MEDICAL SURGICAL NURSING II
VNRS B85
NURSING CARE OF CLIENTS WITH PERIPHERAL VASCULAR
DISORDERS
Introduction:
Clients with disorders of the peripheral vascular and lymphatic systems require nursing
care centered on relieving pain, improving the circulation of peripheral blood floe or
lymphatic fluid, preventing tissue damage, and promoting healing. The major processes
that interfere with the normal flow of peripheral blood and lymphatic fluid include
constriction, obstruction, inflammation, and vasospasm.
Learning Outcomes:
Upon completion of this chapter, the student will be able to:
A.
B.
Theory
1.
Describe the etiology, pathophysiology, and manifestations of common
peripheral vascular and lymphatic disorders.
2.
Compare and contrast the manifestations and effects of disorders affecting
large and small vessels, arteries, and veins.
3.
Explain risk factors for and measures to prevent peripheral vascular
disorders and their complications.
4.
Explain the nursing implications for medications and other
interdisciplinary treatments used for clients with peripheral vascular
disorders.
5.
Describe the preoperative and postoperative nursing care of clients having
vascular surgery.
Clinical - See NURS B85LV and B86LV
Assignment - LeMone-Burke Chapter 35
MEDICAL SURGICAL NURSING II
CHAPTER 35
LECTURE OUTLINE
NURSING CARE OF CLIENTS WITH PERIPHERAL VASCULAR
AND LYMPHATIC DISORDERS
Common Peripheral Vascular and Lymphatic Disorders
•
Primary Hypertension
–
Pathophysiologic causes
•
Sympathetic nervous system overstimulation
•
Alterations of the renin-angiotensin-aldosterone system
•
Chemical mediators of vasomotor tone and blood volume
•
Interaction between insulin resistance, hyperinsulinemia and endothelial
function
Common Peripheral Vascular
and Lymphatic Disorders
–
Manifestations
•
Initially asymptomatic
•
Headache, confusion
•
Nocturia
•
Nausea and vomiting
•
Visual disturbances
–
Complications
•
Cardiovascular
•
Neurologic
•
Renal systems.
Common Peripheral Vascular and Lymphatic Disorders
•
Secondary Hypertension
–
Related to a specific underlying cause
•
Kidney disease
•
Coarctation of the aorta
•
Endocrine disorders
•
Neurologic disorders
•
Drug use
•
Pregnancy
Common Peripheral Vascular and Lymphatic Disorders
•
Hypertensive Crisis
–
Malignant hypertension
–
Rapid elevation of the blood pressure
–
Treatment is initiated within 1 hour
–
–
•
•
•
•
Manifestations
Headache, confusion
Papilledema, blurred vision
Restlessness
Motor and sensory defects
Common Peripheral Vascular and Lymphatic Disorders
•
Lymphadenopathy
–
Enlarged lymph nodes
–
Can be localized or generalized
–
•
Localized Lymphadenopathy
–
Generally results from an inflammatory process
•
–
–
•
–
–
Lymphangitis
Inflammation of the lymph vessels
Characterized by a red streak
Lymphedema
Primary lymphedema
Secondary lymphedema
Disorders Affecting Large and Small Vessels, Arteries, and Veins
•
Aneurysm
–
Abnormal dilation of a blood vessel
–
Commonly affect aorta and peripheral arteries
–
May also develop in the ventricles
–
Form due to weakness of the arterial wall
–
Hypertension is major contributing factor
•
–
–
Aortic Dissection
A life-threatening condition
Tear in artery inner layer allows blood to dissect or split the vessel wall
Disorders Affecting Large and Small Vessels, Arteries, and Veins
•
Peripheral Vascular Disease
–
Hardening and narrowing of peripheral arteries
–
Impairing blood supply to peripheral tissues
–
Collateral circulation usually inadequate
•
–
–
–
Thromboangiitis Obliterans
Also called Buerger’s disease
Occlusive vascular disease
Inflammation and spasm cause clots to form in peripheral arteries
Disorders Affecting Large and Small Vessels, Arteries, and Veins
•
Raynaud’s Disease and Phenomenon
–
