cardiac disorders handout.doc

7/28/2019 cardiac disorders handout.doc

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CARDIAC DISORDER PATHOPHYSIOLOGY ASSESSMENT FINDINGS INTERVENTIONS MEDICATIONS

I. DYSRYTHMIAS- are disorders of the formation and/or

conduction of the electrical impulses withinthe heart. These disorders can causedisturbances of the hearts rate, rhythm, orboth.

A. SINUS DYSRYTHMIAS

A.1 Sinus Bradycardia- when the sinus node createsan impulse at a slower-than-normal rate

A.2 Sinus Tachycardia- occurs when the sinus nodecreates an impulse at a faster-than-normal rate.

A.3 Sinus Arrythmia-occurs when the sinus nodecreates an impulse at anirregular rhythm; the rate usuallyincreases with inspiration anddecreases with expiration.

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B. ATRIAL DYSRYTHMIAS

B.1 Premature Atrial Complex(PAC)- An ectopic beat that originatesin the atria and is discharged ata rate faster than that of SANode

Sinus Node slows because of stimulationof the parasympathetic fibers (vagalnerve).

The sympathetic fibers are stimulatedthereby, speed up excitation of the SANode

An Irregularity in rhythm which is related torespiratory exchange occurs when the SANode creates an impulse at an irregularrhythm

Occurs when an electrical impulse startsin the atrium before the next normalimpulse of the sinus node.

ECG:Ventricular and Atrial Rate: 100bpm inAdult, Ventricular and Atrial Rhythm:Irregular, QRS Shape and Duration: Usuallynormal, but maybe regularly abnormal, PWave: Normal and consistent shape, always infront of the QRS but maybe buried in thepreceding T Wave PR Interval: Consistentinterval between 0.12-0.20 s, P:QRS- 1:1

ECG:Ventricular and Atrial Rate: 60-100bpm inAdult, Ventricular and Atrial Rhythm:Irregular, QRS Shape and Duration: Usuallynormal, but maybe regularly abnormal, PWave: Normal and consistent shape, always infront of the QRS, PR Interval: Consistentinterval between 0.12-0.20 s, P:QRS- 1:1

ECG:Ventricular and Atrial Rate: Depends on the

underlying cause, Ventricular and AtrialRhythm: Irregular due to early P Waves,creating a PP interval that is shorter than theothers. This is sometimes followed by a longer-than-normal PP interval, but one that is lessthan twice the normal PP interval. This type ofinterval is called a NONCOMPENSATORYPHASE QRS Shape and Duration: The QRSthat follows the early P wave is usually normal,but it maybe abnormal. It maybe absent(blocked PAC) , P Wave: An early and diff. Pwave may be seen in the Y-wave, other Pwaves in the strip are consistent, PR Interval:

If the decrease in HR results fromstimulation of the vagus nerve, such asbearing down during defecation orvomiting, attempts are made to preventfurther vagal stimulation

Treat the underlying cause (fever, shock,Fluid and Electrolyte disturbances)

Sinus arrhythmia does not cause anysignificant hemodynamic effect and usuallyis not treated

If PACs are insufficient, no treatment.

Atropine Sulfate 0.5-1.0 mg/IVP toblock vagal stimulation

Isoproterenol 1mg/500 mL D5W to

stimulate sympathetic response Pacemaker (transcutaneous

pacing)

Digitalis Administration

Calcium Channel Blockers

Beta Blockers

No medications given.

If it increases in frequency (>6/min),Quinidine or Calcium Channel

Blocker maybe necessary


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I. CORONARY ARTERY DISEASE-most common is atherosclerosis, which is

an abnormal accumulation of lipid, or fattysubstances and fibrous tissue in thevessel of the wall. These substancescreate blockages or narrow the vessel in away that reduces blood flow to themyocardium.

