1. Interventions for Clients with Vascular Problems

2. Arteriosclerosis and Atherosclerosis
Arteriosclerosis: thickening or hardening of the arterial wall
Atherosclerosis: type of arteriosclerosis involving the formation of plaque within the arterial wall
Etiology and genetic predisposition
Factors related to atherosclerosis include obesity, lack of exercise, smoking, and stress.
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4. Laboratory Assessment
Lipid level, including cholesterol and triglycerides, is elevated in atherosclerosis clients.
High serum levels of homocysteine can allow cell walls to become vulnerable to plaque buildup.
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5. Interventions
Evaluation of total serum cholesterol levels and lifestyle changes
Diet therapy
Smoking cessation
Exercise
Drug therapy

6. Hypertension
Hypertension: systolic blood pressure ≥ 135 mm Hg and/or diastolic blood pressure ≥ to 85 mm Hg (not including diabetics)
Malignant hypertension: elevated blood pressure that progresses rapidly to systolic pressure > 200 mm Hg and diastolic pressure > 130 mm Hg

8. Diseases Diseases that commonly cause secondary hypertension:
Renal vascular
Renal parenchymal
Dysfunction of the adrenal medulla or the adrenal cortex
Primary aldosteronism
(Continued)

9. Diseases (Continued) Pheochromocytomas Cushing’s syndrome
Coarctation of the aorta
Neurogenic disturbances, such as brain tumors, encephalitis, and psychiatric disturbances

10. Knowledge Deficit Interventions include: Sodium restriction
Weight reduction
Moderation of alcohol intake
Exercise
Relaxation techniques
Tobacco and caffeine avoidance

11. Drug Therapy Diuretics Calcium channel-blocking agents ACE inhibitors
Angiotensin II receptor antagonists
Aldosterone receptor antagonists
Beta-adrenergic blockers
Central alpha agonists
Alpha-adrenergic agonists

12. Risk for Ineffective Therapeutic Regimen Management
Interventions include:
Teach medication compliance, usually for the rest of life.
Discuss goals of therapy, potential side effects, and how to identify potential problems.
Assist client to understand therapeutic regimen.
Discuss consequence of noncompliance.

13. Peripheral Arterial Disease
Disorders that alter the natural flow of blood through the arteries and veins of the peripheral circulation
Manifestation of systemic atherosclerosis: a chronic condition in which partial or total arterial occlusion deprives the lower extremities of oxygen and nutrients

15. Physical Assessment Intermittent claudication
Pain that occurs even while at rest; numbness and burning
Inflow disease affecting the lower back, buttocks, or thighs
Outflow disease causing cramping in calves, ankles, and feet
(Continued)
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16. Physical Assessment (Continued)
Hair loss and dry, scaly, mottled skin and thickened toenails
Ulcers: arterial ulcers, diabetic ulcers, venous stasis ulcers

18. Diagnostic Assessments
Angiography
Segmental systolic blood pressure measurements
Exercise tolerance testing
Plethysmography

19. Nonsurgical Management
Exercise
Positioning
Promoting vasodilation
Drug therapy
Percutaneous transluminal angioplasty
Laser-assisted angioplasty
Atherectomy

20. Surgical Management Preoperative care
Operative procedures (bypass surgery)
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22. Surgical Management (Continued)
Postoperative care
Assessment for graft occlusion
Promotion of graft patency
Treatment of graft occlusion
Monitoring for compartment syndrome
Assessment for infection

23. Acute Peripheral Arterial Occlusion
Embolus: the most common cause of occlusions, although local thrombus may be the cause
Assessment: pain, pallor, pulselessness, paresthesia, paralysis, poikilothermia
Drug therapy
Surgical therapy
Nursing care

24. Aneurysms of Central Arteries
Aneurysm: a permanent localized dilation of an artery, enlarging the artery to twice its normal diameter
Fusiform aneurysm
Saccular aneurysm
Dissecting aneurysm (aortic dissections)
Thoracic aortic aneurysms

