Clinical Nursing - Disorders of Arterial Circulation

Learning Outcomes

  • At the end of this lecture, students will be able to:
    • Describe common types of arterial disorders.
    • Identify complications and causes of different arterial disorders.
    • Recognize clinical manifestations of each arterial disorder.
    • Identify common diagnostic tests for different arterial disorders.
    • Discuss medical and nursing management of different arterial disorders.

Common Types of Arterial Disorders

  • Peripheral Artery Disease (PAD): Narrowing of arteries affecting blood supply to lower and upper limbs.
  • Raynaud’s Disease: Spasms of blood vessels causing reduced blood flow to fingers.
  • Aortic Aneurysm: Localized outpouching or dilation of the aortic wall.
  • Aortic Dissection: Tear in the inner layer of the aorta leading to blood vessel splitting.

Peripheral Artery Disease (PAD)

  • Causes:
    • Arteriosclerosis/Atherosclerosis (plaque buildup).
  • Affected Areas: Common in femoral, popliteal, posterior, and anterior tibial arteries.
  • Symptoms show when vessels are 60%-75% blocked.
  • Risk Factors:
    • High blood cholesterol, diabetes, coronary artery disease, hypertension, kidney disease, smoking, stroke.
  • Complications:
    • Skin atrophy, delayed wound healing, infection, tissue necrosis, arterial ulcers, gangrene, possible amputation if untreated.
  • Clinical Manifestations:
    • Intermittent Claudication: Muscle cramp pain in limbs, relieved by rest.
    • Rest Pain: Persistent pain when at rest, indicative of severe PAD.
    • Skin changes: Pale color, loss of hair, brittle nails, ulcers, cyanosis.
    • Pulsation abnormalities: Weak or absent pulses, cool skin.

Diagnostic Tests for PAD

  1. Doppler Ultrasound: Measures blood flow in limbs using sound waves.
  2. Ankle-brachial Index (ABI): Compares blood pressure in ankle vs. arm.
  3. Segmental Blood Pressures: Detect BP differences in limbs to suggest blockage.
  4. Computed Tomography Angiography (CTA): Imaging to visualize blood vessels.
  5. Magnetic Resonance Angiography (MRA): Similar to CTA but uses MRI.
  6. Peripheral Angiography: X-ray to find blockages.
  7. Exercise Treadmill Test: Evaluates walking performance and changes in blood pressure.

Medical Treatments for PAD

  • Pletal (Cilostazol): Treats claudication by increasing blood flow.
  • Aspirin/Plavix (Clopidogrel): Reduces cardiovascular risks.
  • Combination therapy might include statins and antihypertensives.

Revascularization Procedures

  1. Percutaneous Transluminal Angioplasty (PTA): Minimally invasive procedure.
  2. Peripheral Artery Bypass Surgery: Bypasses blocked section with a graft.

Nursing Education for PAD

  • Lifestyle modifications:
    • Smoking cessation, low fat and cholesterol diet, weight management.
    • Maintain regular exercise, avoid tight clothing, manage foot care especially in diabetic patients.

Raynaud’s Disease

  • Definition: Decreased blood flow to fingers due to vasospasm; symptoms can last from minutes to hours.
  • Risk Factors: Often seen in young women, usually triggered by cold or stress.
  • Complications: Digital ulcerations or gangrene.
  • Clinical Manifestations:
    • Cold/numb fingers, color changes (white/blue), tingling pain upon warming.
  • Diagnosis: Based on symptoms and history of attacks.
  • Medication: Vasodilators to improve blood flow, surgery (sympathectomy) in severe cases.
  • Nursing Education: Wear loose clothing, use gloves in cold, avoid tobacco/caffeine, manage stress.

Aortic Aneurysm

  • Definition: Permanent enlargement of the aorta.
  • Types: Degenerative, congenital, infectious, inflammatory, and mechanical.
  • Risk Factors: Family history, gender (more common in males), smoking, hypertension, atherosclerosis.
  • Complications: Risk of rupture leading to severe hemorrhage and death.
  • Clinical Manifestations: Often asymptomatic; may include deep chest pain, difficulty swallowing, back pain.

Diagnostic Tests for Aortic Aneurysm

  1. Chest X-ray: Shows widened mediastinum.
  2. Abdominal X-ray: May show calcified arteries.
  3. 12 lead ECG: Assesses heart conditions.
  4. Echocardiography: Assesses aneurysm size.
  5. CT Scan: High accuracy in diagnosing size and severity.

Medical and Surgical Management for Aortic Aneurysm

  • Conservative therapy: Monitor small aneurysms (<5.4 cm), modify risk factors.
  • Surgery: Recommended for aneurysms ≥5.5 cm. Procedures include Open Aneurysm Repair (OAR) and Endovascular Graft Procedure (EVAR).

Aortic Dissection

  • Definition: Tear in the inner layer of the aorta, leading to blood vessel splitting.
  • Complications: Cardiogenic shock, renal/abdominal ischemia, high mortality rate.
  • Types: Type A (involves ascending aorta) and Type B (does not involve ascending aorta).
  • Clinical Manifestations: Sudden chest/back pain, pulselessness, hypotension.

Management of Aortic Dissection

  • Medical Management: Control BP and HR, pain relief, monitor closely.
  • Surgical Management: Emergency surgery for acute dissection with complications.

Summary

  • Arteriosclerosis/atherosclerosis are major contributors to artery diseases.
  • Types of vessels diseases need in-depth assessment.
  • PAD leads to gradual issues while aortic aneurysm/dissection can result in immediate life-threatening conditions.
  • Nursing interventions are crucial in both hospital and long-term home care scenarios.