ANGINA PECTORIS- clinical syndrome usually characterized

by episodes or paroxysms of pain orpressure in the anterior chest. The cause

CADbegins as fatty streaks, lipids that are

deposited in the intima ofthe arterial wall. Although,they are thought to be theprecursors ofatherosclerosis, fattystreaks are common evenin childhood. Moreover,not all develop into moreadvanced lesions. Thereason why fatty streakscontinue to develop isunknown, althoughgenetic and environmentfactors are involved. Thecontinued development of

CAD involves aninflammatory response. Tl ymphocytes andmonocytes infiltrate thearea to ingest the lipidsand then die; this causessmooth muscle cells

within the vessel toproliferate an die; thiscauses smooth musclecells within the vessel toproliferate and from afibrous cap over the deadfatty core. These depositscalled atheromas or

plaques, protrude into thelumen of the vessel,narrowing it andobstructing blood flow. Ifthe f ibrous cap of theplaque is thick and thel ipid pool r emainsrelatively stable, it can

Angina Pectoris

Myocardial Ischemia (acute onset of chest

pain)

Heart Failure

ECG abnormalities

High levels of cardiac enzymes

Dysrythmias

CAD is believed to result from inflammationof the arterial endothelium. C-reactive

Controlling Cholesterol Abnormalities

CABG

Dietary Measures

Regulating Physical Activity

Promoting cessation of tobacco use

Treatment

1. Percutaneous TransluminalCoronary Angioplasty

2. Percutaneous TransluminalRevascularization (PTMR)

3Hydroxy-3methylglutaryl

coenzyme A (HMG-CoA) reductase

inhibitors or statins block

cholesterol synthesis, lower LDL and

triglyceride levels, and increase HDL

levels.

Nicotinic acids decrease

lipoprotein synthesis, lower LDL and

triglyceride

Fibric Acid or fibrates decrease

synthesis of cholesterol

Vasodilators (Nitrates)

Beta- adrenergic blockers

Calcium channel blockers


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is usually insufficient coronary blood flow.

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MYOCARDIAL INFARCTION- formation of localized necrotic areaswithin the myocardium.- Prolonged ischemia lasting morethan 35 45 minutes producesirreversible cellular damage and necrosisof the myocardium

resist the stress fromblood flow and vesselmovement. If the cap isthin, the lipid core maygrow causing it to ruptureand hemorrhage into thep laque, a llowing athrombus to develop. Thethrombus may obstructblood flow, leading to

sudden cardiac death oran cute MI which is thedeath of heart tissue.

Atherosclerosis, hypertension, DM,thromboangitis obliterans, polycythemiavera, aortic regurgitation coronarytissue perfusion myocardialoxygenation anaerobic metabolism lactic acid production (lacticacidosis) angina

Several factors are associated with anginal

pain:1. physical exertion which can

precipitate an attack by

myocardial o2 demand2. Exposure to cold which can

cause vasoconstriction and an

elevated BP with O2 demand

3. Eating a heavy meal which

blood flow to the mesentericarea for digestion, therebyreducing the blood supplyavailable to the heart muscle

4. Stress which increases thesympathetic response

protein (CRP) is a marker for inflammationof vascular endothelium. High bloodlevels of CRP have been associated withincreased coronary artery calcification andrisk of an acute cardiovascular event inseemingly healthy individuals. There isinterest in using CRP blood levels as anadditional risk factor for cardiovasculardisease in clinical use and research.

An elevated blood level of homocysteine, anamino acid, has also been proposed as anindependent risk factor for cardiovasculardisease. However, studies have notsupported the relationship between mild tomoderate elevations of homocysteine andatherosclerosis. No study has yet shownthat reducing homocysteine levels reducesthe risk for CAD.

CLINICAL MANIFESTATIONS

Pain described as transient, paroxysmalsubsternal or precordial pain. Heaviness ortightness of the chest, indigestion,crushing, Radiates down both arms, leftshoulder, jaw, neck and back. Precipitatedby activity or exertion and relieve by rest ornitroglycerine

Diaphoresis

Dyspnea

Pallor Faintness

Palpitations

Dizziness

Digestive Disturbance due to vagalsimulation

Pain Crushing, severe, prolonged,unrelieved by rest or nitroglycerine,often radiating to one or both arms, theneck and back - Characterized byLevines sign

Anxiety and Apprehension

-feeling of doom, restlessness

Shock -systolic pressure below80mmHg, gray, facial color, lethargy,cold diaphoresis, peripheral cyanosis,Tachycardia/ Bradycardia, weak pulse

Oliguria -


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MI is usually caused by reduce bloodflow in a coronary artery due toatherosclerosis and occlusion of anartery by an embolus or thrombus.Because unstable angina and acuteMI are considered to be the same

process. Other causes of MI includevasospasm of coronary artery,

oxygen supply and demand for O2.

