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WITHPERIPHERAL
VASCULAR DISORDERS
Introduction
Vascular disorders have become major health concerns
among people in this present generation. These are primarily
lifestyle diseases, therefore greatly preventable.
Diagnostic Tests
• Limb Blood Pressure
Acute and chronic arterial occlusion produces regional
hypotension
• Doppler Ultrasonography.
Use high-frequency sound waves.
Permits assessment of arterial and venous flow in the limbs with
the use of a probe moved over a skin surface.
• Ultrasonic Duplex Scanning
Provides ultrasonographic image of the vessel and doppler
signal.
Localizes the site of vascular obstruction and evaluates the
degree of narrowing and the amount of vascular reflux.
Detects deep vein thrombosis
• Computed Tomography
Allows visualizations of the arterial wall and its structures.
May detect AAA( Abdominal Aortic Anuerysm)
Nursing Interventions
Explain the procedure. That the client will be placed in a tunnel-like
device
NPO, if with contrast medium
Ascertain history of allergy to iodine and seafoods
Assess for claustrophobia.
Advise client to remain still during the entire procedure.
Sedation is done if client is unable to remain still.
Magnetic Resonance Imaging
Use magnetic fields to obtain sectional images of the body
Used to detect aneurysms and DVT from pelvic iliac veins and leg
veins.
Nursing Intervention
Assess for implanted metal devices in the body, including artificial
cardiac pacemakers. These make the client ineligible to undergo MRI
Assess for claustrophobia. The client will be placed in tunnel-like
device
Instruct client to remain still during the procedure. To have accurate
result.
Sedation may be done if the client is a child or is restless
• Plethysmography
Measures venous blood volume changes in the extremities
Pressure cuff is applied
Last 30-60 minutes
Placed in supine position with the involved extremity elevated
above the level of the heart.
Venography
Involves injection of contrast medium into the veins via catheter,
followed by radiographic studies
• Vascular Endoscopy (Angioscopy)
Permits imaging of intra- arterial disease in color and in three
dimensions through the use of fiberoptic endoscope
• Angiograpgy
Involves injection of iodinated contrast medium into the arteries
via a catheter followed by radiographic studies
Nursing Intervention
• Before the procedure
o NPO for 2 to 6 hours
o Assess for allergy to seafoods and iodine
o Mild sedative is administered
o Local anesthesia at the injection site
o Procedure last 30-90 minutes.
• After the procedure
o Monitor VS, LOC (Level of Consciousness), peripheral pulses
o Assess puncture site for hematoma
o Bed rest for 6 to 8 hours with the punctured extremity extended.
o Apply pressure dressing and small ice pack at the puncture site. To
prevent bleeding.
o IV fluids foe 6 to 8 hours to excrete contrast medium
Pathophysiology: Peripheral Vascular Disorders
Causes
Atherosclerosis
Trombosis
Embolization
Hypercoagulability of Blood
Hypertension
Inflammatory processes
Mechanical/Chemical Trauma
Tissue Ischemia
Tissue Hypoxia
Necrosis
Ulceration/ Gangrene
Hypertension (HPN)
• Is an abnormal elevation of BP; systolic pressure above 140 mmHg
and or diastolic pressure above 90mmHg for at least two readings.
• Positive family history strongly supports the diagnostic of HPN
• Classification of Hypertension
Essential/ Idiopathic/Primary of HPN
Accounts for 90% to 95% of all cases HPN
Cause is unknown
Secondary HPN
Due to known causes, e.g. Renal failure, Hyperthyroidism,
pheochromocytoma, Crushing’s disease, etc.
Malignant Hypertension
Is severe, rapidly progressive elevation in BP that causes rapid onset 0f the
end target organ complications
Labile HPN
Is intermittently elevated BP
Resistant HPN
Is HPN that does not respond to usual treatment
White Coat HPN
Is elevated of BP only during clinic visit
Hypertensive Crisis
Situation that requires immediate blood pressure lowering (within 1 hour,
systolic pressure above 240mmHg; Diastolic pressure above 120mmHg)
HYPERTENSION
• Accelerates atherosclerosis
• In hypertension, vasoconstriction-> vasospasm-> increased Peripheral Vascular
Resistance-> decreased blood flow to organs (brain, heart, kidneys, eyes-the
end target organs)
• Hypertensive effects on target organs are as follows
Heart- Myocardial ischemia and infarction, congestive heart failure,
myocardial hypertrophy, dysrhythmias
Eyes- blurred/ impaired vision, retinopathy, cataract
Afterload
Blood Pressure
Renal Perfusion Beta-receptor
activation
3. Alpha-adrenergic blockers
Block alpha-adrenergic receptors, resulting in vasodilation and decreased
blood pressure
Alpha blockers do not affect glucose metabolism and they do not affect
respiratory function. They are safe for patients with diabetes and COPD
These drugs cause sodium and water retention with edema. Diuretics are
frequently given with alpha-adrenergic blockers to decrease fluid
accumulation in the extremities
Examples of alpha-adrenergic blockers
Selective alpha- adrenergic blockers
Cardura (doxazosin mesylate)
Minipress (prozosin HCI)
Hytrin (terazosins HCI)
Nonselective alpha-adrenergic blockers
Dibenzyline (phonexybenzamine HCl)
Regitine (phentolamine)
Priscoline HCI (tolazoline HCI)
Side effects and adverse reactions (alpha-adrenergic blockers)
Dizziness
Faintness
Lighteadedness due to postural
hypotension
Increased heart failure
Nausea
Drowsiness
Nasal congestion caused by vasodilation
Edema
Weight gain
Side effects of phentolamine
Hypotension
Reflex tachycardia
Nasal congestion
GI disturbances
Examples of centrally acting sympatholytics:
• Catapress (clonidine HCL)
• Wytensin (guanabenz Acetate)
• Tenex (guanfacine HCI)
• Aldomet (methyldopa)
Arterial Disorders
Arteriosclerosis is hardening of arteries. It affects the tunica media.
