10 arterial venous disease.pdf

Kiang Wu Nursing College of Macau Bachelor of Science in Nursing Subject: BN 2411 Adult Nursing II: Maintenance of Oxygenation 成人護理 II - 氧的作用與維持 Adult Nursing II: Arterial & Venous Disorders Mina Lam Annah Au This PPT is made and acknowledged by Alice TSANG & Annah AU Learning Outcomes Us...

Kiang Wu Nursing College of Macau Bachelor of Science in Nursing Subject: BN 2411 Adult Nursing II: Maintenance of Oxygenation 成人護理 II - 氧的作用與維持 Adult Nursing II: Arterial & Venous Disorders Mina Lam Annah Au This PPT is made and acknowledged by Alice TSANG & Annah AU Learning Outcomes Use assessment parameters appropriate for determining the status of peripheral circulation rest pGin → move sevare → 间竭性跛⾏ pulseabsnt, 表⽪ temp ↓ , pallor : paim 較弱 cramping 酸 ,aching. edend ( pulsepasentbntdiffioultto palpate), pignentation 动脈 usnally 运动后更痛 ( 供 靜 O 2 ) Apply the nursing process as a framework of care for patients with vascular insufficiency of the extremities , , 动 静: 。 AB 了 , nltrasond ulfrasonnd ,. CT CT , , 造影 造影 Describe the management and prevention for patient having 抗⾎脂 抗⾎⼩板凝集 抗凝 vascular disorders Xsmoking (arteriosclerosis 動脈硬化and atherosclerosis動脈粥樣硬化, peripheral arterial occlusive disease PAD, Arterial embolism栓塞 and arterial thrombosis血栓, Raynaud disease 雷諾氏病, veduce Aneurysms 動脈瘤, dissecting aorta動脈夾層; venous Vasodilation thromboembolism VTE靜脈栓塞, varicose veins靜脈曲張). , , ↑ , alchol stumnli \ ( Nrisk ( 破裂 ) 易致死 , HBP , 治疗 : of vupfure) 降⾎压 HR 脚低于⼼ 保暖 , wallimg 弹性 , elevated ⻘静服 → , 扩張动脈 → Describe the patient education on taking anticoagulant Please read Hinkle& Cheever (2021) Chapter 26 , What factors can influence the peripheral blood flow and tissue oxygenation/ 营养提供 nourishment? Rescource from https://socratic.org/questions/what-is-thedifference-between-veins-arteries-andcapillaries (Hinkle & Cheever, 2021, P818-819) Resource from https://en.wikipedia.org/wiki/Lymphatic_system#/media/File:Blausen _0623_LymphaticSystem_Female.png Resource from https://www.pinterest.com/pin/433260426648620411/ Artery Vein Diameter Aorta = 2.5cm Artery=4mm Arterioles=30mcm Intima 內膜: a smooth surface for contact with The thin , less muscular structure distend more than arteries (75% of total the flowing blood blood volume ) Media中膜: elastic and connective tissue Valves : Valves are composed of ability fibers, smooth muscle constrict and dilate 11 leaflets, the competency of | 內⽪细胞 endothelial 固定 " Adventitia外膜: anchors the vessel to its which depends on the integrity of the 完整性 surroundings vein wall. Walls: approximately 25% of the total diameter of the artery Walls: 10% of the diameter peripheral vascular disease Different characteristics in general & ulcer Health Assessment General Characteristics Arterial Pain: intermittent | " claudication 間歇性跛行 to sharp劇痛, unrelenting, constant持續 prolonged capilldry Pulses: Diminished 減弱or absent Venous Pain: Aching痛(持續), throbbing搏動性痛, cramping 絞痛 Coustant refill tivne 垂脚 → 流⾎⼩ ↓ 但动脈闭塞 中层平滑肌供⾎ ↓ → → 3 - Skin Characteristics: ↓ dependent rubor紅 --body elevation pallor of foot; dry, shiny光 shin; cool-to-cold temperature; loss of hair over toes and dorsum背 of foot; nails thickened and ridged隆起 wbren the lioub ← is lowerthay the vast of Vasolilation dependeut