In each case, a profound imbalanceexists between myocardial supplyand demand.

Fever-slight elevation of temp. occurswithin 24 hours and extends 3-7 daysaccompanied by leukocytosis andelevated ESR

Indigestion -gas pains around the heart,nausea and vomiting

Acute Pulmonary Edema-sense ofsuffocation, Dyspnea, orthopnea,

gurgling/ bubbling respiration

ECG changes - MI causes elevation ofST segment, inversion of T wave andenlargement of the Q wave

Elevated CK-MB, LDH, AST

6. Bed rest is usually prescribed for 24-

48 hours to o2 demand.

Progressive ambulation isimplemente4ted ASAP, unless thereare complications

Nursing Management

1. Promote oxygenation and tissueperfusion

2. Promote adequate Cardiac

Output3. Promote Comfort4. Provide rest

5. Promote gradual in activity

6. Promote Proper Nutrition andElimination

7. Promote Relief of Anxiety andFeeling of Well-Being

8. Facilitate learning


II. ACQUIRED VASCULARDISEASE

MITRAL VALVE PROLAPSE- formerly known as mitral prolapsesyndrome, is a deformity that usuallyproduces no symptoms. Rarely, itprogresses and can result in suddendeath.

IN MVP, a portion of a mitral leafletballoons back into the atrium duringsystole. Rarely, the ballooning stretchesthe leaflet to the point that the valvedoesnt remain closed during systole.Blood then regurgitates form the LVback into the LA

Maybe asymtomatic

fatigue, shortness of breath

light-headedness, dizziness,syncope, palpitations, chest painand anxiety

Physical Examination of the heartdiscloses an extra heart soundreferred as mitral click

Symptoms of Heart Failure

Medical Management:1. Symptomat ic2. Advised to eliminate caffeine

and alcohol3. Stop smoking

Surgical Intervention

1. Mitral Valve Repair orReplacement in advancedstages

Nursing Management:1. Health education2. Instruct patients to take the

prescribed medications on timeand complete the drug

3. Tell the patients to avoidcaffeine and alcohol


Beta Adrenergic Blockers


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MITRAL STENOSIS

AORTIC REGURGITATION- is the flow of blood back into the left

ventricle from the aorta during diastole. Itmay be caused by inflammatory lesionsthat deform the leaflets of the aortic valve,preventing them form completely closingthe aortic valve orifice.

Normally, the mitral valve opening is aswide as the dm. Of 3 fingers. In cases ofmarked stenosis, the opening narrows to

the width of a pencil. The LA has greatdifficulty moving blood into the ventricle

because of the resistance of the

narrowed ori fice; i t d ilates and

hypertrophies because of BV it holds.

Because there is no valve to protect thepulmonary veins from the backward flow ofblood from the atrium, the pulmonarycirculation becomes congested. As aresult, the RV must contract against anabnormally high pulmonary arterialpressure and is subjected to excessivestrain. Eventually the RV fails.

Blood from Aorta LV (diastole) LV

dilates and hypertrophies arteries try to

compensate for the pressure (reflex

vasodilation) peripheral arterioles

relax peripheral resistance and

diastolic BP

The pulse is weak and often irregularlybecause of atrial fibrillation. A low-pitched,rumbling, diastolic murmur is heard at the

apex. As a result of the increased bloodvolume and pressure, the atrium dilates,hypertrophies, and becomes electricallyunstable, and the patient experiences atrialdysrythmias. Echocardiography is used todiagnose mitral stenosis. ECG and cardiaccatherterization with angiography are usedto determine the severity of the mitralstenosis.

A diastolic murmur is heard as a high-pitched,blowing sound at the third or fourth intercostalsspace at the left sternal border. The pulsepressure is considerably widened in patientswith aortic regurgitation. One characteristic signof the disease is the water-hammer pulse, inwhich the pulse strikes the papating finger witha quick, sharp stroke and then suddenlycollapses.

