Level III Nursing Theory - Vascular Disorders PDF

2024-07-08 1 NSG 5130: Level III Nursing Theory Med-Surg Week 5: Vascular Disorders Rachael Jaffray, RN, MScN 2 3 Vascular Disorders Can lead to impaired perfusion...

2024-07-08 1 NSG 5130: Level III Nursing Theory Med-Surg Week 5: Vascular Disorders Rachael Jaffray, RN, MScN 2 3 Vascular Disorders Can lead to impaired perfusion Ischemia Blood supply is available, but decreased Reversible cellular injury caused by: Lack of blood flow Lack of oxygen What could cause Ischemia? Infarction/necrosis Indicates death of tissue with an inability to regenerate What could cause cell death? 4 Vascular Disorders Causes of arterial insufficiency Arteriosclerosis Walls of arteries become “hardened”, occurs with aging Atherosclerosis (central and peripheral) Accumulation of lipids, blood components & other cells on the innermost layer of arterial wall Emboli Clot in artery Causes of venous insufficiency Dysfunction of valves Prolonged time standing (nursing work) Prevention & Treatment: compression stockings & vein treatments Smoking – chronic vasoconstriction 5 Risk Factors: Vascular Disorders and Impaired Perfusion Smoking High cholesterol Sedentary lifestyle Obesity Diabetes Hypertension Age Sex 6 Why is smoking a risk factor? Tobacco use is one of the main risk factors for vascular disorders 1  2024-07-08 Tobacco use is one of the main risk factors for vascular disorders Acts as a vasoconstrictor Impairs transport of oxygen Impairs cellular use of oxygen Increases blood viscosity Increases homocysteine levels 7 Arterial Disorders PAD, AAI & Aneurysms 8 Peripheral Artery Disease 9 Peripheral Artery Disease Narrowing of the arteries (upper and lower extremities) Related to other types of cardiovascular disease (CVD) More likely to have coronary artery disease (next week) Higher risk of premature death: CVD, coronary events, stroke Causes: Atherosclerosis (thickening of artery walls) Can be caused by: Lipid accumulation Connective tissue deposits Replication of muscle cells Infiltration of types of immune cells 10 11 Most common sites of PAD: Iliac Femoral Popliteal Tibial Carotid (not shown here) Coronary (not shown here) 12 Peripheral Artery Disease: Risk Factors Smoking Hyperlipidemia lipid accumulation C-reactive protein chronic inflammation Uncontrolled hypertension Sedentary lifestyle Obesity Diabetes mellitus 2  2024-07-08 13 PAD: Clinical Manifestations in Lower Extremities (most common) Often no symptoms until 60-75% of the vessel is occluded Depends on site ~20% adults over 60 show symptoms of PAD (Bailey et al., 2014) Classic: intermittent claudication ischemic muscle ache/pain precipitated by constant level of exercise and relieved with 10 minutes of rest, and is repeatable (predictable) Pain = accumulation of end products of anaerobic activity (no oxygen from blood flow), like lactic acid (exercise example) Numbness and tingling r/t nerve tissue ischemia 14 Examples: PAD site - Iliac Claudication in buttocks and thighs PAD site – Femoral or popliteal Claudication in calves 15 PAD: Diagnostics Doppler U/S Map blood flow Segmental BPs while patient is supine (laying) Thigh BTK (below the knee) Ankle Drop in BP >30mm Hg suggests PAD ABI (ankle-brachial pressure index) Ratio of BP in upper extremity vs. lower (ankle/brachial) (Nead et al., 2013) 2 weeks, arterial ulcers or gangrene 4  2024-07-08 Goals of therapy Protect from further trauma, good foot care Decreasing ischemic pain Opioids and positioning (reverse Trendelenburg) Proper wound care and prevent/control infection *remember that unlike pressure ulcers, arterial ulcers do not have the same blood supply, so will likely not heal PAD/CVD prevention measures Can undergo revascularization therapies Bypass graft around atherosclerosed artery Removal of obstructive plaque Amputation is least desirable end-stage option 23 PAD: Management Risk Factor Modification Nursing Management Medical Management (Drug Therapy) 24 PAD: Risk Factor Modification Prevention: Lifestyle modifications: BP