Caring for Clients With Disorders of Coronary and Peripheral Blood

Vessels

Chapter 28
Heart Disease
Coronary artery disease (CAD) is the most common type

Leading cause of death in U.S.

Coronary Artery Disease (CAD)
Is when the arteries that supply blood to the heart are narrowed and
hardened.
Due to the build up of plaque

Atherosclerosis

Cause of plaque build up?

Begins in childhood
Excessive fat in the blood, hyperlipidemia
High serum cholesterol or high levels of low-density lipoproteins
(LDL)
Diet high in saturated fat cause increased blood cholesterol level

Genetics

Good vs. Bad

Lipoproteins
Low density (LDL)
Bad

Transfers fat to arteries

High density (HDL)

Good

Transfers fat to liver to be processed and used

Cholesterol Lab Values

Atheroscl erosis

Risk Factors
Modifiable risk factors

Cholesterol levels

Cigarette smoking

Hypertension

Diabetes mellitus

Sedentary lifestyles
 Obesity
Competitive, aggressive personality

High fat diet

Nonmodifiable risk factors

Age

Gender

Family history

Race

Prevention
Cigarette smoking should be discouraged.
Regular aerobic exercise that lasts 30–60 minutes on most days of the
week should be encouraged.
Diet high in veggies
High blood pressure should be identified and treated.
Obesity should be avoided or reduced.
Diabetes mellitus should be diagnosed and treated.
Foods to avoid
Red meat
Fried chicken
Whole milk
Egg yolks
Butter
Ice cream
Pastry

Atherosclerosis Summary
Narrow the arteries so that less blood can flow to the heart muscle
Completely block the arteries and the flow of blood
Cause blood clots to form and block the arteries.
Potential Complication of CAD
Angina
Myocardial infarction
Heart attack
Heart Failure
Arrhythmias
Myocardial Ischemia
Angina Pectoris
Pain in the chest

When the myocardial oxygen demand exceeds the supply, ischemia of

the heart muscle occurs, resulting in chest pain or angina
Symptoms
Pain
Dull or tightness under the sternum
May radiate down right arm
SOB
Pallor or flushing
Profuse sweating
Apprehension
Treatment
The signs and symptoms of angina are often very similar to those of MI.
Temporary
Often relieved by rest and medication
Nitroglycerin dilates the coronary arteries and increases the blood
flow; but does not affect MI pain.
Nursing Process
Assess chest pain and vital signs
Administer oxygen, drugs and encourage rest
Notify physician

Prevention
Eliminating modifiable risk factors
Avoid precipitating events
Physical exertion

Emotional excitement

Eating a heavy meal

Exposure to cold

Medications
Nitroglycerin

Statins

Antiplatelets

Medical and Surgical Management

Medical management
Drug therapy

Nitrates

Educate on lifestyle changes

Surgicalmanagement
PTCA (balloon angioplasty)

Coronary stent
 CABG

Percutaneous Transluminal Coronary Angioplasty

Nursing interventions for PTCA
Cleanses and remove hair from cath site
Withholds anticoagulants therapy before procedure
Monitors all vascular sites for bleeding (hematoma)
Assess all distal pulses
Monitor urine output
Reports chest pain, or abnormal vital signs
Coronary Stent
Coronary Artery Bypass Graft
(CABG)
Coronary artery revascularization utilizes another vein to bypass
diseased coronary artery

Heart Attack “a.k.a.” Myocardial Infarction

Atherosclerosis or
Embolus
Occludes major artery of blood flow
No oxygen to cells

Infarcted areas
Heart muscles die

Pain

Signs and Symptoms

Heavy pressure or squeezing
Pain, left arm and to the neck, jaw and teeth
Anxiety
Dyspnea
Weakness, faintness
Nausea
Pallor
Erratic behavior
Hypotension, shock
Cardiac rhythm changes
Vomiting
Fever
Diaphoresis
 Pa in with a myoca rdial infarction
Diagnostic Findings
Elevated serum cardiac markers
Troponin
Ck-MB (cardiac muscle-specific enzymes)
ECG changes
T-wave inversion
Medical Management
Increase tissue perfusion
Decrease workload of the heart
Promoting tissue oxygenation
Oxygen

Nitroglycerin

Relieving pain
Morphine

Preventing complications
Limit the size of the infarct
Thrombolytic therapy

PTCA

CABG

Thrombolytic Therapy
Dissolve clots in occluded artery, reopening the vessel and allowing
perfusion of the heart muscle.
3-6 hours of the onset of symptoms
st
Most effective in 1 1hour
Excluded
Internal bleeding