Asyymptomatic

forceful heart beat

marked arterial pulsations that are palpable

exertional Dyspnea

fatigue

progressive signs of LCHF

diastolic murmur at the 3 rd or 4th ICS at theleft sternal border

Wide Pulse Pressure

WATER hammer pulse

Diagnosis confirmed by 8D- Echo, MRI ,radionuclide imaging and

4. Encourage the patient to readdrug labels carefully

5. Explore with the patientspossible diet, activity, sleep andother lifestyle

Medical management

1. Antibiotic prophylaxis therapy2. T reat CHF

Surgical Management:1. Valvuloplasty2. Mitral Valve Replacement

Nursing Management:1. Health education2. Instruct patients to take the

prescribed medications on timeand complete the drug

3. Tell the patients to avoidcaffeine and alcohol

4. Encourage the patient to readdrug labels carefully

5. Explore with the patients

possible diet, activity, sleep andother lifestyle

Medical Management1. Antibiotic prophylaxis2. Treat dysrythmias and HF

Surgical Management:1. Aortic valvuloplasty2. Valve Replacement

Nursing Intervention:1. Health education2. Instruct patients to take the

prescribed medications on time

and complete the drug3. Tell the patients to avoid

caffeine and alcohol4. Encourage the patient to read

drug labels carefully5. Explore with the patients

possible diet, activity, sleep and

Prophylactic Antibiotics

Anticoagulants - Warfarin

(Coumadin)

Prophylactic Antibiotics


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AORTIC STENOSIS- aortic valve is narrowing of theorifice between the left ventricle and the

aorta.

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Progressive narrowing of the valve

orifice LV obstruction pressure on

LV thickening of the muscle wall

heart muscle hypertrophies HeartFailure

Cardiac catheterization

Asymtomatic

exertional Dyspnea

dizziness and syncope angina pectoris

Low BP

rough-loud systolic murmur is heard in theaortic area

systolic crescendo-decrescendo murmur

LVH- 12 lead ECG

2D-Echo- diagnose and monitor theprogression

Pressure tracings form the aortahigher systolic pressure in the LV thanthe aorta during systole

other lifestyle

MEDICAL MANAGEMENT1. Antibiotic prophylaxis to prevent

endocarditis

SURGERY: replacement of aortic valve

Patients who are symptomatic and arenot surgical candidates may benefitform 1 or 2 balloon PercutaneousValvuloplasty


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III. CADIOMYOPATHY- is a heart muscle disease associated with

cardiac dysfunction. It is classifiedaccording to the structural and functionalabnormalitites of the heart muscle.

V. INFECTIOUS DISEASES OF THEHEART

PERICARDITIS- refers to an infection of t he pericardium,the membranous sac enveloping the heart

Stroke Volume SNS and RAA

Systemic Vascular Resistance Na

and water retention workload of the

heart Heart Failure

Underlying Cause: idiopathic, viral andbacterial infection, disorders of connectivetissue, hypersensitivity states, disorders ofadjacent structures, neoplastic disease,radiation therapy, trauma, renal failure and

uremia, TB accumulation of fluid in the

pericardial sac pressure on the

heart

cardiac tamponade

stable and asymptomatic

signs and symptoms of Heart Failure

PND

orthopnea

fluid retention

peripheral edema

nausea

chest pain

palpitations

dizziness

syncope with exertion

sudden death with HCM

Tachycardia and extra heart sounds

2D Echo and ECG

CXR

Cardiac Cath to rule out coronary arterydisease as a cause

Endomyocardial biopsy

Pain in the anterior chest, aggravated bycoughing, yawning, swallowing, twistingand turning the torso; relieve by upright,leaning forward position

Pericardial friction rub

Dyspnea

Fever, sweating, chills

Joint pains Arrhythmias

Medical management:1. Treat the underlying cause2. Low Na d ie t3. Exercise Rest Regimen4. Control dysrythmias with

medications5. If there are symptoms of CHF

limit fluid intake into 2 L/day

6. Pacemaker

Surgical Management

1. Heart Transplantation2. LVAD3. Left Ventricular Outflow Tract

Surgery

Nursing Management

1. I mprove CO2. Increase activity tolerance3. Reduce anxiety4. Decrease the sense of

powerlessness5. Promote Self-Care6. Promote Home and Community-

Based care7. Continuing Care

Medical and Surgical Management:1. Determine the cause, administer

therapy and be alert for cardiactamponade

2. Pericardiocentesis3. Pericardictomy

Nursing Management:

