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The Cardiovascular System

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The Cardiovascular System NRS 108-ECC Majuvy L. Sulse RN, MSN, CCRN Lola Oyedele RN, MSN, CTN SITES FOR PALPATING PERIPHERAL PULSES VEINS IN THE LEG VENOUS THROMBOSIS ... – PowerPoint PPT presentation

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Title: The Cardiovascular System


1
The Cardiovascular System
  • NRS 108-ECC
  • Majuvy L. Sulse RN, MSN, CCRN
  • Lola Oyedele RN, MSN, CTN

2
SITES FOR PALPATING PERIPHERAL PULSES
From Monahan, F. Neighbors, M. (1998).
Medical-surgical nursing Foundations for
clinical practice, ed 2, Philadelphia W.B.
Saunders
3
VEINS IN THE LEG
From Jarvis, C. (2000). Physical examination and
health assessment, ed 3, Philadelphia W.B.
Saunders
4
VENOUS THROMBOSIS
  • DESCRIPTION
  • Thrombus can be associated with an inflammatory
    process
  • When a thrombus develops, inflammation occurs
    that thickens the vein wall leading to
    embolization

5
TYPES OF VENOUS THROMBOSIS
  • THROMBOPHLEBITIS
  • A thrombus associated with inflammation
  • PHLEBOTHROMBUS
  • A thrombus without inflammation
  • PHLEBITIS
  • Vein inflammation associated with invasive
    procedures such as IVs
  • DEEP VEIN THROMBOPHLEBITIS (DVT)
  • More serious than a superficial thrombophlebitis
    because of the risk for pulmonary embolism

6
RISKS FACTORS FOR VENOUS THROMBOSIS
  • Venous stasis from varicose veins, heart failure,
    immobility
  • Hypercoagulability disorders
  • Injury to the venous wall from IV injections,
    fractures, trauma
  • Following surgery, particularly hip surgery and
    open prostate surgery
  • Pregnancy
  • Ulcerative colitis
  • Use of oral contraceptives

7
PHLEBITIS
  • ASSESSMENT
  • Red, warm area radiating up an extremity
  • Pain and soreness
  • Swelling
  • IMPLEMENTATION
  • Apply warm, moist soaks as prescribed to dilate
    the vein and promote circulation
  • Assess temperature of soak prior to applying
  • Assess for signs of complications such as tissue
    necrosis, infection, or pulmonary embolus

8
DEEP VEIN THROMBOPHLEBITIS (DVT)
  • ASSESSMENT
  • Calf or groin tenderness or pain with or without
    swelling
  • Positive Homans sign
  • Warm skin that is tender to touch

9
DEEP VEIN THROMBOPHLEBITIS (DVT)
  • IMPLEMENTATION
  • Provide bed rest
  • Elevate the affected extremity above the level of
    the heart as prescribed
  • Avoid using the knee gatch or a pillow under the
    knees
  • Do not massage the extremity
  • Provide thigh-high compression or antiembolism
    stockings as prescribed to reduce venous stasis
    and to assist in the venous return of blood to
    the heart

10
DEEP VEIN THROMBOPHLEBITIS (DVT)
  • IMPLEMENTATION
  • Administer intermittent or continuous warm, moist
    compresses as prescribed
  • Palpate the site gently, monitoring for warmth
    and edema
  • Measure and record the circumference of the
    thighs and calves
  • Monitor for shortness of breath and chest pain,
    which can indicate pulmonary emboli

11
DEEP VEIN THROMBOPHLEBITIS (DVT)
  • IMPLEMENTATION
  • Administer thrombolytic therapy (t-PA, tissue
    plasminogen activator) if prescribed, which must
    be initiated within 5 days after the onset of
    symptoms
  • Administer heparin therapy as prescribed to
    prevent enlargement of the existing clot and
    prevent the formation of new clots
  • Monitor APTT during heparin therapy
  • Administer warfarin (Coumadin) therapy as
    prescribed when the symptoms of DVT have resolved

12
DEEP VEIN THROMBOPHLEBITIS (DVT)
  • IMPLEMENTATION
  • Monitor PT and INR during warfarin (Coumadin)
    therapy
  • Monitor for the hazards and side effects
    associated with anticoagulant therapy
  • Administer analgesics as prescribed to reduce
    pain
  • Administer diuretics as prescribed to reduce
    lower extremity edema
  • Provide client teaching

