Assessment/management
Inspection
Skin: shiny
Hair Loss: Lack of because there's not blood flow for hair to grow
JVP: jugular venous pressure
Edema/sores
Cardiac output
4-8 CO average
Mean arterial pressure (MAP)
[(2x diastolic)+systolic]/3
Normal range 70/110
NEED at least 60 to get blood back to brain
HTN
goal: dec. cardiac output
altered nutrition
sexual dysfunction
EXPENSIVE (make sure pt are taking meds)
Atherosclerosis: hardening/thickening
Arteriosclerosis: Plaque buildup
Dissection=tearing
Veins
Thin walled
low pressure
Vlaves: one way!
Relies on skeletal muscles
Legs: deep veins 90% of bloodflow to heart
Pathophysiology
Sympathetic: stress= Fight or flight!
Vascular endothelium: Secretes vasodilator substances
Renal (sodium/water retention)
ABI
Ankle systolic pressure (PT/DP)
Ex.
R brachial: 120 , L brachial: 100
USE BIGGER NUMBER
Left dp: 80
80/120 = 0.67
Aortic
Graft leakage: need a good BP range! D
Bowel ischemia (death from potassium problems)-eventually gangrene, blood in stool
Spinal cord ischemia, motor/sensory problems, decreased pain sensation
Occlusive disease
90% lower extremities
Assessment
Smoking, HTN, DM, obesity history, source of embolism, physical findings (dim/absent pulses, INTERMITTENT CLAUDICATION)
Dx tests: ABI, doppler, stress testing, angio (check creatinine, dye can hurt kidneys)
Management:
risk factor modification, increase activity and circulation
Promote vasodilation
Meds (calcium channel blocksrs
skin care NO harsh soaps/ pat dry
Wear shoes!
No heat pads
Virchows triad
1. Venous stasis
2. activation of blood coagulation
3. vein damage
2 out of 3 is considered a thrombus
Varicose Veins
Tx: elevate, compression stockings, sclerotherapy
Dx- doppler, maybe surgery (not often)
Symptoms
usually asymptomatic (which is why it gets so bad, cause its unnoticed)
SILENT KILLER
Possible S/S: blackouts, fainting, papiledema (back of eye swelling) blurred vision, headache
HTN Dx
Echo/xray/ecg
BS, electrolyte panel, creatinine
lipid panel
Aortic Disorders
Aneurysm (dilation) 90% caused from smoking!
Thoracic (10%) More deadly! Neck pain, dyspnea, cough
Abdominal (AAA) 90%
pulsating mass, low back pain, hearing bruit
Xrays, CTs, arteriography
Rupture survival rate <10%
Varicose Veins
Valve incompetence (tortuous veins)
Risk factors: women 35+, obesity, hemmeroids
Women are increased risk because hormones
-Relaxed vein walls during pregnancy
s/s: leg heaviness, itching, warmth
DVT
Pt history
GET ACTIVE
drink lots of water
pain level
Prevention! (knees flexed, SCDs, SQ Hep)
Nursing Care
prevention!
Decrease weight, stop smoking/drinking
DASH diet
if modifications dont work youll need meds
DVT
Ultrasound: velocity of flow
MRI: Deep pelvic veins, vena cava
Venogram
Disorders
Thrombus: blood clot (dehydration, inflammation, too many RBCs)
Embolism: foreign object (air, bacteria, fat)
Thromboemboli: MIs, valve problems, Afib, starts on left side leads to occlusion of blood flow
Buergers: thromboangitis obliterans, BLUE fingers, Pain @ rest, associated with smoking
Raynauds: arterial vasospasm
Typically in fingers
response to a trigger, normally cold
Red/White/Blue
CVI
commonly caused from DVT trauma and/or varicose veins
occlusion-causes pressure which damages valves
pressure increases with ambulation
S/S Lots of itching, hard to treat (use cold)
VERY edemic
Check CWMS, com[ression stockings, promote healing and elevations
DRY CLEAN AND MOISTURIZED
Elderly
loss of elasticity in aorta
Systolic HTN
Decreased pulses
Drier and thinner skin and less hair
decreased baroreceptors
Bruit: feels like a runble, sounds like a murmur
Primary vs Secondary
Primary (essential)
-HTN without reason, 90% of all HTN, increases with age Risk factors: obesity, ETOH, stress
Secondary (specific cause!)
-sleep apnea (CPAP will dec. BP)
Kidney and endocrine disease
preeclampsia (most common cause of fetal death)
Drugs (meth, cocaine)
Vascular (congenital heart disease)
ABI guidelines
Over 1.40= noncompressible calcified vessels
1.0-1.4= normal
0.9-0.99=boarderline
0.5/0.59= mild/moderate disease
<0.5= severe disease
Discharge teaching
Medical Management: Control BP, dec. stress
Surgical repair (anticoagulants, avoid prolonged sitting)
STOP SMOKING
Med/Surg management
Balloon angioplasty w/stent
Arterial bypass (reroute bloodstream, Pulses are SUPER IMPORTANT!!!)
Endarterectomy (pulls out plaque)
Embolectomy (Pull out embolus (NOT easy)
amputation (last resort)
Check for compartment syndrome
Pulmonary Embolism
Life threatening!
Dyspnea, chest pain, tachypnea, chest pain
Surgery is LAST RESPORT
medication is first call
IVC: promotes venous return
SCD wraps
anticoagulation
dont cross your legs
Art. Ulcers
Revascularization procedure
Cellulitis (oral/IV antibiotics
Protective dressings: lambs wool, rooke boots, bed cradle
Medications
HTN meds
Thiazide Diuretics: Cheap! Hydrochlorothiazide
Ace inhibitors (PRILS), RASS, cough is s/e, doesnt work as well on african american
Angiotensin (ARBS)
Receptor blockers
losartan and valsartan
Beta blockers(-olols)
decrease workload of heart
Not for people with COPD/asthma
Aldosterone antagonists (pot. sparing)
spironolactone
Adrenergic Inhibitors (can be slow to act, and need to be weaned!)
Central alpha agonists
alpha blockers( not used geriatrics, taken at night, dec. peripheral resistance)
direct vasodilators (3rd line drugs)
DVT!
PE is the first sign of a DVT!
80% start in calf veins
Risk factors: IMMOBILITY! surgery, cancer, hormone therapy, pregnancy, trauma
Manifestations: Pain (dull ache/cramping), tenderness, warmth, swelling/edema, color changes (cyanosis)
Ven. Ulcers
Compression!
Cellulitis: antibiotics
ELEVATION
Anti-inflammatory creams for dermatitis
Ulcers
Deep pale
pallor-evelation
rubor-dangling
cool to touch
low to no edema
severe pain
gangrene can occur (from infection)
Decreased/absent pulse
Ulcers
Medial leg/ankle
Pink
Brown discoloration, cyanotic dangling
Warm
Edema to extreme
No gangrene
Pulses are present
Lymphedema
Swelling of lymph nodes (infection) if it is generalized
Lymph accumulation
heat, pain, swelling
Goals: Decrease edema, protect from injury, low sodium diet