1. Elevate HOB. Place pillow onthe overbed table so that thepatient can lan on it

2. Bed rest3. Administer prescribed

pharmacotherapy4. Assist in pericardiocentesis

Antidysythmic drugs for dysrythmia

Analgesics

NSAIDS

Cortocosteroids


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INFECTIVE ENDOCARDITIS- is the infection of the valves and the

endothelium surface of the heart.

MYOCARDITIS- is an inflammatory process involving themyocardium. Myocarditis can cause heartdilation, thrombi on the heart wall,infiltration of circulating blood cells aroundcoronary vessels and between the musclefibers.

The invasion of bacteria producesvegetative growths on the heart valves, theendocardial lining or the endothelium of ablood vessel that may embolize thespleen, kidneys, CNS and lungs

Viral, bacterial, fungal, parasitic, protozoal

infection inflammation in one small area

and spread throughout the myocardium

myocarditis

nonspecific and include malaise weakness,anorexia, athralgia, night sweats, chills,valvular insufficiency and intermittentfever for weeks

loud regurgitant murmur

embolization of other vital organs

chest pain

dysrythmias

cardiomegaly faint heart sounds

gallop rhythm

systolic murmur

Medical and Surgical Management:

Supportive treatment- bed rest

Surgical valve replacement

aortic or mitral valve excision arerequired

Nursing Management:

Monitor vital signs

Assess signs of organ damage

Administer pharmacotherapy

Instruct activity restrictions,medications and signs andsymptoms of infection

Emotional support

Coping strategies

If patient received surgicalmanagement, strict post-op careis observed

Medical and Surgical Management:

Bed rest

Limit sports or strenuousactivities for 6 months

Physical activity is increasedslowly

If develops heart failuremanagement is essentially thesame

Nursing Management:

Monitor VS

Proper cardiac monitoring

Elastic compression stockings

Passive and active exercisesshould be used

Instruct the patient not to takeaspirin, take caution when takingcorticosteroids

Antibiotic therapy

Antipyretics

Antibiotic therapy

corticosteroids

Antipyretics


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VI. COMPICATIONS FROM HEARTDISEASES

CONGESTIVE HEART FAILURE

CARDIOGENIC SHOCK (POWER/PUMPFAILURE)

Heart Damage, Ventricular Overload,

Ventricular Contraction it may lead to

Tachycardia, ,ventricular dilatation.

Myocardial hypertrophy CO

renal perfusion Na retentionosmotic pressure ADH water

absorption edema heart failure

MASSIVE MI Myocardial Contractility

CO Hypoperfusion (heart, brain ,

kidney) Tissue Hypoxia Organ

Damage Death

Left CHF

Dyspnea

PND

Orthopnea

Rales /Crackles

Moist cough

wheezing blood tinged frothy sputum

syncope

fatigue

weakness

anorexia

hypokalemia

clubbing of fingers

polycythemia

S3,S4 sounds, pulsus alternans

PAO, PWCP, LVEDP

Right CHF

Jugular Vein Engorgement

Hepatomegaly

Splenomegaly Portal Hpn

Ascites

Peripheral Edema

Jaundice

Hemolytic Anemia

Internal Hemorrhoids

Weight gain

Leg Varicosities

Cardiac cirrhosis

Extra Heart Sounds

Elevated CVP reading

1. Systolic Blood Pressure

2. Oliguria

3. Cod, clammy skin, weak pulse,cyanosis due to circulatoryinsufficiency

4. mental lethargy, confusion due topoor cerebral perfusion

Oxygen therapy

balanced program of activity andrest

Sodium restricted to preventfluid excess

Nursing Management

Provide Oxygenation

Provide rest and activity

Decrease anxiety

Facilitate fluid balance

Provide skin care

Promote proper nutrition

Promote elimination

Facilitate learning

If acute pulmonary edema occurs:

