Documente Academic
Documente Profesional
Documente Cultură
System
By:
BLOOD VESSEL
BLOOD
HEART
Hollow, muscular
4-chambered
Located in middle of thoracic cavity
between lungs in space called
mediastinum ( The space between the
lungs, which includes the heart,
pericardium, aorta and vena cava)
“Inverted cone”
The Cardiovascular System
HEART
Normal Anatomy: Microscopic
Consists of Three layers- epicardium,
myocardium and endocardium
The Cardiovascular System
The epicardium covers the outer surface
of the heart
The myocardium is the middle muscular
layer of the heart
The endocardium lines the chambers and
the valves
The Cardiovascular System
The layer that covers the heart is the
PERICARDIUM
There are two parts- parietal and visceral
pericardium
The space between the two pericardial
layers is the pericardial space
PERICARDIAL EFFUSION
The Cardiovascular System
Normal Anatomy: Gross
The heart is located in the LEFT side of
the mediastinum
The Cardiovascular System
The heart chambers are guarded by
valves
The Atrio-ventricular valves-
Great vessels:
large veins and
arteries leading
directly to and
away from heart
SUPERIOR VENA CAVA
AND INFERIOR VENA
CAVA
PULMONARY ARTERY
PULMONARY VEIN
AORTA
LAUGH BREAK
BOY: Isang babaeng siopao nga!
LEA: Babaeng siopao?
BOY: Oo, yung may saping papel, may
napkin!
LEA: Ah ganun ba? Mayrun kaming
siopao na bading
BOY: Bading na siopao?
LEA: May sapin din, pero may itlog sa
loob!
LAUGH BREAK
AMO: Day, gamitin mo sa pader itong
chalk pamatay ng ipis.
MAID: Yis ati!
NEXT DAY
... nagulat ang amo, nakasulat sa
pader:
EPES MAMATAY KAYUNG LAHAT!
SYET! PAKYO!
LAUGH BREAK
PASYENTE: Dok bakit pag tuwing
umiinm ako ng alak sumasakit ang tyan
ko? Pero pag libre, di naman?
DKTOR: Normal yan, manipis kasi atay
mo. Tapos makapal mukha mo!
LAUGH BREAK
BUS HINOLDAP!
Holdaper: Re-reypin ko lahat ng babae
dito!
Conductivity
Excitability
Refractoriness
The Cardiovascular System
The CONDUCTING SYSTEM OF THE
HEART
Consists of the
1. SA node- the pacemaker
2. AV node- slowest conduction
3. Bundle of His – branches into the
Right and the Left bundle branch
4. Purkinje fibers- fastest conduction
LAUGH BREAK
HONEYMOON:
Blood pressure
Control is neural (central and
peripheral) and hormonal
Baroreceptors in the carotid and aorta
Hormones- ADH, Adrenergic
hormones, Aldosterone and ANF
The Cardiovascular System
Blood pressure
Hormones- ADH, Adrenergic hormones,
Aldosterone and ANF
ADH increases water retention
Aldosterone increases sodium retention
and water retention secondarily
Epinephrine and NE increase HR and BP
Increased afterload
Cardiac compensatory
mechanisms
When the normal compensatory
mechanisms cannot maintain cardiac
output to meet body needs, the client is
in a state of cardiac
decompensation.
SUKO SA MISTER:
Misis 1: Suko na ako sa mister ko, lagi
na lang ako binubugbog bago
niroromansa. ..
Figure 11.9
Slide 11.27
Tutpik!
Kustomer: Ano ba naman itong
tutpik nyo, iisa na nga lang, ang
dali pang mabali!
Figure 11.11
Slide 11.30
Blood Supply to:
Bone – Haversian canal and Volkmann’s canal
Blood Vessel – vasa vasorum
Heart – coronary arteries
Brain – common carotid artery – external and
internal carotid artery,
anterior, middle and posterior cerebral artery
(Circle of Willis)
Upper Extremities – basillic – cephalic – brachial
– radial and ulnar
Lower Extremities –iliac – femoral popliteal –
saphenous – tibial
Blood Supply to:
Eyes – choroids (between sclera and retina)
cornea gets 02 from the atmosphere
Kidneys – renal artery – interlobar artery –
arcuate artery – interlobular artery – afferent
arteriole – glomerulus – efferent arteriole - vasa
recta – back to the heart
Liver – celiac artery – hepatic artery and hepatic
portal vein (food laden) - liver sinusoids (mixed
blood) – hepatic cells extract 02, nutrients and
detoxify toxic substances.
