Understanding Perfusion

Perfusion

• Perfusion refers to the flow of blood through arteries and capillaries, delivering nutrients and oxygen to cells.

Perfusion Scope

• Optimal Perfusion
• Impaired Perfusion
• No Perfusion

Giddens Concept of Perfusion: Normal Physiologic Process

• Central Perfusion involves:
  • Conduction
  • Cardiac cycle
  • Cardiac output
• Tissue Perfusion also vital for overall perfusion
• Age Related Differences in perfusion as patient ages

Giddens Concept of Perfusion: Variation & Context

• Impaired Central Perfusion can disrupt the entire system
• Impaired Local /Tissue Perfusion affects specific areas

Giddens Concept of Perfusion

• There are Physiological Consequences to impaired Perfusion
• Several Risk Factors contribute to perfusion issues
• There are Populations at Risk, needing special attention
• Individual Risk Factors vary from person to person

Giddens Concept of Perfusion: Individual Risk Factors for Impaired Perfusion

• Modifiable risk factors include:
  • Smoking: nicotine vasoconstricts
  • Elevated serum lipids: contribute to atherosclerosis
  • Sedentary lifestyle: contributes to obesity
  • Obesity: increases risk for type 2 diabetes and atherosclerosis
  • Diabetes: increases risk of atherosclerosis
  • Hypertension: increases work of myocardium
• Unmodifiable risk factors include:
  • Age: increases with age
  • Gender: men > women
  • Genetics: family history

Giddens Concept of Perfusion: Assessment

• Requires a thorough History
  • Baseline hx
  • Problem based hx:
    • Pain
    • Syncope
    • Dizziness
    • Dyspnea
    • Edema
    • Fatigue
• Incorporates Examination Findings:
  • Vital Signs (VS)
  • Inspection
  • Palpation (chest, extremities)
  • Auscultation

Giddens Concept of Perfusion: Diagnostic Tests

• Key Diagnostic Tests:
  • Cardiac Enzymes/Markers
  • Serum Lipids
  • Complete Blood Count
  • B-type Natriuretic Peptide (BNP)
  • ECG (Electrocardiogram)
  • Cardiac Stress Test
• Key Radiologic Studies:
  • CXR (Chest X-Ray)
  • Ultrasound
  • Arteriogram: allows visualization of coronary arteries and heart chambers, involving catheter insertion and contrast injection for visualizing patency
  • Venogram

Cardiac Enzymes/Markers

• Enzymes released from damaged cells circulate in the blood
• Can be measured to confirm number of cardiovascular conditions.
• Creatine kinase (CK) is an enzyme present in myocardium (CK-MB), muscle (CK-MM), and brain (CK-BB) tissues, with elevated CK-MB levels 3-6 hours after myocardial infarction.
• Cardiac troponins are myocardial muscle proteins released after myocardial injury, important for their high specificity for cardiac damage and used in evaluating patients with suspected acute coronary syndromes.
• Myoglobin is an oxygen-binding protein in cardiac and skeletal muscles, with increased levels indicating cardiac injury or death about 3 hours after infarction.
• Homocysteine (Hcy) is an amino acid, where elevated levels may act as an independent risk factor for ischemic heart disease, cerebrovascular disease, and peripheral arterial disease.

Giddens Concept of Perfusion: Clinical Management

• Focuses on Primary Prevention through:
  • Baseline hx
  • Problem based hx:
    • Pain
    • Syncope
    • Dizziness
    • Dyspnea
    • Edema
    • Fatigue
• Secondary Prevention (Screening) includes:
  • BP screening
  • Lipid Screening

Giddens Concept of Perfusion: Collaborative Interventions

• Crucial Collaborative Interventions:
  • Stress Management/Stress Reduction
  • Nutrition Therapy
  • Smoking Cessation
  • Activity & Exercise
  • Pharmacotherapy

Perfusion and Interrelated Concepts

• Perfusion is linked with
• Pain
• Stress and Coping
• Cognition
• Intracranial Regulation
• Elimination
• Inflammation
• Gas Exchange
• Patient Education
• Clotting
• Nutrition
• Mobility

Cardiovascular Health Challenges: Hypertension

• Hypertension Diagnostic Algorithm for Adults includes:
  • Elevated BP Suspected (office, home or pharmacy)
  • Office Visit Assessment of BP
  • Mean Office BP > 180/110 leads to probable HTN.
  • If Mean Office BP is is not Greater than/equal to 180/110:
    • Check for diabetes
      • If present measure OBPM
      • If diabetes not present check AOBP
      • Follow decision tree in diagram

