Chapter 26

Chapter Overview

  • Focuses on assessment and management of patients with vascular disorders and problems of peripheral circulation.

Vascular System Structure

  • Consists of two interdependent systems:

    • Right side of the heart: pumps blood through the lungs (pulmonary circulation).

    • Left side of the heart: pumps blood to body tissues (systemic circulation).

  • Major components include:

    • Arteries and arterioles.

    • Capillaries.

    • Veins and venules.

    • Lymphatic vessels.

Functions of the Vascular System

  • Supports circulatory needs of tissues:

    • Blood flow and blood pressure regulation.

    • Facilitates capillary filtration and reabsorption.

    • Maintains hemodynamic resistance.

    • Regulates peripheral vascular mechanisms.

Pathophysiology of the Vascular System

  • Common issues affecting vascular health:

    • Pump failure affecting circulation.

    • Alterations in blood and lymphatic vessels.

    • Circulatory insufficiency of extremities.

Circulatory Pathways

  • Systemic vs. Pulmonary Circulation:

    • Details the flow of blood from the body through the heart and lungs, highlighting various major vessels and their circulation paths.

Gerontologic Considerations

  • Aging effects on blood vessel walls lead to:

    • Stiffening, increased peripheral resistance, impaired blood flow.

    • Results in increased workload on the left ventricle.

Assessment of the Vascular System

  • Key aspects of assessment include:

    • Health history: symptoms like intermittent claudication and location of pain.

    • Physical examination: assessing skin conditions, pulse presence, and overall health indicators.

Peripheral Pulses Assessment

  • Examination of peripheral pulses to evaluate blood flow in extremities.

Diagnostic Evaluations

  • Various diagnostic methods include:

    • Doppler ultrasound flow studies.

    • Ankle-brachial index (ABI).

    • Exercise testing and duplex ultrasonography.

    • Advanced imaging techniques like CT scanning, angiography, and lymphoscintigraphy.

Assessment of Peripheral Vascular Problems

  • Components:

    • Health history, medications, risk factors, and clinical symptoms.

    • Identification of pain types including claudication and rest pain.

    • Observation of color changes and skin breakdown.

Planning and Goals for Patients with Peripheral Vascular Problems

  • Major goals to aim for:

    • Increase arterial blood supply.

    • Decrease venous congestion.

    • Facilitate vasodilation and prevent vascular compression.

    • Manage pain and maintain tissue integrity.

    • Encourage patient adherence to self-care programs.

Improving Peripheral Arterial Circulation

  • Strategies include:

    • Positioning body parts below heart level.

    • Engaging in exercise programs (walking, isometric exercises).

    • Managing temperature sensitivities and reducing nicotine use.

    • Emphasizing stress reduction techniques.

Arterial Disorders

  • Key conditions include:

    • Arteriosclerosis, atherosclerosis, peripheral artery disease, and various aneurysms.

    • Understanding conditions like Raynaud’s phenomenon.

Risk Factors for Atherosclerosis and PAD

  • Modifiable risk factors:

    • Nicotine use, diabetes, hypertension, and diet.

  • Non-modifiable factors include age, genetics, and familial predisposition.

Peripheral Artery Disease (PAD)

  • Characterized by intermittent claudication.

  • Pain associated with activity, relieved by rest.

  • Describes critical ischemia as persistent and severe pain.

Common Atherosclerotic Obstruction Sites

  • Lists various arteries susceptible to atherosclerotic blockage including:

    • Common carotid, renal arteries, and femoral arteries.

Pharmacologic Therapy for PAD

  • Important medications include:

    • Cilostazol (Phosphodiesterase III inhibitor).

    • Antiplatelet agents (Aspirin, Clopidogrel).

    • Statins for cholesterol management.

Aneurysms

  • Defined as localized dilation in arterial walls.

  • Classified as either saccular or fusiform based on shape and formation.

Raynaud’s Phenomenon

  • Characterized by vascular occlusion in extremities.

  • Causes color changes, numbness, and pain, triggered by cold or stress.

  • Common in young women; emphasizes protection from triggers.

Venous Disorders

  • Includes conditions like VTE, chronic venous insufficiency, and varicose veins.

Preventive Measures for Venous Thromboembolism

  • Recommendations such as early ambulation, use of compression stockings, and lifestyle changes to mitigate risk.

Management of Leg Ulcers

  • Assessment focus on history, pain, peripheral pulses, and potential infection.

  • Treatment strategies may include anti-infective therapy and compression.

Nursing Interventions for Leg Ulcers

  • Strategies to restore skin integrity, enhance mobility, and ensure adequate nutrition for healing.

Varicose Veins Prevention

  • Clear guidelines on lifestyle changes and activities to avoid venous stasis.

Lymphatic Disorders

  • Includes conditions like lymphangitis, lymphadenitis, and lymphedema, detailing etiology and management.

Question and Answers

  • Discusses hypothetical patient scenarios for vascular conditions, emphasizing educational aspects and nursing care explanations.