Peripheral Vascular Disorders Clinical Manifestations

Any factor that narrows, obstructs, or damages blood ✓ Headache: (Upon Waking) Most Characteristic
vessels and thus impede blood flow is dangerous. Manifestation
Pathophysiology: ✓ Epistaxis
Causes  Blood Tissue Ulceration ✓ Dizziness
Necrosis
HEAT HIM Flow Ischemia Gangrene ✓ Tinnitus
Hypertension Embolism, Atherosclerosis, Thrombosis ✓ Unsteadiness
Hypercoagulability of the blood, Inflammation process, ✓ Blurred Vision
Mechanical/ chemical trauma ✓ Nocturia
Hypertension ✓ Retinopathy
➢ Abnormal elevation of BP for at least two readings Management
➢ Hx strongly supports the diagnosis of hypertension. 1. Prevention
Risk Factors 1. Primary: reducing risk factors of HPN
1. Family History ➢ Moderation of Na intake
2. Age ➢ Decrease saturated fats in diet
3. High Salt intake ➢ Maintenances of IBW
4. Low potassium Intake (sodium and potassium have ➢ Cessation of cigarette smoking
an inverse relationship; low; high) ➢ Moderation of alcohol consumption
5. Obesity ➢ Stress reduction
6. Excess Alcohol Consumption 2. Secondary: Focused on Identification and control
7. Smoking of HPN in high risk groups
8. Stress 2. Pharmacological control of HPN
Classification of HPN Diuretics
• Essential/Idiopathic/Primary HPN ➢ Potassium wasting diuretics (THIAZIDES)
o 90-95 percent of all cases of HPN • Diuril
• Secondary HPN • Hydrodiuril
o Due to known causes • Furosemide
▪ Renal failure ➢ Potassium Sparring Diuretics
▪ Hyperthyroidism • Aldactone
▪ Pheochromocytoma ➢ Thiazides with potassium sparing diuretics
▪ Cushing's disease • Moduretic
• Malignant HPN • Aldactazide
o Severe, rapidly progressive elevation of BP that Sympatholytic (Sympathetic Depressant)
causes rapid onset of end target organ 1. Beta Adrenergic blockers (Beta blockers)
complications. • Reduces cardiac output by diminishing SNS
• Labile HPN – intermittently elevated BP response
• Resistant HPN – doesn’t respond to usual treatment • Lower BP by diminishing vascular resistance
• White coat HPN – elevated only during clinic hours. ✓ Acebulol
• Hypertensive Crisis ✓ Metoprolol
o Situation requires blood pressure lowering (within ✓ Propanolol
1-hour systolic pressure above 240 mmHg: ✓ Nadolol
Diastolic pressure above 120 mmHg.) 2. Centrally acting Sympatholytic
Note: • Decrease SNS response from the brainstem to the
• Accelerates atherosclerosis peripheral vessels
• Decrease blood flow to organs ✓ Clonidine (Catapress)
o Heart: Myocardial ischemia and infarction, CHF ✓ Methyldopa
myocardial hypertrophy, dysrhythmias ✓ Guanfacine HCl
o Eyes: blurred vision, retinopathy, cataract ✓ Guanabenz Acetate
o Brain: CVA, encephalopathy 3. Alpha-Adrenergic Blockers
o Kidneys: Renal insufficiency • Blocks alpha-adrenergic blocker receptors,
o Peripheral Blood Vessels: dissecting aneurism, resulting in vasodilation and decrease BP.
gangrene. • Decrease VLDL and LDL that re responsible for
Pathophysiology atherosclerosis
• Increase HDL
✓ Doxazosin Mesylate
✓ Przosin HCl
✓ Terazosin HCl
✓ Phenoxybenzamine HCl
✓ Phentolamine
4. Adrenergic Neuron blockers (peripherally acting
sympatholytic)
• Block norepinephrine release from SNS lowering
Permease both cardiac output and peripheral
vascular resistance.
• Guandrel Sulfate (Hylorel)
• Guanethidine Monosulfate(ismelin)
5. Alpha 1 and Beta 1 adrenergic blockers
• Blocking the alpha 1 receptors: dilation of the
arterioles and veins occurs
• Blocking the cardiac beta 1 receptors, decrease
HR and arterio-ventricular contractility
 Example: o Decrease penile circulation
✓ Carteolol (Cartrol) o Terminal aorta (occlusion)
✓ Trandate,Normodyne(Labetalol HCl) Management: Medications
Direct-Acting Arteriolar Vasodilators 1. Vasodilators
• Relax smooth muscle of blood vessels. 2. Antihyperlipidemic – lower abnormal blood lipid
• Mainly arteries causing vasodilation levels.