Organs of the GIT – celiac trunk
Lungs – bronchial arteries
Major Veins of Systemic Circulation
Figure 11.12
Slide 11.31
Arterial Supply of the Brain
Figure 11.13
Slide 11.32
Hepatic Portal Circulation
Figure 11.14
Slide 11.33
Circulation to the Fetus
Slide 11.34
LAUGH BREAK
• Temperature
• Heat has a vasodilation effect
• Cold has a vasoconstricting effect
• Chemicals
• Various substances can cause increases or
decreases
• Diet
Slide 11.39b
Factors Determining Blood Pressure
Figure 11.19
Slide 11.40
Pulse
• Pulse –
pressure wave
of blood
• Monitored at
“pressure
points” where
pulse is easily
palpated
Figure 11.16
Slide 11.35
Pulse Pressure
Difference between
systolic and diastolic
pressures
Increases when
stroke volume
increases or vascular
compliance
decreases
Pulse pressure can
be used to take a
pulse to determine
heart rate and
rhythmicity
Variations in Blood Pressure
• Human normal range is variable
• Normal
• 140–110 mm Hg systolic
• 80–75 mm Hg diastolic
• Hypotension
• Low systolic (below 110 mm HG)
• Often associated with illness
• Hypertension
• High systolic (above 140 mm HG)
• Can be dangerous if it is chronic
Slide 11.41
Effects of Aging on the
Heart
Gradual changes in heart function,
minor under resting condition, more
significant during exercise
Hypertrophy of left ventricle
Maximum heart rate decreases
Increased tendency for valves to
function abnormally and arrhythmias to
occur
Increased oxygen consumption
required to pump same amount of blood
The Cardiovascular System
Cardiac
Assessment
The Cardiovascular System
Cardiac History
Interview
Focused assessment
CARDIAC ASSESSMENT
Health History
Obtain description of
present illness and the chief
complaint
Chest pain, DOB, Edema,
etc.
Assess risk factors
CARDIAC ASSESSMENT
Physical examination
Vitalsigns- BP, PP,
Inspection of the skin
Inspection of the thorax
Palpation of the PMI, pulses
Auscultation of the heart
sounds
Fig. 13.23
WHY NURSING?
Do you know why I took up nursing? It
was in 4th year high school that I saw a
vision of a great woman bearing a light
in her right hand wearing a long gown
and a headress calling me to serve
her…….
STATUE OF LIBERTY
CARDIAC ASSESSMENT
Laboratory and diagnostic
studies
CBC
Cardiac catheterization
Lipid profile
Arteriography
Cardiac enzymes and proteins
CXR
CVP
ECG
Holter monitoring
Exercise ECG
The Cardiovascular System
2. To identify abnormalities
3. To assess inflammation
The Cardiovascular System
Troponin I and T
REMEMBER to AVOID IM
injections before obtaining
blood sample!
Early and late diagnosis can be
made!
