Raynaud's

disease
Raynaud’s disease
• Vasospasms of arterioles and arteries
of the upper and lower extremities.
• Vasospasm causes constriction of the
cutaneous vessels.
• Attacks are the intermittent and occur
with exposure to cold or stress.
• Affects primarily fingers, toes, ears
and cheeks.
assessment
• Blanching of the extremity, followed by
cyanosis during vasoconstriction.
• Reddened tissue when the vasospasm is
relieved.
• Numbness, tingling, swelling and a cold
temperature at the affected body part.
interventions
o Monitor pulses.
o Administer vasodilators as prescribed.
o Instruct the client regarding medication therapy.
o Assist the client to identify and avoid
precipitating factors such as cold and stress.
o Instruct the client to avoid smoking.
o Instruct the client to wear warm clothing, socks
and gloves in cold water
o Advise the client to avoid injuries to fingers and
hands.
Buerger’s
disease
Buerger’s disease
 An occlusive disease of the media and small
arteries and veins.
 The distal upper and lower limbs are affected
most commonly
assessment
 Intermittent claudication.
 Ischemic pain occurring in the digits while at rest
 Aching pain that is more severe at night.
 Cool, numb or tingling sensation.
 Diminished pulses in the distal extremities.
 Extremities that are cool and red in the
dependent position.
 Development of ulcerations in the extremities
interventions
 Instruct the client to stop smoking.
 Monitor pulses.
 Instruct the client to avoid injury to the
upper and lower extremities.
 Administer vasodilators as prescribed.
 Instruct the client regarding medication
therapy.
 Aortic
aneurysms
Aortic aneurysms
 An abnormal dilation of the arterial wall
caused by localized weakness and stretching in
the medial layer or wall of an artery.
 The aneurysm can be located anywhere along
the abdominal aorta.
 The goal of treatment is to limit the
progression of the disease by modifying risk
factors, controlling the BP to prevent strain
on the aneurysm, recognizing symptoms early
and preventing rupture.
Types of aortic
aneurysm
1. fusiform
• Diffuse dilation that involves the entire
of the arterial segment.
2. saccular
• Distinct localized outpouching of the
artery wall.
3. dissecting
• Created when blood separates the
layers of the artery wall, forming a
cavity between them.
4. False (pseudoaneurysm)
• Occurs when the clot and connective
tissue are outside the arterial wall.
• Occurs as a result of vessel injury or
trauma to all three layers of the
arterial wall.
assessment
a. THORACIC ANEURYSM
– Pain extending to neck, shoulders, lower back or
abdomen.
– Syncope
– Dyspnea
– Increased pulse
– Cyanosis
– Weakness
– Hoarseness, difficulty swallowing because of
pressure from the abeurysm
b. ABDOMINAL ANEURYSM

• Prominent pulsating mass in abdomen at ar

above umbilicus.
• Systolic bruit over the aorta.
• Tenderness on deep pulsation
• Abdominal or lower back pain.
c. RUPTURING ANEURYSM

• Severe abdominal and back pain

• Lumbar pain radiating to the flank and groin
• Hypotension
• Increased pulse rate
• Hematoma at flank area
• Signs of shock
DIAGNOSTIC TESTS

• Diagnostic tests are done to confirm the

presence, size and location of aneurysm.
• Tests includes abdominal ultrasound,
computed tomography scan and arteriography.
 interventions
• Monitor vital signs.
• Assess risk factors for arterial disease process.
• Obtain information regarding the sensation of
palpation in the abdomen.
• Inspect the skin for the presence of vascular
disease breakdown.
• Check peripheral circulation, including pulses,
temperature and color.
• Observe for signs of rupture.
• Note any tenderness on the abdomen
• Monitor for abdominal distention.
Nonsurgical interventions
• Modify risk factors.
• Instruct the client regarding the procedure
for monitoring BP.
• Instruct the client on the importance of
regular physician visits to follow the size of
the aneurysm.
• Instruct the client that if severe back or
abdominal pain or fullness, soreness over the
umbilicus, sudden development of
discoloration in the extremities elevation of
BP occurs to notify the physician immediately.
• Instruct the client with a thoracic
aneurysm to report immediately the
occurrence of chest or back, shortness
of breath, difficulty swallowing or
hoarseness.
Pharmacological interventions

• Administer antihypertensive to maintain the

BP within normal limits and to prevent strain
on the aneurysm.
• Instruct the client about the side effects and
schedule of medication.
 Abdominal aortic aneurysm resection

• Surgical resection of excision of the

aneurysm; the excised section is replaced
with a graft that is sewn end.
PREOPERATIVE INTERVENTIONS
• Assess all peripheral pulses as a baseline for
postoperative comparison.
• Instruct the client in coughing and deep
breathing exercises.
POSTOPERATIVE INTERVENTIONS
• Monitor vita signs.
• Monitor peripheral pulses distal to the graft site.
• Monitor for signs of graft occlusion, including
changes in pulses, cool to cold extremities below
the graft, white or blue extremities or flanks,
severe pain or abdominal distention
• Limit elevation of the head of the bed to 45
degrees to prevent flexion of the graft.
• Monitor for hypovolemia and renal failure
resulting from significant blood loss during
surgery.
• Monitor urine output hourly and notify the
physician if it is the lower than 30 to 50
ml/hr.
• Monitor serum creatinine and blood, urea
nitrogen levels daily.
• Monitor respiratory status and auscultate
breath sounds to identify respiratory
complications.
• Encourage turning, coughing and deep
breathing and splinting the incision
• Ambulate as prescribed.
• Maintain nasogastric tube to low suction until
bowel sounds return
• Assess for bowel sounds and report their return to
physician.
• Monitor for pain and administer medications as
prescribed.
• Assess incision site for bleeding or signs of
infection.
• Prepare the client for discharge by providing
instructions regarding pain management, wound care
and activity restrictions.
• Instruct client not to lift objects heavier than 15
to 20 lbs for 6 to 12 weeks.
• Advise the client to avoid activities requiring
pushing, pulling, or straining.
• Instruct the client not to drive a vehicle until
approved by the physician.
 Thoracic aneurysm repair
• A thoracotomy or median sternotomy
approach is used to enter the thoracic cavity.
• The aneurysm is exposed and excised and a
graft or prosthesis is sewn onto the aorta.
• Total cardiopulmunary bypass is necessary for
excision of aneurysms in the ascending aorta.
• Partial cardiopulmunary bypass is used for
clients with an aneurysm in the descending
aorta.
 Postoperative interventions
• Monitor vital signs and neurological and renal
status.
• Monitor for signs of hemorrhage such as a drop in
BP and increased pulse rate and respirations and
report to the physician immediately.
• Monitor chest tubes for an increased in chest
drainage which may indicate bleeding or separation
of the graft site.
• Assess sensation and motion of all extremities and
notify the physician if deficits occur because of
lack of blood supply to the spinal cord during
surgery
• Monitor respiratory status and auscultate
breath sounds to identify respiratory
complications.
• Encourage turning, coughing and deep
breathing while splinting the dysrhythmias.
• Monitor for pain and administer medication as
prescribed.
• Assess the incision site for bleeding or signs
of infection.
• prepare the client for discharge by providing
instructions regarding pain management ,
wound care and activity restrictions.
• Instruct the client not to lift objects heavier
than 15 to 20 lbs for 6 to 12 weeks.
• Advise the client to avoid activities requiring
pushing, pulling or straining.
• Instruct the client not to drive a vehicle until
approved by the physician.
That’s all…