Nursing Care of Clients with Vascular Disorders

usual treatment.
Midterm
○ Uses 3 different antihypertensive
drugs.
6. White Coat HPN
○ Elevation of BP during clinic visits
Problem in Systemic Circulation or seeing healthcare professionals
wearing white suit.
7. Hypertensive Crisis
VASCULAR PROBLEM ○ Emergency case
○ Situation that requires immediate
● Conditions that disrupt blood flow through blood pressure lowering within 1
the arteries and veins, excluding the hours for Bp >240/120 mmHg.
coronary arteries and cerebral vessels. ○ Cardiac arrest may happen
anytime.
● Alterations in systemic circulations
Causes:
Risk factors for Peripheral Vascular Disease (PVD) ● Genetics
● Age (elderly) ● Obesity
● Sex (male) ● Sedentary living
● Smokers ● Too much salt in the diet
● HPN / DM / Family Hx of atherosclerosis ● Too much alcohol consumption
● Obesity / Hyperlipidemia ● Stress
● Old age
● Sedentary living / lack of exercise
● Emotional stress Types:
● Essential- unknown cause.
HYPERTENSION- having an increased pressure ○ Genetics
against the arteries. “Pushing” ○ Diet
● Secondary- has an underlying diseases and
CATEGORY SYSTOLIC DIASTOLIC medication problems.
○ Atherosclerosis (hardening)
○ Diabetes
NORMAL <120 and <80 ○ Obesity
○ Drugs (corticosteroids)
Prehypertension 120-139 80-89 ○ Thyroid problem

Predisposing Factors:
Hypertension ● Family hx
● Stage 1 140-159 or 90-99 ● African-American
● Stage 2 160-179 or 100-109 ● Women who are pregnant
● Stage 3 >/180 >/110 ● Women who are taking birth control pills
● Age >40
● Sedentary living
Classification of HPN: ● Alcoholic / smokers
1. Essential / Idiopathic / Primary HPN ● Eating too much / Obesity - fats
○ Unknown cause ● Stress
2. Secondary HPN
○ Due to known causes (Renal Health-related problems:
Failure, Hyperthyroidism) ● Stroke
3. Malignant HPN ○ Ischemic Stroke- due to cholesterol
○ Severe rapidly progressive build up in the arteries/plaque
elevation of BP that causes rapid (Atherosclerosis).
onset of end organ complications. ○ Hemorrhagic Stroke- Rupture of
○ There are factors that causes tiny blood vessels due to pressure.
elevated BP, e,g medications, ● Heart failure- Heart attack
eclampsia, sudden withdrawal to ● Kidney failure- due to poor perfusion.
smoke or alcohol. ● Visual problems
4. Labile HPN also called as Paroxysmal HPN.
○ Intermittently elevated BP S/Sx:
○ Meaning it’s episodic; may be due ● Asymptomatic - most of the time
to emotional stress, can be ● Morning occipital headache
modified or changed. ● Fatigue, dizziness
5. Resistant HPN ● Palpitation
○ HPN that does not respond to ● Flushing
 ● Epistaxis
● Diuresis
● Retinal changes (hemorrhages, exudates,
arteriolar narrowing)
● Papilledema is optic disc swelling that is
caused by increased ICP
Diagnostic:
● Physical examination- obtaining VS
● Health history
● Routine laboratory test (Na, K, Crea, Fasting
glucose, Total and HDL)- to check for renal
failure.
● ECG
● Urine test, renin level (may be done)- to
check for renal failure.
Nursing Interventions:
● Modify/change lifestyle
● Diet: DASH
○ Dietary approaches to stop
hypertension, foods such as dairy
products fat free, lean meat,
yogurt, fruits & vegetables
containing potassium, magnesium.
● Exercise
● Health teaching regarding medication/s:
○ Don’t drink alcohol while taking
calcium channel blockers to avoid
drug ineffectiveness.
○ Don’t take other BP meds in
combination with Ca channel
blocker.
■ Antihypertensives
combined w/ diuretics
may impair electrolyte
imbalance.
Medical Interventions:
Medications
● ACE inhibitors (angiotensin converting
enzymes)- widens/dilates the vessels
● ARBs (angiotensin receptor blockers)-
decrease chemicals
● Diuretics (first line)
● Beta blockers
● Ca channel blockers
ARTERIAL DISORDER
● Any disturbance in the structure of the
arteries.
● Interferes with the transport of blood from
the heart to the tissues.
● Symptoms of arterial diseases are not
caused by the “degree of obstruction” or
“narrowing” but to which the involved part
is deprived of circulation.
Characteristics:
● Pain- intermittent claudication to sharp,
unrelenting, constant usually calf muscle to
relieve by rest.
● Pulse - diminished or absent
● Skin - dependent rubor- elevation pallor of
foot; dry, shiny; hot to cold temp, loss of hair
over toes, nails thick and ridged.
BUERGER’S DISEASE- causes vasoconstriction.
● Inflammatory occlusive peripheral vascular
disease.
● Occlusive peripheral vascular disease
● Thromboangitis obliterans (TAO)- other
name.
● An aterio-venous disorder
● A recurring inflammation of the intermediate
and small arteries and veins of the lower and
upper extremities. (medium to small arteries
in the finger and toes)
● Due to the narrowing or an occlusion
● Very rare disorder
● Legs are more often affected than the arms
● Young or middle aged group (20-35y/o)
● Male/tobacco user
Etiology
● Idiopathic
● Believed to be an auto-immune disease that
results to the occlusion of the distal vessels
● Due to thrombus formation and occlusion of
the vessels
● Due to inflammatory infiltration of the
adventitia and medial walls.
S/Sx:
● Claudication
○ Arching pain or cramping sensation
upon walking.
○ Most common - foot or lower calf
(due to ischemic changes)
○ (+) pain arch/foot during exercise
Pain
● Involves the hands (bilateral & symmetric)
● Burning pain relieved by rest
● Aggravated with emotions & nicotine
Skin
● Color and temperature change (cyanosis)
● Sensitive to cold
● May have sore ulcers
● Tingling, numbness sensation
● Severe case, “gangrene”- a dangerous and
potentially fatal condition that happens when
the blood flow to a large area of tissue is cut
off.
Management:
● Modify lifestyle
● Vasodilators (Hydralazine)
● Analgesics
● Wound debridement
● Surgical intervention: “AMPUTATION”

