With venous flow problems there

will be.....

Venous Pooling

With arterial blood flow problems

you wil see...

A blockage of Oxygenated blood.

PVD risk factors

Family history of cardiovascular disease

High blood pressure

Age

Diabetes

Smoking

High Cholesterol

High levels of homocysteine

Peripheral Arterial Disease Symptoms

*Intermittent Claudication

*Numbness

Weakness

heaviness in the muscles

*burning/aching pain 

Cooling of skin

*Color changes in the skin

Toe and foot sores that do not heal

Erectile dysfunction

Silent??

Diagnosis of PAD

Medical history

Physical exam

Ultrasound

X-ray

Angiography

Magnetic resonance imaging

Treatment of PAD

Lifestyle changes such as:

 Quit Smoking

 Eat a healthy diet

 Blood Pressure control

 Activity level - regular

 Medications taken as prescribed

PVD Diagnostic Test

Ankle-brachial index (ABI)- 

systolic ankle divided by systolic brachial

Medical History and Physical Exam 

Treadmill Exercise Test

Thoracic Aortic Aneurysms

Usually asymptomatic

If present: 

 - substernal, neck, or back pain

 - Pressure on trachea, esophagus

 - Dyspnea, stridor, cough

 - Painful swallowing, hoarseness, edema of face and neck

 - JVD

 statistics of aortic diameter changes

Aorta that is dilated > 1.5 x normal (usually thoracic) or abdominal aorta with a diameter of 3.0 cm or greater

Diameters of greater than 6 cm ---50% rupture in a year

AAA Signs/Symptoms

Usually asymptomatic

If pain:

 - Can be Nonspecific

 - Constant or Intermittent

 - Mid abdominal region or lower back

 - Mild to severe

 - severe pain may indicate impending rupture

Urinary Retention

Pulsatile abdominal mass with a bruit

Age

Hypertension

Atherosclerosis

Smoking

******Connective tissue disorder

 *****Marfan syndrome

First degree relative with history of AAA

Prior AAA

Assess 

Reassess

Report

 - Changes in Vital signs

 - Differences from side to side

 - Pain

 - Increase in abdominal girth

AAA Signs and Symptoms of Rupturing Aneurysm

sudden excruciating substernal pain radiating to back 

Altered mental status (decreased O2)

Dyspnea, orthopnea

Diaphoresis, syncope

Pale, dusky, ashen or cyanotic skin

Decreased/absent pulses in lower extremities

Hemiplegia or paraplegia in end stage

Variation between R and L BPs.

AAA Diagnostic Studies

Abdominal xrays

**** CT scan of abd.

 (Optimal and Followed by ultrasound)

Angiogram

Aortogram

Echocardiogram (Thoracic more than abdominal)

**** Doppler US

Renal function studies (Decreased perfusion)

Type and crossmatch for blood products

AAA Interventions

osition pt. for comfort

Two large bore IVs, RL

Monitor: 

 - BP, LOC, cardiac rhythm

 - Urinary output, respirations

Prepare for emergency surgery

AAA Medications:

Vasodilators

 - Nitro drip to keep BP 80/40

Beta-blockers

Analgesics

Aortic Dissection (AD)

Definition

Aortic Dissection (AD)  S/S

S/S if present:

 - syncope, dyspnea, weakness

 - weak or absent pulses

 - bruit over aorta

AD Interventions

Diagnostics: 

 - CXR, Ultrasound, TEE, CT, MRI

Monitor BP and I/O

Prepare for surgery

AD Medications

Beta Blockers

Nipride

Surgical Aneurysm Repair for Aorta

Thoracic > 6cm

Abdominal > 5 cm

Synthetic fabric graft inside aorta

Post Op Care for Aorta

Changes in pulses (Femoral/Pedal)

