MEDICINE AND

MEDICAL NURSING
PERIPHERAL VASCULAR DISORDER

SIMPLE COMPILATION BY:

GUNDA GADZIKA (RN)

INTRODUCTION

• Peripheral vascular disorders are circulatory conditions presenting with narrowing of

blood vessels leading to a reduction in the blood flow to body parts, particularly
extremities.
• Three Main Diseases are notice in this group of disorders:
• Arteriosclorosis
• Atherosclerosis
• Thrombosis (Varico)

• Enjoy
ARTERIOSCLEROSIS/
ATHEROSCLEROSIS
• Arteriosclerosis literally means “hardening of the arteries”; it is a generic term for
arterial wall thickening and loss of elasticity. Limiting blood flow to tissue and organs
• Arteriolosclerosis affects small arteries and arterioles, and may cause downstream
ischemic injury. The two anatomic variants, hyaline and hyperplastic.
• Atherosclerosis is the build up of plaque along the arterial walls
PREDISPOSING FACTORS

• High cholesterol
• High blood fats (triglycerides)
• Smoking/tobacco products
• Insulin resistance due to Obesity and diabetes
• High blood pressure
• Poor diet and lack of exercise
• Inflammatory diseases
IS ATHEROSCLEROSIS HEREDITARY?

• Not necessarily…
• Disease itself is not hereditary

• Other health risks can cause it to occur.

• Family History of Early Heart Disease
• High blood pressure
• High Cholesterol
 SIGNS/SYMPTOMS

• Usually, you will not notice any symptoms 70% of your artery is
clogged at certain points. Different signs will occur if it is at
different places.
• If it is near the heart, you can have chest pains, a heart attack, or heart
palpitations.
• If it is near the brain, facial drooping, weakness, slurred speech due to
strokes.
• If in the kidneys, you have high blood pressure and/or kidney failure

• Typically, you will experience pain and cramps in the main body
part where the clog is.

http://www.shutterstock.com/pic-118624588/stock-photo-
arteriosclerosis-phases.html
HOW TO PREVENT ATHEROSCLEROSIS

• You can prevent it by having healthy lifestyle choices.

• High Cholesterol-eat diet low in saturated fats
• Type I diabetes-Eat healthy, and exercise often.
• High blood pressure-Reduce salt intake, and maintain healthy
weight.
• Physical Inactivity- Exercise at least 30 minutes/day.
• Obesity- Eat healthy foods and exercise often.
• Don’t smoke

http://www.searteriosclerosis.org/curs12/alimentacion-y-
arteriosclerosis
 TREATMENTS

• Cholesterol Medications
• Lower “bad” cholesterol levels, and higher “good” cholesterol levels.

• Anti Platelet Medications

• Aspirins that can reduce chance of platelets clogging arteries.

• Beta Blocker Medications

• Lower heart rate and blood pressure which causes less demand on heart.

• Water Pills
• Lowers blood pressure and causes blood to “thin out” to pass through artery easier.

• Bypass Surgery
• May create artificial artery, or put two different arteries together so they won’t pass
through the clogged artery.

• Endarterectomy
DRUG SIDE EFFECTS?

• Cholesterol Medications
• Stomach upset, gas, cramping, nausea, diarrhea, constipation, headache, and mild muscle pain.

• Beta Blocker Medications

• Fatigue, cold hands, headache, upset stomach, constipation, diarrhea, and dizziness.

• Water Pills
• Dizziness, headaches, increased thirst, muscle cramps, increased blood sugar, and increased cholesterol.

• Bypass Surgery
• Excessive bleeding, infection, blood clots, lung or breathing problems, and death (rare).

• Endarterectomy
• Bleeding, infection, blood clots, brain damage, and stroke or heart attack.

• Anti Platelet Medications

• Dizziness, headache, difficulty swallowing, difficulty breathing, chest pain, fever, chills, sore throat, swelling, and severe stomach pain.
 FACTS

• Approximately 4.6 million people are affected by it.

