Vascular Disorders & Problems of peripheral Circulation pt.1

Cardiovascular Assessment

History & Physical

Health History

• Family History

• past medical history

• past surgical history

• medications

• Activity

• Exercise

Physical Assessment

• BP & HR

• Pulses

• skin

• Cap Refill time

Labs

• medication levels

• lipid panel

• coagulation studies

• CBC

• CMP/BMP

• HgbA1C

Gerontologic Considerations

Peripheral Arterial Disease (PAD)

= Difficulty getting perfusion to lower extremities

Caused by:

• Atherosclerotic plaques

• thrombemboli

• Truma

Acute

• Sudden ischemia

• tissue death

Chronic (Gradual)

• Collateral circulation

  • Compensatory

• Slow ischemia & tissue death

Who is at risk?

• Family history

• Age (65 and older)

• Smoking - causes sever vasoconstriction

• Pre-existing health conditions:

  • Coronary artery disease (CAD)

  • Cerebral artery disease

  • Diabetes Mellitus

  • Hypertension

  • Dyslipidemia

  • Clotting disorders

  • Hyperthromocysteinemais

Clinical Manifestations

• Structural changes

  • Hair loss distal to the occlusion

  • thick, opaque nails; shiny, dry skin

  • Skeletal muscle atrophy

• Skin color changes:

  • Elevational pallor

  • dependent rubor (Red color when limb dependant from dilated damaged vessels)

• Pulse changes:

  • Pulse diminidshed or absent belwo area of stenosis/obstruction-pedal, posterior tibial, popliteal, femoral

  • Cool extremity distal to occlusion

• sensation changes:

  • Paresthesias

  • numbness

  • tingling of extremities

  • ulcer sor gangrene on tips of toes

  • edema

Critical limb ischemia

• paint at rest

• non-healing ulcers

• Gangrene

Acute Limb ischemia

• sudden decrease in perfusion

Intermittent Claudication = Carmp-like pain with exertion, relieved with rest, pain persists distally to problematic vessel, dependent position reduces pain.

Ankel-brachial index

• Ankle SBP: brachail SBP

• < 0.9 indicative of PAD

Diagnostic Studies

• Doppler ultrasound

• Invasive DIgital Angiography

  • asses allergies to iodine and contrast die

  • adequate renal function needed

Medical Management

• Exercise - treats intermittent claudication

• RIsk modification

  • Smoking cessation

  • weight loss

• pharmacologic

  • Cilostazol: Vasodilator, interferes with platelet aggregation

  • ASA (Asprin) & Plavix: Antiplatelet agents

  • Statin (Anti-lipedema)

  • Anti-HTN

• Thrombolysis

  • Injecting thrombolytic agent directly into thrombus]

• Revascularization

  • Arterial bypass

  • angioplasty

Nursing Management

• Post-operative care

  • Activity appropriate for pt Pain relief

  • Anticoagulant therapy

  • Monitor for complications

  • Report change in condition

• Maintain tissue integrity

  • prevent amputation

• Patient teaching

  • Avoid Trauma

  • Well fit shoes

  • wound care

  • risk modification

Upper Extremity Arterial Occlusive DIsease

Caused by:

• Vasospasm

• trauma

• constrictive arterial disorders

Subclavian Steal syndrome = while arm is being used, preferential blood flow reverts to the extremity and away from the brain

Clinical Manifestations

• Arm pain & fatigue with exertion

• Dizziness

• vertigo

• Ataxia

• Syncope

• Bilateral visual disturbances

Nursing Assessment

• coolness

• pallor

• decreased CRT

• Decreased Amplitude in radial pulse

• Arm BI difference of > = 15 mmHg

management

• surgical bypass

• percutaneous transluminal angioplasty (PTA)

Raynaud Disease & Phenomenon

DIsease Vs. Phenomenon

Primary

• Idiopathic

• vasospasm due to cold or stress

Secondary

• disease processes that mimic s/s of Raynaud’s

• EX. Scleroderma, SLE

Phenomenon - initial = white in fingertips - sustained = blue - resolved = red meaning blood flow returned

Management

• typically benign and self-limiing

• Avoid stimuli that provoke vasoconstriction

• Dress warmly to prevent reflex vasoconstriction

• tobacco is contraindicated

• calcium-channel blockers

• digital sympathectomy

Thromboangiitis Obliterans (Buerger’s Disease)

• autoimmune vasculitis

• recurrent inflammation in small arteries and veins causing occlusion

• occurs most in males, between 25-45 yos

• #1 cause = smoking

• manifests as bilateral pain

• can occur in feet

Treatment

• Sympathetic block - dilates vessels & increases blood flow

• Smoking cessation