V. PERIPHERAL VASCULAR DISEASE

Positioning

  • ARTERIAL: Flat on Bed

  • VENOUS: Elevated

Patency of the vessel

1. ATHEROSCLEROSIS OBLITERANS (ASO)

  • Chronic inflammation of vessels due to atheroma

2. THROMBOANGINITIS OBLITERANS (TAO)

  • Buerger’s Disease

  • Common: Men

  • Trigerred by: Smoking

  • BV = small and medium sized arteries of hands and feet

  • Hallmark Signs ( 6 P’s)

    • Paresthesia (Earliest)

    • Pain

    • Pallor

    • Paralysis

    • Poikilothermia

    • Pulselessness

  • Diagnostic Test:

    • Ankle Brachial Index

      • Formula: Ankle Pressure/Arm Pressure

        • 110/70 / 120/80

        • 40/40 = 1

        • Interpretation: If >.90 = Normal

          • 0.71-0.90 = Mild

          • 0.41-0.70 = Moderate

          • 0.00-0.40 = Severe

    • Doppler UTZ= monitor BV based on turbulence

    • Arteriography – Most reliable

    MANAGEMENT

    • P – Promote adequate tissue perfussion

    • U – Understand Medications

      • Pentoxifylline

      • Papavarine

      • Plasma Expanders (Dextran)

      • Anticoagulant

      • Platelet Inhibitor

      • Antithrombotic (Cilostazol)

    • L – Limit/Stop Smoking and Caffeine

    • S – Safety of the leg = heat sensitive

      • No warm compress on the leg

      • Place it on the abdomen

      • Insulated leather shoes

    • E – Exercise: Buerger-Allen’s Exercise

      • Elevate extremities 5 degrees

      • Dangle the legs

      • Flat on bed

    • S – Surgery

      • Femoral-popliteal bypass graft

      • Rotational Atherectomy

      • Amputation

        • Pre-Op:

          • Psychological Preparation

          • Teach to prevent deformity

          • Phantom limb sensation

        • Post-Op:

          • Monitor for bleeding (always have a tourniquet)

          • No pillow under the knee (can cause flexion deformity)

          • Passive ROM

          • Prepare for crutchwalking

3. RAYNAUD’s PHENOMENON

– unknown etiology

  • Common : Female

  • Trigerred by : Smoking, Stress, Cold environment

  • Hallmark Sign: Flat color changes sign

    • Pallor = Whole - Vasoconstriction

    • Cyanotic = Blue - Vasoconstriction

    • Erythema = Red - Vasodilation

  • Diagnostic Test: Allen’s Test

Management

  • Reduce stress

  • Avoid cold environment

  • Use gloves and mittens

  • Use brandy/whisky (black label, red label)

  • Monitor pulse

  • Administer vasodilator

4. VENOUS DISORDERS (DVT)

PATENCY OF THE VESSELS

A. Inflammatory: Thrombophlebitis

Etiology

  • Hypercoagability of the blood

  • Endothelial Injury – blood vessel wall damage

  • Venous/Blood stasis- decrease venous return

Signs and Symptoms

  • Homan’s Sign

  • Increase in leg girth

  • Erythema of the leg

  • Edema

Management

  • Bedrest

  • Don’t massage(leg)

  • Elevate

  • Apply warm compress

  • Use elastic support

  • Improve hydration

  • Anti-coagulants

B. Functional: Varicose Vein

– abnormal dilation of vessel wall of vein

Etiology

  • Congenital, genetically weak BV

  • Prolonges sitting and standing

Signs and Symptoms

  • Dilated Tortorous vein

  • Dull achy sensation of the leg at the end of the day

Management

  • Elevate the leg

  • Foot massage

  • Note color changes

  • Hose applications

  • Ulcer treatment:

    • Stasis Dermatitis = non-healing ulcer of the leg

      • UNNA PASTE BOOT = dressing with zinc oxide to facilitate wound healing

      • Vein Stripping = veins larger for 4 months

      • Sclerotherapy = injection of solution to hardened vessels (2 -3 weeks)

      • Incision and Drainage

      • Pressure dressing for 12-18 hours

C. DEGENERATIVE: ANEURYSM

out patching of the artery due to damage in tunica media (congenitally weak)

Etiology:

S - Syphilis

A - Artherosclerosis (70%) enhanced by HTN

M - Marfan Syndrome

S – Sacular (one-sided dilated)

F – Fusiform ( 2 sided dilated)

D – Disecting (more sided dilated)

A – Abdominal

A – Aortic

A – Aneurysm

Consideration:

  • Do not palpate the abdomen = it can rupture

  • Asymptomatic

  • Abdominal mass pulsation

  • Flank pain/ Abdominal Pain (sign of aneurysm)

  • Sudden sharp knifelike pain (ruptured aneurysm)

D. CONSTRICTIVE: HYPERTENSION

TYPES

  • Primary = BP grading of 140/90 mmHg in 2 consecutive readings with 4-6 hours apart, unknown cause

  • Secondary = Secondary to disease

    • Ex. Chronic Renal Failure

  • Isolated = Calcification of Aorta R/T aging process

    • Seen in elderly

    • Asymptomatic

    • Most dangerous because it is related to high incidence of stroke

  • Malignant = Occipital headache due to anatomical placement of brain stem

    • Epistaxis

    • Paresthesia

    • Occipital Headache

MANAGEMENT

1. Lifestyle Modification

  • Diet: Prudent diet

  • Low alcohol

  • Stop smoking

2. Pharmacologic approach

A – ACE INHIBITORS “PRIL”

  • Vasoconstrictor

  • Side Effects: Bradycardia, HOPN, Pruritus, Cough, Angioedema

Nursing Considerations

  • Monitor the action of the drug

Contraindications

  • Patients with Renal Insufficiency

B – BETA BLOCKERS “OLOL”

  • B1 = Heart

    • Increase in Cardiac Rate, Increase BP

  • B2 = Lungs

    • Bronchodilation

  • P – Propranolol (Inderal)

  • A – Atenolol

  • T – Timolol

    • Contraindications: CHF/COPD

  • M – Metoprolol (Lopressor)

  • N – Nadolol (Corgard)

    • Blocks B1 can be given to asthmatic patients

C – CALCIUM – CHANNEL BLOCKERS

  • (-) INOTROPIC EFFECT = blocks the entrance of Calcium in the myocardial cell

    • Decreases Cardiac Contraction

  • C – Calan (Verapamil)

  • C – Cardizem

  • C – Calcibloc

  • A – Amlodipine (Norvasc)

  • N – Nifedipine (Procardia)

    • Contraindications: CHF

D – DIURETICS

  • A – Aldactone (Spinorolactone) K Sparring

    • Side Effects: Hyperkalemia = Irregular heartbeats

  • B – Bumex = Ototoxicity

  • C – Chlorthiazide ( Diuril) = K wasting; can cause Pancreatitis- monitor Amylase

  • F – Furosemide (Lasix) = Loop Diuretic