High Fowlers position

Morphine Sulfate

Oxygen therapy

Aminophylline Rapid digitalization

Diuretic therapy

Vasodilators

Dopamine or dobutamine

Monitor serum K

Medical and Nursing Management1. Perform hemodynamic

monitoring:PAP, PWCP

measurements, Intraarterial BP2. Administer oxygen therapy3. Correct Hypovolemia4. Administer IV fluids as ordered5. Monitor I and O, LOC,

arrhythmias6. Provide psychosocial support7. Decrease pulmonary edema

Digitalis Therapy

Diuretic Therapy

Vasodilators

Vasodilators

Inotrophic Agents

Diuretics


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8. Utilize counterpulsation todecrease ventricular work withsevere shock


VII. PERIPHERAL VASCULARDISORDERS

HYPERTENSION

ARTERIOSCLEROSIS

RISK FACTORS: Family History. Age,

High Salt Intake, Low K intake, Obesity,Excess Alcohol Consumption, Smoking,

Stress Changes in Arteriolar Bed

Systemic Vascular Resistance

Afterload Blood Flow to Organs

Renal Perfusion, BP, Beta receptor

activation Juxtaglomerular cells

(Hypovolemia and hyponatremia )

Renin Angitensinogen (ACE)

Angiotensin 1 (ACE) Angiotensin II

Arteriolar vasoconstriction Peripheral

Vascular Resistance

The most common direct result ofartherosclerosis include narrowing of thelumen, obstruction, aneurysm, ulcerationand rupture. Its indirect results aremalnutrition and subsequent fibrosis of theorgans. All actively functioning tissue cellsrequire an abundant supply of nutrientsand oxygen and are sensitive to anyreduction in the supply of these nutrients. Ifsuch reductions are severe and

permanent, the cell undergoes necrosisand is replaced by fibrous tissue, whichrequire lesser blood flow.

headache. The most characteristic

sign epistaxis

dizziness

tinnitus

unsteadiness

blurred vision

depression

nocturia

retinopathy,papilledema

Maybe asymptomatic

Intermittent claudication is anaching, persistent cramplikesqueezing pain that occurs after acertain amount of exercise of theaffected extremity. It is relieved byrest

Coldness or cold sensitivity

Color changes

Ulceration and gangrene

Edema

Sexual dysfunction

Prevention

a. PrimaryModeration in Na intake,

saturated fats, maintenance ofIBW, maintenance of regularpattern of exercise, cessation ofcigarette smoking, moderation inalcohol consumption, stressreduction

b. SecondaryControl of HPN in high risk groups

NURSING INTERVENTIONS:1. Patient teaching and counseling2. Teaching about medication3. Prevent non-compliance

Primary, Secondary TertiaryPrevention

Quit smoking

Control serum lipid levels

Skin and foot care

Low fat, low cholesterol

Daily walking program

SURGICAL MANAGEMENT

1. Bypass Graft2. Endarterectomy

3. Endovascular Surgery4. Balloon angioplasty5. Laser angioplasty6. Stent7. Amputat ion

NURSING INTERVENTION1. Promote Tissue Perfusion

1. Diuretics

a. Thiazidesb. Loopc. Potassium sparing

2. Adrenergic Inhibitorsa. Beta Adrenergic

Blockersb. Centrally acting

alpha blockersc. Peri pheral ly acting

Adrenergic antagonistsd. Alpha-1 adrenergic

blockerse. Vasodilatorsf. ACE Inhibitorsg. Calcium Channel

Blockers3.ACE inhibitors4. Angiotensin II receptor blockers

Vasodilators

Antihyperlipidemics


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PERIPHERAL ARTERIALOCCLUSIVE DISEASE

