Chapter 31

Assessment and Management

of Patients With Vascular
Disorders and Problems of
Peripheral Circulation

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Question

Is the following statement True or False?

Arteries are thick-wall structures that carry blood from the

heart to the tissues.

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Answer

True

Arteries are thick-wall structures that carry blood from the

heart to the tissues.

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Vascular System

Arteries and arterioles

Capillaries
Veins and venules
Lymphatic vessels
Function of the vascular system

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Systemic and Pulmonary Circulation

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Peripheral Blood Flow

Flow rate = P/R

Movement of fluid across the capillary wall; hydrostatic
and osmotic force
Hemodynamic resistance
Blood viscosity
Vessel diameter
Regulation of peripheral vascular resistance

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Question

Is the following statement True or False?

Intermittent claudication is caused by the inability of the

venous system to provide adequate blood flow to the
tissues in the face of increased demands for nutrients
and oxygen during exercise.

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Answer

False

Intermittent claudication is caused by the inability of the

arterial system, not the venous system, to provide
adequate blood flow to the tissues in the face of
increased demands for nutrients and oxygen during
exercise.

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Assessment

Characteristics of arterial and venous insufficiency

Intermittent claudication
Rest pain
Changes in skin and appearance
Pulses
Aging changes

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Assessing Peripheral Pulses

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Peroneal, Dorsalis Pedis, and Posterior
Tibial Pulse Sites

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Continuous-wave Doppler ultrasound detects
blood flow, combined with computation of ankle
or arm pressures; this diagnostic technique helps
characterize the nature of peripheral vascular
disease.

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Color Flow Duplex Image

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Nursing Process: The Care of the Patient
with Peripheral Arterial Insufficiency
Assessment
Health history
Medications
Risk factors
Signs and symptoms of arterial insufficiency
Claudication and rest pain
Color changes
Weak or absent pulses
Skin changes and skin breakdown
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Nursing Process: The Care of the Patient
with Peripheral Arterial Insufficiency
Diagnoses
Altered peripheral tissue perfusion
Chronic pain
Risk for impaired skin integrity
Knowledge deficient

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Nursing Process: The Care of the Patient
with Peripheral Arterial Insufficiency
Planning
Major goals include increased arterial blood supply,
promotion of vasodilatation, prevention of vascular
compression, relief of pain, attainment or maintenance of
tissue integrity, and adherence to self-care program.

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Improving Peripheral Arterial Circulation

Exercises and activities: walking, graded isometric

exercises. Note: consult primary health care provider
before prescribing an exercise routine
Positioning strategies
Temperature; effects of heat and cold
Stop smoking
Stress reduction

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Maintaining Tissue Integrity

Protection of extremities and avoidance of trauma

Regular inspection of extremities with referral for
treatment and follow-up for any evidence of infection or
inflammation
Good nutrition, low-fat diet
Weight reduction as necessary

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Progression of Atherosclerosis

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Common Sites of Atherosclerotic
Obstruction

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Risk Factors for Atherosclerosis and PVD
Modifiable Nonmodifiable
Nicotine Age
Diet
Gender
Hypertension
Familial
Diabetes predisposition/genetics
Obesity
Stress
Sedentary lifestyle
C-reactive protein
Hyperhomcysteinemia
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Question

What is a nonmodifiable risk factor for atherosclerosis and

PVD ?
A.Hypertension
B.Diabetes
C.Obesity
D.Familial predisposition/genetics

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Answer

Hypertension, diabetes, and obesity are modifiable

risk factors for atherosclerosis and PVD. Familial
predisposition/genetics is a nonmodifiable risk factor.

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Medical Management

Prevention
Exercise program
Medications
Pentoxifylline (Trental) and cilostazol (Pletal)
Use of antiplatelet agents
Surgical management

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Buergers DiseaseThromboangitis
Obliterans

Recurring inflammatory process of the small and

intermediate vessels of (usually) the lower extremities;
probably an autoimmune disorder.
Most often occurs in men ages 20 to 35.
Risk or aggravating factor: tobacco.
Progressive occlusion of vessels results in pain, ischemic
changes, ulcerations, and gangrene.