• Promotes increase blood flow to the brain and ✓ Questran (Cholestyramine Resin
kidneys. ✓ Atromid-S (Clofibrate)
✓ Diazoxide (Hyperstat, Proglycem) ✓ Lopid (Gemfibrozil)
✓ Hydralazine HCl (Apresoline HCl) ✓ Vastatins/Statins
✓ Minoxidil (Loniten,Rogaine) - Zocor (Simvastatin)
Angiotensin Antagonist (Angiotensin –Converting Enzyme - Lescol (Fluvastatin)
- Mevacor (Lovastatin)
Inhibitors)
NOTE:
• Inhibits ACE
✓ Gemfibrozil should not be used in combination of
• Aldosterone
Lovastatin because of increase CPK. Gallstone
✓ Benazepril HCl : (Lotensin)
may occur with long term use.
✓ Captopril (capoten)
✓ May take several weeks before antilipidemic can
✓ Fosonopril (Monopril)
affect decline blood lipid levels
✓ Ramipril (Altace)
✓ Hepatotoxicity
✓ Perindopril (aceon)
✓ Abrupt withdrawal of statins could lead to acute
Angiotensin II Receptor Antagonist/Blockers (ARBs)
MI and possible death
• Blocks the angiotensin II absorption by the receptors
3. Peripheral Vasodilators
found in the tissues.
o Alpha-Adrenergic Antagonist
• A-II prevents release of aldosterone
ꙋ Isoxsuprine HCl (vasodilan)
✓ Candesartan (atacand)
ꙋ Tolazoline (Priscoline HCl)
✓ Eprosartan (Teveten
o Direct Acting Peropheral Vasodilators
✓ Losartan (Cozaar)
ꙋ Ergoloid Mesylate (hydergine)
✓ Telmisartan (Micardia)
ꙋ Papaverine (pavabid)
✓ (Valsartan (Diovan)
o Hemorrheologic
Calcium Channel Blockers
ꙋ Pentoxifylline (Trental)
• CCB’s or Calcium Antagonist/Calcium Blockers
Management
• Calcium increase muscle contractility, peripheral
• Treatment for Arterial Disorders:
resistance and BP
o Quit smoking
✓ Verapamil (Calan SR, Isoptin SR
o Skin and foot care
✓ Diltiazem HCl (Cardizem CD or SR
o Diet
✓ Amlodipine (Norvasc)
o Activity: walking program
✓ Felodipine (Plendil)
• Surgical Management
✓ Nifedipine (Procardia)
o Balloon angioplasty
Teaching About Medications
o Laser angioplasty
• Most common side effect of diuretics are potassium
o Stents
depletion and orthostatic hypotension
o Amputation
• The most common side effect of the different
Nursing Interventions
hypertensive drugs is orthostatic hypotension.
• Promote Tissue perfusion
• Take anti-hypertensive drugs at regular basis.
• Maintain skin integrity and prevent infection
• Assume sitting or lying position for few minutes
• Promote activity: to promote circulation
• Change position gradually
• Prevent Injury to prevent gangrene formation
• Avoid alcoholic beverages avoid prolong standing or
specially in LOW –EX
sitting
Aneurysm
• Avoid tyramine-rich foods
• Localized irreversible dilation of an artery due to
• Hpn crises
alteration in the integrity of its wall
• Preventing non-compliance
o Fusiform Aneurysm
• Inform client that absence of symptoms does not
o Saccular Aneurysm
indicate control of bp.
o Dissecting Aneurysm
• Advice the client against abrupt withdrawal of
o Abdominal Aortic Aneurysm
medication; rebound hypertension may occur.
Clinical Manifestation
• Device ways to facilitate remembering of takin g
• Pulsatile mass
medication
• LBP, LAP, FP.
• Labeled containers
• Collapse and shock due to hemorrhage.
Arterial Disorders
➢ Common cause is HPN
➢ Arteriosclerosis: Hardening of the arteries. (tunica
➢ Most dangerous Complication: Rapture
media)
Management:
➢ Atherosclerosis: narrowing /occlusion of the lumen
1. Anti-HPN drugs
due to accumulation of fatty plaques in the tunica
2. Surgery if greater that 4 cm.
intima.
3. Treflon, Dacron or Gortex graft may be use in surgical
Signs and symptoms:
repair of aneurysm.