wuBor Pulses: Present, but may be difficult to palpate through edema 受损 廢物累积 → ⿊⾊素沉著→ 長期→ ! Skin Characteristics: gliter Pigmentation色素沉著 in gaiter area (area of medial and lateral malleolus踝區), skin thickened and tough硬, may be reddish blue, frequently with associated dermatitis皮炎 veim aicer avla < l _ Health Assessment General Characteristics Intermittent claudication Health history Pain Dend -stagl : iuadequate blood duvingest Rest pain! pain. occurs duvnng exeroise , blood oupply to the musdewhem ( inadequaTe ) 1 blockage arteri al Mavvon 0 https://youtu.be/0IbjDeqXXBo resolue after vest lewough blood ) Resource From https://www.otsuka.co.jp/en/health_ill ness/pad/seikei/page1.html Health Assessment Ulcer Characteristics Arterial hustconmon in ⽉端⽀ ! 滴 vssels易阻塞 ) Location: tip of toes, toe webs, heel or other pressure areas if confined限於 to bed Pain: Very painful Depth of ulcer: Deep, often involving joint space 間隙 Shape: Circular圓形 Ulcer base: Pale to black and ← dry gangrene壞疽 O iodry death of tissue iMadequateofbloodsuppy Leg edema: minimal unless extremity kept in dependent position constantly to relieve pain 元⾎. d leto ( 0 causes : ischaenia Venous Location: Medial malleolus, 川 lateral malleolus 內外踝, or anterior tibial 脛前area Pain: Minimal pain if 淺表 superficial or may be very painful Depth of ulcer: Superficial Shape: Irregular border不規則 邊框 Ulcer base: Granulation 肉芽 tissue---beefy red to yellow fibrinous in chronic long-term ulcer Leg edema: Moderate to severe Catlect⻘事脈⾎回了 0 canses : impaiued dvamage Health Assessment ← Ulcer Characteristics cyanotic ( 缺 O 2) ateical ← ateria 胫前表婆⽜⾁样 vein Diagnostic evaluation Diagnostic evaluation Doppler ultrasound杜卜勒超聲波 https://youtu.be/tttaSS9Z8hk 臂 Ankle-brachial index (ABI): the ratio of the SBP (ankle) to SBP (arm) https://www.youtube.com/watch?v=0_0VlLSTAAE&t=5s Exercise testing Duplex ultrasonography多普勒超声 Page 822-824 (Also read P824, chart 26-1 Avoiding Common Errors in Obtaining the Ankle-Brachial Index ) Diagnostic evaluation Diagnostic evaluation renaltuuc 不好慎⽤ ( 造影剂经 ranal 排出了 Computed tomography scanning X射線電腦斷 ( 層掃描 CT ) 造影剂 经不了 vessels ↓ obstructed https://www.cancer.gov/publication s/dictionaries/cancer-terms/def/ctscan https://ctisus.com/redesign/teachingfiles/vasc ular/395680 (Hinkle & Cheever, 2018, P847-849) Diagnostic evaluation Diagnostic evaluation Magnetic resonance angiography磁力共振血管造影 https://www.researchgate.net/figure/Magnetic-ResonanceAngiogram-MRA-of-the-peripheral-arterial-systemextending-from-the_fig5_221845139 Diagnostic evaluation Diagnostic evaluation Venography 靜脈造影 https://www.intechopen.com/books/angiography-and-endovascular therapy-for-peripheral-artery-disease/basics-of-angiography-forperipheral-artery-disease https://en.wikipedia.org/wiki/Venography Angiography Ginsertedvive → 打造影剂 → 的直接放 stent Diuvasive Arterial Disorders ". atevalibstructed 1 steuosis Arterial disorders cause ischemia缺血 and tissue necrosis壞死 Arterial disorders Arteriosclerosis動脈硬化 and Atherosclerosis動脈粥樣硬化 Peripheral Arterial occlusive disease, PAD Arterial embolism栓塞 and arterial thrombosis血栓 Raynaud disease 雷諾氏病 Aneurysms動脈瘤 Dissecting aorta動脈夾層 Arterial disorders 1 " ' " 動脈硬化 Arteriosclerosis loss of elastic fibers 內⽪ thicken of muscle fibers