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Interventions for Clients with Vascular Problems

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Interventions for Clients with Vascular ... syndrome Assessment for infection Acute ... of graft occlusion or rupture. Thoracic Aortic Aneurysm Repair ... – PowerPoint PPT presentation

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Title: Interventions for Clients with Vascular Problems


1
Interventions for Clients with Vascular Problems
2
Arteriosclerosis and Atherosclerosis
  • Arteriosclerosis thickening or hardening of the
    arterial wall
  • Atherosclerosis type of arteriosclerosis
    involving the formation of plaque within the
    arterial wall
  • Etiology and genetic predisposition
  • Factors related to atherosclerosis include
    obesity, lack of exercise, smoking, and stress.

3
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4
Laboratory Assessment
  • Lipid level, including cholesterol and
    triglycerides, is elevated in atherosclerosis
    clients.
  • High serum levels of homocysteine can allow cell
    walls to become vulnerable to plaque buildup.

5
Interventions
  • Evaluation of total serum cholesterol levels and
    lifestyle changes
  • Diet therapy
  • Smoking cessation
  • Exercise
  • Drug therapy

6
Hypertension
  • Hypertension systolic blood pressure 135 mm Hg
    and/or diastolic blood pressure to 85 mm Hg
    (not including diabetics)
  • Malignant hypertension elevated blood pressure
    that progresses rapidly to systolic pressure gt
    200 mm Hg and diastolic pressure gt 130 mm Hg

7
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8
Diseases
  • Diseases that commonly cause secondary
    hypertension
  • Renal vascular
  • Renal parenchymal
  • Dysfunction of the adrenal medulla or the adrenal
    cortex
  • Primary aldosteronism
  • (Continued)

9
Diseases (Continued)
  • Pheochromocytomas
  • Cushings syndrome
  • Coarctation of the aorta
  • Neurogenic disturbances, such as brain tumors,
    encephalitis, and psychiatric disturbances

10
Knowledge Deficit
  • Interventions include
  • Sodium restriction
  • Weight reduction
  • Moderation of alcohol intake
  • Exercise
  • Relaxation techniques
  • Tobacco and caffeine avoidance

11
Drug Therapy
  • Diuretics
  • Calcium channel-blocking agents
  • ACE inhibitors
  • Angiotensin II receptor antagonists
  • Aldosterone receptor antagonists
  • Beta-adrenergic blockers
  • Central alpha agonists
  • Alpha-adrenergic agonists

12
Risk for Ineffective Therapeutic Regimen
Management
  • Interventions include
  • Teach medication compliance, usually for the rest
    of life.
  • Discuss goals of therapy, potential side effects,
    and how to identify potential problems.
  • Assist client to understand therapeutic regimen.
  • Discuss consequence of noncompliance.

13
Peripheral Arterial Disease
  • Disorders that alter the natural flow of blood
    through the arteries and veins of the peripheral
    circulation
  • Manifestation of systemic atherosclerosis a
    chronic condition in which partial or total
    arterial occlusion deprives the lower extremities
    of oxygen and nutrients

14
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15
Physical Assessment
  • Intermittent claudication
  • Pain that occurs even while at rest numbness and
    burning
  • Inflow disease affecting the lower back,
    buttocks, or thighs
  • Outflow disease causing cramping in calves,
    ankles, and feet
  • (Continued)

16
Physical Assessment (Continued)
  • Hair loss and dry, scaly, mottled skin and
    thickened toenails
  • Ulcers arterial ulcers, diabetic ulcers, venous
    stasis ulcers

17
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18
Diagnostic Assessments
  • Angiography
  • Segmental systolic blood pressure measurements
  • Exercise tolerance testing
  • Plethysmography

19
Nonsurgical Management
  • Exercise
  • Positioning
  • Promoting vasodilation
  • Drug therapy
  • Percutaneous transluminal angioplasty
  • Laser-assisted angioplasty
  • Atherectomy

20
Surgical Management
  • Preoperative care
  • Operative procedures (bypass surgery)
  • (Continued)

21
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22
Surgical Management (Continued)
  • Postoperative care
  • Assessment for graft occlusion
  • Promotion of graft patency
  • Treatment of graft occlusion
  • Monitoring for compartment syndrome
  • Assessment for infection

23
Acute Peripheral Arterial Occlusion
  • Embolus the most common cause of occlusions,
    although local thrombus may be the cause
  • Assessment pain, pallor, pulselessness,
    paresthesia, paralysis, poikilothermia
  • Drug therapy
  • Surgical therapy
  • Nursing care

24
Aneurysms of Central Arteries
  • Aneurysm a permanent localized dilation of an
    artery, enlarging the artery to twice its normal
    diameter
  • Fusiform aneurysm
  • Saccular aneurysm
  • Dissecting aneurysm (aortic dissections)
  • Thoracic aortic aneurysms

25
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26
Assessment of Abdominal Aortic Aneurysm (AAA)
  • Pain related to AAA is usually steady with a
    gnawing quality, is unaffected by movement, and
    may last for hours or days.
  • Pain is in the abdomen, flank, or back.
  • Abdominal mass is pulsatile.
  • Rupture is the most frequent complication and is
    life threatening.