Episodes of intense vasospasm in the small arteries and arterioles
–
–
Raynaud’s disease
•
No identifiable cause
•
Blue-white disease
•
–
•
•
•
–
Raynaud’s phenomenon
Secondary to another disease or condition
Acute Arterial Occlusion
May occur acutely by thrombus or by embolism
Disorders Affecting Large and Small Vessels, Arteries, and Veins
•
Venous Thrombosis
–
Also known as thrombophlebitis
–
Condition in which a blood clot forms on the wall of a vein
–
Causes inflammation of the vein
–
Some degree of venous blood flow obstruction
•
Chronic Venous Insufficiency
–
Disorder of inadequate venous return over a prolonged period
–
Most common cause is deep vein thrombosis
–
Venous status occurs, impairing arterial circulation
Disorders Affecting Large and Small Vessels, Arteries, and Veins
•
Varicose Veins
–
Irregular, tortuous veins with incompetent valves
–
Commonly found in the lower extremities
Risk Factors for Peripheral Vascular Disorders
•
Primary Hypertension
–
Aging
–
Race
–
Family history of hypertension
–
High sodium intake
–
Low potassium, calcium, and magnesium intake
–
Obesity
–
Insulin resistance
–
Excess alcohol consumption
–
Stress
Risk Factors for Peripheral Vascular Disorders
•
Hypertensive Crisis
–
Sudden discontinuance of medications
–
Poorly controlled hypertension
Risk Factors for Peripheral Vascular Disorders
•
Aneurysm
–
Hypertension
–
Cystic medial necrosis
–
Male gender
–
Advancing age
–
Pregnancy
–
Congenital defects of the aortic valve
–
Coarctation of the aorta
–
Inflammatory aortitis
Risk Factors for Peripheral Vascular Disorders
•
Peripheral Vascular Disease
–
Diabetes mellitus
–
Hypercholesterolemia
–
Hypertension
–
Cigarette smoking
–
High homocysteine levels
Risk Factors for Peripheral Vascular Disorders
•
Thromboangiitis Obliterans
–
Cigarette smoking
•
Raynaud’s Disease
–
Genetic predisposition
Risk Factors for Peripheral Vascular Disorders
Acute Arterial Occlusion
–
Arteriosclerosis (or atherosclerosis)
–
Sepsis
–
Cancer
–
Pregnancy
–
Long bone fracture
–
Myocardial infarction
–
Valvular heart disease
–
Atrial fibrillation
–
Foreign body embolism
•
Risk Factors for Peripheral Vascular Disorders
•
Venous Thrombosis
–
Hospitalization
–
Immobility
–
Abdominal or thoracic surgery
–
Certain cancers
–
Trauma
–
Pregnancy
–
Use of oral contraceptives
–
Hormone replacement therapy
Risk Factors for Peripheral Vascular Disorders
•
Chronic Venous Insufficiency
–
Deep vein thrombosis
–
Varicose veins
–
Leg trauma
Risk Factors for Peripheral Vascular Disorders
•
Varicose Veins
–
Aging
–
Prolonged standing
–
Obesity
–
Venous thrombosis
–
Congenital arteriovenous malformations
–
Sustained pressure on abdominal veins
Nursing Implications for Peripheral Vascular Disorders
•
Primary Hypertension
–
Medications
•
Diuretics
•
Beta-adrenergic blockers
•
Central acting sympatholytics
•
Vasodilators
•
ACE inhibitors
•
Angiotension II receptor blockers
•
Calcium channel blockers
Nursing Implications for Peripheral Vascular Disorders
–
Nursing diagnoses
•
Ineffective health maintenance
•
Risk for noncompliance
•
Imbalanced nutrition: More than body requirements
•
Excess fluid volume
Nursing Implications for Peripheral Vascular Disorders
•
Hypertensive Crisis
–
Medications
•
IV antihypertensives
–
Nursing care
•
Continuous blood pressure monitoring
•
Titrating medications to blood pressure readings
•
Avoiding rapid blood pressure changes
•
Providing calm reassurance to the client and family
Nursing Implications for Peripheral Vascular Disorders
•
Aneurysm
–
Thoracic aortic aneurysms
•
Long-term beta-blockers
•
Other antihypertensive medications
–
Aortic dissection
•
IV beta blockers
•
Sodium nitroprusside
•
Calcium channel blockers
Nursing Implications for Peripheral Vascular Disorders
–
Aortic dissection (cont.)