13
ASSESSING FOR PERIPHERAL EDEMA
From Black, J., Hawks, J, and Keene, A. (2001).
Medical-surgical nursing, ed 6, Philadelphia
W.B. Saunders
14
DEEP VEIN THROMBOPHLEBITIS (DVT)
  • CLIENT EDUCATION
  • Hazards of anticoagulation therapy
  • Signs and symptoms of bleeding
  • Avoid prolonged sitting or standing, constrictive
    clothing, or crossing legs when seated
  • Elevate the legs for 10 to 20 minutes every few
    hours each day
  • Plan a progressive walking program

15
DEEP VEIN THROMBOPHLEBITIS (DVT)
  • CLIENT EDUCATION
  • Inspect the legs for edema and how to measure the
    circumference of the legs
  • Antiembolism stockings (hose) as prescribed
  • Avoid smoking
  • Avoid any medications unless prescribed by the
    physician
  • Importance of follow-up physician visits and
    laboratory studies
  • Obtain and wear a Medic Alert bracelet

16
ANTIEMBOLISM HOSE
From Elkin MF, Perry AG, Potter PA Nursing
interventions and clinical skills, ed. 2, St.
Louis, 2000, Mosby.
17
VENOUS INSUFFICIENCY
  • DESCRIPTION
  • Results from prolonged venous hypertension that
    stretches the veins and damages the valves
  • The resultant edema and venous stasis causes
    venous stasis ulcers, swelling, and cellulitis
  • Treatment focuses on decreasing edema and
    promoting venous return from the affected
    extremity
  • Treatment for venous stasis ulcers focuses on
    healing the ulcer and preventing stasis and ulcer
    recurrence

18
VENOUS INSUFFICIENCY
  • ASSESSMENT
  • Stasis dermatitis or discoloration along the
    ankles extending up to the calf
  • Edema
  • The presence of ulcer formation

19
PERIPHERAL VASCULAR DISEASE
From Bryant RA (1992) Acute and chronic wounds
nursing management, St. Louis Mosby. Courtesy of
Abbott Northwestern Hospital, Minneapolis, MN.
20
VENOUS INSUFFICIENCY
  • WOUND CARE
  • Provide care to the wound as prescribed by the
    physician
  • Assess the clients ability to care for the
    wound, and initiate home care resources as
    necessary
  • If an Unna boot (a dressing constructed of gauze
    moistened with zinc oxide) is prescribed, it will
    be changed by the physician weekly

21
VENOUS INSUFFICIENCY
  • WOUND CARE
  • The wound is cleansed with normal saline prior to
    application of the Unna boot providone-iodine
    (Betadine) or hydrogen peroxide is not used
    because they destroy granulation tissue
  • The Unna boot is covered with an elastic wrap
    that hardens, to promote venous return and
    prevent stasis
  • Monitor for signs of arterial occlusion from an
    Unna boot that may be too tight
  • Keep tape off of the clients skin

22
VENOUS INSUFFICIENCY
  • MEDICATIONS
  • Apply topical agents to wound as prescribed to
    debride the ulcer, eliminate necrotic tissue, and
    promote healing
  • When applying topical agents, apply an oil-based
    agent as petroleum jelly (Vaseline) on
    surrounding skin, because debriding agents can
    injure healthy tissue
  • Administer antibiotics as prescribed if infection
    or cellulitis occur

23
VENOUS INSUFFICIENCY
  • CLIENT EDUCATION
  • Wear elastic or compression stockings during the
    day and evening as prescribed
  • Put on elastic stockings upon awakening before
    getting out of bed
  • Put a clean pair of elastic stockings on each day
    and that it will probably be necessary to wear
    the stockings for the remainder of life

24
VENOUS INSUFFICIENCY
  • CLIENT EDUCATION
  • Avoid prolonged sitting or standing, constrictive
    clothing, or crossing legs when seated
  • Elevate the legs for 10 to 20 minutes every few
    hours each day
  • Elevate legs above the level of the heart when in
    bed

25
VENOUS INSUFFICIENCY
  • CLIENT EDUCATION
  • The use of an intermittent sequential pneumatic
    compression system, if prescribed instruct the
    client to apply the compression system twice
    daily for 1 hour in the morning and evening
  • Advise the client with an open ulcer that the
    compression system is applied over a dressing