Nursing Interventions:
● Emotional support
● If amputated: post op 1st 24 hours
● Stump care/bandaging
● Skin assessment
● Prevent further injury
Health teaching:
● “Thrombophlebitis” (redness, heat)
● “Arterial obstruction” (pallor, coldness)
Smoking cessation
ANEURYSM
● A permanent ballooning of the artery wall
(bulge out)
● Usually form in the abdominal or thoracic
portion of the aorta, main blood vessels
(carries blood from the
● heart/arteries nourishing the brain)
Types:
● True Aneurysm
○ Fusiform- whole BV bulges out.
○ Saccular- only a part bulges out.
○ Dissecting- hematoma, splits
layers of arterial wall.
● False Aneurysm
ABDOMINAL AORTIC ANEURYSM
● Most common type of degenerative
aneurysm.
● Most common cause of abdominal aortic
aneurysm is atherosclerosis
● More common among Caucasians
● Affects men four times more often than
women
● Most prevalent in elderly patients
Risk factors:
● Genetic predisposition
● Smoking (or tobacco use)
● Hypertension- increased pressure against
the arteries may lead to rupture.
S/sx:
● Feels their heart beating in their abdomen
when lying down, or they may say they feel
an abdominal mass or abdominal throbbing
● Cyanotic toes
Medical Management:
● Surgery is the treatment of choice for
abdominal aneurysms wider than 5cm (2
inches) wide or those that are enlarging
○ Open surgical repair of the
aneurysm by resecting the vessel
and sewing a bypass graft in place.
● Endovascular grafting
○ Involves the transluminal
placement and attachment of a
sutureless aortic graft prosthesis
across an aneurysm.
○ Dacron / Teflon / Gortex Graft
surgical repair aneurysm
○ Minimally invasive procedure which
is guided by an xray.
Nursing Management:
● Assess for signs of rupture- rupture in any
arteries lead to rapid blood loss.
○ Severe back pain or abdominal
pain, which persistent and
intermittent localized in the middle
or lower abdomen to the left of the
midline.
○ Falling blood pressure; and
decreasing Hematocrit
● Assess for signs of HF
● Postoperative care requires intense
monitoring of
○ Pulmonary, cardiovascular, renal,
and neurologic status.
○ Breathing and possible infection.
● Monitor for possible complications of surgery
○ Arterial occlusion, hemorrhage,
infection, ischemic bowel, renal
failure, and impotence
RAYNAUD’S PHENOMENON
● Localized, episodic vasoconstriction of the
small digital arteries with exposure to cold
and emotional stress
● Blood flow to the surface tissue of the hands
& feet is temporarily decrease (1-2 digits)
● Affects women 16-40; cold climate
2 types:
● Primary/Raynaud’s Disease
● Secondary/Raynaud’s Syndrome
Causes: dermatitis.
● Immunologic disorders
● Certain medications (Pseudoephedrine) Risk factors:
● Usage of vibrating power tools ● Endothelial damage
● Smoking ● Trauma
● Exposure to cold climate - frostbite ● Surgery
● Emotional stress ● Central venous catheters
● Dialysis access catheters
Phases: ● Local vein damage
● 1st > PALLOR - or pale (vasoconstriction) ● Repetitive motion injury
● 2nd > CYANOSIS - or bluish discoloration ● Venous stasis
(vasoconstriction of the venules) ● Bed rest or immobilization
● 3rd > RUBOR - or redness (active ● Obesity
hyperemia) ● Hx of varicosities
● 4th > Return to Normal ● Spinal cord injury
● Age (>65 yr)
S/sx: ● Coagulopathy
● Feels numb or cold - as if fallen asleep ● Cancer
● Skin turns white-blue-red ● Pregnancy
● Area is throbbing, aching, tingling sensation- ● Oral contraceptive use
needle pain ● Antithrombin III deficiency
● Bilateral involvement and symmetric ● Polycythemia ↑ RBC
● Septicemia
Medical Management:
● Avoiding the particular stimuli (eg. cold, S/Sx:
tobacco) that provoke vasoconstriction ● Affected extremities are swollen, tense,
● Ca channel blockers eg. Nifedipine painful, and cool to touch
