other obstructions

such as tumors, orlocate suitable vein forcoronary bypass graft.-Resulting film is aphlebogram.

ELECTROCARDIOGRAPHY


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- Process of recording

electrical activity of themyocardium.-Record of the electricalactivity is known as theelectrocardiogram.

ELECTROCARDIOGRAPHY


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STRESS TESTS-ECGs used to assesscardiovascular healthand function during andafter application ofstress such as exercise

on a treadmill.

THALLIUM STRESS TESTS


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-flow of blood through theheart during activity isassessed through the use of

thallium during a stress test.

ULTRASONIC DIAGNOSTIC


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ULTRASONIC DIAGNOSTICPROCEDURES

ECHOCARDIOGRAPHY(ECHO)-ultrasonic diagnosticprocedure used toevaluate structures andmotion of the heart.

- may be performedtransthoracically(device tranducer onthe chest).

-Echo: sound-Cardio: heart-Graphy: to record

ULTRASONIC DIAGNOSTIC


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ULTRASONIC DIAGNOSTICPROCEDURES

TRANSESOPHAGEAL

ECHOCARDIOGRAPHY(TEE)-ultrasonic procedurethat images the heart

from inside the esophagus


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CARDIOLOGIST: specializes indiagnosing and treating abnormalitiesand disorders of the heart.

HEMATOLOGIST: specializes indiagnosing and treating diseases anddisorders of the blood and blood-forming tissues.

CORONARY ARTERY


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CORONARY ARTERYDISEASE

Stages:

I. Myocardial InjuryAtherosclerosis

II. Myocardial IschemiaAngina PectorisIII. Myocardial NecrosisMyocardial infarction

CORONARY ARTERY


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CORONARYARTERYDISEASE (CAD)

-Atherosclerosisof the coronaryarteries that maycause:

angina pectoris myocardial

infarction sudden death

EDISEASE

CORONARY ARTERY


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DISEASE

CORONARY ARTERY


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ATHEROSCLEROSIS

Hardening and

narrowing of the

arteries due to a

buildup of cholesterolplaques.

athero: plaque or fatty

substance

sclerosis: abnormalhardening

DISEASE

CORONARY ARTERY


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ATHEROMA: Plaque (fatty deposit) withinthe arterial wall; characteristic ofatherosclerosis.

ather: plaque

oma: tumor

DISEASE


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ATHEROSCLEROSIS

A. PREDISPOSING FACTORS

Sexmen

RaceBlack

Smoking Hyperlipidemia

Obesity

Sedentary lifestyle

Diet high in saturated fats DM

Hypothyroidism


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ATHEROSCLEROSIS

B. SIGNS AND SYMPTOMS

Chest pain

Dyspnea Tachycardia

Palpitations

Diaphoresis


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ATHEROSCLEROSIS

C. TREATMENT

Percutaneous Transluminal Coronary Angioplasty

(PTCA)done in patients with single occluded vessel

Revascularize myocardium

Prevent angina

Increase survival rate

Coronary Artery Bypass and Graph Surgery (CABG)

Single or 2 or more occluded vessels

CLEARING BLOCKED ARTERIES


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PERCUTANEOUS through the skin

Percutaneous Transluminal CoronaryAngioplasty (PTCA)

STENT metal mesh implanted in acoronary artery to provide support to

the arterial wall to prevent restenosis.RESTENOSIS describes the conditionwhen an artery that has been opened by

angioplasty closes again.

TRANSLUMINAL within the lumen of

an artery

CLEARING BLOCKED

ARTERIES
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(PTCA) - STENTARTERIES

Deflated balloon catheter and vascular

stent is being led through artery.Balloon catheter carrying stent is

approaching narrowed area of artery.

CLEARING BLOCKED


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Balloon catheter carrying stent is in place

in narrowed section of artery prior to

inflation.

Vascular stent has been fully extended

through the inflation of the balloon

catheter. Lumen of artery has been

widened.

CLEARING BLOCKEDARTERIES


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Vascular stent has been fully extended and the ballooncatheter is being removed. Expanded stent keeps arterylumen open.

CLEARING BLOCKEDARTERIES


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ARTERIES

CORONARY ARTERY BYPASS GRAFT (CABG)Requires opening the chest.Piece of vein from the leg is implanted on the

heart.Bypass a blockage in the coronary artery and

improve flow of blood to the heart.

