2. Arteriole Embolism By Christopher Salas

3. Etiology Arteriol Emboli are blood clots in the arterial bloodstream. Arteriol Emboli are blood clots in the arterial bloodstream. They may originate in the heart from an atrial disrhythmia, MI, valvular heart disease, or congestive heart failure. They may originate in the heart from an atrial disrhythmia, MI, valvular heart disease, or congestive heart failure. Detached arteriosclerotic plaque or tissue may result in arterial emboli. Detached arteriosclerotic plaque or tissue may result in arterial emboli.

5. Clinical Manifestations Sudden loss of blood flow to tissues causes severe pain. Sudden loss of blood flow to tissues causes severe pain. Distal pulses area absent and the affected extremity may become pale, cool, and numb. Distal pulses area absent and the affected extremity may become pale, cool, and numb. Necrotic changes may occur. Necrotic changes may occur. If the embolus occludes a large artery, shock may result. If the embolus occludes a large artery, shock may result.

6. Assessment Subjective data includes figuring out onset of pain and numbness and the location, quality, and occurrence of these symptoms. Subjective data includes figuring out onset of pain and numbness and the location, quality, and occurrence of these symptoms. Objective data includes assessing pulses in the affected extremity. The nurse should compare both extremities to determine skin temperature, color, and pulse volume. Objective data includes assessing pulses in the affected extremity. The nurse should compare both extremities to determine skin temperature, color, and pulse volume.

7. Diagnostics Untrasonography and angiography are used to obtain a diagnosis. Untrasonography and angiography are used to obtain a diagnosis. Angiography and the kit.

8. Ultrasonography Ultrasonography

9. Medical Management Medications include anticoagulants and fibrinolytics or thrombolytics. Medications include anticoagulants and fibrinolytics or thrombolytics. Anticoagulants are used to prevent further clot formation. Anticoagulants are used to prevent further clot formation. Thrombolytics or fibrinolytics are used to dissolve an existing clot. Thrombolytics or fibrinolytics are used to dissolve an existing clot. Endarterectomy (the surgical removal of the intimal lining of an artery) is the treatment of choice. Endarterectomy (the surgical removal of the intimal lining of an artery) is the treatment of choice. Embolectomy (surgical removal of a blood clot) is another treatment used when larger arteries are obstructed. Embolectomy (surgical removal of a blood clot) is another treatment used when larger arteries are obstructed.

10. Medications cont. Embolectomy must be done within 6 to 10 hours of the event to prevent necrosis and loss of the extremity. Embolectomy must be done within 6 to 10 hours of the event to prevent necrosis and loss of the extremity. Endarterectomy and embolectomy may be done together to deal with the existing emboli and prevent recurrence. Endarterectomy and embolectomy may be done together to deal with the existing emboli and prevent recurrence.

11. Diagnostics cont. Embelectomy

12. Interventions Patient must be monitored for changes in skin color and temperature of the extremity distal to the embolus. Patient must be monitored for changes in skin color and temperature of the extremity distal to the embolus. Promote vasodilation by providing warmth to the extrimities. Promote vasodilation by providing warmth to the extrimities. Avoid sharp flexion on area or graft(increases arterial blood flow) Avoid sharp flexion on area or graft(increases arterial blood flow) Tell the patient not to add dark green and yellow vegetables to diet(contains vitamin k, which counteracts the anticoagulant drug effect). Tell the patient not to add dark green and yellow vegetables to diet(contains vitamin k, which counteracts the anticoagulant drug effect). Instruct patient to restrict alcohol intake(increases anticoagulant effect). Instruct patient to restrict alcohol intake(increases anticoagulant effect).