LABORATORY PROCEDURES
CARDIAC Proteins and enzymes
Myoglobin
Not seen alone in cardiac
problems
Muscular and RENAL disease
can have elevated myoglobin
LABORATORY PROCEDURES
SERUM LIPIDS
Lipid profile measures the
serum cholesterol,
triglycerides and lipoprotein
levels
Cholesterol= <200 mg/dL
Triglycerides- 40- 150 mg/dL
LABORATORY PROCEDURES
SERUM LIPIDS
LDL- 130 mg/dL
ELECTROCARDIOGRAM
(ECG)
A non-invasive procedure
that evaluates the electrical
activity of the heart
Electrodes and wires are
attached to the patient
LABORATORY PROCEDURES
ELECTROCARDIOGRAM
(ECG)
Tell the patient that there is
no risk of electrocution
Avoid muscular
contraction/movement
LABORATORY PROCEDURES
Holter Monitoring
A non-invasive test in
which the client wears a
Holter monitor and an
ECG tracing recorded
continuously over a
period of 24 hours
The Cardiovascular System
LABORATORY PROCEDURES
Holter Monitoring
Instruct
the client to resume
normal activities and
maintain a diary of activities
and any symptoms that may
develop
LABORATORY PROCEDURES
ECHOCARDIOGRAM
Non-invasive test that
studies the structural and
functional changes of the
heart with the use of
ultrasound
No special preparation is
needed
LABORATORY PROCEDURES
Stress Test
A non-invasive test that
studies the heart during
activity and detects and
evaluates CAD
Exercise test,
pharmacologic test and
emotional test
The Cardiovascular System
LABORATORY PROCEDURES
Stress Test
Treadmill testing is the most
commonly used stress test
Used to determine CAD,
Chest pain causes, drug
effects and dysrhythmias in
exercise
The Cardiovascular System
LABORATORY PROCEDURES
Stress Test
Pre-test:
consent may be
required, adequate rest, eat
a light meal or fast for 4
hours and avoid smoking,
alcohol and caffeine
The Cardiovascular System
LABORATORY PROCEDURES
Post-test: instruct client to
notify the physician if any
chest pain, dizziness or
shortness of breath
Instruct client to avoid taking
a hot shower for 10-12 hours
after the test
The Cardiovascular System
LABORATORY PROCEDURES
Pharmacological stress test
Use of dipyridamole
CARDIAC catheterization
Used to diagnose CAD,
assess coronary artery
patency and determine
extent of atherosclerosis
LABORATORY PROCEDURES
Pretest: Ensure Consent,
assess for allergy to
seafood and iodine, NPO,
document weight and
height, baseline VS, blood
tests and document the
peripheral pulses
LABORATORY PROCEDURES
Post-test:
Monitor VS and cardiac rhythm
Monitor peripheral pulses, color and
warmth and sensation of the
extremity distal to insertion site
Maintain sandbag to the insertion
site if required to maintain pressure
Monitor for bleeding and hematoma
formation
LABORATORY PROCEDURES
Maintain strict bed rest for 6-12 hours
Client may turn from side to side but
bed should not be elevated more than
30 degrees and legs always straight
Encourage fluid intake to flush out the
dye
Immobilize the arm if the antecubital
vein is used
Monitor for dye allergy
LABORATORY PROCEDURES
CVP
The CVP is the pressure
within the SVC
Reflects the pressure
under which blood is
returned to the SVC and
right atrium
LABORATORY PROCEDURES
CVP
NormalCVP is 0 to 8 mmHg/ 4-
10 cm H2O
LABORATORY PROCEDURES
CVP
ElevatedCVP indicates
increase in blood volume,
excessive IVF or heart/renal
failure
LABORATORY PROCEDURES
CVP
LowCVP may indicate
hypovolemia, hemorrhage
and severe vasodilatation
LABORATORY PROCEDURES
Measuring CVP
1. Position the client supine with
bed elevated at 45 degrees (CBQ)
2. Position the zero point of the
CVP line at the level of the right
atrium. Usually this is at the MAL,
4th ICS
3. Instruct the client to be relaxed
and avoid coughing and straining.
