Vascular System

Care of Clients With Peripheral-Vascular Disorders

Earl Francis R. Sumile, RN Instructor, College of Nursing University of Santo Tomas

Care of Clients With Peripheral-Vascular Disorders 

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Arteries or Arterioles – thick walled vessels that transport 02 and blood via the aorta away from the heart to the tissues; blood under higher pressure Capillaries – principal functional unit of cardio vascular system; minute semi-permeable membranes that connect arterioles to smallest veins or venules Veins or Venules – thin walled vessels that transport deoxygenated blood from the capillaries back to the right heart; blood is under much lower pressure;has valves to maintain flow in one direction

Risk factors for Peripheral Vascular Disease  Modifiable  Cigarette

smoking  Hypertension, DM, obesity, no exercise  Hyperlipidemia  Unmodifiable  Age  Sex  Family

History

Diagnostic Tests  Doppler

Ultrasonography – uses high frequency sound waves directed through a transducer (audible tone proportional to blood velocity)  Segmented limb pressure – evaluates artery occlusion; systolic pressure reading from each limb through pneumatic pressure cuffs and Doppler probes.  Radionuclide scan – injection of radionuclide followed by scan  Arteriography (angiography) – dye through catheter inserted at femoral or brachial artery followed by x-ray

Common Peripheral Vascular Diseases 

Hypertension (WHO) – persistent elevation of systolic pressure of over 140 mmHg and diastolic pressure of over 90 mmHg 

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Essential – loss of elastic tissue and arteriosclerotic changes in aorta and large vessels with decreased caliber of arterioles Secondary – increase of blood pressure as a result of another disease Idiopathic – exact etiology is unknown

Signs and Symptoms – throbbing occipital headache, dizziness, visual disturbance; edema, epistaxis, retinal hemorrhages

Hypertension  Diagnostic 

Assessment:

Fundoscopy – papilledema; retinal hemorrhages

 Management:   

Diet – low sodium, low fat Rest and exercise Pharmacotherapeutics  *diuretics

– loop diuretics; K-sparing  *vasodilators – hydrolazine (apresoline)  *CNS acting – methyldopa (aldomet)  *alpha blockers – clonidine (catapres

Hypertension  Management:  Pharmacotherapeutics  *B-adrenergic

blockers – propranolol (inderal), metoprolol (betaloc)  *calcium channel blockers – nefidipine (adalat)  *ACE inhibitors (Angiotensin Converting Enzyme) – captopril (capoten)

Common Peripheral Vascular Diseases  Hypertensive

Crisis (Malignant Hypertension) – sudden elevation of blood pressure with severe headache, nausea and vomiting, neurological symptoms to coma; diastolic BP > 120mmHg; retinal hemorrhage; renal insufficiency; encephalopathy; left ventricular failure  Nursing management:  

pharmacotherapeutics – Hyperstat (diazoxide); Nipride (Na Nitroprusside) ICU care; symptomatic

Common Peripheral Vascular Diseases 

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Buerger’s Disease (Thromboangitis Obliterans) – acute inflammatory disorder affecting medium or smaller arteries and veins of the lower extremities. Etiology – unknown; could be due to hypersensitivity to tobacco and alteration in cellular and humoral immunity Incidence – males 25-40 years; smokers Signs and Symptoms    

Intermittent claudication – sharp, stabbing pain, worse on ambulation or activity Gray ulceration or necrosis located at lateral malleolus, toes or heels Sensitive to cold Decreased or absence of peripheral pulses

Buerger’s Disease  Signs

and Symptoms

 Intermittent

claudication – sharp, stabbing pain, worse on ambulation or activity  Gray ulceration or necrosis located at lateral malleolus, toes or heels  Sensitive to cold  Decreased or absence of peripheral pulses

Buerger’s Disease  Nursing  Pain

Management

control – narcotic-analgesic  For intractable pain –  Lumbar sympathectomy – surgical removal of sympathetic ganglia and nervous tissue to eliminate vasospasm

Common Peripheral Vascular Diseases 

Raynaud’s Phenomenon – intermittent episode of arterial spasms frequently involving fingers 

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Etiology – hypersensitivity to cold, immunologic factors; sympathetic innervation, emotional stress Incidence – women, teenagers

Raynaud’s Phenomenon  Signs

and Symptoms

 coldness  numbness  tingling

in one or more digits  pain precipitated by exposure to cold, emotional stress and tobacco use  intermittent color changes – pallor, cyanosis, rubor  small ulceration and gangrene at tips of digits.

Raynaud’s Phenomenon  Diagnostic

Assessment:

 Cold

stimulation – patient’s hands submerged in ice water bath in 20 seconds

 Nursing  Stop

Management

smoking  Maintain warmth especially in cold weather, use gloves  Pharmacotherapeutics – anti-hypertensive drugs and vasodilators

Common Peripheral Vascular Diseases 

Aneurysm – sac formed by dilation of an artery secondary to weakness and stretching of artery wall   

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Fusiform – entire circumference of the artery Sacular – outpouching on one side only Dissecting – separation of artery wall layers to form a cavity that fills with blood

Etiology – hypertension, trauma, infection, syphilis Incidence – men above 50 years

Aneurysm  Management:  Surgery

– Resection of aneurysm with replacement of Teflon or Dacron graft  Pharmacotherapeutics  *Anticoagulants-

heparin (antidote:protamine sulfate) and coumadin (antidote: vitamin K)  *Fibrinolytics – streptokinase (synthetic) and urokinase (human)

Venous Disorders 

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Varicose veins (varicosities) dilated and tortuous veins because the valves become stretched and incompetent with resultant venous pooling or stagnation edema. Etiology:  

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Congenital absence of valves Acquired valve incompetence

Sites:     

Lower extremities (most common) Anal – hemorrhoids Esophagus Vulva Spermatic veins (variocele)

Varicose veins  Prevention:  If

positive family history, wear support stockings especially when pregnant or in long standing  Prevent venous congestion – elevated legs when sitting, avoid prolonged standing  No continuous pressure on veins – no constricting clothing, no round garters, no tight girdles, no crossing of legs

Varicose veins  Management:  Sclerosing

agents (Na murrhate, Natetradecyl

SO4)  Surgery – ligation and stripping  Nursing

management post-op:

 unwrap

and rewrap plastic bandage on lower extremities  check circulation sensation and mobility of the affected extremitity

Venous Disorders    

Thrombolphlebitis – inflammation of vessel wall with cloth formation. Phlebitis – inflammation of vein wall secondary to injury, prolonged pressure or infection Phlebothrombosis – formation of blood clot within a vein with no associated inflammation. Embolism – thrombus carried and lodged in the blood stream.

Thrombolphlebitis  Frequent

sites – saphenous, femoral and popliteal vein  Superficial

– redness, warmth, tenderness, vein hard and sensitive to pressure  Deep vein thrombosis – pain, edema, increased circumference on thigh of calf, positive Homan’s sign (pain during dorsiflexion)

Thrombolphlebitis  Nursing

management:

 Bedrest

with leg elevated  Moist heat  Elastic stockings (anti-embolytic)  Anticoagulants, fibrinolytics, vasodilators  Surgery – embolectomy, thrombectomy