Aneurysm

Recent head trauma

Hx of hemorrhagic stroke

Surgery within the past 10 days

Nursing Intervention
Administer oxygen
Administer medications
IV Morphine
Heparin
Antiplatelets
Stool softeners
Bed rest
Teaching
Treatment regimen
Cardiac rehab
Medications
Lifestyle changes
Dietary restrictions
Sexual activity
Warning symptoms
Nursing Process for MI
Assessment
Client’s description of pain
Vital signs
Cardiac rhythm
Nursing Process for MI
Nursing Diagnosis
Acute pain related to diminished myocardial oxygenation
Ineffective tissue perfusion (cardiovascular) related to
____________________
Anxiety or Fear

Nursing Process for MI

Interventions
Administer prescribed nitroglycerin
Administer morphine
Administer oxygen
Pain will be within client’s identified comfort level within 30minutes
Occlusive Disorders of Peripheral Blood Vessels
Peripheral Vascular Disease
“PVD”
What is peripheral vascular disease?
Peripheral vascular disease, or PVD, is a condition in which the blood
vessels that carry blood to the arms or legs become narrowed or clogged.
Arterial
Venous

Symptoms of PVD
Intermittent claudication- pain with exercises, particularly walking,
causes excruciating pain in limb that disappears at rest.
Tingling and numbness – extremity becomes numb, or the feeling of a
persistent tingling sensation, caused by poor circulation
Symptoms of PVD
Coldness and difference in size- extremities feel cold to touch, one leg
may be colder and larger than the other.
Lack of tissue growth- skin becomes paper thin, shiny, and easily
subject to breakdown
Venous stasis ulcers- breakdown from inflamed skin causing fluid to
ooze causing skin to be impaired

Arteriosclerosis
Goals for peripheral arterial disease
Increased arterial blood supply to the extremities
Promotion of vasodilation
Prevention of vascular compression
Relief of pain
Maintaining tissue integrity
Interventions
Positioning the part below the level of heart
Reclining position
Walking
Not with pain

Promoting vasodilation
Warmth, avoid cold temperatures
Warm clothes, warm drink

Pt should test temp first

Nursing care for PVD

Protect the client’s feet and legs from undue pressure of linens
Take great care in trimming toenails
Be sure to dry carefully between the toes after washing them
Be very careful about application of heat. Use extra clothing rather
external heat
Use warm baths to increase circulation

Postoperative Treatment
Pulses
Color and temperature
Capillary refill
Sensory and motor function

Allow no leg crossing, LOC, UO,VS, Bleeding, elevate extremity, monitor

incision site for infection
Notify surgeon of any changes immediately
Raynaud’s Disease
Constriction
Brief spasms
Females that get upset, cold, or smokes
Fingers turn blue, then white, then red
Painful and cause ulceration
Avoid cause, use warmth.
Peripheral thrombosis (arterial embolism)
Embolus lodges in a blood vessel causing blockage
Severe pain at site
Distal portion pale, cold, numb, and no pulse
Without circulation gangrene occurs
Amputation
Endarterectomy
Embolectomy
Venous Disorders
Venous insufficiency
Varicose veins
Venous Insufficiency
Blood pools in the lower extremity
Fluid leaves the blood vessel
Causing edema and the skin to become shiny and hard
Unoxygenated cells die causing release of inflammatory chemicals
Skin becomes red and hot, tissue appears dark brown, deep purple, or
black
Chronic Venous Insufficiency
Results from obstruction of venous valves in legs or reflux of blood back
through valves
Venous ulceration is serious complication
Pharmacological therapy is antibiotics for infections
Venous stasis ulcer
Medical Management
Promote wound healing and preventing infection
Diet
Protein intake

Albumin is lost through ulcers

Vitamin A& C, zinc needed to promote tissue healing

Debridement of necrotic tissue

Wet-to-dry dressing

Enzyme ointments
 Surgical debridement
Unna’s paste boot
Disorders of blood vessel walls
Varicose veins results from weakening of the valves of the veins so that
blood pools in the legs.
The congestion stretches the veins and over time they cannot recoil and
remain distended.
Prolonged standing
Elevate the legs for a few minutes throughout day

Avoid constricted clothing

Stripping and ligation of surgical therapy

Early ambulation is important after surgery.

Varicose Veins