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PVD Disorders

Medical-Surgical Nursing Fifth Edition

Aneurysm Is an abnormal dilation of a blood vessel, commonly at a site of weakness or a tear in the vessel wall
Aneurysm Pathophysiology Forms due to weakness of the arterial wall
Collagen Provides tensile strength of the vessel, preventing excessive dilation
Elastin Allows vessel recoil, during which the vessel returns to its original size following systole
True Aneurysms Are caused by slow weakening of the arterial wall due to long-term, eroding effects of atherosclerosis and hypertension
False Aneurysms Are caused by a traumatic break in the vessel wall rather than weakening of the vessel
Fusiform Aneurysms Are spindle shaped and taper at both ends. Considered a true aneurysm
Circumferential Aneurysm Involve the entire diameter of the vessel. Considered a true aneurysm
Berry Aneurysm Is a type of saccular aneurysm. They are often small (less than 2 cm in diameter)Caused by congenital weakness in the tunica media of the artery. Commonly found in the circle of Willis in the brain.
Dissecting aneurysms Develops when a break or tear in the tunica intima and media allows blood to invade or dissect the layers of the vessal wall
Aortic Aneurysms - Thoracic (10% of all) Manifestations May be asymptomatic; back, neck, or substernal pain; dyspnea, stridor, or brassy cough if pressing on the trachea; Hoarseness & dysphagia if pressing on esophagus or laryngeal nerve; edema of the face and neck; distended neck vein
Aortic Aneurysms - Abdominal Manifestations Pulsating abdominal mass; Aortic calcification noted on x-ray; mild to severe mid-abdominal or lumbar back pain; cool, cyanotic extremities if iliac arteries are involved; Claudication (ischemic pain with exercise, relieved by rest)
Aortic Aneurysms - Aortic dissection Manifestations Abrupt,severe, ripping or tearing pain; mild or marked hypertension early; weak or absent pulses and BP in upper extremities; syncope
Abdominal Aortic Aneurysms Associated with: arteriosclerosis,hypertension, age,smoking,found >65, develops below renal arteries(usually where the abd aorta branches to form the iliac arteries
intermittent claudication Cramping or pain in the leg muscles brought on by exercise and relieved by rest
Dissection Is a life-threatening emergency caused by a tear in the intima of the aorta with hemorrhage into the media. The hemorrhage dissects or splits the vessel wall,forming a blood-filled channel between its layers
Type A Dissection Affects the ascending aorta
Type B Dissection Is limited to the descending aorta
Thoracic Aortic Aneurysms Meds Treated with long-term beta-blocker therapy and additional anti-hypertensive drugs as needed to control heart rate and blood pressure
Aortic Dissection Meds Treated with intravenous beta blockers such as propranolol (Inderal), metoprolol (Lopressor), or esmolo (Brevibloc) to reduce the heart rate to about 60 bpm
Endovascular Stent Grafts (EVSG) Treats abd & thoracic aortic aneurysm.The stent, which consists of a metal sheath covered with polyester fabric or a woven polyester tube, usually is placed percutaneously via the femoral artery. Fluoroscopy is used to guid its placement
Endovascular Stent Grafts (EVSG) Complication Is a persistent perfusion of the aneurysm (endoleak) caused by an ineffective seal at the proximal or distal end of the graft.
Endovascular Stent Grafts (EVSG) Follow-up Care Abd CT Scans is necessary to detect an endoleak
Aneurysm Repair Endovascular stent grafts; Open surgical procedure
Aneurysm Interdisciplinary Care Most found on routine physical exam,history. Chest x-ray, ultrasound,angiography, tranesophageal for thoracic. Surgery, EVSG (Stent graphs), anticoagulant therapy
Aneurysm Meds beta-blockers, keep heart rate 60, Nipride, keep systolic at 120
Aneurysm Nursing Care Risk for ineffective tissue perfusion; Assess for increase in pain, change in pulses; prevent straining; provide calm environment; measure abd girth, assess the abd, monitor all pulses, and urinary output.
