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Perfusion Concept Guide
anastomosis: junction of two vessels aneurysm: a localized sac or dilation of an artery formed at a weak point in the vessel wall angioplasty: an invasive procedure that uses a balloon-tipped catheter to dilate a stenotic area of a blood vessel ankle-brachial index (ABI): ratio of the ankle systolic pressure to the brachial systolic pressure; an objective measurement of arterial disease that provides quantification of the degree of stenosis arteriosclerosis: diffuse process whereby the muscle fibers and the endothelial lining of the walls of small arteries and arterioles thicken atherectomy: an invasive procedure that uses a cutting device or laser to remove or reduce plaque in an artery atherosclerosis: inflammatory process involving the accumulation of lipids, calcium, blood components, carbohydrates, and fibrous tissue on the intimal layer of a large- or medium-sized artery bruit: sound produced by turbulent blood flow through an irregular, tortuous, stenotic, or dilated vessel cyanosis: a bluish tint of the skin manifested when the amount of oxygenated hemoglobin contained in the blood is reduced deep vein thrombosis (DVT): a blood clot or thrombus located within a deep vein that causes obstruction or occlusion
dissection: separation of the weakened elastic and fibromuscular elements in the medial layer of an artery duplex ultrasonography: combines B-mode grayscale imaging of tissue, organs, and blood vessels with capabilities of estimating velocity changes by the use of a pulsed Doppler embolus: a blood clot, fatty deposit, or air that travels through the blood, lodges in an artery or vein, and blocks flow endovascular: a type of procedure that uses a puncture or small incision to place catheters inside a blood vessel to repair it or insert a device intermittent claudication: a muscular, cramplike pain or fatigue in the extremities consistently reproduced with the same degree of exercise or activity and relieved by rest ischemia: deficient blood supply pulmonary embolism (PE): a blood clot or thrombus within a pulmonary artery that blocks or obstructs blood flow to the lungs rest pain: persistent pain in the foot or digits when the patient is resting, indicating a severe degree of arterial insufficiency rubor: reddish-blue discoloration of the extremities; indicative of severe peripheral arterial damage in vessels that remain dilated and unable to constrict stenosis: narrowing or constriction of a blood vessel thromboembolus: a blood clot that may become dislodged from the vessel where it originally formed
Figure 26-1 • Systemic and pulmonary circulation. Oxygen-rich blood from the pulmonary circulation is pumped from the left heart into the aorta and the systemic arteries to the capillaries, where the exchange of nutrients and waste products takes place. The deoxygenated blood returns to the right heart by way of the systemic veins and is pumped into the pulmonary circulation.
2.Identify risk factors for the development of PAD
PAD: Peripheral Artery Disease
Arterial insufficiency of the extremities occurs most often in
men and is a common cause of disability
o The legs are most frequently affected; however, the upper
extremities may be involved. The age of onset and the
severity are influenced by the type and number of
atherosclerotic risk factors (see Chart 26-3).
o In PAD, obstructive lesions are predominantly confined to
segments of the arterial system extending from the aorta
below the renal arteries to the popliteal artery (see Fig. 26-
o Distal occlusive disease is frequently seen in patients with
diabetes and in older patients
Risk Factors Include : Family history of PAD Diabetes Smoking High blood pressure or family history of high blood pressure Stroke or family history of stroke High cholesterol or family history of high cholesterol Coronary artery disease (CAD) Obesity Increasing age, especially after 50 years of age High levels of homocysteine HIV infection
duplex ultrasonography, or other imaging studies described
earlier in this chapter
6.Discuss principles of nursing, medical and pharmacological
management in the treatment of PAD
SET Program
arm-ergometer exercise training
Cilostazol, a phosphodiesterase III inhibitor , is a direct
vasodilator that inhibits platelet aggregation – treatment of
claudification
o decreasing intimal hyperplasia after angioplasty and stenting
o patients prescribed cilostazol report improvement in
maximal walking distance and pain-free walking distance
within 4 to 6 weeks
o This agent is contraindicated in patients with a
history of heart failure
Aspirin or clopidogrel, Antiplatelet agents , prevent the
formation of thromboemboli which can lead to myocardial
infarction (MI) and stroke
o recommended to treat patients with symptomatic PAD
o ADR of Aspirin is gastrointestinal upset or bleeding
Statins improve endothelial function in patients with PAD.