AORTIC ANEURYSM

RAYNAUDS DISEASE

Atheromatous plaques blood flow

tissue Ischemia

tissue hypoxia

necrosis ulceration and gangrene

Hypertension Alteration in integrity of its

wall irreversible. Localized dilatation of

an artery

Cold exposure, stress Digital artery

Contraction/ Spasm Occlusion of

intermittent Claudication

Coldness or cold sensitivity

Color changes

Ulceration and gangrene

Sexual dysfunction

Impaired arterial pulsation

Edema

pulsatile mass over the abdomen

Low back pain

Lower abdominal pain

Flank pain

Collapse

Shock

Possible complication is rupture,causing massive internalhemorrhage, shock and death

pallor

cyanotic

2. Maintain Skin Integrity andPrevent Infection

3. Promote Activity4. Prevent Injury

MEDICAL MANAGEMENT

Exercise Program combinedwith weight reduction andcessation of tobacco and alcoholuse

SURGICAL MANAGEMENT

Bypass Graft

Endarterectomy

Endovascular Surgery

Balloon angioplasty

Laser angioplasty

Stent

Amputation

MEDICAL MANAGEMENT

1. Medicat ions

Surgery:If greater than 4 cmTeflon/Dacron/gortex graft may be used ina surgical repair

NURSING INTERVENTION AFTERSURGERY:1. Monitor VS and hemodynamic

measurements, urine output, BUNcreatinine, bowel sounds peripheralpulses

2. Promote Fluid Volume by checkingexcessive drainage, Hgb and Hct

levels

MEDICAL MANAGEMENT

Avoid exposure to cold

Quit smoking

Teach effects of smoking

Vasodilators

Antihyperlipidemics

Antihypertensives



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THROMBOPHLEBITIS

DEEP VEIN THROMBOSIS

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VARICOSE VEINS

arteries Tissue Ischemia Tissue

Hypoxia Tissue Necrosis Tissue

Ulceration Gangrene

Results form venous thrombosis andinflammation in a superficial vein

Venous Stasis, Vessel Wall Injury,

Hypercoagulability of the Blood DVT

Congenital absence of valves of the veins,hereditary weakness of the valves,

color sequence: white-blue-red

numbness, tingling and burning pain

pain

tenderness

palpable induration along the courseof vein

no edema

calf pain (+) Homan Sign

edema

tenderness

palpable induartion along the courseof the brain

dilated, purplish, tortuous veins

leg pain

Teach to avoid exposure to cold

Discuss importance of reducingemotional stress

Avoid drugs that causesvasoconstriction such as pills,beta blockers and ergotamines

Surgery

1. Amputation - Sympathectomy to relievevasospastic symptoms

MEDICAL MANAGEMENT;

Bed rest with leg elevation

Local moist heat application

Compression support stockings

NURSING INTERVENTIONS:

Prevent venous stasis

Prevent recurrence

Maintain IBW

Alternate standing with sitting atwork or at home

Regular Patterns of exercise

MEDICAL MANAGEMENT:

Minimize intake of green leafyvegetables

SURGERY:

Thromboembolectomy

Greenfield vena cava fiber toprevent pulmonary embolism

NURSING INTERVENTIONS:

Maintaining tissue perfusion

Promote comfort

MEDICAL MANAGEMENT:

Elevation of affected limp for 15-30 min at a time. Average of 20min.]

Compression with support

Vasodilators

NSAIDS

NSAID

Non-narcotic analgesic

Anticoagulation therapy

Thrombolytics

1.Analgesics as ordered


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BUERGERS DISEASE(Thromboangitis Obliterans)

prolonged sitting or standing, wearing ofconstricting clothing, obesity,thrombophlebitis, pregnancy, RCHF, liver

cirrhosis effects of gravity on venous

pressure dilated, prominent veins

Diffuse inflammation of the small and

medium arteries then veins

leg edema

heaviness in the legs

Intermittent Claudication

Skin Cyanosis

Pain

stockings

Sclerotherapy

Early ambulation

SURGERY:1. Vein ligation and stripping to

relive pain

NURSING INTERVENTION

1. Wear elastic stockings during

activities requiring long periodsof standing or during pregnancy

2. Moderate exercise and elevatethe legs during sitting

3. Proper post-operative care

Medical Management:1. eliminate smoking

Surgery:

1. Sympathectomy2. Amputation of ulcerated fingers

and toes

Nursing Management:

1. during activities requiring longperiods of standing or duringpregnancy

2. Moderate exercise and elevatethe legs during sitting

3. Proper post-operative care

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Anticoagulants


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