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Raynaud's Disease

Intermittent arterial vasoocclusion, usually of the fingertips

or toes.
Raynaud's phenomenon is associated with other underlying
disease such as scleroderma.
Manifestations: sudden vasoconstriction results in color
changes, numbness, tingling, and burning pain.
Episodes are usually brought on by a trigger such as cold
or stress.
Occurs most frequently in young women.
Protect from cold/other triggers. Avoid injury to
hands/fingers.
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Question

What is an aneurysm?
A.Junction of two vessels.
B.Narrowing of constriction of a vessel.
C.A localized sac or dilation of an artery formed at a weak
point in the vessel wall.
D.Sound produced by turbulent blood flow through an
irregular, tortuous, stenotic, or dilated vessel.

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Answer

An aneurysm is a localized sac or dilation of an artery

formed at a weak point in the vessel wall. Anatomosis is
a junction of two vessels. Stenosis is narrowing of
constriction of a vessel. Bruit is the sound produced by
turbulent blood flow through an irregular, tortuous,
stenotic, or dilated vessel.

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Other Disorders

Aortoiliac disease
Aneurysms
Thoracic aortic aneurysm
Abdominal aortic aneurysm
Aortic dissection

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Aortoiliac Endarterectomy

Refer to fig. 31-10

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Characteristics of Arterial Aneurysms

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Repair of an Ascending Aortic Aneurysm

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AneuRx Endograft Repair of Abdominal
Aortic Aneurysm

Refer to fig. 31-13

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Venous Thromboembolism

Pathophysiology
Risk factors
Endothelial damage
Venous stasis
Altered coagulation
Manifestations
Deep veins
Superficial veins

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Blood flow and function of valves in veins.
Note impaired blood return due to
incompetent valve.

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Preventive Measures

Elastic hose
Pneumatic compression devices
Subcutaneous heparin or LMWH, warfarin (Coumadin) for
extended therapy
Positioning: periodic elevation of lower extremities
Exercises: active and passive limb exercises, and deep
breathing exercises
Early ambulation
Avoid sitting/standing for prolonged periods; walk 10
minutes every 1-2 hours.

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Nursing Process: The Care of the Patient
with Leg UlcersAssessment

History of the condition

Treatment depends upon the type of ulcer
Assess for presence of infection
Assess nutrition

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Arterial Ulcer, Gangrene Due to Arterial
Insufficiency, and Ulcer Due to Venous
Stasis

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Medical Management

Anti-infective therapy is dependent upon infecting agent

Oral antibiotics are usually prescribed.
Compression therapy
Debridement of wound
Dressings
Other

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Nursing Process: The Care of the Patient
with Leg Ulcers- Diagnoses

Impaired skin integrity

Impaired physical mobility
Imbalanced nutrition

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Collaborative Problems/Potential
Complications

Infection
Gangrene

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Nursing Process: The Care of the Patient
with Leg UlcersPlanning

Major goals include restoration of skin integrity, improved

physical mobility, adequate nutrition, and absence of
complications.

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Mobility

With leg ulcers, activity is usually initially restricted to

promote healing
Gradual progression of activity
Activity to promote blood flow; encourage patient to
move about in bed and exercise upper extremities
Diversional activities
Pain medication prior to activities

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Other Interventions
Skin integrity
Skin care/hygiene and wound care
Positioning of legs to promote circulation
Avoidance of trauma
Nutrition
Measures to ensure adequate nutrition
Adequate protein, vitamin C and A, iron, and zinc are
especially important for wound healing
Include cultural considerations and patient teaching in
the dietary plan
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Cellulitus and Lymphatic Disorders

Cellulitus: infection and swelling of skin tissues

Lymphangitis: inflammation/infection of the lymphatic
channels
Lymphadenitis: inflammation/infection of the lymph
nodes
Lymphedema: tissue swelling related to obstruction of
lymphatic flow
Primary: congenital
Secondary: acquired obstruction

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