27
Assessment of Thoracic Aortic Aneurysm
  • Assess for back pain and manifestation of
    compression of the aneurysm on adjacent
    structures.
  • Assess for shortness of breath, hoarseness, and
    difficulty swallowing.
  • Occasionally a mass may be visible above the
    suprasternal notch.
  • Sudden excruciating back or chest pain is
    symptomatic of thoracic rupture.

28
Diagnosis and Management
  • X-rays
  • Computed tomography scan to assess size and
    location of aneurysm
  • Aortic angiography
  • Ultrasonography
  • Goal of nonsurgical management monitor growth of
    the aneurysm and maintain blood pressure at
    normal level

29
Abdominal Aortic Aneurysm Resection
  • Preoperative care
  • Operative procedure
  • Postoperative care
  • Monitor vital signs.
  • Assess for complications.
  • Assess for signs of graft occlusion or rupture.

30
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31
Thoracic Aortic Aneurysm Repair
  • Preoperative care
  • Operative procedure
  • Postoperative care assessments
  • Vital signs
  • Complications
  • Sensation and motion in extremities
  • Respiratory distress
  • Cardiac dysrhythmias

32
Endovascular Repair of Abdominal Aortic Aneurysm
  • Clients selected for endovascular repair are
    generally at high risk for major abdominal
    surgery.
  • Various designs

33
Aneurysms of the Peripheral Arteries
  • Femoral and popliteal aneurysms
  • Symptoms limb ischemia, diminished or absent
    pulses, cool to cold skin, and pain
  • Treatment surgery
  • Postoperative care monitor for pain

34
Aortic Dissection
  • May be caused by a sudden tear in the aortic
    intima, opening the way for blood to enter the
    aortic wall
  • Pain described as tearing, ripping, and stabbing
  • (Continued)

35
Aortic Dissection (Continued)
  • Emergency care goals include
  • Elimination of pain
  • Reduction of blood pressure
  • Decrease in the velocity of left ventricular
    ejection
  • Nonsurgical treatment
  • Surgical treatment

36
Buergers Disease
  • Thromboangiitis obliterans relatively uncommon
    occlusive disease limited to the medium and small
    arteries and veins
  • Often identified with tobacco smoking
  • Nursing interventions to prevent progression of
    disease

37
Other Disorders
  • Subclavian steal occurring from artery occlusion
    or stenosis
  • Thoracic outlet syndrome resulting in arterial
    wall damage
  • Popliteal entrapment

38
Raynauds Phenomenon
  • Caused by vasospasm of the arterioles and
    arteries of the upper and lower extremities
  • Drug therapy Procardia, Cyclospasmol, and
    Dibenzyline
  • Lumbar sympathectomy
  • Reinforcement of client education restriction of
    cold exposure

39
Venous Thromboembolism
  • Thrombus a blood clot
  • Thrombophlebitis
  • Deep vein thrombosis
  • Pulmonary embolism
  • High rate of death

40
Assessment
  • Calf or groin tenderness or pain
  • Sudden onset of unilateral swelling of the leg
  • Positive Homans sign
  • Localized edema
  • Venous flow studies

41
Nonsurgical Management
  • Rest
  • Drug therapy includes
  • Unfractionated heparin therapy
  • Lowmolecular weight heparin
  • Warfarin therapy
  • Thrombolytic therapy

42
Surgical Management
  • Thrombectomy
  • Inferior vena caval interruption
  • Ligation or external clips

43
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44
Venous Insufficiency
  • Result of prolonged venous hypertension,
    stretching veins and damaging valves
  • Stasis dermatitis, stasis ulcers
  • Management of edema
  • Management of venous stasis ulcers
  • Drug therapy
  • Surgical management

45
Varicose Veins
  • Distended, protruding veins that appear darkened
    and tortuous
  • Collaborative management includes
  • Elastic stockings
  • Elevation of extremities
  • Sclerotherapy
  • Surgical removal of veins
  • Radio frequency energy to heat the veins

46
Phlebitis
  • Inflammation of the superficial veins
  • Management warm, moist soaks and elastic
    stocking
  • Complications tissue necrosis, infection, or
    pulmonary embolus
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