26
VARICOSE VEINS
  • DESCRIPTION
  • Distended protruding veins that appear darkened
    and tortuous
  • Vein walls weaken and dilate, and valves become
    incompetent
  • ASSESSMENT
  • Pain in the legs with dull aching after standing
  • A feeling of fullness in the legs
  • Ankle edema

27
NORMAL VEINS AND VARICOSITIES
From Monahan, F. Neighbors, M. (1998).
Medical-surgical nursing Foundations for
clinical practice, ed 2, Philadelphia W.B.
Saunders
28
VARICOSE VEINS
From Mosbys Medical, Nursing, and Allied Health
Dictionary, ed 6, (2002). St. Louis Mosby
29
VARICOSE VEINS
  • TRENDELENBURG TEST
  • Place the client in a supine position with the
    legs elevated
  • When the client sits up, if varicosities are
    present, veins fill from the proximal end veins
    normally fill from the distal end

30
TRENDELENBURG TEST
From Jarvis, C. (2000). Physical examination and
health assessment, ed 3, Philadelphia W.B.
Saunders
31
VARICOSE VEINS
  • IMPLEMENTATION
  • Assist with the Trendelenburg test
  • Emphasize the importance of antiembolism
    stockings as prescribed
  • Instruct the client to elevate the legs as much
    as possible
  • Instruct the client to avoid constrictive
    clothing and pressure on the legs
  • Prepare the client for sclerotherapy or vein
    stripping, as prescribed

32
SCLEROTHERAPY
  • DESCRIPTION
  • A solution is injected into the vein followed by
    the application of a pressure dressing
  • An incision and drainage of the trapped blood in
    the sclerosed vein is performed 14 to 21 days
    after the injection, followed by the application
    of a pressure dressing for 12 to 18 hours

33
VEIN STRIPPING
  • DESCRIPTION
  • Varicose veins are removed if they are larger
    than 4 mm in diameter or if they are in clusters
  • PREOPERATIVE
  • Assist the physician with vein marking
  • Evaluate pulses as a baseline for comparison
    postoperatively

34
VEIN STRIPPING
  • POSTOPERATIVE
  • Maintain elastic (Ace) bandages on the clients
    legs
  • Monitor the groin and leg for bleeding through
    the elastic bandages
  • Monitor the extremity for edema, warmth, color,
    and pulses
  • Elevate the legs above the level of the heart

35
VEIN STRIPPING
  • POSTOPERATIVE
  • Encourage range-of-motion exercises of the legs
  • Instruct the client to avoid leg dangling or
    chair sitting
  • Instruct the client to elevate the legs when
    sitting
  • Emphasize the importance of wearing elastic
    stockings after bandage removal

36
PERIPHERAL ARTERIAL DISEASE (PAD)
  • DESCRIPTION
  • A chronic disorder in which partial or total
    arterial occlusion deprives the lower extremities
    of oxygen and nutrients
  • Tissue damage occurs below the level of the
    arterial occlusion
  • Atherosclerosis is the most common cause of PAD

37
ARTERIES IN THE LEG
From Jarvis, C. (2000). Physical examination and
health assessment, ed 3, Philadelphia W.B.
Saunders
38
PERIPHERAL ARTERIAL DISEASE (PAD)
  • ASSESSMENT
  • Intermittent claudication (pain in the muscles
    resulting from an inadequate blood supply)
  • Rest pain, characterized by numbness, burning or
    aching in the distal portion of the lower
    extremities, that awakens the client at night and
    is relieved by placing the extremity in a
    dependent position
  • Lower back or buttock discomfort

39
PERIPHERAL ARTERIAL DISEASE (PAD)
  • ASSESSMENT
  • Loss of hair and dry scaly skin on the lower
    extremities
  • Thickened toenails
  • Cold and gray-blue color of skin in the lower
    extremities
  • Elevational pallor and dependent rubor in the
    lower extremities
  • Decreased or absent peripheral pulses

40
PERIPHERAL ARTERIAL DISEASE (PAD)
  • ASSESSMENT
  • Signs of arterial ulcer formation occurring on or
    between the toes, or on the upper aspect of the
    foot, that are characterized as painful
  • Blood pressure measurements at the thigh, calf,
    and ankle are lower than the brachial pressure
    (normally BP readings in the thigh and calf are
    higher than those in the upper extremities)