CARDIAC IMPLEMENTATION
Buerger’s disease
Aneurysm
Varicose veins
Deep vein thrombosis
CAD
CORONARY ARTERY DSE
results from the focal
narrowing of the large and
medium-sized coronary
arteries due to deposition of
atheromatous plaque in the
vessel wall
CAD
RISK FACTORS
1. Age above 45/55 and Sex- Males and
post-menopausal females
2. Family History
3. Hypertension
4. DM
5. Smoking
6. Obesity
7. Sedentary lifestyle
8. Hyperlipedimia
CAD
RISK FACTORS
Most important MODIFIABLE
factors:
Smoking
Hypertension
Diabetes
Cholesterol abnormalities
CAD: Pathophysiology
Fatty streak formation in the vascular intima
Atheroma
myocardial ischemia
CAD
Pathophysiology
There is decreased perfusion of
myocardial tissue and inadequate
myocardial oxygen supply
If 50% of the left coronary arterial
lumen is reduced or 75% of the
other coronary artery, this
becomes significant
CAD
Pathophysiology
Potential for Thrombosis and
embolism
Angina Pectoris
Chest pain resulting from
coronary atherosclerosis
or myocardial ischemia
Angina Pectoris: Clinical Syndromes
THREE COMMON TYPES OF ANGINA
1. STABLE ANGINA
The typical angina that
occurs during exertion,
relieved by rest and drugs
and the severity does not
change
Angina Pectoris: Clinical Syndromes
Three Common Types of ANGINA
2. Unstable angina
Occurs unpredictably
during exertion and
emotion, severity increases
with time and pain may not
be relieved by rest and drug
Angina Pectoris: Clinical
Syndromes
Three Common Types of ANGINA
3. Variant angina
Prinzmetal angina, results
from coronary artery
VASOSPASMS, may occur
at rest
Angina Pectoris
ASSESSMENT FINDINGS
1. Chest pain- ANGINA
The most characteristic symptom
PAIN is described as mild to
severe retrosternal pain,
squeezing, tightness or burning
sensation
Radiates to the jaw and left arm
Angina Pectoris
ASSESSMENT FINDINGS
1. Chest pain- ANGINA
Precipitated by Exercise, Eating
heavy meals, Emotions like
excitement and anxiety and
Extremes of temperature
Relieved by REST and Nitroglycerin
Angina Pectoris
ASSESSMENT FINDINGS
2. Diaphoresis
3. Nausea and vomiting
4. Cold clammy skin
5. Sense of apprehension and
doom
6. Dizziness and syncope
Angina Pectoris
LABORATORY FINDINGS
ECG may show normal tracing if
patient is pain-free.
- Ischemic changes may show ST
depression and T wave inversion
Angina Pectoris
LABORATORY FINDINGS
2. Cardiac catheterization
Provides the MOST DEFINITIVE
source of diagnosis by showing the
presence of the atherosclerotic
lesions
Angina Pectoris
NURSING DIAGNOSES:
Decreased cardiac output
Impaired gas exchange
Activity intolerance
Anxiety
Angina Pectoris
NURSING MANAGEMENT
1. Administer prescribed medications
Nitrates- to dilate the venous vessels
decreasing venous return and to some
extent dilate the coronary arteries
Aspirin- to prevent thrombus formation
Beta-blockers- to reduce BP and HR
Calcium-channel blockers- to dilate
coronary artery and reduce vasospasm
Angina Pectoris
2. Teach the patient management of
anginal attacks
Advise patient to stop all activities
Put one nitroglycerin tablet under the
tongue
Wait for 5 minutes
If not relieved, take another tablet and wait
for 5 minutes
Another tablet can be taken (third tablet)
If unrelieved after THREE tablets seek
medical attention
Angina Pectoris
3. Obtain a 12-
lead ECG
Angina Pectoris
4. Promote myocardial perfusion
Instruct patient to maintain bed rest
Administer O2 @ 3 lpm
Death of myocardial
tissue in regions of the
heart with abrupt
interruption of coronary
blood supply
Myocardial infarction
ETIOLOGY and Risk factors
1. CAD
2. Coronary vasospasm
3. Coronary artery occlusion by
embolus and thrombus
4. Conditions that decrease
perfusion- hemorrhage, shock
Myocardial infarction
Risk factors
1. Hypercholesterolemia
2. Smoking
3. Hypertension
4. Obesity
5. Stress
6. Sedentary lifestyle
Myocardial infarction
PATHOPHYSIOLOGY
Interrupted coronary blood flow
myocardial ischemia anaerobic
myocardial metabolism for several
hours myocardial death
depressed cardiac function
triggers autonomic nervous
system response further
imbalance of myocardial O2
demand and supply
Myocardial infarction
ASSESSMENT findings
1. CHEST PAIN
Chest pain is described as
severe, persistent, crushing
substernal discomfort
Radiates to the neck, arm, jaw
and back
Myocardial infarction
ASSESSMENT findings
1. CHEST PAIN
Occurs without cause, primarily
