CHAPTER 33
ARTERIOSCLEROSIS & ARTHEROSCLEROSIS Arteriosclerosis – refers to loss of
elasticity or hardening of the arteries. Atherosclerosis- refers to accumulation
of fat deposits in the lumen of the arteries, called plaque.
Hyperlipidemia –high levels of blood fats. Factors: Heredity- diet – sex-
OCCLUSIVE DISORDER OF CORONARY BLOOD VESSELS Coronary occlusion- closing of a coronary artery
which results in total interruption in blood supply to the muscle area.
Coronary Artery Disease (CAD) – refers to atherosclerotic & arteriosclerotic changes in the coronary arteries supplying the myocardium.
Risk factors: Inherited behavioral male sex smoking DM obesity increased lipid levels competitive, aggressive hypertension high- fat diet genetic predisposition sedentary lifestyle
ASSESSMENT FINDINGS
SIGNS AND SYMPTOMS:FatigueChest pain( angina)Pain radiating to shoulders,
arms,especially on the left side,
jaw, neck or TeethSqueezing, burning, crushing
tightness in chest & throat
HyperlipidemiaAcrus senilisxanthelisma
Diagnostic findingsTotal serum cholesterol &
triglycerides – elevatedLDL (bad cholesterol)- higher
ratio of cholesterol than protein
HDL (good Cholesterol)- lower than desired
Apolipoproteins-low or absent
ECGCoronary arteriographyElectron- beam computed
tomography
MEDICAL AND SURGICAL MANAGEMENT DRUG THERAPHYnitrates- nitroglycerin,
isorbide dinitrateBeta adrenergic blocking
agentsCalcium channel blocking
agentsAntibiotic – AzithromycinNicotinic acids- niacinVit. B6 and B12- Aspirin
Surgiacal TheraphyPercutaneous transluminalcoronary angioplasty (PTCA)Coronary Stent-Atherectomy- 4 types1. Directional Coronary Atherectomy2. Transluminal extraction3. Percutaneous transluminal
Cath.4. Laser angioplastyCoronary Artery Bypass
Graft
NURSING MANAGEMENT Asess character of pain AdministerPrescribed medication Encouraged client to rest & administerO2
Notify physician ifpain does not relieve Low fat diet & anerobic exercise
MYOCARDIAL INFARCTION It occurs whenthere is totalocclusion Of coronaryarterial blood flow. Coronary Thrombosis Most common cause of MI3 zones of tissue damage Central area of
necrotic death of myocardial cells
Injured cells, sorround the 1st zone
Ischemic area
COMPLICATIONSDysrhythmias Cardiogenic shockVentricular ruptureVentricular aneurysmArterial embolismVenous thrombosis Pulmonary EmbolismPericarditisMitral insufficiency
ASSESMENT FINDINGS
S & Sx, Severe chest painSame signs &Symptoms Withangina, Client appear pale And diaphoreticSqueezing & crushingPainHypotensive and faint
DIAGNOSTIC FINDINGSCreatinine kinase &Lactate dehydrogenase-
all elevatedWBC, C- reactive protein,Erythrocytesedimentation rate-inc.Blood glucose- elevatedECG- ST segment elev. , T- wave inversion, and QWave.
MEDICAL AND SURGICAL MANAGEMENT DRUG THERAPHYVasodilators – nitroglycerineBeta-adrenergic blockers-
propanolol(inderal)Thrombolytics – alteplase
(Activase); Anticougalants – heparin
sodium(Hepalaen)Calcuim channel blockers-
diltiazine(cardizem)Diuretics- furosimide (Lasix)
SURGICAL MANAGEMENTCardiac rehabilitation Nursing ManagementAsses character of painVital signs every 30 min.
until stablePresence of N&V,
diaphoresis, anxietyO2 saturation level by
oximeterECG for cardiac rhythmDrug Hx (OTC),herbs.Hx of DM, Hypertension,
allergy to drugs,
NURSING DIAGNOSIS
Acute pain related to diminished myocardial oxygenation
Hemorrhage related to thrombolytic therapy
Dysrhythmias related to reperfusion of myocardium with thrombolytic therapy and instability of the conduction system.
OCCLUSIVE DISORDERS OF PERIPHERAL BLOOD VESSELS Peripheral vascular
disorder –affect blood vessels.
RAYNAUDS DISEASE- periodic constriction of arteries that supply extremeties.