CORONARY ARTERY BYPASS GRAFT (CABG)


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CORONARY ARTERY BYPASS GRAFT (CABG)

Autologous veinsare graftedbetween the aortaand just below the

occlusion in thecoronary arteries toprovide adequateblood flow to theheart.

ANGINA PECTORIS


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ANGINA PECTORIS

clinical syndrome characterized by paroxysmalchest pain that is usually relieved by rest or by

taking NTG d/t temporary myocardial ischemia

CORONARY ARTERY


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ANGINA PECTORIS:

Severe episodes of

spasmodic choking or

suffocating chest pain.

Due to interference

of oxygen supply to the

myocardium.

DISEASE

ANGINA PECTORIS


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ANGINA PECTORIS

A. PREDISPOSING FACTORS Sexmen

RaceBlack

Smoking

Hyperlipidemia

Obesity

Sedentary lifestyle

Diet high in saturated fats DM

Hypothyroidism

ANGINA PECTORIS


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ANGINA PECTORIS

B. PRECIPTATING FACTORS

Excessive strenuous physical exertion

Extreme emotional response

Exposure to cold environment

Excessive intake of foods rich in saturated

fats

ANGINA PECTORIS


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ANGINA PECTORIS

C. SIGNS AND SYMPTOMS LEVINES SIGNhand clutching of heart

Chest painsharp, stabbing, excruciating, crushingsubsternal pain

Usually radiates from back, shoulder, arms, axilla, and jawmuscles

Usually relieved by rest or by taking NTG

Dyspnea

Tachycardia

Palpitations

Diaphoresis


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NURSING MANAGEMENT


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NURSING MANAGEMENT

1. Enforce CBR.

2. Administer medication as ordered.

1. Nitroglycerin (NTG)

2. Beta-blockerspropanolol

3. ACE inhibitorscaptopril

4. Ca-channel blockers - nefedipine

NURSING MANAGEMENT


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NURSING MANAGEMENT

3. Administer O2 inhalation as ordered

4. Place client on semi-fowlers position

to promote lung expansion

5. Monitor strictly VS, IO, ECG tracing

6. Provide a dietary intake low in Na,

Saturated fat and caffeine (stimulant)


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MYOCARDIAL INFARCTION (MI)


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The terminal stage of CAD characterized bypermanent malocclusion leading to necrosis

and scarring

TYPES

Transmuralmost dangerous type; both R and L

Coronary arteries are blocked

Subendocardialocclusion of 1 coronary artery

CORONARY ARTERY

DISEASE


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MI due to blood clot

DISEASE

MYOCARDIAL INFARCTION

(MI)HEARTATTACK

Occlusion (closing off)

of a coronary artery

resulting in an infarct ofthe affected

myocardium.

Damage to the

myocardium impairs the

hearts ability to pump

blood through the body.

CORONARY ARTERY

DISEASE


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MI due to blood clot

DISEASE

MYOCARDIAL INFARCTION

(MI)HEARTATTACK

INFARCT: Localized

area of necrosis (tissue

death) caused by an

interruption of the blood

supply.


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B. SIGNS AND SYMPTOMS Chest painexcruciating, visceral pain, substernal, rarely

precordial Radiates from back, shoulder, arms, axilla, jaws and abdominal muscles

Not relieved by rest or NTG

dyspnea

hypothermia initial rise in BP

cool, moist, ashen skin

mild apprehension, restlessness

occasional findings:

split S1 and S2 Pericardial friction rub

Rales/crackles

S4atrial gallop



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C. DIAGNOSTICS Cardiac Enzymes

CPK-MBCreatinine Phosphokinase

LDHlactic acid dihydrogenase

SGPT (ALT)Serum Glutamic Pyruvate Transaminase

SGOT (AST)Serum Oxaloacetic Pyruvate Transaminase

Treponin testincreased levels

ECG

ST segment elevation

Widening of QRS complexes arrhythmia

Peaked T waves

Serum uric acid and cholesterol elevated

CBCWBC elevated


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D. NURSING MANAGEMENT(Goal : decreasemyocardial workload)

6. Diet: GL to soft diet low in Na, saturated fats and

caffeine7. Monitor v/s, I&O, ECG strictly

8. Encourage patient to take 20-30cc/week of

whisky or brandyinducesvasodilation

9. Assist I surgical procedure CABG


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ANTIHYPERTENSIVEMEDICATIONS


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MEDICATIONSACE InhibitorsBeta-blockersCalcium channel blockersDiuretics

Additional Medications:

StatinsDigoxinNitroglycerinAnticoagulantAntiarrhytmicTissue plasminogenactivator

VasoconstrictorVasodilator

Administeredto lower

bloodpressure

ANTIHYPERTENSIVEMEDICATIONS


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MEDICATIONS

ACE Inhibitors (Angiotensin Converting Enzyme)

- treat hypertension and CHF- interfere with action of kidney hormonerenin that causes the heart muscles tosqueeze.