41
ARTERIAL OBSTRUCTIONS AND CORRESPONDING AREAS OF
CLAUDICATION
From Monahan, F. Neighbors, M. (1998).
Medical-surgical nursing Foundations for
clinical practice, ed 2, Philadelphia W.B.
Saunders
42
ARTERIAL INSUFFICIENCY
From Lemmi FO, Lemmi CAE Physical assessment
findings CD-ROM, Philadelphia, 2000, W.B.
Saunders.
43
GANGRENE
From Auerbach PS Wilderness Medicine Management
of wilderness and environmental emergencies, ed.
3, St. Louis, 1995, Mosby.
44
PERIPHERAL ARTERIAL DISEASE (PAD)
  • IMPLEMENTATION
  • Assess pain
  • Monitor the extremities for color, motion and
    sensation, and pulses
  • Obtain BP measurements
  • Assess for signs of ulcer formation or signs of
    gangrene
  • Assist in developing an individualized exercise
    program that is initiated gradually and slowly
    increased

45
PERIPHERAL ARTERIAL DISEASE (PAD)
  • IMPLEMENTATION
  • Encourage prescribed exercise, which will improve
    arterial flow through the development of
    collateral circulation
  • Instruct the client to walk to the point of
    claudication, stop and rest, then walk a little
    further

46
PERIPHERAL ARTERIAL DISEASE (PAD)
  • IMPLEMENTATION
  • As swelling in the extremities prevents arterial
    blood flow, instruct the client to elevate his or
    her feet at rest, but to refrain from elevating
    them above the level of the heart, because
    extreme elevation slows arterial blood flow to
    the feet
  • In severe cases of PAD, clients with edema may
    sleep with the affected limb hanging from the bed
    or they may sit upright in a chair for comfort

47
PERIPHERAL ARTERIAL DISEASE (PAD)
  • CLIENT EDUCATION
  • Avoid crossing the legs, which interferes with
    blood flow
  • Avoid exposure to cold (causes vasoconstriction)
    to the extremities and to wear socks or insulated
    shoes for warmth at all times
  • Never to apply direct heat to the limb such as
    with a heating pad or hot water, because the
    decreased sensitivity in the limb may result in
    burning

48
PERIPHERAL ARTERIAL DISEASE (PAD)
  • CLIENT EDUCATION
  • Inspect the skin on the extremities daily and to
    report any signs of skin breakdown
  • Avoid tobacco and caffeine because of their
    vasoconstrictive effects
  • Use of hemorrheologic and antiplatelet
    medications as prescribed
  • Importance of taking all medications prescribed
    by the physician

49
PERIPHERAL ARTERIAL DISEASE (PAD)
  • PROCEDURES TO IMPROVE ARTERIAL BLOOD FLOW
  • Percutaneous transluminal angioplasty
  • Laser-assisted angioplasty
  • Atherectomy
  • Bypass surgery (aortofemoral or
    femoral-popliteal)

50
RAYNAUDS DISEASE
  • DESCRIPTION
  • Vasospasms of the arterioles and arteries of the
    upper and lower extremities
  • Vasospasm causes constriction of the cutaneous
    vessels
  • Attacks are intermittent and occur with exposure
    to cold or stress
  • Affects primarily fingers, toes, ears, and cheeks

51
RAYNAUDS DISEASE
  • ASSESSMENT
  • Blanching of the extremity, followed by cyanosis
    during vasoconstriction
  • Reddened tissue when the vasospasm is relieved
  • Numbness, tingling, swelling, and a cold
    temperature at the affected body part

52
RAYNAUDS PHENOMENON
From Barkauskas VH et al (1998) Health and
physical assessment (2nd ed.). St. Louis Mosby.
53
RAYNAUDS DISEASE
  • IMPLEMENTATION
  • Monitor pulses
  • Administer vasodilators as prescribed
  • Assist the client to identify and avoid
    precipitating factors such as cold and stress
  • CLIENT EDUCATION
  • Medication therapy
  • Avoid smoking
  • Wear warm clothing, socks, and gloves in cold
    weather
  • Avoid injuries to fingers and hands

54
BUERGER'S DISEASE
  • DESCRIPTION
  • An occlusive disease of the median and small
    arteries and veins
  • The distal upper and lower limbs are most
    commonly affected
  • Also known as thromboangiitis obliterans