• Pain – relieved by rest
4. Aneurysm clip
• Coldness or cold sensitivity – tissue ischemia
Raynad’s Disease
• Color changes – cyanosis
➢ Intermittent vasospasm of arteries in the digits as a
• Ulceration and gangrene – tissue ischemia, hypoxia or
result of exposure to cold and emotional stress.
trauma
➢ Aggravated by cigarette smoking
• Sexual dysfunction
➢ Women 15-40 y/o most commonly affected.
Management: o Check pulse distal to the site of thrombosis.
• Medications: o Assess presence of edema
o Calcium Channel Blockers o Monitor calf pain
o Vasodilators o Promoting Comfort: Analgesic and NSAIDS
o Anti-inflammatory-Analgesics Varicose Veins
• Surgery ➢ Dilated veins usually in the LE
o Sympathectomy to relieve vasospastic symptoms Causes:
o Amputation for severely infected or non-healing 1. Congenital Absence of valves of the veins
ulcerations and gangrene. 2. Prolonged sitting or standing
Nursing Intervention 3. Wearing constrictive clothing’s
➢ Patient teaching 4. Obesity
➢ Avoid exposure to cold 5. Thrombophlebitis
o Wear gloves 6. Pregnancy
o Practice caution when cleaning ref. 7. Disease condition such as RSCHF, LC
o Wear socks during cold climates Manifestations
➢ Smoking causes vasoconstriction ➢ Dilated, purplish, tortuous veins
➢ Reduce emotional stress ➢ Leg edema
➢ Avoid drugs that cause vasoconstriction ➢ Heaviness in the legs
o Contraceptive Pills and Ergotamine's Management:
Venous Disorders • Elevation of legs (15 to 30 minutes)
Superficial Thrombosis • Use of compression or support stockings
➢ Venous thrombosis & inflammation in superficial vein. • Sclerotherapy; injection of sclerotic agent in to the
➢ The greater or lesser saphenous veins in the leg are varicose veins.
commonly affected. • Surgery: vein ligation and stripping
Manifestations: o Prevention of thrombophlebitis
1. Pain in the calf of the leg o Early Ambulation
2. Tenderness o Monitor for bleeding post op
3. Palpable induration along the course of the vein Arterial and Venous Disorders
Management: Buergers Diseases: Thromboangitis Obliterants
1. Bedrest with leg elevation ➢ Diffuse inflammation of the small medium arteries.
2. Local moist heat application Followed by the veins. It also involves inflammation
3. Non-narcotic –analgesics and fibrosis of nerves.
4. NSAIDS ➢ Males 30/50 y/o
5. Patient teaching ➢ Common cause: smoking
• Prevention of venous stasis Manifestation:
• Prevention of recurrence of SVT • Immediate claudication
Deep Vein Thrombosis Management
➢ Venous thrombosis and inflammation in deep vein. • Eliminate Smoking
Causes: (VT) • Medication: CCB, Anti-platelet agents
1. Vessel wall injury • Surgery
2. Venous stasis o Sympathectomy
3. Hypercoagulability o Amputation of ulcerated fingers and toes
Life threatening may lead to pulmonary embolism. Comparison between Arterial and Venous Disorders
Manifestation: Arterial Disorders Venous Disorders
➢ Calf-pain
➢ Tenderness Pain: Homans Sign:
➢ Palpable induration intermittent claudication; Improved by exercise and
➢ Edema aggravated by walking elevation of legs
Management: DVT: Medical management and elevation of legs
• Thrombolytics: disintegrates blood clots)
o Streptokinase Thin, shiny skin in the legs; Brown pigment around
o Urokinase Loss of hair in the legs; the ankle; Normal toenails
o t- PA thick toenails.
o APSAC
Elevated legs: pale skin Redness of skin
o Reteplase
o Tenecteplase Skin cool to touch Skin warm to touch
• Anticoagulants (thrombophlebitis)
o Coumadine (warfarine)
Surgery Decrease sensation, Itching
• Thrombectomy: removal of blood clot with the use of numbness, paresthesia,
balloon tipped catheter. itching
• Greenfield Vena cava Filter and Umbrella filter:
Pulse is diminished or Pulse is present
Inserted in the inferior vena cava to prevent
absent
pulmonary embolism in the clients with
thromboembolism Edema is absent Edema, worse at end day;
Management: DVT Nursing Intervention improve thru elevation
• Maintain Tissue Perfusion:
o BR 5-7 days: prevent dislodgement of b-clots. Ulcers occurs in toes Ulcers occurs in ankles
o Elevate leg
Gangrene may develop Gangrene does not
o Apply compression support stockings
develop
o Avoid prolong standing and sitting