Hypertension Diagnosis Algorithm Notes

• AOBP stands for Automated Office Blood Pressure, performed with the patient unattended in a private room. OBPM: Office Blood Pressure Measurement and performed in office using electronic upper arm device with a provider in the room.
• ABPM: Ambulatory Blood Pressure Monitoring
• HBPM: Home Blood Pressure Monitoring
• WCH: White Coat Hypertension
• HTN: Hypertension

Hypertension: Mean Office BP ≥ 180/110 mmHg

• If Mean office BP ≥ 180/110 mmHg, the diagnosis is hypertensive emergency
• There is no need for additional BP assessment to make the hypertension diagnosis
• Diagnose with hypertension and initiate treatment

Patient Evaluation: Assessment

• BP should be assessed in all adult patients at all appropriate visits to determine cardiovascular risk and monitor antihypertensive treatment.
• Routine Lab Testing: Preliminary investigations of patients with hypertension
  1. Urinalysis
  2. Blood chemistry (potassium, sodium and creatinine)
  3. Fasting blood glucose and/or glycated hemoglobin (A1c)
  4. Serum total cholesterol, low-density lipoprotein (LDL), high-density lipoprotein (HDL), non-HDL cholesterol, and triglycerides; lipids may be drawn fasting or non-fasting
  5. Standard 12-lead ECG
• Follow-up investigations of patients with hypertension are necessary

Follow-up Investigations & Target Organ Damage

• Tests, including electrolytes, creatinine, fasting lipids, and pregnancy tests, should be repeated with a frequency reflecting the clinical situation during the maintenance phase of hypertension management.
• Consider pregnancy testing when initiating health changes or drug therapy.
• Target Organ Damage (TOD) should be assessed in patients with hypertension.
• Presence of any of the following would put a patient into the moderate-to-high or high-risk categories for therapy
• Cardiovascular Disease, Cerebrovascular Disease, Hypertensive Retinopathy

Target Organ Damage: Continued

• Peripheral Arterial Disease
• Renal Disease
• Global Cardiovascular Risk Assessment
• Multifactorial risk assessment models can be used to more accurately predict global cardiovascular risk and antihypertensive therapy.
• Assessments can be done through risk calculators such as:
  • www.ccs.ca/en/resources/calculators-forms
  • www.myhealthcheckup.com
  • www.epicore.ualberta.ca/epirxisk/
• Improve Risk Factor Modification; Inform patients of their global risk and consider using analogies that describe comparative risks like "cardiovascular age", "vascular age", or "heart age”.

Hypertension: Assess CV Risk Factors

• History of clinically overt ASCVD (eg, PAD, stroke, TIA)
• Nonmodifiable:
  • Age ≥ 55 years
  • Male sex
  • Family history of premature CVD (age < 55 in men and < 65 in women)
• Modifiable:
  • Sedentary lifestyle
  • Poor dietary habits
  • Abdominal obesity
  • Dysglycemia
  • Smoking
  • Dyslipidemia
  • Stress
  • Nonadherence

Hypertension: Clinical Manifestations

• Usually asymptomatic-"The Silent Killer”.
• May cause headache, dizziness, blurred vision when greatly elevated.

Hypertension: Routine and Optional Lab Testing

• Routine Tests:
  • Urinalysis
  • Blood chemistry (potassium, sodium, and creatinine)
  • Fasting blood glucose and/or A1C
  • Serum total cholesterol, LDL-C, HDL-C, non-HDL-C and triglycerides
  • Standard 12-lead electrocardiography
• Optional tests (clinical circumstance):
  • Patients with diabetes (ACR, and according to Diabetes Canada guidelines)
  • Pregnancy test
  • Echocardiogram (when clinically relevant)
  • Left ventricular ejection fraction assessment (when evidence of heart failure)

Hypertension: Thresholds and Targets

• Hypertension Canada stratifies patients by cardiovascular risk and, based on that risk, there are different thresholds and targets for treatment.
• Hypertension Canada High-Risk Patient for intensive BP management:
  • Individuals ≥50y AND with SBP 130-180 mmHg AND
  • With one or more of the following CV risk factors
    • Should be considered for intensive BP management:
    • Clinical or sub-clinical cardiovascular disease
    • Chronic kidney disease
      • (non-diabetic nephropathy, proteinuria <1g/d, *estimated glomerular filtration rate 20-59 mL/min/1.73m²)
      • OR
    • Estimated 10-year global cardiovascular risk ≥15%

Populations and Stratification

• Age ≥75 years
• OR
• Four variable Modification of Diet in Renal Disease (MDRD) equation
  • Framingham Risk Score
• Attaining blood pressure targets is vital to prevent cardiovascular and cerebrovascular complications in patients with documented hypertension.