55
BUERGER'S DISEASE
  • ASSESSMENT
  • Intermittent claudication
  • Ischemic pain occurring in the digits while at
    rest
  • Aching pain that is more severe at night
  • Cool, numb, or tingling sensation
  • Diminished pulses in the distal extremities
  • Extremities are cool and red in the dependent
    position
  • Development of ulcerations in the extremities

56
BUERGER'S DISEASE
  • IMPLEMENTATION
  • Instruct the client to stop smoking
  • Monitor pulses
  • Instruct the client to avoid injury to the upper
    and lower extremities
  • Administer vasodilators as prescribed
  • Instruct the client regarding medication therapy

57
AORTIC ANEURYSMS
  • DESCRIPTION
  • Abnormal dilation of the arterial wall, caused by
    localized weakness and stretching in the medial
    layer or wall of an artery
  • The aneurysm can be located anywhere along the
    abdominal aorta
  • The goal of treatment is to limit the progression
    of the disease by modifying risk factors,
    controlling the BP to prevent strain on the
    aneurysm, recognizing symptoms early, and
    preventing rupture

58
ARTERIAL OCCLUSION AND ANEURYSMS
From Monahan, F. Neighbors, M. (1998).
Medical-surgical nursing Foundations for
clinical practice, ed 2, Philadelphia W.B.
Saunders
59
TYPES OF ANEURYSMS
  • FUSIFORM
  • Diffuse dilation that involves the entire
    circumference of the arterial segment
  • SACCULAR
  • Distinct localized outpouching of the artery wall

60
TYPES OF ANEURYSMS
  • DISSECTING
  • Created when blood separates the layers of the
    artery wall forming a cavity between them
  • FALSE (PSEUDOANEURYSM)
  • Occurs when the clot and connective tissue are
    outside the arterial wall
  • Formed after complete rupture and subsequent
    formation of a scar sac

61
TYPES OF ANEURYSMS
From Monahan, F. Neighbors, M. (1998).
Medical-surgical nursing Foundations for
clinical practice, ed 2, Philadelphia W.B.
Saunders
62
THORACIC AORTIC ANEURYSM
  • ASSESSMENT
  • Pain extending to neck, shoulders, lower back, or
    abdomen
  • Syncope
  • Dyspnea
  • Increased pulse
  • Cyanosis
  • Weakness

63
ABDOMINAL AORTIC ANEURYSM
  • ASSESSMENT
  • Prominent, pulsating mass in abdomen, at or above
    the umbilicus
  • Systolic bruit over the aorta
  • Tenderness on deep palpation
  • Abdominal or lower back pain

64
RUPTURING ANEURYSM
  • ASSESSMENT
  • Severe abdominal or back pain
  • Lumbar pain radiating to the flank and groin
  • Hypotension
  • Increased pulse rate
  • Signs of shock

65
RUPTURED ABDOMINAL AORTIC ANEURYSM
From Cotran RS, Kumar V, Collins T Robbins
pathologic basis of disease, ed. 6, Philadelphia,
1999, W.B. Saunders.
66
AORTIC ANEURYSMS
  • DIAGNOSTIC TESTS
  • Done to confirm the presence, size, and location
    of the aneurysm
  • Includes abdominal ultrasound, CT scan, and
    arteriography

67
AORTIC ANEURYSMS
  • IMPLEMENTATION
  • Monitor vital signs
  • Obtain information regarding back or abdominal
    pain
  • Question the client regarding the sensation of
    palpation in the abdomen
  • Inspect the skin for the presence of vascular
    disease or breakdown

68
AORTIC ANEURYSMS
  • IMPLEMENTATION
  • Check peripheral circulation including pulses,
    temperature, and color
  • Observe for signs of rupture
  • Note any tenderness over the abdomen
  • Monitor for abdominal distention

69
AORTIC ANEURYSMS
  • NONSURGICAL IMPLEMENTATION
  • Modify risk factors
  • Instruct the client regarding the procedure for
    monitoring BP
  • Instruct the client on the importance of regular
    physician visits to follow the size of the
    aneurysm

70
AORTIC ANEURYSMS
  • NONSURGICAL IMPLEMENTATION
  • Instruct the client that if severe back or
    abdominal pain or fullness, soreness over the
    umbilicus, sudden development of discoloration in
    the extremities, or a persistent elevation of BP
    occurs, to notify the physician immediately
  • Instruct the client with a thoracic aneurysm to
    immediately report the occurrence of chest or
    back pain, shortness of breath, difficulty
    swallowing, or hoarseness