DIAGNOSTIC FINDINGSDiagnosis Hx of the Sx Laboratory examination
S & SxAfter exposure to coldHands becomes cold, blanched, wet with perspirationNumbness & tinglingCyanotic & begins to AcheIschemiaPainSlow healing of minor lesions
MEDICAL AND SURGICAL MANAGEMENT
Avoid smokingIsoxsupirine(Vasodilan)Nifidipine ( Procardia)IV infusion of prostaglandin ESympathectomy(cutting of per.Symphatitic nerves
NURSING MANAGEMENTEncourages client to Imagine warming Hands by holding Them together near aFire.Snow skiers (McIntyre manueversHealth teachings about the
dis.Instuct client to avoid
smokingNail care
THROMBOSIS, PHLEBOTHROMBOSIS AND EMBOLISM Thrombosis- a clot
forms in the blood vessels
Phlebothrombosis- dev. Of clot within a vein without inflammation
Embolus- a moving mass (clot) of particles, either solid or gas, in the bloodstream.
S &SxIschemiaExtremities becomes pale,Cold,& extremely painfulArterial pulsation is absentNumbness, tingling, CrampingMild fever & pain, HomansSign
MEDICAL AND SURGICAL MANAGEMENT ARTERIAL OCCLUSIVE
DISEASEImmediate inject. OfHeparin,Administeringvasodilation drugsNarcoticsThrombolytic agentThrombectomy,embolectoMy, endarterectomy,CABG
VENOUS OCCLUSIVE DISEASEBed restElevation of the ExtremetiesLocal heatAnalgesic for painContinues heparin therapyOral coagulants once
heparin achieved therapeutic effect
thrombectomy
VENOUS INSUFFICIENCY A peripheral disorder in
which venous blood is impaired through deep or superficial
veins .Varicose, valvular damage, S & SxSwollen foot, dilatedSuperficail veins, not uniform skin color, lesionDrainage color opaque,Moderate pain, pedal & tibial difficult to palpate
DIAGNOSTIC FINNDINGS Doopler ultrasoundPhotoplethysmographyAir photoplethysmography NURSING MANAGEMENTAssess appearance of the
extremitiesIf ulcer is present measure
and describe apperanceRate pain & admin.
AnalgesicsMeasure calf,ankle, length of
legs for stockingsimplements wound care
MEDICAL AND SURGICAL MANAGEMENT NON-SURGICAL
THERAPHYApply elastic compression stockingMild analgesicsClean wound by soap
& water or disinfectant
Topical hyperbaric oxygen
SURGICAL THERAPHY
Vascular therapyNecrotic tissue
debridement
DIORDERS OF BLOOD VESSEL WALLS VARICOSE VEINSDilated varicose that may
occur in the other parts, such as rectum, & esophagus.
Prolonged standing, obesity, pressure on blood vessels from an enlarging fetus, liver, or abdominal tumor, thrombophlebitis.
ASSESSMENT FINDING S & SxLegs feels heavy and
tired, leg veins distended which appears to be dark blue or purple, snakelike, elevations.
Swollen feet, ankles, & legs
Diagnostic findingsBrodie-trendelenburg testUltrasonography &
venography
MEDICAL, SURGICAL AND NURSING MANAGEMENT MEDICAL MNGT.exercising( walking or
swimming), losing weight if needed, wearing elastic support stockings, avoid prolong standing.
SURGICAL MAN.Vein ligationVein stripping
NURSING MNGT.Assess skin, distal
circulation, peripheral edema.
Monitor for swelling in the operative legs & its affect in circulation
Rewrapped bandage to facilitate blood flow.
Inspect dressing for active bleeding
ANUERYSMS Stretching and bulging of
an arterial wall. Arterosclesoris,
hypertension, trauma, or congenital weakness affects the tunica media, causing the part of the vessels to buldge.
When the blood flow decreases or stops, tissue necrosis.
S & SxPain, discomfort, dysphagia,
dyspnea, Nausea and vommiting,
pulsating mass around the umbilicus. Bruit ( blowing or purring sound
Difference in BP on the Left arm & right arm maybe different, and so is in both legs.
DIAGNOSTIC FINDINGSRadiographsaortagraphs
MEDICAL, SURGICAL AND NURSING MANAGEMENT MEDICAL TREAT.Administering anti-
hypertensive drugs SURGCAL TREAT.Bypass or grafting. NURSING INTER.Minimize activityInstruct client to avoid
straining during bowel movement, coughing, & holding breaths when positioning.
Monitor BP, PR, hourly urine output, skin color, LOC, and chatheristic of pain.
Monitor client for possible shock and adequate tissue perffusion.