early morning
NOT relieved by rest or
nitroglycerin
Lasts 30 minutes or longer
Myocardial infarction
Assessment findings
2. Dyspnea
3. Diaphoresis
4. Cold clammy skin
5. N/V
6. restlessness, sense of doom
7. tachycardia or bradycardia
8. hypotension
9. S3 and dysrhythmias
Myocardial infarction
Laboratory findings
1. ECG- the ST segment is
ELEVATED, T wave inversion,
presence of Q wave
2.Myocardial enzymes-
elevated CK-MB, LDH and
Troponin levels
Myocardial infarction
Laboratory findings
3. CBC- may show elevated
WBC count
4. Test after the acute stage-
Exercise tolerance test,
thallium scans, cardiac
catheterization
Myocardial infarction
Pain
Decreased cardiac output
Impaired gas exchange
Activity intolerance
Altered tissue perfusion
Constipation
Myocardial infarction
Nursing Interventions
1. Provide Oxygen at 2 lpm, Semi-
fowler’s
2. Administer medications
Morphine to relieve pain
Nitrates, thrombolytics, aspirin
and anticoagulants
Stool softener and hypolipidemics
Myocardial infarction
Nursing Interventions
3. Minimize patient anxiety
Provide information as to
procedures and drug therapy
Allow verbalization of feelings
Morphine can be administered
Myocardial infarction
ASSOCIATED FACTORS
1. Heavy alcohol intake
2. Pregnancy
3. Viral infection
4. Idiopathic
DILATED CARDIOMYOPATHY
PATHOPHYSIOLOGY
Diminished contractile proteins
poor contraction decreased
blood ejection increased blood
remaining in the ventricle
ventricular stretching and
dilatation.
SYSTOLIC DYSFUNCTION
HYPERTROPHIC
CARDIOMYOPATHY
Associated factors:
1. Genetic
2. Idiopathic
HYPERTROPHIC
CARDIOMYOPATHY
Pathophysiology
Increased size of myocardium
reduced ventricular volume
increased resistance to
ventricular filling diastolic
dysfunction
RESTRICTIVE
CARDIOMYOPATHY
Pathophysiology
Rigid ventricular wall
impaired stretch and diastolic
filling decreased output
Diastolic dysfunction
CARDIOMYOPATHIES
Assessment findings
1. PND
2. Orthopnea
3. Edema
4. Chest pain
5. Palpitations
6. dizziness
Medical Management
1. Surgery= heart transplant
2. pacemaker insertion
Oxygen therapy
Nursing Management
3. Reduce patient anxiety
Support patient
Offer information about
transplantations
Support family in anticipatory
grieving
Infective endocarditis
Etiologic factors
1. Bacteria- Organism
depends on several factors
2. Fungi
Infective Endocarditis
Risk factors
1. Prosthetic valves
2. Congenital malformation
3. Cardiomyopathy
4. IV drug users
5. Valvular dysfunctions
Infective endocarditis
Pathophysiology
Direct invasion of microbes
Chronic cardiomyopathies
CHF
Classified according to the
major ventricular
dysfunction:
2. Left Ventricular failure
3. Right ventricular failure
CHF
Etiology of CHF
1. CAD
2. Valvular heart diseases
3. Hypertension
4. MI
5. Cardiomyopathy
6. Lung diseases
7. Post-partum
8. Pericarditis and cardiac tamponade
New York Heart Association
Class 1
Ordinary physical activity does
NOT cause chest pain and
fatigue
No pulmonary congestion
Asymptomatic
NO limitation of ADLs
New York Heart Association
Class 2
SLIGHT limitation of ADLs
NO symptom at rest
Symptoms with INCREASED
activity
Basilar crackles and S3
New York Heart Association
Class 3
Markedly limitation on ADLs
Class 4
SYMPTOMS are present at
rest
CHF
PATHOPHYSIOLOGY
LEFT Ventricular pump failure
peripheral edema
CHF
PATHOPHYSIOLOGY
RIGHT ventricular failure
LABORATORY FINDINGS
1. CXR may reveal
cardiomegaly
2. ECG may identify Cardiac
hypertrophy
3. Echocardiogram may show
hypokinetic heart
CHF
LABORATORY FINDINGS
4. ABG and Pulse oximetry may
show decreased O2 saturation
5. PCWP is increased in LEFT
sided CHF and CVP is
increased in RIGHT sided CHF
CHF
NURSING INTERVENTIONS
1. Assess patient's cardio-
pulmonary status
2. Assess VS, CVP and
PCWP. Weigh patient daily to
monitor fluid retention
CHF
NURSING INTERVENTIONS
3. Administer medications-
usually cardiac glycosides are
given- DIGOXIN or DIGITOXIN,
Diuretics, vasodilators and
hypolipidemics are prescribed
CHF
Cardiotonics To increase cardiac
Positive contractility
inotropic
agents
Diuretics To decrease the
intravascular volume
in the circulation
Low Sodium To minimize water
Diet retention
Hypolipidemic To decrease the lipid
s levels of high risk
CHF
NURSING INTERVENTIONS
Digoxin Health teaching
Oral tablet usually once a day
Increases force of contraction
4.