71
AORTIC ANEURYSMS
  • PHARMACOLOGICAL IMPLEMENTATION
  • Administer antihypertensives to maintain the BP
    within normal limits and to prevent strain on the
    aneurysm
  • Instruct the client in the purpose of the
    medications
  • Instruct the client about the side effects and
    schedule of the medication

72
ABDOMINAL AORTIC ANEURYSM RESECTION
  • DESCRIPTION
  • Surgical resection or excision of the aneurysm
  • The excised section is replaced with a graft that
    is sewn end-to-end

73
ANEURYSM RESECTION WITH GRAFT
From Monahan, F. Neighbors, M. (1998).
Medical-surgical nursing Foundations for
clinical practice, ed 2, Philadelphia W.B.
Saunders
74
ABDOMINAL AORTIC ANEURYSM RESECTION
  • PREOPERATIVE
  • Assess all peripheral pulses as a baseline for
    postoperative comparison
  • Instruct the client on coughing and
    deep-breathing exercises
  • Administer bowel preparation as prescribed

75
ABDOMINAL AORTIC ANEURYSM RESECTION
  • POSTOPERATIVE
  • Monitor vital signs
  • Monitor peripheral pulses distal to the graft
    site
  • Monitor for signs of graft occlusion, including
    changes in pulses, cool to cold extremities below
    the graft, white or blue extremities or flanks,
    severe pain, or abdominal distention
  • Limit elevation of the head of the bed to 45
    degrees to prevent flexion of the graft

76
ABDOMINAL AORTIC ANEURYSM RESECTION
  • POSTOPERATIVE
  • Monitor for hypovolemia and renal failure due to
    significant blood loss during surgery
  • Monitor urine output hourly, and notify the
    physician if it is less than 50 ml per hour
  • Monitor serum creatinine and BUN daily
  • Monitor respiratory status and auscultate breath
    sounds to identify respiratory complications

77
ABDOMINAL AORTIC ANEURYSM RESECTION
  • POSTOPERATIVE
  • Encourage turning, coughing and deep breathing,
    and splinting the incision ambulate as
    prescribed
  • Maintain nasogastric tube to low suction until
    bowel sounds return
  • Assess for bowel sounds and report their return
    to the physician
  • Monitor for pain and administer medication as
    prescribed
  • Assess incision site for bleeding or signs of
    infection

78
ABDOMINAL AORTIC ANEURYSM RESECTION
  • POSTOPERATIVE
  • Prepare the client for discharge by providing
    instructions regarding pain management, wound
    care, and activity restrictions
  • Instruct the client not to lift objects greater
    than 15 to 20 pounds for 6 to 12 weeks
  • Advise the client to avoid activities requiring
    pushing, pulling, or straining
  • Instruct the client not to drive a vehicle until
    approved by the physician

79
THORACIC AORTIC ANEURYSM REPAIR
  • DESCRIPTION
  • A thoracotomy or median sternotomy approach is
    used to enter the thoracic cavity
  • The aneurysm is exposed, excised, and a graft or
    prosthesis is sewn onto the aorta
  • Total cardiopulmonary bypass is necessary for
    excision of aneurysms in the ascending aorta
  • Partial cardiopulmonary bypass is used for
    clients with an aneurysm in the descending aorta

80
THORACIC AORTIC ANEURYSM REPAIR
  • POSTOPERATIVE
  • Monitor vital signs
  • Monitor for signs of hemorrhage such as a drop in
    BP, increased pulse rate and respirations, and
    report to the physician immediately
  • Monitor chest tubes for an increase in chest
    drainage, which may indicate bleeding or
    separation at the graft site

81
THORACIC AORTIC ANEURYSM REPAIR
  • POSTOPERATIVE
  • Assess sensation and motion of all extremities
    and notify the physician if deficits occur, which
    can be due to a lack of blood supply during
    surgery
  • Monitor respiratory status and auscultate breath
    sounds to identify respiratory complications
  • Encourage turning, coughing, and deep breathing,
    splinting the incision
  • Monitor cardiac status for dysrhythmias

82
THORACIC AORTIC ANEURYSM REPAIR
  • POSTOPERATIVE
  • Monitor for pain and administer medication as
    prescribed
  • Assess the incision site for bleeding or signs of
    infection
  • Prepare the client for discharge by providing
    instructions regarding pain management, wound
    care, and activity restrictions

