MSE 2 Vascular Problems

Vascular Problems

Review of Anatomy & Physiology

• Venous Circulation: Carries deoxygenated blood from the extremities back to the heart for replenishment with oxygen.

• Arterial Circulation: Carries oxygenated blood that flows to the extremities.

Venous Disease

Risk Factors

• Arterial Factors:

  • Smoking

  • High cholesterol (obesity)

  • Diabetes Mellitus Type II (DM Type II)

  • Uncontrolled Hypertension (HTN)

• Venous Factors:

  • Being cisgender female (+ history of using birth control pills)

  • Pregnancy

  • Obesity

  • Sitting or standing for long periods

  • Advanced age

Types of Disease

• Arterial Diseases:

  • Atherosclerosis

  • Raynaud’s Disease

  • Buerger’s Disease (affects arteries & veins)

• Venous Diseases:

  • Varicose Veins

  • Venous Insufficiency

  • Deep Vein Thrombosis (DVT)

Signs and Symptoms of Vascular Issues

• Mnemonic: Remember: “Vessel”

• Various Positions: Certain positions may help alleviate discomfort/pain.

• Characteristics of Pain: Document when pain happens and its characteristics.

• Skin Assessment: Observe for color, temperature, and nail conditions.

• Strength of Pulse: Evaluate to determine health of arterial flow.

• Edema: Look for swelling in lower extremities.

• Lesions: Examine for ulcers, noting their location and appearance.

Pain Characteristics by Type

Arterial vs. Venous Pain Description

Nursing Care for Peripheral Arterial Disease

Assessments

• Vital Assessments:

  • Pulses

  • Skin color and temperature

  • Doppler pulses

  • Pain level

  • Sensation

• Ankle-Brachial Index (ABI) Testing: Used to assess the blood flow.

Interventions to Improve Circulation

• Avoid constrictive clothing and footwear.

• Smoking Cessation: Causes vasoconstriction.

• Avoid knee-flex position or crossing legs (impedes blood flow).

• Medications:

  • Antiplatelet or anticoagulants as prescribed.

  • Lower cholesterol through medication and diet.

  • Develop an exercise program (e.g. walking).

Pain Relief

• Administer medications as per MD/APRN order.

Interventions for Skin Integrity

• Avoid excessive pressure on pressure points of extremities.

Surgical/Medical Interventions

• Heparin drips: Used to manage clotting.

• Percutaneous Transluminal Angioplasty (with or without stent) for peripheral arteries.

• Arterial bypass surgery in severe cases.

• Amputation as a last resort if tissue is critically damaged.

Nursing Care for Venous Disease

Assessments

• Monitor:

  • Pulses

  • Color and temperature of skin

  • Pain level

  • Sensation

  • Wound assessment

Preventing Venous Stasis

• Elevate lower extremities above heart level throughout the day.

• Encourage avoidance of prolonged standing.

• Compression Stockings: Wear elastic compression stockings on affected extremities routinely (ensure they are clean and changed daily).

Wound Care

• Assess the wound for signs of infection and provide care as per physician’s orders.

• Promote healthy nutrition for wound healing.

Avoiding/Treating Clots

• Recognize clot signs and symptoms: redness, swelling, area warmth, and pain.

• Danger Signs: Dyspnea, chest pain, increased respirations, decreased oxygen saturation.

• Treatment options include blood thinners (e.g., heparin, warfarin).

Preventing Infection

• Monitor CBC (Complete Blood Count) for WBC levels.

• Examine wound site and administer proper wound care protocols.

• Administer antibiotics if indicated.

Raynaud’s Disease

Overview

• Definition: Vasospasm of peripheral arteries, mainly affecting fingers and toes.

• Symptoms: Numbness or tingling, discoloration (white or bluish), followed by redness with prickling upon warming.

Treatment

• Medications: Calcium channel blockers.

• Lifestyle: Avoidance of known triggers (e.g., cold exposure, stress).

Buerger’s Disease

Overview

• Blood vessels swell, restricting blood flow, leading to clots that may cause pain, tissue damage, or gangrene.

• Severe cases may require amputation.

• Risk Factor: Strongly linked to smoking.

Inflammatory & Infectious Problems

Pericarditis

Overview

• Definition: Inflammation of the pericardium layer of the heart.

Causes of Pericarditis

• Illness: Viral or bacterial infections.

• Trauma: Heart attack, surgery, or physical injury.

• Autoimmune: Body's immune response (e.g., Lupus).

• Idopathic: Unknown causes.

Types of Pericarditis

• Acute: Lasts less than 6 weeks (most common).

• Chronic: Develops over time, lasting around 6 months.