13. Prognosis How well a patient does depends on the location of the clot and how much the clot has blocked blood flow. Arterial embolism can be serious if not treated promptly. How well a patient does depends on the location of the clot and how much the clot has blocked blood flow. Arterial embolism can be serious if not treated promptly. There is a 25-30% death rate. There is a 25-30% death rate. The affected area can be permanently damaged. Up to approximately 25% of cases require amputation. The affected area can be permanently damaged. Up to approximately 25% of cases require amputation. Arterial emboli can come back even after successful treatment. Arterial emboli can come back even after successful treatment.

14. Thromboangiitis Obliterans (Buerger’s Disease)

15. Etiology Thromboangiitis obliterans is an occlusive vascular condition in which the small and medium-sized arteries arteries become inflamed and thrombotic. Thromboangiitis obliterans is an occlusive vascular condition in which the small and medium-sized arteries arteries become inflamed and thrombotic. Cause not fully understood, man between the ages of 25 and 40 years who smoke have this disorder. Cause not fully understood, man between the ages of 25 and 40 years who smoke have this disorder. Develops in the small arteries and veins of the feet, hands, wrists and lower legs. Develops in the small arteries and veins of the feet, hands, wrists and lower legs. It is thought that the disease occurs in people who smoke. It is thought that the disease occurs in people who smoke.

16. Clinical Manifestations The main characteristic is inflammation of vessel walls. The main characteristic is inflammation of vessel walls. The most common symptom is pain with exercise affecting the arch of the foot(instep claudication) The most common symptom is pain with exercise affecting the arch of the foot(instep claudication) Pain may occur at rest and be frequent and persistent. Pain may occur at rest and be frequent and persistent. The affected skin may be cold and pale, and ulcers and gangrene may be present. The affected skin may be cold and pale, and ulcers and gangrene may be present. An esrly sign of Buerger’s disease may be superficial thrombophlebitis. An esrly sign of Buerger’s disease may be superficial thrombophlebitis.

17. Clinical Manifestation cont.

18. Assessment Subjective data includes information about pain, claudication, sensitivity to cold and risk factor assessment. Subjective data includes information about pain, claudication, sensitivity to cold and risk factor assessment. Objective data includes presence of pulses, skin color, and temperature in the affected areas. Objective data includes presence of pulses, skin color, and temperature in the affected areas.

19. Diagnostics There are no diagnostic tests specific to Buerger’s disease. There are no diagnostic tests specific to Buerger’s disease. Diagnosis is made based on age of onset, history of tobacco use, clinical symptoms, involvement of distal vessels, presenve of ischemic ulcerations, and exclusion of diabetes mellitus, autoimmune disease, and proximal source of emboli. Diagnosis is made based on age of onset, history of tobacco use, clinical symptoms, involvement of distal vessels, presenve of ischemic ulcerations, and exclusion of diabetes mellitus, autoimmune disease, and proximal source of emboli.

20. Medical Management Treatment includes complete cessation of tobacco use in any form(including secondhand smoke). Treatment includes complete cessation of tobacco use in any form(including secondhand smoke). Nicotine-replacement products should not be used, and trauma to the extremities must be avoided. Nicotine-replacement products should not be used, and trauma to the extremities must be avoided. Sympathectomy-surgical interruption of part of the sympathetic nerve pathways. Sympathectomy-surgical interruption of part of the sympathetic nerve pathways.

21. Interventions Hydration and cleanliness to prevent necrosis and gangrene. Hydration and cleanliness to prevent necrosis and gangrene. Well-fitting shoes and socks alleviate pressure. Well-fitting shoes and socks alleviate pressure. Educate patient that smoking makes the disease the worse, which will eventually lead to amputation of the affected limbs. Educate patient that smoking makes the disease the worse, which will eventually lead to amputation of the affected limbs. None of the palliative treatments are effective if the patient does not stop smoking. None of the palliative treatments are effective if the patient does not stop smoking.

22. Prognosis Symptons of this disease may disappear if the person stops tobacco use. Symptons of this disease may disappear if the person stops tobacco use. For some, amputation is necessary. For some, amputation is necessary.

23. The End