Population Blood Pressure Thresholds

• Blood pressure thresholds for initiation of antihypertensive therapy and treatment targets in adults:
  • Hypertension Canada High-Risk Patient: if SBP is equal to or greater than 130, target SBP is less than 120
  • Diabetes mellitus: if SBP is equal to or greater than 130 and DBP greater than 80, target SBP is less than 130 and DBP less than 80
  • Moderate-to-high Risk (TOD or CV risk factors): if SBP is equal to or greater than 140 and DBP greater than 90, target SBP is less than 140 and DBP less than 90
  • Low Risk (No TOD or CV risk factors): if SBP is equal to or greater than 160 and DBP greater than 100, target SBP is less than 140 and DBP less than 90

Hypertension Therapy: Health Behaviour Recommendations

• Health Behaviour Recommendations include:
  • Being More Physically Active
  • Weight Reduction
  • Moderation in Alcohol Intake
  • Eating Healthier
  • Relaxation Therapies
  • Smoking Cessation
• Objective recommendation summary in slide

Health Behaviours

• Physical Exercise:
• 30-60 minutes of moderate-intensity dynamic exercise (eg, walking, jogging, cycling, or swimming) 4-7 days per week
• Higher intensities of exercise are not effective
• Use of resistance or weight training exercise (such as free-weight lifting, fixed-weight lifting, or handgrip exercise) does not adversely influence BP
• Weight Reduction:
  • Assess height, weight and waist circumference and calculate BMI
  • Maintenance of a healthy weight is recommended
  • All hypertensive patients with a BMI > 25 kg/m² should be advised to lose weight
• Alcohol:
  • In healthy adults, abstaining from alcohol or reducing alcohol intake to 2 drinks per day or less to prevent hypertension

Health Behaviours Continued

• Diet:
• High in fruit, vegetables, low-fat dairy products, whole grain foods rich in dietary fibre and protein from plant sources that is reduced in saturated fat and cholesterol (DASH)
• Sodium:
• ↓intake to 2000 mg/day
• Calcium and magnesium:
  • Not recommended
• Potassium
  • If not at risk of hyperkalemia, ↑to reduce BP
• Stress management
  • Individualized cognitive-behavioural interventions are more likely to be effective when relaxation techniques are used

Risk Factors of Hyperkalemia

• Assess for those at high risk of hyperkalemia before advising increased potassium intake:
  • Patients taking renin-angiotensin-aldosterone inhibitors
  • Patients taking other drugs that can cause hyperkalemia (eg, trimethoprim and sulfamethoxazole, amiloride, triamterene)
  • Chronic kidney disease (glomerular filtration rate < 45 mL/min/1.73 m²)
  • Baseline serum potassium > 4.5 mmol/L

BP Thresholds for Initiation and Targets by Patient Population

• Low risk (no target organ damage or CV risk factors)
• BP Initiation > SBP 160 or DBP 100
• BP Target < SBP 140 or DBP 90
• High risk of CVD*:
• BP Initiation > SBP 130
• BP Target < SBP 120
• Diabetes mellitus:
  • BP Initiation > SBP 130 or DBP 80
  • BP Target < SBP 130 or DBP 80
• All others:
  • BP Initiation > SBP 140 or DBP 90
  • BP Target < SBP 140 or DBP 90
• **Measured by automated office blood pressure measurement

Hypertension: Dx Key Messages

• Hypertension remains the most prevalent risk factor for cardiovascular disease in Canada
• Standardized BP measurement, using validated protocols and devices, continues to be recommended to screen for cases of hypertension
• Frequency and timing of screening can be tailored to each patient's risk of hypertension.
• Common risk factors for hypertension include:
  • Diabetes mellitus
  • Chronic kidney disease
  • Low level of consumption of fresh fruits and vegetables
  • Sedentary behaviour

