Vascular Disorders: Diagnosis, Atherosclerosis, and PAD

• These are notes summarizing vascular disorders

Diagnostic Tools

• Doppler and Duplex ultrasounds are used for vascular diagnostics
• Exercise testing helps assess vascular function
• Computed Tomography (CT) scans can be performed with or without contrast
• Magnetic Resonance Angiography (MRA) is also conducted with contrast

Atherosclerosis

• This disease is characterized by the buildup of fatty materials in the vessel walls, leading to narrowed and blocked arteries
• It is critical to understand the modifiable versus non-modifiable risk factors for vascular diseases, detailed in Chart 26-3

Peripheral Artery Disease (PAD)

• PAD involves a chronic atherosclerotic vascular condition that commonly affects the legs
• Intermittent claudication, pain with activity relieved by rest, is a hallmark symptom
• Decreased capillary refill in the toes, along with decreased or unequal pulses, can be indicative of PAD
• Other findings include dry, scaly, mottled skin, thick toenails, and potential ulcers or gangrene

Nursing Interventions for PAD

• Dependent positioning is important, along with educating patients about improving circulation
• Regular, gradual exercise increases circulation
• Monitor for fluid imbalances
• Advise against leg crossing
• Strategies to promote vasodilation such as warm environment, insulated socks
• Exposure to cold and vasoconstrictive agents like nicotine or emotional stress must be avoided
• Tissue integrity must be maintained, as poorly perfused tissues are prone to injury or infection
• Trauma to the extremities should be avoided
• Encourage good nutrition with sufficient protein, vitamin C, and zinc, alongside a diet low in fats and lipids

Abdominal Aortic Aneurysm (AAA)

• Patients may notice a pulsating sensation in the abdomen or feel an abdominal mass
• Monitor for signs of impending rupture
• Hypertension must be managed pharmacologically
• Endovascular and surgical management involves monitoring the aneurysm's size and potential resection with a bypass graft
• Closely monitor for post-procedure complications
• Hemorrhage leading to shock is a serious risk
• Bed Rest is necessary
• There are also vital sign assessments performed at the access sight
• Diet and fluids are necessary

Raynaud's Phenomenon

• This condition involves intermittent arteriolar vasoconstriction, resulting in coldness, pain, and pallor in the fingers and toes
• Emotional factors, stress, or sensitivity to cold act as triggers
• Pallor from sudden vasoconstriction is a key manifestation
• A sequence of color changes—white, blue, and red—is characteristic, accompanied by numbness, tingling, and burning pain
• Management includes avoiding stimulants that provoke vasoconstriction
• Calcium channel blockers alleviate symptoms; be cautious of orthostatic hypotension

Venous Thromboembolism (VTE): Deep Vein Thrombosis (DVT) & Pulmonary Embolism (PE)

• VTE involves thrombus blocking the venous system
• Pulmonary Embolism is primarily caused by dislodged DVT clot that migrated to the lung

Deep Vein Thrombosis (DVT)

• It involves the formation of a blood clot in a deep vein
• The entire extremity may become swollen, tense, and painful
• The affected extremity may feel warmer than the unaffected extremity
• Preventative measures must be taken
• Diagnostics include labs and US
• Prevent thrombus extension using anticoagulants
• Thrombectomy and US guided thrombolytic therapy may be needed for early removal
• Assess DVT progression and anticoagulant
• Vitamin K and protamine sulfate act as reversal agents
• Provide comfort and encourage exercise

Pulmonary Embolism (PE)

• Dyspnea and tachypnea are the most common clinical presentations
• Followed by sudden and pleuritic chest pain
• Apprehension, fever, cough, diaphoresis, tachycardia, hemoptysis, and syncope can also occur
• Diagnostic includes chest x-ray, ECG, ABG, and MDCTA
• Unstable massive PE is life threatening due to ABCs complications (airway, breathing, circulation) and needs thrombolytic therapy
• Ongoing includes managing: pain, anxiety and preventing recurrent PE
• See TABLE 26-2 in Lippincott Textbook for details on the usage and precautions

Chronic Venous Insufficiency (CVI)

• CVI manifests as edema, altered pigmentation, pain, and stasis dermatitis
• Symptoms worsen throughout the day
• The skin becomes dry, cracked, and itchy, increasing the risk of injury and infection
• Venous ulceration with drainage may be present once skin breaks
• Management includes leg elevation and compression of superficial veins using stockings and intermittent pneumatic compression

Varicose Veins

• Individuals may experience dull aches, muscle cramps, increased muscle fatigue in the lower legs, ankle edema, a feeling of heaviness, and nocturnal cramps
• Diagnostics include Duplex US
• Thermocautery ablation is the nonsurgical option
• Vein ligation and stripping as outpatient procedure
• Managing and cleaning wounds

Lymphangitis & Lymphadenitis

• Acute inflammation in the lymphatic channels occurs due to bacterial infection
• Symptoms include red streaks extending up an extremity
• It can cause necrosis and forming ulcers

Lymphedema

• Includes diuretics, antibiotics
• Meticulous skin care and inspect the skin for evidence of infection
• Surgery
• Excision of the affected subcutaneous
• Antibiotics and skin grafting are also options
• Assess and report unusual drainage
• There should be no inflammation around the incision

Cellulitis

• Clinical manifestations include swelling, localized redness, warmth, and pain
• Can involve redness that skip areas and develops in pitting
• Can treat using oral medicines (mild) and IV medicine (severe)
• Elevate the location and apply cool packs
• Do not scratch the skin, keep it clean
• Reinforcement about skin and foot care especially with diabetics and/or peripheral vascular diseases