Atherosclerosis is narrowing /occlusion of lumen of arteries due to
accumulation off fatty plaques in the tunica intima
The Clinical Manifestation of arterial disorders are as follows.
1. Pain. Intermittent claudication. This is leg pain on activity
and exercise , relieved by rest. Rest improves blood flow and
oxygen supply to the legs, thus pain is relieved.
2. Coldness or cold sensitivity. This is because of tissue
ischemia. 3.
3. Impaired arterial pulsations. Indicates decreased blood
flow due to arterial spasm.
4. Color changes. Cyanosis on dependency of legs.
5. Ulceration and gangrene. Due to tissue ischemia, hypoxia or
trauma
6. Sexual dysfunction. Decreased penile circulation due to
occlusion of terminal aorta. This may be experienced as
unsustained erection.
Collaborative Management for Arterial Disorders:
1. Medication
Vasodilator
Antihyperlipidemics
Peripheral Vasodilators
=Increased blood flow to the extremities, by promoting
vasodilation
Examples:
Alpha – Adrenergic antagonists
Vasodilation (isoxsuprine HCL)
Priscoline HCl (totazoline)
Direct Acting Peripheral Vasodilators
Hydergine (Ergoloid mesylate)
Pavabid (papaverine
Hemorrheologic
Trental (pentoxifylline)
Side effects and adverse reaction (Peripheral vasodilators)
Lightheadedness
Dizziness
Orthostatic hypotension
Tachycardia
Palpitation
Flush
GI distress
2. Surgical management
Balloon angioplasty
Laser angioplasty
Stents: It involves use of rigid but flexible structure that maintains the
integrity of the vascular wall and patency of the artery.
Amputation. It is performed in clients with gangrene. Gangrene is a wound
composed of necrotic tissues that is usually infected and does not heal.
3. Nursing Intervention
Promotion tissue perfusion.
Surgical management
Thromboembolectomy. Surgical removal of blood clotwith the use of
balloon-tipped catheter.
Greenfield vena cave filter and umbrella filter. These are inserted in the
inferior vena cava to prevent pulmonary embolism in clients with
thromboembolism.
Nursing Intervention
Maintaining tissue perfusion
Bed rest for 5 to 7 days. To prevent dislodgement of blood clots.
Evaluate legs to promote venous retum and to prevent edema
Apply compression support stocking to promote venous retum. It is
inverted (turned inside out) to facilitate application.
Check pulse distal to the site of thrombosis, to asses for circulatory
blockage
Monitor calf-pain. Presence of calf pain indicates thromphlebitis.
Promoting comfort
Analgesics to relieve pain
NSAIDs to reduce edema.
Varicose Vein. Dilated veins, usually in the lower extremities
The most common cause of varicose veins is hereditary weakness of the
valves of the veins.
Other causes are congenital absence of valves of the veins, prolonged sitting
or standing, wearing of constricting clothings, obesity, thrombophlebitis,
pregnancy, disease condition, e.g. right –sided CHF, liver cirrhosis
The clinical manifestation of varicose veins are as follows.
Dilated, purplish, tortuous veins
Leg edema
Heaviness in the legs
Collaborative management of varicose veins
Evaluation of the legs for 15 to 30 minutes at a time, average of 20 minutes
Use of compression or support stocking
Sclerotherapy. Injection of sclerosing agent into the varicose veins
Surgery vein ligation and stripping
The priority consideration after vein surgery is prevention of the
thrombophlebitis. Early ambulation prevents thrombophlebitis.
Monitor for bleeding postop.
Arterial and Venous Disoders.
Buerger’s Disease. (Thromboangitis Obliterans). It is diffuse inflammation of
the small and medium arteries, followed by the veins. It involves inflammation
and fibrosis of nerves
Males, 30 to 50 years of age are most commonly affected
Most common ethiologic factors is cigarette smoking.
Other causes are genetic factors and coagulation abnormalities.
Most characteristics clinical manifestation is intermittent claudication
Collaborative management for Buerger’s Disease.
1. Eliminate cigarette smoking
2. Medication: Calcium- channel blockers, anti-platelet agents
3. Surgery
Sympathectomy (to eliminate vasospasm)
amputation of ulcerated finger and toes.