•
Direct vasodilators are avoided
•
Post-operative anticoagulant therapy
–
Nursing diagnoses
•
Risk for ineffective tissue perfusion
•
Risk for injury
•
Anxiety
Nursing Implications for Peripheral Vascular Disorders
•
Peripheral Vascular Disease
–
Medications
•
Drugs to inhibit platelet aggregation
•
Platelet inhibitors
•
Drugs to decrease blood viscosity
•
Parenteral vasodilator prostaglandins
–
Nursing diagnoses
•
Ineffective tissue perfusion: peripheral
•
Pain
•
Impaired skin integrity
•
Activity intolerance
Nursing Implications for
Peripheral Vascular Disorders
•
Thromboangiitis Obliterans
–
Surgical treatment
•
Sympathectomy
•
Arterial bypass graft.
•
–
Nursing care
•
Promotion of arterial circulation
•
Prevention of prolonged tissue hypoxia
•
Smoking cessation support
•
Relief of acute manifestations
Nursing Implications for
Peripheral Vascular Disorders
•
Raynaud’s Disease
–
Medications
•
Vasodilators
•
Sustained release calcium channel blockers
•
Alpha-adrenergic blockers
•
Transdermal nitroglycerine
•
Longer-acting oral nitrates
–
Nursing care
•
Education
•
Support
Nursing Implications for
Peripheral Vascular Disorders
•
Acute Arterial Occlusion
–
Medications
•
Anticoagulation
•
Thrombolytic therapy
•
–
Nursing diagnoses
•
Ineffective tissue perfusion: peripheral
•
Anxiety
•
Altered protection
Nursing Implications for
Peripheral Vascular Disorders
•
Venous Thrombosis
–
Medications
•
Anticoagulants
•
Thrombolytics
•
NSAIDs
–
•
•
•
•
•
Nursing diagnoses
Pain
Ineffective tissue perfusion: peripheral
Ineffective protection
Impaired physical mobility
Risk for ineffective tissue perfusion: Cardiopulmonary
Nursing Implications for Peripheral Vascular Disorders
•
Chronic Venous Insufficiency
–
Medications
•
Corticosteroids
•
Zinc oxide
•
Clotrimazole
•
Miconazole
•
Burrow’s solution
Nursing Implications for Peripheral Vascular Disorders
–
Nursing diagnoses
•
Disturbed body image
•
Ineffective health maintenance
•
Risk for infection
•
Impaired physical mobility
•
Impaired skin integrity
•
Ineffective tissue perfusion: peripheral
Nursing Implications for Peripheral Vascular Disorders
•
Varicose Veins
–
Treatments
•
Compression stockings
•
Regular, daily walking
•
Discouraging prolonged sitting or standing
•
Regular periods of leg elevation
–
•
•
•
•
Nursing diagnoses
Chronic pain
Ineffective tissue perfusion: Peripheral
Risk for impaired skin integrity
Risk for peripheral neurovascular dysfunction
Nursing Implications for Peripheral Vascular Disorders
•
Lymphedema
–
Treatments
•
Generally conservative
•
Positioning
•
Avoidance of infection
•
Diuretic therapy
–
•
•
•
Nursing diagnoses
Impaired tissue integrity
Excess fluid volume
Disturbed body image
Nursing Implications for Peripheral Vascular Disorders
•
Preoperative Care
–
Teaching
–
Routine preoperative care
–
Reduction of anxiety and fear
–
Medications to control blood pressure
•
–
Postoperative Care
According to surgical procedure performed