Week 7 (Arterial/Venous Dz)

Veins Characteristic

Thin-Walled with Valves

• Pumps De-Oxyenated blood to the heart

• Tissue to Blood

Proper flow

• Proper functioning valves to avoid backflow

• Well-toned muscles to squeeze vessel together and allow valves to flap together.

Chronic Venous Insufficiency Description

Characteristic

• Most Venous Issue

• Valves in the legs are floppy, and cause backflow (AKA, Gravity Winning)

• Venous stasis causes increased Hydrostatic Pressure, then edema.

Risk factors

• aging

• obesity

• pregnancy

• Job with standing too long

Veins Characteristic

Thin-Walled with Valves

• Pumps De-Oxyenated blood to the heart

• Tissue to Blood

Proper flow

• Proper functioning valves to avoid backflow

• Well-toned muscles to squeeze vessel together and allow valves to flap together.

Chronic Venous Insufficiency Description

Characteristic

• Most Venous Issue

• Valves in the legs are floppy, and cause backflow (AKA, Gravity Winning)

• Venous stasis causes increased Hydrostatic Pressure, then edema.

Risk factors

• aging

• obesity

• pregnancy

• Job with standing too long

Chronic Venous Insufficiency (COMPLICATIONS)

• Venous Stasis Ulcers

• Thrombus

Deep Vein Thromobosis Description

Characteristic:

• clot develops on vessel wall at thigh or calves

• Thrombophlebitis

Virchow’s Triad (Risk Factors)

• Injury of endothelium

  • ex: surgery

• Venous Stasis

  • venous insufficiency, immobility

• hypercoagulability states

  • Dehydration due to concentrated blood with platelets and clotting factors finding each other easily.

  • estrogen presence

  • Pregnant or birth control

Deep Vein Thrombosis Signs and Symptoms

• SHEP= Local edema (swelling), warmth (heat), erythema (redness), pain.

• Unilateral (on one leg)

• Extreme or hardly noticeable

• Sometimes no S&S

Virchow’s Triad Elements

• Sits for long time

• Have cast or bed ridden

• Pregnant or Obese

• Diuretic (dehydration) medication

• Hormone therapy (estrogen increase clotting factors)

• Pre-existing circulation issues.

True

True or False: Deep Vein Thrombosis can cause Pulmonary Embolus

Pulmonary Embolus

Characteristic:

• Thrombus break free from DVT and flows to the right atrium → right ventricle→ pulmonary artery.

Signs and Symptoms

• Hemoptysis (bloody sputum)

• Shock (low blood pressure)

• Chest Pain

• SOB

Venous Disorder Treatment

• Encourage mobility and hydration

• Elevate Feet

• Watch for Skin problems (tightness edema)

• Administer anticoagulant to prevent thrombus

  • Coumadin

  • Heparin

  • Aspirin

Artery Characteristic

Thick wall with oxygenated blood.

• Flexible, compliant vessel.

• No ischemia

Good perfusion

• Cap Refill < 2 seconds

• Pink, dry skin

• Good mentation

• Good blood Pressure (110/60-115/70)

• Normal Pulse

• Good urine output and cardiac output

Arteriosclerosis

Characteristic:

• Arteries stiffens and thickens due damaged arteries by hypertension

• Collagen fills in the damaged gaps and hardens.

• Elasticity and compliance decrease → abnormal tone and resistance

Risk Factors:

• aging

• hypertension

• diabetes II

• hyperlipidemia (high cholesterol).

Atherosclerosis

Characteristic:

• Fat deposits on artery (specifically micro-injuries)→ trigger inflammation → plaque (fat + collagen + clot)

Modifiable Risk Factor

• High LDL, low HDL.

• Smoking

  • Cause vasoconstriction arteries

• Sedentary lifestyle (no exercise and more fast food)

• Diet like hyperglycemia

• Heavy alcohol

Non Modifiable Risk Factor

• Genetics (family history)

• Aging

Hypertension Description

Characteristics

• Blood Pressure above 130/80

• Primary Hypertension

  • Most common

  • Unknown cause (Idiopathic)

• Secondary Hypertension

  • Medical reason (i.e., adrenal tumor)

Risk Factors

• arterial disease

• High sodium intake

• Water retention

Hypertension PATHOPHYSIOLOGY

Etiology:

• Sympathetic Nervous System Overdrive

  • Caused by genetics, sustained or sudden flight or fight response.

  • epinephrine elevates→ tachycardia→ increase contractility and ejection

• RAAS

  • Becomes chronically activated

  • Vasoconstrict and Retain NA + H20 →elevate blood volume and pressure → high BP

Sequela

• Artery damage

• Hypertrophy (heart muscle enlarge)

• Hyperplasia (inner lining thickens)

• Inflammation (histamine, leukotrienes, and prostaglandin)

Hypertension Signs and Symptoms

Neurologic System

• Stroke: due to ischemia of narrowed artery and high pressure

• Eyes: narrow artery infarction at retina and change vision

Renal System

• High pressure cause hematuria (bloody urine) or proteinuria (protein urine)

• Renal Failure

Cardiovascular system

• Increased workload into narrow stiff arteries

• Heart Attacks

Aneurysm

Characteristics

• small pouch outside arterial wall due to

  • Stiff, non-compliant arteries

  • Hypertension

• blood can seep through and cause rupture.

If found in Brain, cause stroke s/s

If found in Aorta (abdomen and thoracic), cause s/s

• Abdomen (AAA): palpable mass, abd. or back pain

• Thoracic: resembles heart attack on X-Rays, chest and back pain.

Arterial Thromboembolic Description

Chaacteristic:

• A clot that forms and moves away from the heart, causing sluggish flow.

• Cause distal tissue Ischemia

• Same S/S as Deep Vein Thrombosis

Examples

• Atrial Fibrillation

• Femoral Artery thrombus

Left Atrium

• Clot flows to the brain and upper arterial system'

Right atrium

• Emboli would go to the lungs

False

True or False, Arterial Thromboembolism does not have same sign and symptoms as Deep Vein Embolism

Treatment for Arterial Problem

Prevention of Hypertension

• Manage stress, stop smoking and alcohol

• Diet with low salt and fat intake. (eat low LDL, high HDL)

• HDL can be raised with excercise, red wine, and niacin

• Omega 3 fat fights inflammation

Medication

• Beta blockers combat sympathetic nervous system (STOP EPINEPHRINE)

• ACE inhibitors blocks RAAS and combat vasoconstrict

• Blood thinners to decrease clotting

  • Aspirin

  • Coumadin

  • Heparin

Nurse Intervention

• Monitor bulse, BP, tissue, Oxygen saturation.

• Watch out for skin break