Hypertension Measurement Key Messages

• Use of out-of-office measurement (24-hour ambulatory BP monitoring [ABPM] or home BP monitoring [HBPM]) is recommended for all adults with:
  • High in-office BP to rule out white coat hypertension
  • Suspected hypertension (including adults with diabetes) to rule out masked hypertension
• Adults with confirmed diagnosis of hypertension should have a baseline assessment of:
  • Cardiovascular risk factors (including screening for diabetes, hyperlipidemia, and renal disease)
  • Target organ damage
  • Routine lab testing.
• The possibility of pregnancy should be considered in all women of reproductive age with a new diagnosis of hypertension, and during follow-up visits

Types of Hypertension

• Primary or Essential Hypertension:
  • Causes of hypertension are absent and accounts for Approximately 90-95% of clients
• Secondary Hypertension:
  • Causative factors are present and account for Approximately 5% of clients

Hypertension: Untreated

• Untreated chronic high blood pressure (hypertension) can lead to:
  • Stroke
  • Eye damage
  • Blood vessel damage (arteriosclerosis)
  • Heart attack or heart failure
  • Kidney failure

Cardiovascular Health Challenges: Coronary Artery Disease

• CAD is caused by Atherosclerosis-a buildup of plaque in the arteries to the heart.

Atherosclerosis

• Involves the progression of arterial plaque:
  • From fatty streaks to fibrous plaques,
  • Can result in complicated lesions with hemorrhage, ulceration, calcification, and thrombosis.
• range of effects from stroke, infarct and gangrene

Pathogenesis of Atherosclerosis

• Chronic Endothelial Injury, involving:
• Hypertension
• Tobacco use
• Hyperlipidemia
• Hyperhomocysteinemia
• Diabetes
• Infections
• Toxins
• Damaged endothelium, progresses to Fatty Streak
• Lipids accumulate and migrate into smooth muscle cells.
• Fibrous Plaque results from:
• Collagen covers the fatty streak
• Vessel lumen is narrowed
• Blood flow is reduced
• Fissures can develop
• Compliated Lesion results from:
• Plaque rupture
• Thrombus formation
• Further narrowing or total occlusion of vessel

Risk Factors for Coronary Artery Disease

• Nonmodifiable Risk Factors:
  • Increasing age
• Sex (men > women until 65 yr of age)
• Ethnicity (Black people > White people)
• Genetic predisposition and family history of heart disease
• Modifiable Risk Factors:
  • Serum lipid alterations: elevated triglyceride and LDL cholesterol levels, decreased HDL levels
  • Blood pressure ≥140/90 mm Hg
  • Tobacco use
  • Physical inactivity
  • Obesity: waist circumference ≥102 cm (40 inches) in men and ≥88 cm (35 inches) in women
• Contributing Factors:
  • Diabetes mellitus
  • Elevated fasting blood glucose level
  • Psychosocial risk factors (e.g., depression, hostility and anger, stress)
  • Elevated homocysteine levels
  • Substance use

CAD Clinical Manifestations

• Chest pain (Angina pectoris), causing inadequate blood flow to the heart; resulting in:
  • Sensation of heaviness, choking or suffocation
  • Frequently retrosternal & may radiate to neck, jaw, shoulders, back or arms
  • Dyspnea, diaphoresis, tachycardia, and high blood pressure.
• Heart attack (Myocardial infarction), resulting in sudden total blockage of a coronary artery.
• Sudden death: fatal rhythm disturbance.

Angina Pectoris

• Angina:
  • Type of chest pain, pressure or discomfort.
• Causes:
  • Pain in the chest radiating up to the jaw (or down the left (or, less often, right) arm) signals a heart attack
• Reversible angina from increased demand on heart.
• Progressive angina associated with heart attack.

Angina Assessment

• PQRST mnemonic is used to assess and ask questions about angina:
  • P: What events or activities precipitated the pain/discomfort (e.g., argument, exercise, resting)?
  • Q: What does the pain/discomfort feel like (e.g., pressure, dull, aching, tight, squeezing)?
  • R: Where is the pain/discomfort located? Does the pain radiate to other areas (e.g., back, arms, jaw, teeth, shoulder, elbow)?
  • S: On a scale of 0 to 10, with 10 being the most severe pain you could imagine, how would you rate the pain/discomfort?
  • T: When did the pain/discomfort begin? Has the pain/discomfort changed since this time? Have you had pain like this before?

