6. ANEURYSM
• PATHOPHYSIOLOGY
• Damage to the intima and media weakness
outpouching
• Dissecting aneurysm tear in the intima and
media with dissection of blood through the
layers
7. ANEURYSM
• ASSESSMENT
• Asymptomatic
• Pulsatile sensation on the abdomen
• Palpable bruit
10. ANEURYSM
• Nursing Management:
• Administer medications
• Emphasize the need to avoid increased
abdominal pressure
• No deep abdominal palpation
• Remind patient the need for serial
ultrasound to detect diameter changes
11. PERIPHERAL ARTERIAL
OCCLUSIVE DISEASE
• Refers to arterial insufficiency of the
extremities usually secondary to peripheral
atherosclerosis.
• Usually found in males age 50 and above
• The legs are most often affected
12. PERIPHERAL ARTERIAL
OCCLUSIVE DISEASE
• Risk factors for Peripheral Arterial
occlusive disease
• Non-Modifiable
• 1. Age
• 2. gender
• 3. family predisposition
15. PERIPHERAL ARTERIAL
OCCLUSIVE DISEASE
• ASSESSMENT FINDINGS
• 1. INTERMITTENT CLAUDICATION- the
hallmark of PAOD
• This is PAIN described as
aching, cramping or fatiguing discomfort
consistently reproduced with the same
degree of exercise or activity
16. PERIPHERAL ARTERIAL
OCCLUSIVE DISEASE
• ASSESSMENT FINDINGS
• 1. INTERMITTENT CLAUDICATION- the
hallmark of PAOD
• This pain is RELIEVED by REST
• This commonly affects the muscle group
below the arterial occlusion
17. PERIPHERAL ARTERIAL
OCCLUSIVE DISEASE
• Assessment Findings
• 2. Progressive pain on the extremity as the
disease advances
• 3. Sensation of cold and numbness of the
extremities
18. PERIPHERAL ARTERIAL
OCCLUSIVE DISEASE
• Assessment Findings
• 4. Skin is pale when elevated and
cyanotic/ruddy when placed on a
dependent position
• 5. Muscle atrophy, leg ulceration and
gangrene
20. PAOD
• Medical Management
• 1. Drug therapy
• Pentoxyfylline (Trental) reduces blood
viscosity and improves supply of O2 blood
to muscles
• Cilostazol (Pletaal) inhibits platelet
aggregation and increases vasodilatation
• 2. Surgery- Bypass graft and anastomoses
21. PERIPHERAL ARTERIAL
OCCLUSIVE DISEASE
• Nursing Interventions
• 1. Maintain Circulation to the extremity
• Evaluate regularly peripheral
pulses, temperature, sensation, motor
function and capillary refill time
• Administer post-operative care to patient
who underwent surgery
22. PERIPHERAL ARTERIAL
OCCLUSIVE DISEASE
• Nursing Interventions
• 2. Monitor and manage complications
• Note for bleeding, hematoma, decreased
urine output
• Elevate the legs to diminish edema
• Encourage exercise of the extremity while
on bed
• Teach patient to avoid leg-crossing
23. PERIPHERAL ARTERIAL OCCLUSIVE
DISEASE
• Nursing Interventions
• 3. Promote Home management
• Encourage lifestyle changes
• Instruct to AVOID smoking
• Instruct to avoid leg crossing
24. Buerger’s Disease
• Also known as Thromboangiitis
obliterans
• Usually a disease of heavy cigarette
smoker/tobacco user men, 25-
40y/o
• Inflammatory arterial disorder that
causes thrombus formation often
extends to adjacent veins & nerves
25. • Affects medium-sized arteries (usually plantar
& digital vessels in the foot or lower legs)
• unknown pathogenesis but it had been
suggested that:
– tobacco may trigger an immune response or
– unmask a clotting defect;
→ these 2 can incite an inflammatory reaction of
the vessel wall
26. Manifestations
Pain – predominant symptom; R/T
distal arterial ischemia
Intermittent claudication in the arch of
foot & digits
Increased sensitivity to cold (due to
impaired circulation
Absent/diminished peripheral pulses
27. Color changes in extremity
(cyanotic on dependent
position; digits may turn reddish
blue)
Thick malformed nails (chronic
ischemia)
Disease progression ulcerate
tissues & gangrenous changes
may arise; may necessitate
amputation
28. Diagnosis & Treatment
• Diagnostic methods – those
that assess blood flow (Doppler
ultrasound & MRI)
• Tx: mandatory to stop smoking
or using tobacco
– Meds to increase blood flow to
extremities
– Surgery (surgical sympathectomy)
– amputation
29. Rynaud’s Disease
Mechanism: intensive vasospasm of arteries &
arterioles in the fingers
Cause: unknown
Usually affects young women
Precipitated by exposure to cold & strong emotions
Raynaud’s phenomenon – associated with previous
injury (i.e.. Frostbite, occupational trauma
associated with use of heavy vibrating
tools, collagen diseases, neuro d/o, chronic arterial
occlusive d/o)
30. Manifestations
• Period of ischemia (ischemia due to
vasospasm)
– change in skin color = pallor to cyanotic
– 1st noticed at the fingertips later moving to
distal phalanges
– Cold sensation
– Sensory perception changes (numbness &
tingling)
• Period of hyperemia – intense redness
– Throbbing
– Paresthesia
31. • Return to normal color
• Note: although all of the fingers
are affected symmetrically, only
1-2digits may be involved
• Severe cases: arthritis may arise
(due to nutritional impairment)
– Brittle nails
– Thickening of the skin of fingertips
– Ulceration & superficial gangrene of fingers
(rare occasions)
32. Diagnosis & Treatment
Dx: initial = based on Hx of vasospastic
attacks
Immersion of hand in cold water to
initiate attack aids in the Dx
Doppler flow velocimetry – used to
quantify blood flow during temperature
changes
Serial Computed thermography (finger
skin temp) – for diagnosing the extent of
disease
33. Tx: directed towards eliminating factors
causing vasospasm & protecting fingers
from injury during ischemic attacks
PRIORITIES: Abstinence in smoking &
protection from cold
Avoidance of emotional stress (anxiety &
stress may precipitate vascular spasm)
Meds: avoid vasoconstrictors (i.e..
Decongestants)
-Calcium channel blockers
(Diltiazem, Nifedipine, Nicardipine) –
decrease episodes of attacks
34. Care Plan for Clients with Altered
Cardiovascular Oxygenation
A. Assessment: C. Goals:
1. Hx of symptoms 1. Relief of pain &
(pain, esp. chest pain; symptoms
palpitations; dyspnea) 2. Prevention of further
2. v/s cardiac damage
B. Nursing Dx: D. Nursing Interventions:
1. ineffective tissue 1. Pain control
perfusion
2. Proper medications
(cardiopulmonary)
2. Impaired gas exchange
3. Decrease client’s anxiety
3. Anxiety due to fear of 4. Health teachings
death (clients with MI or (meds, activities, diet, ex
Angina) ercise, etc)