and the endothelial lining of the wall owmmal process of agelug , mgor cause f HBP Arterial disorders HBP. smoking → 使 intima受损 ( 破裂了 ruptune→+Hwmyos 73 1 ⼼梗 → ↑ →凝⾎吸引⼉ DL(堵住伤⼝侵入肌⾁层 变厚 ( v7 skfactor ) 內膜 → cause by 使⾎管內⽪更易受损 ) " … 1 Atherosclerosis 動脈粥樣硬化 porvidge like navadeting affecting the intima of large and medium-sized arteries chrowlc system accumulation of lipids, calcium, blood components, carbohydrates, and fibrous tissue on the intimal layer of the artery The most common direct results of atherosclerosis in arteries include narrowing (stenosis) of the lumen Atherosclerosis can develop at any point in the body, but certain sites are more vulnerable, such as regions where arteries bifurcate 分叉or branch into smaller vessels o → - inflaumationdnd activation of the immnne Caus | stiflening HBB strain of heart steu513 bloodflowd vuptave thrombosis (Hinkle & Cheever, 2021, P827, Fig 26-6) Arterial disorders 闭塞 Peripheral Arterial occlusive disease, PAD 由 Gthewsdewsis 引起 Arterial insufficiency of the extremities occurs and is a common cause of disability Distal occlusive disease is frequently seen in patients with diabetes and in older patients ↓ intima 脆化 , 糖化浸 Arterial disorders Arterial embolism栓塞 and arterial thrombosis血栓 From thrombi that develop in the chambers of the heart as a result of atrial fibrillation, myocardial infarction, infective endocarditis,↓ chronic heart ⼼房 左⼼耳 failure, or atherosclerosis 进入体循环 blovdaccumulatin esp thvombosis These thrombi become detached and are carried from the left side of the heart into the arterial system , 0 " 1 modification of risk faotors stop " low suloking , control loodsugav fat and cholesterol diet : ,. freat wedical Condition 高同半胱胺酸血症 Prevention? (Hinkle & Cheever, 2021, P828, chart 26-3) Arterial disorders Atherosclerosis動脈粥樣硬化 & Peripheral Arterial occlusive disease, PAD & Arterial embolism栓塞 and arterial thrombosis血栓 Clinical Manifestations -Intermittent claudication -rest pain -d 周边神经营养 ↓ -Coldness or numbness -cyanotic -Ruddy -Pulse: diminished or absent -six Ps (pain, pallor, pulselessness, paresthesia感覺異常, poikilothermia:coldness, paralysis麻) ⾯下垂肠乐膜有沙尿 -Cerebral, mesenteric, renal, and coronary arteries are often involved in Medical Management -Pharmacologic therapy ⼩流 Cilostazol西洛他唑: 磷酸二酯酶III抑制劑 (擴張血管及抗血小板藥) Aspirin: 抗血小板藥 thrombus Clopidogrel (Plavix): 抗血小板藥 I 川 Statins:降血脂藥 [ LBL 了 - -Endovascular management Percutaneous transluminal angioplasty PTA, ⽓球 laser, Stents (a less than 50% diameter reduction) stroke if wot effective v -Surgical Management CABG bypass 搭桥 、 iminate onstrucfed Part @ uetal stents Arterial disorders Arterial embolism栓塞 and arterial thrombosis血栓 Medical Management Medical Management Therapy Pharmacologic Therapy Pharmacologic 較⼤ ∵直接影响凝⾎因⼦ -Heparin therapy (an initial -alteplase阿替普酶 (Activase, t-PA) side eftect iisk. : ⑪ IV bolus of 60 U/kg body weight is given, followed by a continuous infusion of 12 U/kg/h until the patient undergoes endovascular treatment or surgery) E : 凝案回 凝核延⺠凝⾎晰抗 -scu-PA, prourokinase 尿激酶原 -r-PA, retavase 瑞替普酶 -TNKase替奈普酶 (intra-arterial thrombolytic 溶栓 medications) 幅作⽤ : bleeding Arterial disorders Atherosclerosis動脈粥樣硬化 & Peripheral Arterial occlusive disease, PAD Nursing Management 1 Improving peripheral arterial circulation - A body part can be enhanced by positioning 。 