o reduce severity of intermittent claudication and increase
walking distance to the onset of claudication
Endovascular interventions can include
- These revascularization procedures are less invasive than
conventional surgery
- establish adequate inflow to the distal vessels
I. a balloon angioplasty
II. stent
III. stent graft
IV. an atherectomy
Surgeries
Endarterectomy is performed, an incision is made into the artery
and the atheromatous obstruction is removed
Bypass grafts are performed to reroute the blood flow around the
stenosis or occlusion
7.Utilize critical thinking in caring for clients with PAD
Chart 26-4 pg. 830
8.Identify preoperative and postoperative care of client
requiring
surgical management of PAD
During the postoperative period, the nurse’s care focuses on
maintaining circulation, identifying and managing potential
complications, and discharge planning.
Important functions of the vascular system include…
**1) supplying the circulatory needs of tissue
- maintaining blood flow and blood pressure
- providing capillary filtration and reabsorption
- hemodynamic resistance
- and other peripheral vascular regulating mechanisms.**
S/S of PAD
2.Identify risk factors for the development of venous insufficiency This problem is more common in people who have DVT. Other things that may raise the risk of CVI are: o Obesity o Lack of physical activity o Having family members with the same problems o Smoking o Pregnancy
3. Identify assessment findings for venous insufficiency resulting in edema, altered pigmentation, pain, and stasis dermatitis The extent and type of pain are carefully assessed The appearance and temperature of the skin of both legs. The quality of all peripheral pulses is assessed, and the pulses in both legs are compared. The legs are checked for edema. o If the extremity is edematous, the degree of edema is determined. Any limitation of mobility and activity that results from vascular insufficiency is identified. The patient’s nutritional status is assessed
o Hx of… o Diabetes o collagen disease o varicose veins is obtained 4.Explain diagnostic testing for venous insufficiency and nursing Implications The doctor will ask about symptoms and health history. A physical exam may be done. This may be enough to suspect CVI. Images of the veins may be taken. I. This can be done with an ultrasound Nursing interventions include Skin integrity Elevating legs Pt teaching of applying stockings absence of complications IMPROVING PHYSICAL MOBILITY PROMOTING ADEQUATE NUTRITION PROMOTING HOME, COMMUNITY-BASED, AND TRANSITIONAL CARE 5.Differentiate arterial vs venous circulatory insufficiency Venous insufficiency refers to a breakdown in the flow of blood in our veins, while arterial insufficiency stems from poor circulation in the arteries What is the difference between arterial and venous circulation? Whereas arteries specifically carry blood “away” from the heart, veins carry blood “toward” the heart. Generally speaking, arterial vessels contain oxygenated blood, and venous vessels carry blood that is low in oxygen 6.Discuss principles of nursing and medical management in the treatment of venous insufficiency Compression stockings to keep blood from pooling in the legs Regular exercise Procedures to reroute blood flow, such as: Sclerotherapy Ablation Povidone–iodine, cadexomer iodine, and silver, Antiseptic agents , inhibit growth and development of most microbes, are broad spectrum, generate relatively little antimicrobial resistance, and can be used for short periods of time Antibiotics 7.Utilize critical thinking in caring for clients with venous insufficiency
- Demonstrates restored skin integrity a.Exhibits absence of inflammation
Leg swelling Pain in the legs, especially after walking: Aching Dullness Tiredness Cramping Red or brown darkening of the skin on the legs Enlarged veins Leg sores, especially around the inside of the ankles Scaling skin on the legs Hard, leathery skin on the legs
Treatments of Venous Insufficiency
**The goal of treatment is to keep blood flowing and prevent it from pooling in the veins. Ways to do this are: o Compression stockings to keep blood from pooling in the legs o Regular exercise o Procedures to reroute blood flow, such as: o Sclerotherapy o Ablation o External Compression Devices and Bandages o Intermittent Pneumatic Compression Devices
- C. Ulcer from venous stasis**
