Peripheral Vascular system

  1. Function of Vascular System
    —Dilate or constrict depending on metabolic needs of tissues

    —Oxygenation and waste product removal

    —Direct the flow of the blood in one continuous direction
  2. PVD Causes:
    —Heart failure

    —thrombus, embolus

    —atherosclerotic plaque,

    —chemical or mechanical injury

    —inflammatory processes

    —vaso-spastic disorders

    —congenital malformations

  3. Number one cause of PVD
    plaque build up of the artery , no peripheral pulse that’s a clue of PVD and edema use a doppler
  4. PVD - Diagnostics
    —Physical assessment of peripheral pulses

    —Lab values

    —Doppler ultrasound flow studies

    —Duplex ultrasound (imaging of tissues, organs, and vessels)

    —Exercise tolerance testing (treadmill)
  5. Plethysmography:
    Diagnostic test for PVD

    —Evaluate arterial flow in lower extremties

    —Uses a doppler and ultrasound to evaluate flow

    —May need to wear blood pressure cuffs on your arms and legs for this test.

    Compares blood pressure in arms to legs – measuring the ABI (ankle – brachial index
  6. CT Scan
    cross-sectional views of tissues usually with contrast medium
  7. CT angiography
    3-D view of aorta and visceral arteries
  8. MRI
    isolates blood vessels (no contrast medium)
  9. Arteriosclerosis
    hardening of the arteries or full-thickness hardening of small arteries and arterioles

    occurs with the aging process, hardening of the arteries
  10. Atherosclerosis
    involves accumulation of lipids, calcium, blood components, carbohydrates, and fibrous tissue on intimal layer of large and medium-sized arteries

    the plaque formation
  11. Arterial Disorders Issue
    poor perfusion and oxygenation
  12. Arterial Disorder Cause
    narrowing of the lumen, obstruction by thrombosis, plaque ulceration, aneurysm, rupture
  13. Arterial Disorder Risk Factors
    • diet, HTN, DM, Hyperlipidemia, Stress, smoking,
    • sedentary lifestyle, age, family history
  14. Arterial Disorders Related Illnesses


    —Myocardial infarction

    —Transient ischemic attacks (TIA) and stroke


    —Renal vascular disease/end-stage renal disease
  15. Manifestations of Arterial Disorders
    —Skin changes r/t color and temperature: “dependent rubor”, or “ elevation pallor”

    —Diminished or absent pulse

    • Ulcers (usually on toes or near toes, +pain, neurologic deficits present
    • —Dependent on stage or severity of arterial insufficiency

    —Pain at Rest

    Pain or intermittent claudication
  16. Medical Interventions
    Angioplasty and stent placement

    —Percutaneous Transluminal Angioplasty (PTA)

    —Laser- Assisted Angioplasty

  17. PVD - Treatments (Surgery)
    —Peripheral arterial bypass operation with autogenous vein to carry blood around the lesion or occlusion.
  18. Peripheral Arterial bypass Nursing Care
    - important to assess for occlusion (pulses, temp etc.)

    - report of pain (type of pain)

    -bedrest for 18-24 hours

    - check blood pressure

    - notify surgeon immediately for abnormal findings
  19. Carotid Endarterectomy (CEA)
    opening the carotid artery and removing the obstructing plaque.

    —Monitor vital signs, neuro status, pulses, bleeding,
  20. Arterial Disorder Complications from interventions




    —Stent embolization or dislodgement

    —Vessel damage
  21. Nursing Interventions for Arterial Disorders
    —Positioning affected part below heart level

    —If edema, position slightly elevated but not above the heart

    —Walking or graded isometric exercises to promote circulation and development of collateral circulation
  22. Patient teaching for Arterial Disorders
    • —medications (vasodilators, lipid lowering agents,
    • anti-platelet agents)

    —No smoking!