Aneurysm Labs/Assessment Ecchymosis of the scrotum, perineum or new expanding hematoma; decrease in motor function or sensation; decrease in H&H; decrease in LOC
Arterial Disorders Pathologic Changes Results In Decreased blood supply to tissues, PVD ; progressive obstruction & decrease blood flow, tissue hypoxia or anoxia. Develops collateral circulation. Effects found primarily abd aorta & LE with 60% occlusion or more
Arterial Disorders Risk Factors Smoker; HTN; Obesity
Arterial Disorders Manifestations Intermittent claudication; pain experienced during activity, elevation aggravates the pain; pulses may be diminished or absent; legs feels cold, or numb; skin pale if elevated or dark red if dependent; Hair loss, toenails thickened; line of demarcation
Intermittent Claudication cramping or aching, calves, thighs, buttocks occurs with predictable level of activity
Arterial Disorders Lab & Diagnostics Angiography, contrast medium, using fluoroscopy; Doppler ultra sound, sound waves reflected off RBSc; transcutaneous oximetry
Arterial Disorders Pharm Beta blockers, control heart rate and BP, Nipride; Low dose aspirin, inhibit platelet aggregation; Plavix, low-weight heparin, inhibits clotting cascade; Thrombolitic therapy, breaks up the clot; Trental; Pletal, platelet inhibitor
Beta Blockers – Action Blocks beta receptors in the heart causing: decreased heart rate; decrease force of contractions; decreases rate of A-V conduction
Beta Blockers – Side Effects Bradycardia; Lethargy; GI disturbance; CHF; decrease BP; Depression; Dry hacking cough
Arterial Disorders – Treatments Conservative-walking, weight loss, no smoking (blockage 60% or less); Surgery-arterial bypass grafting, endartectomy (clean out)
Arterial Disorders – Nursing Care Altered Tissue Perfusion; assess the extremities; keep extremities dependent; keep-extremities warm; change position; meticulous foot care; close monitoring
Why Plagues are formed Tissue is torn or damaged & the body forms the plagues in a response in fixing it
Arterial Disorders-Nursing Care Pain-pain scale; changes in degree of obstruction, increase in pain; stress reduction; Impaired Skin Integrity
Arterial Thrombosis Blood clot-adheres to vessel wall, occlusion of arterial blood flow
Arterial Thrombosis Mainfestations pain in affected region; numbness; pallor, mottling, muscle spasm; collateral circulation; risk for necrosis and gangrene; loss of perfusion; pulselessness; possible paralysis
Pain Indicates change in status
Arterial Embolism Occlusion of blood flow by a foreign object, air bubbles, bacteria, fat, cancer cells
Arterial Embolism S/SX pain; numbness; coldness; tingling
Arterial Embolism Treatment Embolism-immd surgery, percutaneous transluminal angioplasty (PTA); stent placement; artherectomy; balloon angioplasty; line of demarcation
Arterial Embolism Nursing Care Anxiety; Altered tissue perfusion, assess peripheral pulses, skin temp, color cap refill, movement and sensation, unrelieved pain; Impaired Physical Mobility; Monitor PTT, PT, INR
Venous Thrombosis Blood clots form on the wall of the vein, may partially or completely occlude flow
Venous Thrombosis Pathologic Factors Virchow's Triad--Statis of blood; increase coagulability; injury to vessel wall
Venous Thrombosis S/SX Dull aching pain; severe pain when walking;cyanosis; elevated temp; general malaise; edema
Venous Thrombosis Collaborative Care Treatment of the inflammatory process; prevent further clotting; restoration of venous blood flow
Venous Thrombosis Lab & Diagnostics Blood cultures; Doppler ultrasound, plethysmography, measure changes in blood flow; ascending contrast venography; MRI; Duplex venous ultrasonography, visualize the vein measure velocity of blood flow
Venous Thrombosis Pharm Anti-inflammatory; anticoagulants, heparin, Coumadin, thrombolytics; surgery-venous thrombectomy
Coumadin lab test PT/INR
Heparin lab test PTT & APTT
Venous Thrombosis Nursing Care Pain; Ineffective tissue perfusion; Impaired physical mobility
Created by: mj8792