26. Assessment of Abdominal Aortic Aneurysm (AAA)
Pain related to AAA is usually steady with a gnawing quality, is unaffected by movement, and may last for hours or days.
Pain is in the abdomen, flank, or back.
Abdominal mass is pulsatile.
Rupture is the most
frequent complication and is life threatening.
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27. Assessment of Thoracic Aortic Aneurysm
Assess for back pain and manifestation of compression of the aneurysm on adjacent structures.
Assess for shortness of breath, hoarseness, and difficulty swallowing.
Occasionally a mass may be visible above the suprasternal notch.
Sudden excruciating back or chest pain is symptomatic of thoracic rupture.
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28. Diagnosis and Management
X-rays
Computed tomography scan to assess size and location of aneurysm
Aortic angiography
Ultrasonography
Goal of nonsurgical management: monitor growth of the aneurysm and maintain blood pressure at normal level
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29. Abdominal Aortic Aneurysm Resection
Preoperative care
Operative procedure
Postoperative care
Monitor vital signs.
Assess for complications.
Assess for signs of graft occlusion or rupture.

31. Thoracic Aortic Aneurysm Repair
Preoperative care
Operative procedure
Postoperative care assessments:
Vital signs
Complications
Sensation and motion in extremities
Respiratory distress
Cardiac dysrhythmias

32. Endovascular Repair of Abdominal Aortic Aneurysm
Clients selected for endovascular repair are generally at high risk for major abdominal surgery.
Various designs
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33. Aneurysms of the Peripheral Arteries
Femoral and popliteal aneurysms
Symptoms: limb ischemia, diminished or absent pulses, cool to cold skin, and pain
Treatment: surgery
Postoperative care: monitor
for pain
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34. Aortic Dissection
May be caused by a sudden tear in the aortic intima, opening the way for blood to enter the aortic wall
Pain described as tearing, ripping, and stabbing
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35. Aortic Dissection (Continued)
Emergency care goals include:
Elimination of pain
Reduction of blood pressure
Decrease in the velocity of left ventricular ejection
Nonsurgical treatment
Surgical treatment

36. Buerger’s Disease
Thromboangiitis obliterans: relatively uncommon occlusive disease limited to the medium and small arteries and veins
Often identified with tobacco smoking
Nursing interventions to prevent progression of disease

37. Other Disorders
Subclavian steal occurring from artery occlusion or stenosis
Thoracic outlet syndrome resulting in arterial wall damage
Popliteal entrapment

38. Raynaud’s Phenomenon
Caused by vasospasm of the arterioles and arteries of the upper and lower extremities
Drug therapy: Procardia, Cyclospasmol, and Dibenzyline
Lumbar sympathectomy
Reinforcement of client education; restriction of cold exposure

39. Venous Thromboembolism
Thrombus: a blood clot
Thrombophlebitis
Deep vein thrombosis
Pulmonary embolism
High rate of death
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40. Assessment Calf or groin tenderness or pain
Sudden onset of unilateral swelling of the leg
Positive Homans’ sign
Localized edema
Venous flow studies

41. Nonsurgical Management
Rest
Drug therapy includes:
Unfractionated heparin therapy
Low–molecular weight heparin
Warfarin therapy
Thrombolytic therapy

42. Surgical Management Thrombectomy Inferior vena caval interruption
Ligation or external clips

44. Venous Insufficiency
Result of prolonged venous hypertension, stretching veins and damaging valves
Stasis dermatitis, stasis ulcers
Management of edema
Management of venous stasis ulcers
Drug therapy
Surgical management

45. Varicose Veins
Distended, protruding veins that appear darkened and tortuous
Collaborative management includes:
Elastic stockings
Elevation of extremities
Sclerotherapy
Surgical removal of veins
Radio frequency energy to heat
the veins
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46. Phlebitis Inflammation of the superficial veins
Management: warm, moist soaks and elastic stocking
Complications: tissue necrosis, infection, or pulmonary embolus
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