(Procardia, Adalat) to treat an acute episode ● A feeling of heaviness
of vasospasm ● Ankle engorgement
● Sympathectomy (interrupting the ● Differences in leg circumference bilaterally
sympathetic nerves by removing the from thigh to ankle
sympathetic ganglia or dividing their ● Increase in the surface temperature of the
branches) leg, particularly the calf or ankle;
● Ankle of tenderness or superficial
Treatment: thrombosis (ie, cordlike venous segment)
● Modify lifestyle- climate; nicotine ● Homans’ sign (pain in the calf as the foot is
● MEDS: Ca Channel blockers (Nifedipine) sharply dorsiflexed)
ARBs (Losartan)
● Others: Biofeedback training Medical Management:
● If secondary cause: tx underlying disease ● Anticoagulant therapy
● Coumadin drug of choice for
Nursing Management: thrombophlebitis. - a warfarin medication to
● Stress management prevent furhter clotting.
● Use of mittens/hats - cold ● A thrombectomy- the removal of the
● Prevent complications - thrombosis/clot.
gangrene/amputation
● Avoid all forms of nicotine vices Nursing Management:
● Safety precaution r/t - OH, exercise and hot ● Assessing and monitoring anticoagulation
weather. therapy. (Monitor INR for Warfarin and APTT
for Heparin)
● Monitor for possible complications
● Bleeding
● Thrombocytopenia ↓ platelets
VENOUS DISORDERS
● Bed rest, elevation of the affected extremity,
elastic compression stockings, and
● Venous Thrombosis analgesics for pain relief
● Deep Vein Thrombosis ● Warm, moist packs applied to the affected
● Thrombophlebitis extremity
● Phlebothrombosis ● Bed exercises, such as dorsiflexion of the
● Pain - aching, cramp, dull heaviness foot.
● Pulse - present but may be difficult to
palpate due to edema VARICOSE VEINS
● Skin - pigmentation in area of medial and ● Torturous varicosities in which veins are
lateral malleolus, skin thickened and tough, dilated and lack surrounding muscle support.
reddish blue and at times associated with ● Saphenous vein most common affected.
 ● Valves of the veins become incompetent to iron leakage from - Skin color: pale due to
Etiology: capillaries which resulted poor blood circulation,
● Thrombophlebitis from increased pressure. cyanotic leading to
● Obesity - Temp- warm gangrene.
● Prolonged standing- can be work-related - Temp: cold
● Abdominal pressure (pregnancy or liver MGT:
dysfunction) - Elevate legs for 20 mins MGT:
to promote venous return. - Dangle the legs.
Assessment: - Use of antiembolic
● Varicose veins appear stockings.
● Distended
● Torturous
● Bluish purplish in color
● Heaviness of legs
● Pain relieved upon elevation
● Brodie-Trendelenburg Test
○ Confirms the diagnosis of varicose
veins
○ Tourniquet is applied in the upper
thigh while pt. Is lying to constrict
saphenous vein.

○ Pt. stands and if blood, flows from

the upper part of the leg into the
superficial part of the veins after
tourniquet is released
○ Venous valves of the superficial
veins is incompetent.

Management:
● Weight loss
● Exercise
● Support hose- or use of antiembolic stocking
● Avoid standing and sitting for a long time
● Sclerotherapy - injection of sclerosing agent
into the varicose veins (Na morrhuate)
● Surgery:
○ Vein ligation - tying of vein.
○ Vein stripping - removes the vein.

Summarized:

PERIPHERAL VENOUS PERIPHERAL

DISEASE (PVD) ARTERIAL DISEASE
(APD)

- “Veins”
- Deprivation of circulation
- Pain: dull, aching
- Puls: nonpalpable
- Leg: (+) homan’s sign/
calf pain at dorsiflexion of
the foot.
- Edema: (+) pitting
edema
- Skin color: Stasis
Dermatitis, a brownish
color, tough and thick due
- “Arteries”
- Deprivation of
circulation
- Pain: “intermittent
claudication” due to
obstruction of blood flow.
It can be relieved by rest
and induced by exercise.
- Pulse: weak or absent
pulse
- Leg: hairless, dry, scaly
- Edema: (-) no edema