Cool/cold extremities below the graft

White or blue extremities or flanks

Severe pain

Abdominal distention: internal bleeding

Decreased Urine output

Decreased motor function of sensation

Keep them supine to reduce pressure on aorta

Acute Arterial Occlusion

Arterial Thrombosis

Arterial Embolism

Peripheral Arteries Disorders Manifestations

Tissue ischemia (results in claudication)

distal pulses absent

Paresthesia

Cyanosis and mottling

Line of demarcation

Surgery for Peripheral Arteries Disorders

to remove clot or bypass it

above the knee only

Nursing Diagnosis for Peripheral Arteries Disorders

Ineffective Tissue Perfusion: Peripheral

Anxiety

Altered Protection

Peripheral AtherosclerosisCauses by:

plaque build up

 - hypertension

Atherosclerosis Manifestations

***Intermittent Claudication

Parathesias/Numbness

Weakness

heaviness in the muscles

burning/aching pain

***Rest Pain (late in disease)

Diminished pulses

***Thin, shiny, hairless skin

***Thickened toe nails

Pallor with elevation

Rubor when dependent

Erectile dysfunction

Atherosclerosis Complications

Gangrene

amputation

rupture of abdominal aortic aneurysm

infection and sepsis

Atherosclerosis Diagnostic Tests

Segmental Pressure Measurements

Ankle-brachial index (ABI)

 - < .9 is diagnostic of PVD

Stress testing

Doppler ultrasound

Duplex Doppler ultrasound

Transcutaneous oximetry

Angiography

Atherosclerosis Medications

Plavix (Clopidogrel)

 - Decreases platelets

 - Watch CBC

Pletal (Cilostazol)

 - Antiplatelet aggregation

Trental (pentoxifylliune)

 - Blood viscosity reducing agent

Atherosclerosis Treatments

Elastic support hose

Elevate HOB on blocks

 - Prevent impingment of femoral artery

Lower BP

Lower Cholesterol 

Foot Care 

Lifestyle changes

 - Smoking

 - Diet

 - Blood Pressure

Activity level

 - Gradually increased with tolerance, improves as collateral circulation increases

Post Op CareAssessment for Graft Occlusion (Pain may be 1st sign)

Promotion of Graft Patency (limited ROM, TCDB, NPO)

Monitoring for Compartment Syndrome (fascia turns necrotic)

Assessment for Infection

Buerger's DiseaseOcclusive vascular disease

Clots form

peripheral arteries become inflamed and spastic

Affects legs and feet

Smoking primary cause

Asian and Eastern European descent

Buerger's Disease SymptomsCramping in calves, feet, forearms and hands

Nails thickened and malformed

Involved digits are: pale, cyanotic, or ruddy and cool

Buerger's DiagnosticsHistory and physical

Doppler studies

Angiography

MRI

Buerger's TreatmentStop Smoking

Keep extremities warm

Keep affected extremities in the dependent position

Promote walking @ 20 min several times per day

Buerger's MedicationsCalcium Channel Blocker (Cardizem)

Trental

Atherosclerosis triggered by

What is Raynaud's Syndrome

Raynaud's Syndrome is triggered by, and affects?

Triggered by:

 - emotions

 - Cold

 - Smoking 

 - Vibrating machinery

Primarily affects Women b/w 20-40

Raynaud's Signs and Symptoms

Pallor

Bluish skin

hyperemia

numbness

tingling

burning

blue, white, red

Raynaud's Treatment

avoid temperature extremes

wear gloves

healthy diet/lifestyle

stress reduction

Raynaud's Medications

Calcium channel blockers

alpha blockers (minipress) counters norepinephrine

vasodilators

DVT Causes

Virchow's triad

 - venous stasis

 - hypercoagulability

 - irritation/inflammation of inner lining of vein

DVT Signs/Symptoms

None

leg pain

color/size change

swelling, cool

DVT Risk Factors

adults over 40

pregnancy

smokers

Hx of varicose veins

surgery

oral contraceptives/hrt

DVT Diagnosis

Ultrasound

D-dimer (fibrin degradation fragment) <250mcg/L

veogram

DVT Treatment

graduated compression stockings

elevation

medication

bed rest

DVT Medications

anticoagulants

thrombolysis

thrombectomy

analgesics

DVT Surgical Intervention

venous thrombectomy

venal caval filters

Arterial Ulcers

laudication

pain at rest

end of and btwx toes

ulcer bed pale with even edges

scant pink granulation tissue

Venous Ulcers

no pain

moderate discomfort

leg/ankle swelling

brown pigmentation

ulcer bed pink, uneven, superficial, with granulation tissue

Varicose Veins

elongated, rope-like, bulged, and thickened