the part below the level of the heart 喇激侧⽀循环⽣⻓ -∞ Walking (Moderate or graded isometric exercises) --- the patient’s primary provider should be consulted 咨询 - Promoting vasodilation 。and preventing vascular compression (applications of warmth) 著襪蓋被 Dwlapplywarm 营养差 感党异常 熱太 highrsh Laviid 损伤 nua - Quit smoking O → → → Arterial disorders Atherosclerosis動脈粥樣硬化 & Peripheral Arterial occlusive disease, PAD Nursing Management 2 Improving peripheral arterial circulation -Emotion ( visk tactors strbs) - Clothing ( keep ) - Not crossing the legs - Relieving pain (Analgesic agents ) - Maintain tissue integrity : ham Arterial disorders Atherosclerosis動脈粥樣硬化 & Peripheral Arterial occlusive disease, PAD Nursing Management 3 --- Nursing care of the postoperative patient Assessment - Maintaining circulation (Pulses, Doppler assessment, 6 Ps color and temperature, capillary refill, and sensory ) bleeding - Monitoring and managing potential complications (urine output,↑ central venous pressure,l mental status,↓ and pulse rate and volume permits early recognition and treatment of fluid imbalances, Bleeding, Edema) Arterial disorders Arterial embolism栓塞 and arterial thrombosis血栓 Nursing Management 1 --- before an intervention or surgery - Bed rest with the affected extremity level or slightly dependent (15 degrees) 溶程治疗 出⾎ → avoid - The affected part is kept at room temperature and protected from trauma (Heating and cooling pads are contraindicated禁) Arterial disorders Arterial embolism栓塞 and arterial thrombosis血栓 Nursing Management 2 --- After treatment of thrombolytic therapy bleeding ↑ → - The patient is admitted to a critical care unit for continuous monitoring - Vital signs are taken initially every 15 minutes and then at progressively longer intervals if the patient's status remains stable - Pulses, Doppler signals, and motor and sensory function are assessed every hour for the first 24 hours (because significant changes may indicate reocclusion) - Nurses minimize the number of punctures for inserting IV lines and obtaining blood samples; and applies pressure at least twice as long as usual after any puncture is performed Arterial disorders Arterial embolism栓塞 and arterial thrombosis血栓 Nursing Management 3 --- during the recovery phase 䪢 -To encourage the patient to move the extremity to stimulate circulation and prevent stasis (The patient’s appropriate activity level based on the patient’s condition) hose bleed , ⿊便 -To assesse local and systemic hemorrhage, including mental status changes, which can occur when anticoagulants are given Arterial disorders Raynaud 雷諾氏病 Raynaud phenomenon is a form of intermittent間歇 arteriolar vasoconstriction收縮 that results in coldness, ↓ pain, and pallor of the fingertips or toes ( basal metabolism ) 可因基础熱量福间 ( 食唔夠野 / 产响熱 ] Primary or idiopathic 特發性 Raynaud’s: occurs in the absence of an underlying disease Secondary Raynaud’s: occurs in association with an underlying disease, usually a connective tissue disorder 結締組織病變, such as systemic lupus erythematosus紅斑 狼瘡, rheumatoid arthritis類風濕性關節炎, or scleroderma 硬皮病; trauma; or obstructive arterial lesions Arterial disorders Raynaud 雷諾氏病 Clinical Manifestations -Pallor -blusih (cyanotic)--numbness, tingling刺痛, and burning pain灼痛 (bailateral 雙側 and symmetric對稱) -red ( 产熱 停⽌收缩 间瞬充⾎. vasoolilation 冻 Vasoantrctim → → ) Medical Management -Avoiding the particular stimuli (e.g., cold, tobacco) that provoke vasoconstriction 直接扩張动脈 -Calcium channel blockers (nifedipne [Procardia], amlodipine [Norvasc]) Arterial disorders Raynaud 雷諾氏病 Nursing management esp 肢端 -the patient should wear layers of clothing when outdoors. Hats and mittens or gloves should be worn at all times when outside in winter -Patients should avoid all forms of nicotine Vessels易 damage Aneurysms動脈瘤 Dissecting aorta動脈夾層 Arterial disorders … Aneurysms 動脈瘤 An aneurysm is a localized sac局部囊 or dilation 擴張formed at a weak point in the wall of the artery 內膜损伤 创⼝ → , 动脈⾎流⾄创⼝ 血塊和結締組織 在動脈壁外 受累血管整個圓周 通常是血腫, 對稱紡錘狀擴張 球根狀突起 可分裂動脈壁各層 " " Saccular Dissecting False aneurysm True aneurysm Fusiform aneurysm aneurysm 真正動脈瘤 aneurysm 搏動性血腫 梭狀動脈瘤 囊狀動脈瘤 夾層動脈瘤 ouly one side onlyonelaylv but 3 botuside 3 , uSually adentitia layer , layer 31 ayer 球形 , A saccular囊狀 aneurysm projects from only one side of the vessel If an entire arterial segment becomes dilated, a fusiform梭狀 aneurysm develops Arterial disorders ” Dissecting Aorta動脈夾層 p ↑→ rlssels⼤破裂 3层曬了 5 累运升主脈影降主动脈 。 无效賉 0 影响主脈 valvl 活⼒脈瘤 mptu吧变夾层了 iumediale ⼿术 usMally major couse o ruptuve inanta :HBP. 可卡因 → 內膜易受损 → ⾎肿 → 缺⼝越来越⼤ ↑ 你克 syMptoms symptoms : 3 P ↓ ( cardiacuriputd ,撕裂性背痛 ) Dissection is caused by rupture破裂 in the intimal layer A rupture may occur through adventitia外膜 or into the lumen through the intima, allowing blood to reenter the main channel and resulting in chronic dissection (e.g., pseudoaneurysm假性動脈 瘤) or occlusion of branches of the aorta 0 X - vay 分辨 aginaldissectingarta Arterial disorders Aneurysms動脈瘤 Thoracic Aortic Aneurysm -The thoracic area is the most common site for a dissecting aneurysm Abdominal Aortic Aneurysm -After an aneurysm develops, it tends to enlarge -Untreated, the eventual outcome may be rupture and death Arterial disorders Aneurysms動脈瘤 Thoracic Aortic Aneurysm Abdominal Aortic Aneurysm Clinical Manifestations -asymptomatic 动脈服瘤⼩时 -pain (supine) -dyspnea 下近升主动⽉低肺 -cough 压通肺部 ) -hoarseness嘶啞, stridor喘 嗚, or weakness or complete loss of the voice 压迫喉反神经 -dysphagia 吞咽困難 压迫食道 ( — ) Clinical Manifestations -40% of patients have symptoms ( 較易有 sympTums -heart beating in their (lying 悸动 | down)---pulsatile mass in the middle and upper abdomen - severe back or abdominal pain, falling blood pressure; and decreasing hematocrit ⾎容量 (rupture破裂) ) - auusoultation :brwit sound Arterial disorders Aneurysms動脈瘤 Thoracic Aortic Aneurysm Abdominal Aortic Aneurysm Medical Management Pharmacologic therapy -beta blockers阻滯劑 (atenolol [Tenormin], metoprolol [Lopressor, Toprol XL], carvedilol [Coreg] controlling blood pressure --dissecting aneurysms -beta blockers阻滯劑 (esmolol or metoprolol) -Hydralazine(Apresoline) -nitroprusside (Nipride) Medical Management Pharmacologic therapy of rupture -Antihypertensive ⼼ agents, including diuretics, beta blockers, ACE inhibitors, ARBs, and calcium channel blockers ( lower visk ) Arterial disorders Aneurysms動脈瘤 Thoracic Aortic Aneurysm Abdominal Aortic Aneurysm Medical Management Surgery -The goal of surgery is to repair the