Morphine is administered to
decreased pulmonary congestion
and to relieve pain, relieve
anxiety
CARDIOGENIC SHOCK
5. Assist in intubation,
mechanical ventilation, PTCA,
CABG, insertion of Swan-Ganz
cath and IABP
6. Monitor urinary output, BP and
pulses
7. cautiously administer diuretics
and nitrates
CARDIAC TAMPONADE
A condition where the heart
is unable to pump blood
due to accumulation of fluid
in the pericardial sac
(pericardial effusion)
CARDIAC TAMPONADE
Causative factors
1. Cardiac trauma
2. Complication of Myocardial
infarction
3. Pericarditis
4. Cancer metastasis
CARDIAC TAMPONADE
3. Increased CVP
6. Anxiety
7. Dyspnea
Laboratory FINDINGS
1. Echocardiogram= shows
accumulated fluid in the
pericardial sac
2. Chest X-ray
CARDIAC TAMPONADE
NURSING INTERVENTIONS
1. Assist in
PERICARDIOCENTESIS
2. Administer IVF
2. Secondary
Due to other conditions like
Pheochromocytoma, renovascular
hypertension, Cushing’s, Conn’s ,
SIADH
HYPERTENSION
PATHOPHYSIOLOGY
Multi-factorial etiology
2. Visual changes
3. chest pain
4. dizziness
5. N/V
HYPERTENSION
DIAGNOSTIC STUDIES
1. Health history and PE
MEDICAL MANAGEMENT
1. Lifestyle modification
2. Diet therapy
3. Drug therapy
HYPERTENSION
MEDICAL MANAGEMENT
Drug therapy
Diuretics
Beta blockers
Calcium channel blockers
ACE inhibitors
A2 Receptor blockers
Vasodilators
HYPERTENSION
NURSING INTERVENTIONS
1. Provide health teaching to
patient
Teach about the disease
process
Elaborate on lifestyle changes
Assist in meal planning to lose
weight
HYPERTENSION
NURSING INTERVENTIONS
1. Provide health teaching to the
patient
Provide list of LOW fat , LOW
sodium diet of less than 2-3
grams of Na/day
Limit alcohol intake to 30 ml/day
Regular aerobic exercise
Advise to completely stop
smoking
HYPERTENSION
Nursing Interventions
2. Provide information about anti-
hypertensive drugs
Instruct proper compliance and not
abrupt cessation of drugs even if pt
becomes asymptomatic/ improved
condition
Instruct to avoid over-the-counter
drugs that may interfere with the
current medication
HYPERTENSION
Nursing Intervention
3. Promote Home care management
Instruct regular monitoring of BP
3. Infection= syphilis
ASSESSMENT
2. Asymptomatic
Ultrasound
X-ray
Aortography
ANEURYSM
Medical Management:
Anti-hypertensives
Synthetic graft
ANEURYSM
Nursing Management:
Administer medications
2. gender
3. family predisposition
PERIPHERAL ARTERIAL
OCCLUSIVE DISEASE
Risk factors for Peripheral Arterial
occlusive disease
Modifiable
1. Smoking
2. HPN
3. Obesity
4. Sedentary lifestyle
5. DM
6. Stress
WALANG
ORIGINA-
LITY!
HHMMPP!