Angina Considerations

• Common locations of pain during angina or myocardial infarction:
  • Midsternal
  • Left shoulder and down both arms
  • Neck and arms
  • Substernal radiating to neck and jaw
  • Substernal radiating down left arm
    • Epigastric
    • Epigastric radiating to neck, jaw, and arms
• Intrascapular

Factors Precipitating Angina

• Physical Exertion:
• Causing an increase in myocardial oxygen demand.
• Isometric exercise of the arms (e.g., raking, lifting heavy objects, or shovelling snow) can cause exertional angina.
• Temperature Extremes:
  • Blood vessels constrict in response to a cold stimulus.
  • Blood vessels dilate and blood pools in the skin in response to a hot stimulus.
• Strong Emotions:
  • The sympathetic nervous system is stimulated.
  • The workload of the heart is increased.
• Consumption of Heavy Meal
  • Blood is diverted to the GI system, which reduces blood flow in the coronary arteries
• Tobacco Use:
• Nicotine stimulates catecholamine release, causing vasoconstriction and an increase in HR.
  • Tobacco diminishes available oxygen by increasing the level of carbon monoxide.

Factors Precipitating Angina Continued

• Sexual Activity: increase of cardiac workload
• Stimulants: HR and subsequent myocardial oxygen demand are increased.
• Circadian Rhythm Patterns:
• Related to the occurrence of chronic stable angina, Prinzmetal's angina, myocardial infarction, and sudden cardiac death.
• Manifestations of CAD tend to occur in the early morning after the patient awakens.

Types of Angina

• Stable Angina:
  • Provoked by exertion or emotional stress.
  • Lasts for 5 to 15 minutes after stopping activity.
  • Relieved by rest and (NTG) nitroglycerin (within 1 minute).
• Unstable Angina (Preinfarction):
  • Occurs at rest or with little physical exertion and is CP new in onset
  • No increase in oxygen demand and acute lack of blood flow to the heart due to presence of plaque.
  • Pain increases in frequency and severity in Worsening pattern
  • Women often have prodrome symptoms such as fatigue, SOB, indigestion, and anxiety
  • Not relieved by rest and NTG and is a sign of a heart attack for MI

Myocardial Infarction

• An area of the myocardium is permanently destroyed due to:
  • Atherosclerosis
  • Thrombus

CAD Diagnostic Tests

• Diagnostic tests and relevant visuals are indicated in the slide

CAD Collaborative Therapy

• Chronic Stable Angina
  • Drug therapy includes:
    • Antiplatelet therapy (e.g., ASA Aspirin], clopidogrel [Plavix])
    • Nitroglycerin
    • ACE inhibitors, ARBs
    • β-adrenergic blockers
    • Calcium channel blockers
    • Lipid-lowering drugs
  • Management of Risk Factors:
    • Management of risk factors for coronary artery disease
    • Coronary Revascularization
    • PCI or CABG surgery
• Acute Coronary Syndrome:
  • Involves 12-lead and continuous ECG monitoring
• IV access and O2 therapy
• Drug therapy includes:
  • Nitroglycerin, Morphine sulfate, ASA
  • β-adrenergic blockers - ACE inhibitors and ARBs
• Unstable Angina/ Non-ST-Segment-Elevation MI (NSTEMI):
• Involves Acute intensive drug therapy and Nitroglycerin
• Involves Antiplatelet therapy for example: ASA, clopidogrel, glycoprotein IIb/IIla inhibitors
• Also calls for Anticoagulation therapy such as Heparin, direct thrombin inhibitors
• Requires Coronary Angiography as well as PCI
• STI segment Elevation
  • Emergent reperfusion therapy through PCI or Thrombolytic therapy
  • CABG surgery
  • Concurrent drug therapy includes Antiplatelet therapy

Emergency Management: Chest Pain

• The key elements to assessing and managing chest pain:
  • Cardiovascular
  • Etiology includes angina, myocardial infarction, dysrhythmia pericarditis, aortic aneurism and aortic valve disease
  • Assessment findings:Pain in chest, neck, arm, or shoulder, Cold, clammy skin,Diaphoresis, Nausea and vomiting, Epigastric pain, Indigestion or heartburn, Dyspnea, Weakness Anxiety, Feeling of impending doom, Tachycardia and Irregular HR as well as murmurs -Palpitations and dysrhythmias result in Decreased blood pressure and Narrowed pulse pressure as well as unequal BP readings in upper extremities, Syncope, loss of consciousness, andDecreased O₂ saturation.
• Respiratory: Etiology includes:
• Costochondritis, Pleurisy
  • Pneumonia
  • Pneumothorax
  • Pulmonary edema
  • Pulmonary embolus
    • Assessment Findings:Decreased or absent breath sounds, Crackles, wheezes
• Chest Trauma:
  • Etiology includes: Rib or sternal fracture,Flail chest,Cardiac tamponade
    • Assessment Findings: Pericardial friction rub
• Initial Assessment:
  • Maintain the patient airway
  • Ensure vitals, administer oxygen
  • Obtain a 12 lead ECG
  • Insert two IV catheters.
  • Assess pain using PQRST method.
  • Provide scheduled medication to ease pain.
  • Continuous ECG monitoring.
  • Portable chest radiograph.
  • Baseline test. - Asses CPR protocol, administer aspirin, B-adrenergic blockers or antidysrhythmic meds