• 1-2/100 people
• Foods/herbs that can lower cholesterol and blood pressure levels
• Black tea, calcium, fish oil, oatmeal and whole oats, barley,
vitamin C

http://www.botanical-online.com/arteriosclerosisdiet.htm
REFERENCES

• Mayo Clinic Staff. "Arteriosclerosis / Atherosclerosis." Mayo Clinic. Mayo Clinic, 10

Aug. 2012. Web. 18 Apr. 2013. <http://www.mayoclinic.com/health/arterio sclerosis-
atherosclerosis/DS00525>.
• Merck Manual of Medical Information. Second ed. West Point: Merck, 2003. Print.
DEEP VEIN
THROMBOSIS
INTRODUCTION

• The venous system is divided into deep and superficial venous systems.
• Vein thrombosis is the formation of clots in the vein.
• Thrombosis of the superficial system usually gives no complications and will not be
discussed further.
• Post operative venous thromboembolism is a serious surgical problem
• Pulmonary embolism occurs in approximately 10% of elderly patients with hip fractures.
CAUSES

• Venous stasis due to immobility, obesity, pregnancy, paralysis, operation and trauma imply an
element of venous obstruction or stasis.
• Intimal damage – external trauma to a vein e.g. during hip replacement operation can provide
a starting point for thrombosis.
• Hypercoagulability – primary hypercoagualable states are those in which an identifiable
abnormality of haemostasis is present. These include deficiencies in anti thrombin III, protein
C, protein S, polycythaemia rubra is also associated with a tendency to thrombosis. Secondary
hypercoagualable states are such as pregnancy and in the puerperium and malignancy.
PATHOPHYSIOLOGY

• 1856 Rudolph Virchow (virchow triad)

1. Retarded blood flow
2. Intimal injury
3. Hypercoagulability
• Increased tendency to thrombosis is called thrombophilia.
• It is associated with antithrombin III deficiency and Factor V leiden deficiency.
RISK FACTORS

• Sickle cell anaemia

• Heterozygous factor v Leiden
• Protein c deficiency
• Protein s deficiency
• Antithrombin III deficiency
• General surgery
• Oral contraceptives
• Pregnancy
• Long trip
• Elevated factor VIII
• Sepsis
• Prolonged immobilization
• Hip surgery
• Surgery for cancer
CLINICAL PRESENTATION

• May be silent and present as Pulmonary embolism

• Signs of inflammation
1. Pain
2. Swelling
3. Hot to touch
4. Loss of function
PREVENTION

• Early mobilization
• Good hydration
• Compression stockings
• Subcutaneous heparin
DIAGNOSIS

• Consider medical history, and symptoms, as well as perform a physical exam.

• Lung scan
• Venography (phlebography) – to identify thrombi or obstruction in veins of lower extremities.
• Radionuclide scan – an imaging technique that uses a small dose of a radio opaque chemical (isotope)
called a tracer detect cancer, trauma, infection or other diseases. The isotope is injected into vein
• Doppler Ultrasonography – to evaluate the network of arteries and veins and measure blood flow through
the blood vessels.
• Impedance plethysmography – measures variations in the electrical resistance due to changes in blood
volume in deep vein thrombophlebitis.
TREATMENT

• Admit to ward
• Bed rest
• Give NSAIDs for pain
• Elevate leg
• Start heparin subcut and warfarin oral
• Heparin intravenously 5,000 units and followed by continuous infusion of 1,500 – 3,000 units per hour by a syringe
pump.
• Drop heparin and continue with warfarin for 3 to 6 months.
• Haemophiliacs may need to take warfarin for life
• The therapeutic INR when on warfarin is between 2 and 3
COMPLICATIONS

• Pulmonary embolism
• Incompetent vein valves leading to poor drainage of limbs and chronic venous ulcers.
TATENDA CHOKWADI