SMU+-+Vascular+Disorders

Vascular Disorders N127 MCA I & II

Learning Outcomes

  • Describe clinical manifestations and management of patients with:

    • Peripheral Artery Disease (PAD) of upper/lower extremities

    • Raynaud’s phenomenon

  • Evaluate risk factors for:

    • Superficial vein thrombosis

    • Deep vein thrombosis (DVT)

  • Distinguish clinical characteristics between superficial vein thrombosis and DVT.

  • Outline management strategies for DVT.

Peripheral Artery Disease (PAD)

  • Definition: Thickening and progressive narrowing of arteries in upper/lower extremities.

  • Major Cause: Atherosclerosis.

    • Gradual thickening of intima and media due to cholesterol and lipid deposits.

Incidence and Mortality

  • Common Age: 60-80 years; can occur earlier in diabetes.

  • Association: Strongly linked to cardiovascular disease and risk factors.

    • Higher risk of mortality, coronary events, and stroke.

Nursing Assessment (PAD)

Clinical Manifestations

  • Intermittent Claudication: Muscle pain with movement, relieved by rest.

  • Paresthesia: Numbness, tingling, burning pain.

  • Reduced Blood Flow: Symptoms include hair loss, delayed capillary refill, diminished pulses.

  • Pain: Worse at night; relief by gravity.

Critical Limb Ischemia (CLI)

  • Chronic ischemia, nonhealing leg ulcers, gangrene.

Diagnostic Studies

  • Doppler Ultrasound

  • Duplex Imaging

  • Ankle-Brachial Index

  • Angiography

  • Magnetic Resonance Angiography (MRA)

Nursing Diagnoses (PAD)

  • Ineffective tissue perfusion

  • Activity intolerance

  • Chronic pain

Goals and Outcomes

  • Achieve adequate tissue perfusion.

  • Provide pain relief.

  • Increase exercise tolerance.

  • Maintain intact, healthy skin on extremities.

  • Enhance patient knowledge of disease and treatment plan.

Nursing Interventions (PAD)

Risk Factor Modification

  • Control blood pressure.

  • Tobacco cessation.

  • Manage hyperlipidemia (diet and statins).

  • Maintain hemoglobin A1C <7% for diabetes.

Interprofessional Collaborative Care

  • Bypass Graft Surgery

    • Option for revascularization utilizing autogenous vein or synthetic graft.

  • Percutaneous Transluminal Angioplasty (PTA)

    • Involves balloon dilation of the vessel, placement of stents.

Other Surgical Options

  • Endarterectomy: Removal of plaque from artery.

  • Patch Graft Angioplasty: Opens artery, removes plaque, and widens lumen with a patch.

  • Amputation: Considered in cases of necrosis, gangrene, osteomyelitis.

Exercise and Nutritional Therapy

  • Exercise: Walking for 30-45 minutes, 3 times a week is effective for claudication.

    • Increases survival rates.

  • Nutritional: Reduced calories/salt for overweight individuals.

Medications

  • ACE Inhibitors: E.g., Ramipril (Altace) to alleviate PAD symptoms.

  • Antiplatelet Agents: Aspirin, Clopidogrel to inhibit aggregation.

  • Phosphodiesterase Inhibitor: Cilostazol for increased vasodilation.

  • Xanthine Derivative: Pentoxifylline to improve blood flow.

Wound Care

  • Post-procedure care and neurovascular assessment of the extremities.

Nursing Evaluation (PAD)

  • Assess neurovascular status including pulses, color, and sensation.

  • Monitor comfort level, wound conditions, and mobility.

Raynaud’s Phenomenon

  • Definition: Episodic vasospastic disorder affecting small cutaneous arteries.

  • Common in women aged 15-40 years.

  • Pathogenesis involves vascular, intravascular, and neuronal changes causing vasodilation.

Clinical Manifestations

  • Characteristic color changes: white, blue, red in fingers, toes, ears, and nose.

  • Symptoms: Coldness, numbness, throbbing pain, tingling, swelling lasting minutes to hours.

  • Frequent episodes can cause thick skin and gangrene.

  • Triggers: Cold, emotional stress, tobacco, caffeine.

Nursing Care for Raynaud’s

  • Patient Education: Prevention strategies including avoiding cold and vasoconstrictors.

  • Drug Therapy: Calcium channel blockers and vasodilators.

Acute and Chronic Venous Disorders

Phlebitis

  • Definition: Acute inflammation of small cannulated veins due to IV catheter placement.

  • Manifestations: Pain, warmth, erythema, swelling, palpable cord.

  • Risk Factors: Catheter irritation, irritating drug infusion, catheter location.

Treatment for Phlebitis

  • Remove catheter, elevate extremity, and manage pain/inflammation with NSAIDs or warm moist heat.

Venous Thrombosis

  • Definition: Formation of a thrombus with vein inflammation.

  • Types: Superficial vein thrombosis, DVT, and venous thromboembolism (VTE).

    • Concern: DVT can lead to pulmonary embolism (PE).

Etiology of Venous Thrombosis

  • Virchow's Triad (Three factors):

    • Venous stasis

    • Damage to endothelium

    • Hypercoagulability of blood.

Risk Factors for Venous Thrombosis

  • Bed rest, prolonged immobility, long transportation, advanced age, surgeries (abdominal, pelvic, orthopedic), heart failure, obesity, pregnancy, tobacco use.

Nursing Assessment for Superficial Vein Thrombosis

  • Highly prevalent in superficial leg veins.

  • Clinical Manifestations:

    • Palpable, firm, cordlike vein; itchy, red, warm; mild fever, leukocytosis.

Nursing Assessment for DVT

Lower Extremity

  • Clinical manifestations: Unilateral edema, pain/tenderness, dilated superficial veins, paresthesias, redness, warmth, fever over 100.4° F.

Upper Extremity

  • Involvement is rare (10% of VTEs).

  • Signs: Swelling and tenderness in arms, neck, back, face; fever over 100.4° F.

Diagnostic Tests for DVT

  • D-dimer test and ultrasound.

Goals and Outcomes for DVT

  • Pain relief, decreased edema, patient understanding of condition and treatment, no skin ulceration, no development of PE.

Nursing Interventions for DVT

Prevention Strategies

  • Core measures for prophylaxis include early mobilization, compression stockings (TED hose), and Sequential Compression Devices (SCD).

Drug Therapy

  • Anticoagulants:

    • Heparin, Enoxaparin.

    • Medication Administration and Monitoring: Types of anticoagulants include Vitamin K antagonists (Warfarin), thrombin inhibitors (Heparin, Enoxaparin), factor Xa inhibitors (Apixaban).

Care for Patients on Anticoagulants

  • Monitor platelet counts, coagulation tests, signs of bleeding, avoid IM injections.

    • Oral care and safety measures to prevent falls.

Interprofessional Collaborative Care for DVT

  • Procedures such as thrombus extraction, angioplasty, and stenting.

  • Vena cava interruption devices (e.g., umbrella filters).

Nursing Evaluation for DVT

  • Evaluate for adequate pain control, skin integrity, absence of hemorrhage/bleeding, and patient understanding of their condition.