83
THORACIC AORTIC ANEURYSM REPAIR
  • POSTOPERATIVE
  • Instruct the client not to lift objects greater
    than 15 to 20 pounds for 6 to 12 weeks
  • Advise the client to avoid activities requiring
    pushing, pulling, or straining
  • Instruct the client not to drive a vehicle until
    approved by the physician

84
EMBOLECTOMY
  • DESCRIPTION
  • Removal of an embolus from an artery using a
    catheter
  • A patch graft may be required to close the artery

85
EMBOLECTOMY
  • PREOPERATIVE
  • Obtain a baseline vascular assessment
  • Administer anticoagulants as prescribed
  • Administer thrombolytics as prescribed
  • Place a bed cradle on the bed
  • Avoid bumping or jarring the bed
  • Maintain the extremity in slightly dependent
    position

86
EMBOLECTOMY
  • POSTOPERATIVE
  • Assess cardiac, respiratory, and neurological
    status
  • Monitor affected extremity for color,
    temperature, and pulse
  • Assess sensory and motor function of the affected
    extremity
  • Monitor for signs and symptoms of new thrombi or
    emboli
  • Administer oxygen as prescribed
  • Monitor pulse oximetry

87
EMBOLECTOMY
  • POSTOPERATIVE
  • Monitor for complications caused by reperfusion
    of the artery, such as spasms and swelling of the
    skeletal muscles
  • Monitor for signs of swollen skeletal muscles,
    such as edema, pain on passive movement, poor
    capillary refill, numbness, and muscle tenseness
  • Maintain bed rest initially, with the client in
    semi-Fowlers position
  • Place a bed cradle on the bed

88
EMBOLECTOMY
  • POSTOPERATIVE
  • Check the incision site for bleeding or hematoma
  • Administer anticoagulants as prescribed
  • Monitor laboratory values related to
    anticoagulant therapy
  • Instruct the client to recognize the signs and
    symptoms of infection and edema
  • Instruct the client to avoid prolonged sitting or
    crossing the legs when sitting

89
EMBOLECTOMY
  • POSTOPERATIVE
  • Instruct the client to elevate the legs when
    sitting
  • Instruct the client to wear antiembolism
    stockings as prescribed and how to remove and
    reapply the stockings
  • Instruct the client to ambulate daily
  • Instruct the client about anticoagulant therapy
    and the hazards associated with anticoagulants

90
VENA CAVAL FILTER AND LIGATION OF INFERIOR VENA
CAVA
  • VENA CAVAL FILTER
  • Insertion of an intracaval filter (umbrella) that
    partially occludes the inferior vena cava and
    traps emboli to prevent pulmonary emboli
  • LIGATION
  • Suturing or placing clips on the inferior vena
    cava to prevent pulmonary emboli

91
VENA CAVAL FILTERS
From Black, J., Hawks, J., Keene, A. (2001).
Medical-surgical nursing Clinical management for
positive outcomes, ed 6, Philadelphia W.B.
Saunders
92
VENA CAVAL FILTER AND LIGATION OF INFERIOR VENA
CAVA
  • POSTOPERATIVE
  • Monitor vital signs
  • Assess cardiac and respiratory status
  • Administer oxygen as prescribed
  • Monitor pulse oximetry
  • Maintain semi-Fowlers position
  • Avoid hip flexion
  • Maintain antiembolism stockings as prescribed

93
VENA CAVAL FILTER AND LIGATION OF INFERIOR VENA
CAVA
  • PREOPERATIVE
  • If the client has been taking an anticoagulant,
    consult with the physician regarding
    discontinuation of the medication to prevent
    hemorrhage

94
VENA CAVAL FILTER AND LIGATION OF INFERIOR VENA
CAVA
  • POSTOPERATIVE
  • Provide activity as prescribed
  • Check the insertion site for bleeding and
    hematoma
  • Assess for peripheral edema
  • Monitor laboratory values related to
    anticoagulant therapy

95
VENA CAVAL FILTER AND LIGATION OF INFERIOR VENA
CAVA
  • CLIENT EDUCATION
  • Signs and symptoms of infection and edema
  • Avoid prolonged sitting or crossing legs when
    sitting
  • Elevate the legs when sitting
  • Wear antiembolism stockings as prescribed and how
    to remove and reapply the stockings
  • Ambulate daily
  • About anticoagulant therapy and the hazards
    associated with anticoagulants
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