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
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
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
ARTERIOSCLEROSIS OF THE EXTREMITIES
PERIPHERAL ARTERIAL
OCCLUSIVE DISEASE
Assessment Findings
4. Skin is pale when elevated
and cyanotic and ruddy when
placed on a dependent position
5.
Muscle atrophy, leg ulceration
and gangrene
PERIPHERAL ARTERIAL
OCCLUSIVE DISEASE
Diagnostic Findings
1. Unequal pulses between the
extremities
2. Duplex ultrasonography
Probably an Autoimmune
disease
Inflammation of the arteries
and veins thrombus
formation occlusion of the
vessels
BUERGER’S DISEASE
ASSESSMENT FINDINGS
1. Leg PAIN
Foot cramps in the arch
4. Paresthesias
BUERGER’S DISEASE
Diagnostic Studies
1. Duplex ultrasonography
2. Contrast angiography
BUERGER’S DISEASE
Nursing Interventions
1. Assist in the medical and surgical
management
Bypass graft
amputation
Cause : UNKNOWN
Most commonly affects WOMEN, 16-
40 years old
RAYNAUD’S DISEASE
ASSESSMENT FINDINGS
1. Raynaud’s phenomenon
A localized episode of
vasoconstriction of the small
arteries of the hands and feet
that causes color and
temperature changes
RAYNAUD’S DISEASE
W-B-R is the acronym for the color
change
Pallor- due to vasoconstriction,
then
Blue- due to pooling of
Deoxygenated blood
Red- due to exaggerated reflow or
hyperemia
RAYNAUD’S DISEASE
ASSESSMENT FINDINGS
2. Tingling sensation
3. Burning pain on the hands
and feet
RAYNAUD’S DISEASE
Medical management
Drug therapy with the use of
CALCIUM channel blockers
To prevent vasospasms
RAYNAUD’S DISEASE
Nursing Interventions
1. instruct patient to avoid situations
that may be stressful
2. instruct to avoid exposure to cold and
remain indoors when the climate is cold
3. instruct to avoid all kinds of nicotine
4. instruct about safety. Careful handling
of sharp objects
LAUGH BREAK
Dependent edema
VARICOSE VEINS
Laboratory findings
Venography
Duplex scan
pletysmography
VARICOSE VEINS
Medical management
Pharmacological therapy
Leg vein stripping and
ligation
Anti-embolic stockings
VARICOSE VEINS
Nursing management
1. Advise patient to elevate
the legs with pillow to
increase venous return
2. Caution patient to avoid
prolonged standing or
sitting
VARICOSE VEINS
Nursing management
3. Provide high-fiber foods
to prevent constipation
4. Teach simple exercise to
promote venous return
VARICOSE VEINS
Nursing management
5. Caution patient to
avoid constrictive
clothing
VARICOSE VEINS
Nursing management
6. Apply anti-embolic
stockings as directed
7. Avoid massage on the
affected area
DVT- Deep Vein Thrombosis
Inflammation of the deep
veins of the lower
extremities and the pelvic
veins
The inflammation results to
formation of blood clots in
the area
DVT- Deep Vein Thrombosis
Predisposing factors
Prolonged immobility
Varicosities
Traumatic procedures
Increased age
Malignancy
Estrogen therapy
Smoking
DVT- Deep Vein Thrombosis
Complication
PULMONARY
thromboembolism
DVT- Deep Vein Thrombosis
Assessment findings
Leg tenderness
HOMAN’s SIGN
The foot is FLEXED upward
(dorsiflexed) , there is a sharp pain
felt in the calf of the leg
indicative of venous inflammation
DVT- Deep Vein Thrombosis
Laboratory findings
Venography
Duplex scan
DVT- Deep Vein Thrombosis
Medical management
Antiplatelets-aspirin
Anticoagulants
Nursing management
1. Provide measures to avoid
prolonged immobility
Repositioning Q2
Early ambulation
DVT- Deep Vein Thrombosis
Nursing management
2. Provide skin care to
prevent the complication of
leg ulcers
3. Provide anti-embolic
stockings
DVT- Deep Vein Thrombosis
Nursing management
4. Administer anticoagulants as
prescribed