Laboratory Findings

• Elevated WBC, Erythrocyte Sedimentation Rate (ESR), and C-Reactive Protein (CRP).

Signs and Symptoms

• Friction Rub: A characteristic sound when auscultating.

• Pain: Radiating substernal pain to the left shoulder, neck, or back, exacerbated by supine position; “stabbing” in nature.

• Breathing Difficulties: Trouble breathing when lying down; inspiration or coughing worsens pain.

• General Symptoms: Fever and overall feelings of sickness and weakness.

• ST Segment Elevation: A notable sign of pericarditis.

Mnemonic for Symptoms

• FRICTION: Friction rub, Radiating pain, Increased pain (supine), Chest pain, Trouble breathing, Inspiration worsens pain, Overall malaise, Noticeable ST elevation.

Potential Complications

• Pericardial Effusion: Accumulation of fluid in the pericardium; symptoms include cough, tachypnea, dyspnea, and muffled heart sounds.

• Cardiac Tamponade: Medical emergency resulting from compression of the heart due to fluid build-up.

Nursing Care for Pericarditis

• Bedrest: Keep head of bed at 45 degrees; anxiety reduction is crucial.

• Medications: Depending on cause; antibiotics for bacterial origins, NSAIDs for inflammatory pain (e.g., Naproxen or high-dose Ibuprofen), Colchicine for recurrent cases, Prednisone taper if NSAIDs are ineffective.

• Procedure: Pericardiocentesis if fluid removal is necessary.

Endocarditis

Overview

• Definition: Inflammation of the endocardium layer of the heart, primarily affecting the heart valves.

• Affects:

  • Interventricular septum (may cause perforation).

  • Chordae tendineae, which connect the papillary muscle to tricuspid and bicuspid valves (may cause rupture).

• Causes: Infective (bacterial, viral, or fungal) or non-infective causes.

Types

• Acute Infective Endocarditis (IE): Affects patients with healthy valves; rapid onset and severe symptoms.

• Subacute IE: Typically affects individuals with pre-existing cardiac conditions; symptoms develop more slowly over weeks or months.

Risk Factors for Endocarditis

• Infective Agents: Bacteria, viruses, or fungi that enter the bloodstream and infect heart valves.

• Predisposing Conditions:

  • History of Mitral Valve Prolapse

  • Rheumatic Heart Disease

  • History of IV drug use

  • Invasive Procedures: e.g., pacemaker insertion, dental work, certain surgeries, central line placement.

  • Congenital Heart Defects.

Signs and Symptoms of Endocarditis

• Physical Symptoms:

  • Petechiae (small red or purple spots).

  • Anorexia (loss of appetite).

  • General tiredness and weakness.

  • High fever and signs of heart failure.

  • Osler's Nodes: Tender, red lesions on hands and feet.

  • Splinter Hemorrhages: Small, dark lines under the nails indicating bleeding.

  • Embolic Events: Erythematous, non-tender nodular lesions (Janeway lesions on palms or soles).

  • Night sweats.

  • New cardiac heart murmur or worsening of existing murmurs.

  • Splenomegaly: Enlargement of the spleen.

  • Roth Spots: Retinal findings associated with endocarditis.

Mnemonic for Symptoms

• PATHOGENS: Petechiae, Anorexia, Tiredness, High fever, Osler's nodes, Janeway lesions, Embolic events, Night sweats, Splenomegaly.

Nursing Care for Endocarditis

Monitoring

• Assess for embolic episodes affecting:

  • Spleen: Radiating abdominal pain to left shoulder.

  • Renal: Flank pain, potential hematuria.

  • Brain: Neurological symptoms including confusion and speech difficulties.

  • Pulmonary: Chest pain, dyspnea, decreased oxygen saturation.

  • Signs of Congestive Heart Failure (CHF).

  • Vital Signs: Pay special attention to temperature, heart rate, blood pressure, and oxygen saturation.

Nursing Care Interventions

• Blood Cultures: Collect to identify infective agents.

• Antibiotics: Administer IV antibiotics; typically require long-term therapy (up to 4-8 weeks) and central line placement for delivery.

Patient Education for Endocarditis

• Prophylactic Treatment Importance: Who should receive it?

  • Patients with a prosthetic heart valve.

  • Patients with a history of infective endocarditis (IE).

  • Patients with congenital heart disease (CHD).

  • Patients who have undergone heart transplant.

• Educate about proper administration of antibiotics and importance of completing the full course.

• Instruction on monitoring central line sites for infection and maintenance of good oral hygiene.

• Provide counseling regarding the risk of relapse and substance abuse prevention resources if needed.