Calcium channel blockers- treat hypertension, angina and arrythmia-reduce the contraction of the muscles thatsqueeze bloodmuscles tight

Beta-blockers slow the hearbeat

Diuretics- treat hypertension and CHF- increase urine secretion to rid the body of

excess sodium and water.

ANTIHYPERTENSIVE

MEDICATIONS


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MEDICATIONS

Statins

- cholesterol-lowering drug- reduce LDL or other lipids in the blood

Digoxin

- also known as digitalis

- treatment of atrial fibrillation-slows and strengthens heart contractions

Nitroglycerin

- vasodilator

- relieve pain of angina

- may be administered sublingually, through the

skin (patch), or orally as a spray.


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CONGESTIVE HEART FAILURE


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CONGESTIVE HEART FAILURE

Inability of the heart to pump

blood towards systemic

circulation

I LEFT-SIDED HEART FAILURE


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I. LEFT-SIDED HEART FAILURE

A. PREDISPOSING FACTORS 90% - mitral valve stenosis

RHD

Aging

MI

IHD

HPN

Aortic valve stenosis



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B. SIGNS AND SYMPTOMS Pulmonary edema/congestion

Dyspnea, 2-3 pillow orthopnea

Productive cough (blood tinged)

Rales

Bronchial wheezing

Pulses alternans

Anorexia and general body malaise

S3 (ventricular gallop)



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C. DIAGNOSTICS CXRcardiomegaly

PAPpulmonary arterial pressure

Measures pressure in right ventricle

Reveals cardiac status

PCWPpulmonary capillary wedge pressure

Measures end-systolic and end-diastolic pressure

Echocardiographreveals enlarged heart chamber

ABG analysis reveals elevated PCO2 and decreased PO2

(respiratory acidosis)

II RIGHT-SIDED HEART FAILURE


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II. RIGHT SIDED HEART FAILURE

A. PREDISPOSING FACTORS Tricuspid valve stenosis

COPD

Pulmonary embolism (char by chest pain and dyspnea)

Pulmonic stenosis

left sided heart failure



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B. SIGNS AND SYMPTOMS(Venous congestion) jugular vein distention

pitting edema

ascites

weight gain hepatosplenomegaly

jaundice

pruritus/ urticaria

esophageal varices anorexia

generalized body malaise



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C. DIAGNOSTICS CXRcardiomegaly

CVPmeasures pressure in right atrium; N = 4-10cc

H2O

Echocardiographyreveals enlarged heart chamber

Liver enzymesSGPT and SGOT elevated

II. RIGHT-SIDED HEART FAILURE


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D. NURSING MANAGEMENT

(Goal: increase myocardial contraction

increase CO; Normal CO is 3-6L/min; N stroke

volume is 60-70ml/h2o Administer medications as ordered

Cardiac glycosidesDigoxin

Loop diureticsLasix

BronchodilatorsAminophylline Narcotic analgesicsMorphine SO4

VasodilatorsNTG, xylocaine



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D. NURSING MANAGEMENT Administer O2 at 3-4 LPM via NC as ordered

high-flow

High-Fowlers Restrict Na and fluids

Monitor v/s, I&O, and breath sounds

Weigh patient daily and assess for pitting

edema

Abdominal girth daily and notify MD



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D. NURSING MANAGEMENT Provide meticulous skin care

Diet low in saturated fats and caffeine

Institute a bloodless phlebotomy

ROTATING TORNIQUETROTATED EVERY 15 MINUTES TO

PROMOTE A DECREASE IN VENOUS RETURN.