aneurysm and restore vascular continuity with a vascular graft ⽀架取替 vessels 薄弱位 ⾎流不经 → , 不撐破 vessels Medical Management Surgery : ⼿术难度⾼ 致死率⼤ ↓ , -an abdominal aortic aneurysm measured at least 5.5 cm (2 in) wide or was enlarging, the standard treatment had been open surgical repair of the aneurysm by resecting the vessel and sewing a bypass graft in place Arterial disorders Aneurysms動脈瘤 Thoracic Aortic Aneurysm Abdominal Aortic Aneurysm Nursing Management --- after endovascular repair -the patient must lie supine for 6 hours (the head may be elevated up to 45 degrees after 2 hours) → awid 压迫脚穿刺点 ⽂架→动脈穿刺 → 压迫⽌⾎ →check压迫不⼤ ? -vital signs and Doppler assessment of peripheral ↓ pulses (and femoral artery 股動脈)are performed initially every 15 minutes and then at progressively longer intervals if the patient’s status remains stable -The nurse assesses for bleeding, pulsation, swelling腫 脹, pain, and hematoma血腫 formation -The patient’s temperature should be monitored every 4 hours intection → Venous Disorders Superficial veins, such as the greater saphenous大隱靜脈, short saphenous (also known as lesser saphenous)小隱靜脈, cephalic頭 靜脈, basilic基底靜脈, and external jugular veins 頸靜脈, are thick-walled muscular structures that lie just under the skin. Deep veins are thin walled and have less muscle in the media Venous disorders cause reduction in venous 受损 blood flow, causing blood stasis 回流 ↓ valve Venous disorders venous thromboembolism VTE靜脈栓塞 varicose veins靜脈曲張 Venous Thromboembolism VTE 靜脈栓塞 Venous disorders | Venous thromboembolism VTE 靜脈栓塞 Deep vein thrombosis (DVT) and pulmonary embolism (PE) ( atevlal embolism 来⾃左⼼ 来⾃下肢) bothhaveinllammatimproless PE is due to a dislodged or fragmented DVT : 左⼼栓⼦脑 [右 … : 、 VTE : “ 、 肾下肢 肺 three factors, are believed to play a significant role in VTE development: endothelial damage, venous stasis, and altered coagulation 凝⾎时间 ↓→ ⾎了夜凝固⼿塞 When a thrombus develops initially in the veins as a " 1 " " 高凝血 but result of stasis淤血 or hypercoagulability l without inflammation, the process is referred to as phlebothrombosis 靜脈血栓 " " P845 Venous disorders Venous thromboembolism VTE 靜脈栓塞 Clinical manifestations Deep Veins -Edema (feeling of heaviness) -Tenderness壓痛 inllammatim } - Warmth Superficial Veins -pain or tenderness -redness -warmth Medical Management Pharmacologic therapy (P849,table26-2) -unfractionated heparin(IV, with oral warfarin for 5 to 7 days) ⻓只有抗凝无抗⾎⼩板不能吃不多 iitk ↓ -Low-Molecular-Weight Heparin (SC) ( g 菜 內脏 ] -Oral Anticoagulants - (warfarin, International a. 、 、 normalized ratio INR國際標準化比例) -Factor Xa inhibitors凝血因子抑制劑 Fondaparinux(Arixtra), SC; Rivaroxaban (Xarelto), PO; Apixaban (Eliquis), PO 不⽤戒⼝ → -direct thrombin inhibitors 直接凝血酶抑制劑 Dabigatran (Pradaxa), PO -Thrombolytic therapy 溶栓 alteplase Endovascular Management Venous disorders Venous thromboembolism VTE 靜脈栓塞 Nursing Management 1 --- patient receive anticoagulant therapy -Assessing and Monitoring Anticoagulant Therapy (To monitor the laboratory values: the aPTT活化部分凝血酶時間, prothrombin time凝血酶原時間 (PT), INR, ACT激活凝血時間, hemoglobin血紅蛋白 and hematocrit values血細胞比容值, platelet count, and fibrinogen纖維蛋白原 levels) Heparin is in the effective, or therapeutic, range when the aPTT is 1.5 times the control warfarin, are monitored by the PT or the INR (when the PT is 1.5 to 2 times normal or the INR is 2.0 to 3.0) Venous disorders Venous thromboembolism VTE 靜脈栓塞 Nursing Management 2 --- patient receive anticoagulant therapy -Monitoring and Managing potential complications withb d ) Bleeding ( dark stool ' ' " 血少板減少症 Thrombocytopenia Drug interactions le 9 nafarinaud , uvine. 