Chest Pain Ongoing Monitoring

• Monitoring includes:
  • Maintaining vitals, oxygen saturation
  • Monitoring patient response to their meds and pain management
  • Provide family and patient support, explaining procedures simply
  • Prepare for intubation and possible CPR or cardioversion if needed.

Percutaneous Coronary Interventions

• Involves the insertion of a guiding cather and use of Balloon Angioplasty

Percutaneous Coronary Interventions with Stent

• Stent implantation involves multiple steps to clear blockages.

CAD Nursing Interventions

• Oxygen therapy with O2 at 2 to 4 L/min via nasal cannula or as ordered.
• Administer medications as needed.
• Manage pain with morphine, positioning and a Diet-low cholesterol, low sodium.
• Restrict activities and promote sleep
• Monitor ECG, vital signs, mental status, I.O., weight, treatments.
• Educate client and family on lifestyle changes and pain managment

Heart Failure (HF)

• Inability of the heart to pump sufficient blood to meet the needs of the tissues for oxygen and nutrients; commonly found in those 65+

Heart Failure Pathophysiology

• Complex in nature and described in slide example

Types of Heart Failure

• Right Heart Failure:
  • Inability of the right side of the heart to adequately pump venous blood into the pulmonary circulation.
  • The condition Causes systemic edema
• Left Heart Failure:
  • Inability of the left side of the heart to pump into systemic circulation.
  • Causes fluid into lungs

Heart Failure Clinical Manifestations

• Right-Sided Failure caused by Systemic Venous Congestion:
  • Weight gain from fluid accumulation and Edema in the ankle or sacral region. -Gl symptoms
  • Distended jugular (neck) veins.
• Left-Sided Failure caused by Pulmonary Congestion:
  • Dyspnea with an anxiety
  • Nonproductive cough with crackles in the lungs
  • Fatigue

Heart Failure: Dx and Tx

• Diagnostic tests include:
• CXR, ECG, ABG, and blood tests (renal function tests, electrolytes).
• Symptomatic can be releived though: -Symptomatic relieve and medications as well as nursing intervention, such has with CAD patients

Peripheral Vascular Diseases

• Varicose Veins and DVT (Deep Vein Thrombosis)

Varicose veins and DVT: Types

• Varicose veins involve:
  • Swollen, twisted, and painful veins filled with abnormal collection of blood.
• DVT involves: -Formation of a blood clot (thrombus) in a deep vein.

Varicose veins and DVT: Risks

• Varicose Viens:
  • Family history, Pregnancy and Obesity
  • Aging, Prolonged bed rest and Smoking
• DVT:
• Pathophysiology
• Manifest via normal vessel clots

Varicose veins and DVT: Manifestions

• Varicose Veins:
  • Characterized clinicaly by:
  • Leg fatigue and aching with leg cramping, as well as pain, Swollen legs, Dilated veins, and Ankle edema.
• DVT:
• Diagnostic Tests include: Client history and Physical Examination, as well as venography andD oppler ultrasound on legs

Varicose veins and DVT: Diagnostics

• Venous anatomy and indications show a normal and deep vein thrombosis comparison

Varicose veins and DVT: Treatments

• Treatments include:Rest with elevation of legs; exercise, anti-embolic stocking;
• Avoid prolong standing,sitting and crossing the legs; manage weight; surgical vein stripping (varicose veins) and anticoagulant therapy (DVT).
• Nursing Interventions include:
• Ensure Post surgery assessment of legs (color, movement, temperature and sensation); encourage leg exercises and client education.

Stasis Ulcers

• Stasis ulcers or venous ulcers are wounds that occur due to improper functioning of venous valves, commonly found in the lower extremities.
• Manifest Open sore that is inflamed and causes swelling, heaviness, fatigue with pigmention
• Results from inadequate oxygen and other nutrients to the tissues.
• Diagnostics can be through venous doppler showings of wound cultures Treatments include compression dressings. Also skin graphs