Professional Documents
Culture Documents
Lecture Objectives
Vascular Disorders
Arterial versus Venous
Also consider
Thrombosis
Structural changes
Vasospasm
Acute or Chronic
Congenital
3
Vascular Assessment
Inspection
Bruising, discolouration, skin texture
Varicosities
Ulcers, lesions
Oedema, cyanosis
Distended neck veins
Percussion, palpation
Pulses, BP, capillary return
Bruits
Cool peripheries
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Diagnostic tests
X-ray
Angiography
Doppler ultrasound
Ankle-brachial index:
http://www.carolinaveincenter.com/du
plex.html
Duplex imaging
Duplex
Doppler
http://www.umm.edu/features/
vascular_disease.htm
5
http://www.carolinaveincent
er.com/duplex.html
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http://www.lymphedemapeople.com/thesite/lymphedema_de
ep_venous_thrombosis.htm
RISK FACTORS
Ca, MS
Oral contraceptive pill
Altered coagulability states
Pregnancy
Age over 50 years
Nursing ManagementPrevention
compression stockings (TEDS)
encourage early ambulation
active & passive ROM exercises
deep breathing exercises
intermittent calf compressors
administration of prophylaxis low-dose
heparin therapy or daily S/C Clexane.
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Nursing ManagementTreatment
Administer Clexane (Low molecular
weight Heparin) &/ or Warfarin
Bed Rest,
Elevation of the extremity
Education
Neurovascular Observations
Monitor for S& S of complications
REMEMBER COMPLICATIONS OF DVT
PULMONARY EMBOLIS
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http://www.clinicalresearch.nl/epidemiology/
wright/venous%20thrombosis.htm
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Neurovascular Observations
Movement- Can they
move the limb?
Sensation any
paraesthesia, numbness?
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http://www.unchealthcare.org/site/woundma
nagement/images/SC000301.JPG/view
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http://www.vnus.com/navigation/patvenousdisease.htm
Nursing Management
Treatment: compression bandaging.
Elevate legs while resting & during sleep
Encourage walking but not standing
Avoid crossing legs
Maintain nutritional status
Keep skin clean, soft & dry and avoid trauma
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Compression bandaging
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(Phillips, 2001, p. 615)
PAD: Treatment
Cease smoking
Control Diabetes, hypertension
Antiplatelets eg aspirin
Nutrition
Exercise program-walking
Care of foot, do not elevate limb
Intervention / Surgery
Stents, balloon angioplasty
Endarterectomy +/- Patch graft
angioplasty
Femoral-popliteal bypass
Amputation
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Aneurysms
An aneurysm is a localized dilation or
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intensivecare.hsnet.nsw.gov.au/.../AAA.jpg
AAA
Diagnosis and Treatment
Diagnosis most often occurs from routine
abdominal X-ray, Ct Scans or ultrasound
MRI can also be used for diagnosis
Generally surgical intervention is required,
(normally when a AAA is > 4cm )
Conservative management in small
aneurysms
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Nursing Management
Pre Op
Assessment of tissue perfusion (peripheral
pulses)
Pain relief
Reduce anxiety (patient & family)
Abdominal girth measurement
Monitoring haemodynamic statusparticularly BP
For HDU/ ICU post-op
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Nursing Management
Post Op
Prevention of infection
Maintaining normal BP
Monitoring Neurovascular obs
Maintaining adequate urine output
Wound management
Early ambulation
Chest physiotherapy
Pain management
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Bibliography
Brown, D., & Edwards, H. (2008). Lewiss medical-surgical
nursing: Assessment and management of clinical problems
(2nd ed). Sydney: Elsevier.
Crisp, J., & Taylor, C. (2009). Potter and Perry's fundamentals of
nursing (3rd ed.). Sydney: Mosby.
Huether, S., & McCance, K. (2004). Understanding
pathophysiology (3rd ed.). St Louis: Mosby.
Jones, J. (2002). Use of compression hosiery in venous leg
ulceration. Nursing Standard, 16(16), 10.
Judge, N. (2007). Neurovascular assessment. Nursing Standard,
21(45), 39-44. Retrieved September 9, 2008, from
http://www.snjourney.com/ClinicalInfo/Systems/PDF/NeuroVas
%20Assessment.pdf