100 iit 1 K ) Venous disorders Venous thromboembolism VTE 靜脈栓塞 Nursing Management 3 --- patient receive anticoagulant therapy -Providing Comfort Elevation of the affected extremity graduated compression stockings (a pressure gradient of 20 to 30 mm Hg is prescribed for patients with asymptomatic varicose veins, whereas at least a pressure gradient of 30 to 40 mm Hg is recommended for patients with venous stasis ulceration) analgesic agents for pain relief are adjuncts to therapy ⼩回流 The patient is encouraged to walk once anticoagulation therapy has been initiated. if 未食 auticoagulant 不 walkowvid栓塞上肺 The nurse should instruct the patient that walking is better than standing or sitting for long periods. Bed exercises, such as repetitive dorsiflexion of the foot重複腳背屈, are also recommended. Pouoth ( ) Self learning : Varicose Veins 靜脈曲張 Venous disorders Varicose veins 靜脈曲張 Varicose veins (varicosities) are abnormally dilated 擴張, tortuous, superficial veins caused by incompetent venous valves The condition is most common in people whose occupations require prolonged standing, such as salespeople, hair stylists, teachers, nurses and ancillary medical personnel, and construction workers. 无⼒ Venous disorders varicose veins 靜脈曲張 stockiugs Prevention? Page 858 Venous disorders Varicose veins 靜脈曲張 Clinical manifestations -dull aches 疼痛 -muscle cramps -increased muscle fatigue in the lower legs -ankle edema - a feeling of heaviness of the legs 夜间 - Nocturnal cramps - chronic venous insufficiency: edema, pain, pigmentation, and ulcerations (deep venous obstruction results ) Medical Management 使⾎液不经靜服曲張段 -Ligation結紥 and Stripping 剝離 Surgery for symptomatic varicose veins -Thermal Ablation 熱消融 -Sclerotherapy 硬化治療 Venous disorders Venous varicose veins 靜脈曲張 Nursing Management 1 --- after ligation and stripping -The patient is instructed to walk every hour for 5 to 10 minutes while awake for the first 24 hours if he or she can tolerate the discomfort, and then to increase walking and activity as tolerated (as soon as sedation has worn off) -Graduated compression stockings are worn continuously for about 1 week after vein stripping -The nurse assists the patient to perform exercises and move the legs -The foot of the bed should be elevated -Standing and sitting are discouraged -Promoting Comfort and Understanding Analgesic agents are prescribed to help the patient move the affected extremities more comfortably Venous disorders Venous varicose veins 靜脈曲張 Nursing Management 2 --- after ligation and stripping -Dressings are inspected for bleeding, particularly at the groin, where the risk of bleeding is greatest -The nurse is alert for reported sensations of “pins and needles.” Hypersensitivity to touch in the involved extremity may indicate a temporary or permanent nerve injury resulting from surgery, because the saphenous vein and nerve are close to each other in the leg Page 830-831