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PERIPHERAL VASCULAR

DISORDERSArterial ulcers

Thromboangitis obliterans /Buergersdisease (feet)

Reynauds Phenomenon (hand)

Venous Ulcers

Varicose veinsThrombophlebitis/DVT

THROMBOANGITIS OBLITERANS (TAO)


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acute inflammatory conditionaffecting the smaller and medium

sized arteries and veins of the lower

extremities



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A. PREDISPOSING FACTORS High risk group men 30 years old above

Chronic smoking

B. SIGNS AND SYMPTOMS Consistent to all arterialdiseases

Intermittent claudicationleg pain upon walking cold sensitivity and skin color changes

white/pallor bluish/cyanosis red/rubor

(+) especially post smoking

decreased peripheral pulses volume particularly in dorsalis pedisand posterior tibial

Trophic changes ulceration

gangrene formation




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C. DIAGNOSTICS oscillometryreveals a decrease in peripheral pulse

volume

Doppler utzdecrease in blood flow to affected

extremity

angiographysite and extent of malocclusion



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D. NURSING MANAGEMENT encourage slow progressive physical activity

walking 3-4x/day

out of bed 3-4x/day

medications as ordered analgesics

vasodilators anticoagulants

instruct patient to avoid smoking and exposure to coldenvironment

institute foot care management avoid barefoot walking

straight nails lanolin cream for feet

(-) constricting clothes

Assist in surgery: BKA

THROM OANGITIS O IT RANS (TAO)

REYNAUDS DISEASE


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REYNAUD S DISEASE

characterized by acuteepisodes of arterial

spasms involving the

digits of hands and

fingers

REYNAUDS DISEASE


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A. PREDISPOSING FACTORS high risk group women 40 years old up

smoking

collagen diseases

SLE

RA

direct hand trauma

piano playing

EXCESSIVE TYPING (tsk tsk! Lagot!)

Carpal tunnel syndrome

Operating chainsaw (nyek!)

Writing (tsk tsk, kaya dapat may module eh! Grr!)

REYNAUD S DISEASE

REYNAUDS DISEASE


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B. SIGNS AND SYMPTOMS Intermittent claudicationleg pain upon walking

cold sensitivity and skin color changes

white/pallor bluish/cyanosis red/rubor

(+) especially post smoking

Trophic changes

ulceration

gangrene formation

REYNAUDS DISEASE


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C. DIAGNOSTICS oscillometryreveals a

decrease in peripheral

pulse volume

angiographysite and

extent of malocclusion

D. NURSINGMANAGEMENT

Administer medications

as ordered

Analgesics

Vasodilators

encourage pt to wear

gloves

instruct: avoid smoking

and exposure to cold

environment

VARICOSE VEINS


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abnormal dilation of the veins ofthe lower extremities d/t

incompetent valves leading toincreased venous pooling and

venostasis decreased venous

return

VARICOSE VEINS Abnormally swollen


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Abnormally swollenveins usually occurring in

the legsA varicosity is one areaof swelling.varices: plural

VARICOSE VEINS


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A. PREDISPOSING FACTORS Hereditary

congenital weakness of veins

thrombophlebitis

cardiac diseases

pregnancy

obesity

prolonged immobility prolonged standing and sitting

VARICOSE VEINS


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B. SIGNS ANDSYMPTOMS

pain after prolonged

standing

dilated tortous skin veins

which are warm to touch

heaviness in the legs

C. DIAGNOSTICS

Venography

trendelenburgs

testreveals that

veins distend

quickly < 35

seconds

incompetentvalves

VARICOSE VEINS


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D. NURSING MANAGEMENT (consistent to allvenous ulcers)

elevate legs above heart level increased venous

return (2-3 pillow elevation)

measure circumference of leg to determine swelling

antiembolic stocking, full support panty hose

medications as ordered analgesics

assist in surgery

vein stripping and ligation

THROMBOPHLEBITIS/DEEP VEIN

THROMBOSIS (DVT)


130/135

THROMBOSIS (DVT)

A. PREDISPOSING FACTORS smoking

obesity

chronic anemia

diet high in saturated fats DM

CHF

MI

post-cannulation (insertion of various catheters) post-surgical operation

sedentary lifestyle


THROMBOSIS (DVT)


131/135

THROMBOSIS (DVT)

B. SIGNS AND SYMPTOMS

pain at the affected extremity

presence of cyanosis

dilated tortous veins

(+) HOMANS pain on calf on

dorsiflexion


THROMBOSIS (DVT)


132/135

THROMBOSIS (DVT)

C. DIAGNOSTICS venography

Doppler utz

angiography


THROMBOSIS (DVT)


133/135

THROMBOSIS (DVT)

D. NURSING MANAGEMENT elevate the legs above heart level

apply warm moist pack to relieve lymphatic congestion

measure circumference of leg muscles to determine if it

is swollen anti-embolic stockings

administer medications as ordered

analgesics

anticoagulantsheparin

prevent complications

pulmonary embolism


134/135


135/135

OXY Gastransport

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