    —applications of warmth,

    —avoidance of cold temperatures,

    avoid heating pads and hot-water bottles

    —avoid emotional upsets,

    —removal of restrictive clothing or accessories

    —avoid crossing the legs, inspection of legs and feet

    —nutrition: weight reduction

    —Diet low fat, low sodium,

    —Encourage soy proteins, folic acid and B6 and B12 vitamins
  23. What benefit does folic acid have on arterial disorders?
    • Folic acid on arterial disorders: homosistene when high causes more plaque formation so when you give
    • folic acid it decreases it
  24. What benefit does soy have on arterial disorders?
    Soy lowers your cholesterol level
  25. —Peripheral Arterial Occlusive Disease
    —Legs most effected, men 50 + years

    —Below renal arteries to popliteal artery

    —Aching, cramping, fatigue, weakness relieved with rest; with severity, pain worse at night/at rest
  26. —Upper extremity Arterial Occlusive Disease
    —Effects the arms/upper extremities

    —Unilateral coolness, discrepancy of 20 mm HG or more on BP right to left
  27. Thromboangiitis Obliterans or Buerger’s Disease
    —Autoimmune vasculitis resulting in in microscopic occlusion of distal vessels caused by heavy smoking/chewing tobacco
  28. Buergers think about
    smoking directly related causes vessel to inflame and have narrowing of the vessels

    When pt stops smoking inflammation does subside
  29. Raynaud’s Disease
    —extreme sensitivity to cold aggravated by nicotine, emotion, chilling, limited to hands and feet

    —Phenomenon (usually unilaterally)

    —Treatment and education related to preventing vasoconstriction

    Can be stress, cold, nicotine , usually one hand or two fingers and promote vasodilation

    Reduce stress, wear gloves
  30. Aortic Aneurysm
    localized sac or dilation (thoracic, abdominal, dissecting aneurysm)
  31. Arterial Embolism and Arterial Thrombosis
  32. Venous Insufficiency
    —Results of prolonged venous hypertension that stretches the vein and damages the valves

    —Damage and hypertension leads to back-up of blood resulting in edema

    —Difficulty eliminating waste and thus they build-up in the tissues resulting in stasis, ulcers, edema, cellulitis

    Usually around ankles
  33. Venous Disorders
    —Venous thrombosis

    —Deep vein thrombosis


    Virchow’s triad:
  34. Virchow’s triad
  35. Who’s at risk for Venous Diosorders
    elderly, bed ridden, post-op patients, oral contraceptives, HRT, smokers, pregnant females, obese, people who stand for a prolonged period of time
  36. Manifestations – Venous Disorders
    —Pain, warmth, redness, and edema

    —Prominence of superficial veins

    —Positive Homan’s sign

    —Signs of pulmonary embolus

    —Ulcers (usually ankle area, +pulses, no claudication, no neurologic deficits)
  37. Therapies
    —Elastic stockings, pneumonic compression device, positioning, exercise

    Heparin IV or SQ

    Coumadin oral

    Low-molecular weight heparin (Lovenox), less risk of thrombocytopenia


    —ASA, Ecotrin, Bayer, Plavix
  38. Heparin IV or SQ what labs do you look at
    • PTT (partial thromboplastin time), 2-3x average
    • INR (international normalized ratio)2.0-3.0

    platelet count
  39. Coumadin Oral Labs to look at
    • PT (prothrombin time) 1.5-2x average
    • INR 2.0-3.0
  40. Drug Therapy- Risks

    —Drug interactions: (ASA, anabolic steroids,, glucagon, chloramphenicol, neomycin, etc) POTENTIATE oral anticoagulant effects

    • —Drug interactions: (Dilantin, barbituates, diuretics,
    • estrogens), DECREASE anticoagulant effects
  41. Management of Chronic Venous Insufficiency
    —leg elevation,

    —elastic stockings

    —removal of restrictive garments

    —proper nutrition

    —Collaborate with Wound care specialist

    —Intermittent pneumatic compression pump

    —Varicose veins and venous reflux: VNUS procedure
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Peripheral Vascular system