Vascular Disease Slide Addendum

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• An aneurysm is a sac or dilation formed at a weak point in the vessel

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• Don’t have to know slides 3-5 for the test

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• Very serious problem
• It dissects between the layers

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• Happens frequently in men 50-70 years of age
• Atherosclerosis causes the shearing effect
• Syphillis can also cause this

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• Thoracic aneurysm impedes venous return
• Usually found on chest xray
• Pain may occur only when they lay down

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• CT scan gives a lot of information
• Can be on the ascending or descending arch of the aorta

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• Endovascular grafts can be done via cardiac catheterization
• Patient may require bypass

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• Nursing interventions depend on what was done

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• Marfan syndrome may make vessels weak
• Infrarenal means below the renal artery (good thing)

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• Patchy mottling feet and toes is where blood clots break off and settle in the feet

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• Small is considered 5cm or less

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• These patients go to CVRU and then 5D
 • Do the neuro checks because clots can break off from the aneurysm and cause a
stroke

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• The patient must lay flat to keep pressure off of reanastamosis
• If the patient had the cath version, the leg must stay straight for 6 hours

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• Patients are usually on some type of anti-coagulant (ASA, coumadin, plavix)

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• AKA Peripheral Arterial Disease
• Can be partially or completely obstructed

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• Risk factors are similar to CAD

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• Intermittent claudication is pain with activity (cramping, aching, tightness)
• Can be in the calves, hips, or rear depending on where the obstruction is
• Rubor = red
• Dangling relieves pain

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• Hypertrophied nails are think
• Skin ulcerations and gangrene of digits are a late sign

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• ABI (1.0) = Ankle pressure divided by Brachial Pressure
• The smaller the number the greater the occlusion

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• Arteriogram angiography is done by the MD to determine whether to do an
intervention

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• Exercise helps the patient develop collateral circulation
• Trental affects platelet aggregation by decreasing blood viscosity. Side effects
include bruising easily and diarrhea
• Pletal inhibits platelet aggregation and vasodilates. Side effects are headaches
and bruising

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• Carnitine helps with muscle metabolism and decreases leg cramping
• Also avoid temperature extremes
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• ClirPath is the new, cool laser and zaps the blockage in the artery
• Endarterectomy involves blowing up a balloon and pulling out the blockage
• If you wait too long, gangrene develops and the only treatment is amputation

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• Check pulses often to make sure blood is flowing
• Monitor pain, color, sensation, motor function, and capillary refill frequently to
monitor for compartment syndrome. The graft can compress nerves secondary to
swelling

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• Acute arterial occlusion happens within a short period of time
• Trauma from crushing injury or fracture
• Embolus is when a clot breaks off and travels, may see heart failure
• Thrombus wherever plaque ruptures a vessel

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• Poikilothermia is cold
• Paralysis will occur if condition lasts long enough and results in irreversible
damage

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• Heparin drip is to prevent clots from getting bigger. It does not dissolve clots
• Amputation if there is permanent damage or gangrene

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• Raynaud’s Disease is a syndrome

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• Norvasc and Procardia dilate arteries

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• Relaxation techniques and biofeedback help to reduce stress and reestablish blood
flow
• Wear gloves/warm socks

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• There is a higher incidence in men that smoke

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• Patients can become dependent on pain meds
• Digital pain in toes and fingers
• Ulcerations and gangrene may lead to amputation
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• These patients are slow to heal due to decreased arterial circulation
• Amputations will be higher than occlusions
• Stop smoking!
• Avoid cold
• Antiplatelet medication
• Ca Channel Blocker will increase vasodilation

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• Avoid elevation of the stump after 24 hours
• Think about body image disturbance with amputations

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• Men get varicose veins too but are more common in women
• Common in pregnancy as well
• Chronic venous insufficiency may cause swelling and creates a potential for stasis
ulcers

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• Elevate the legs frequently
• Muscle contractions increase venous return

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• Done on outpatient basis in the hospital or office
• Ligation involves tie off and pull out of the vein
• Sclerotherapy is done in the office and a chemical is injected into the vein,
causing it to close up
• Laser therapy inside or outside of vein

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• Ambulate next day
• Can wear compression stockings or Ace bandage to help with edema

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• Pins and needles may indicate damage to the saphenous vein
• Avoid application of lotion until scabs fall off
• Decreased vascular resistance equals increase venous pressure

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• Venous thrombosis is without inflammation
• Thrombophlebitis is with inflammation

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 • Virchow’s Triad means the client will probably develop a clot
• Injury to the intimal lining includes IV, broken bones, and pacer wires
• Hypercoagulability can come from smoking, oral birth control pills, dehydration
• Can occur from heart failure, shock, or crouched positions

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• Think about the appearance of an infiltrated IV site

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• Swelling impedes venous return and fluid goes into interstitial space
• Homan’s sign = pain with dorsiflexion of the foot
• Important to understand signs/symptoms

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• D-dimer test = byproducts of fibrin breakdown
• Venograms are not common

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• Easier to prevent than treat
• Intermittent pneumatic compression devices are SCD’s
• Compression stockings are TED hose and not as common
• Encourage deep breathing to change thoracic pressure and increase venous return
• Elevate the feet
• Watch abdominal surgery and immobilized patients

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• ASA, Plavix, SQ Heparin

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• Bedrest for several days
• Heparin may also be given SQ, just depends on the doctor

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• Monitor patient once a month until PT/INR is stable
• Some health foods and supplements will potentiate coumadin including cranberry
juice
• Remember PT is 1.5-2.5 times control
• INR is therapeutic at 2.0-3.0

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• Don’t usually do thrombolytic therapy

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• Inferior vena cava plication is common for patient with repeated PE’s
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• Stay away from scars and belly button because they decrease absorption
• No IM injections

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• Chronic edema
• The hemoglobin causes brown staining of the leg

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• Swollen limb is a big sign that the problem is venous
• Stasis ulcers from on the medial side, above the ankle

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• Important to elevate the foot of the bed 6 inches

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• Ulcerations take a long time to heal

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• Venous ulcers are above the medial ankle
• Arterial ulcers usually occur on or between the toes or involving the digits

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• Enzymatic debridement is done with panafil
• Calcium algenate absorbs drainage

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• Ulcers heal better while moist
• Hydrocolloid dressings absorb drainage
• Unna boot is a pink boot with calamine lotion and zinc oxide that allows exudate
to move out for a quicker healing time
• Hyperbaric medicine is very expensive and timely

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• Massage especially with mastectomy surgery
• BP checks and IV’s in the affected arm increase the risk of infection and edema