Care of Clients With

Peripheral-Vascular Disorders

Earl Francis R. Sumile, RN

Instructor, College of Nursing
University of Santo Tomas
Care of Clients With Peripheral-Vascular
Disorders
 Arteries or Arterioles – thick walled vessels that
transport 02 and blood via the aorta away from the heart
to the tissues; blood under higher pressure
 Capillaries – principal functional unit of cardio vascular
system; minute semi-permeable membranes that
connect arterioles to smallest veins or venules
 Veins or Venules – thin walled vessels that transport
deoxygenated blood from the capillaries back to the right
heart; blood is under much lower pressure;has valves to
maintain flow in one direction
Risk factors for Peripheral Vascular
Disease
 Modifiable
 Cigarette smoking
 Hypertension, DM, obesity, no exercise

 Hyperlipidemia

 Unmodifiable
 Age

 Sex

 Family History
Diagnostic Tests
 Doppler Ultrasonography – uses high frequency
sound waves directed through a transducer
(audible tone proportional to blood velocity)
 Segmented limb pressure – evaluates artery
occlusion; systolic pressure reading from each
limb through pneumatic pressure cuffs and
Doppler probes.
 Radionuclide scan – injection of radionuclide
followed by scan
 Arteriography (angiography) – dye through
catheter inserted at femoral or brachial artery
followed by x-ray
Common Peripheral Vascular Diseases
 Hypertension (WHO) – persistent elevation of
systolic pressure of over 140 mmHg and
diastolic pressure of over 90 mmHg
 Essential – loss of elastic tissue and arteriosclerotic
changes in aorta and large vessels with decreased
caliber of arterioles
 Secondary – increase of blood pressure as a result of
another disease
 Idiopathic – exact etiology is unknown

Signs and Symptoms – throbbing occipital

headache, dizziness, visual disturbance; edema,
epistaxis, retinal hemorrhages
 Hypertension
 Diagnostic Assessment:
 Fundoscopy – papilledema; retinal hemorrhages

 Management:
 Diet – low sodium, low fat
 Rest and exercise
 Pharmacotherapeutics
 *diuretics– loop diuretics; K-sparing
 *vasodilators – hydrolazine (apresoline)
 *CNS acting – methyldopa (aldomet)

 *alpha blockers – clonidine (catapres

 Hypertension
 Management:
 Pharmacotherapeutics
 *B-adrenergic blockers – propranolol (inderal),
metoprolol (betaloc)
 *calcium channel blockers – nefidipine (adalat)

 *ACE inhibitors (Angiotensin Converting Enzyme) –

captopril (capoten)
Common Peripheral Vascular Diseases

 Hypertensive Crisis (Malignant Hypertension) –

sudden elevation of blood pressure with severe
headache, nausea and vomiting, neurological
symptoms to coma; diastolic BP > 120mmHg;
retinal hemorrhage; renal insufficiency;
encephalopathy; left ventricular failure
 Nursing management:
 pharmacotherapeutics – Hyperstat (diazoxide); Nipride
(Na Nitroprusside)
 ICU care; symptomatic
Common Peripheral Vascular Diseases
 Buerger’s Disease (Thromboangitis Obliterans) – acute
inflammatory disorder affecting medium or smaller
arteries and veins of the lower extremities.
 Etiology – unknown; could be due to hypersensitivity to
tobacco and alteration in cellular and humoral
immunity
 Incidence – males 25-40 years; smokers
 Signs and Symptoms
 Intermittent claudication – sharp, stabbing pain, worse on
ambulation or activity
 Gray ulceration or necrosis located at lateral malleolus, toes or
heels
 Sensitive to cold
 Decreased or absence of peripheral pulses
 Buerger’s Disease
 Signs and Symptoms
 Intermittentclaudication – sharp, stabbing
pain, worse on ambulation or activity
 Gray ulceration or necrosis located at lateral
malleolus, toes or heels
 Sensitive to cold

 Decreased or absence of peripheral pulses

 Buerger’s Disease
 Nursing Management
 Pain control – narcotic-analgesic
 For intractable pain –

 Lumbar sympathectomy – surgical removal of

sympathetic ganglia and nervous tissue to
eliminate vasospasm
Common Peripheral Vascular
Diseases
 Raynaud’s Phenomenon – intermittent
episode of arterial spasms frequently
involving fingers
 Etiology – hypersensitivity to cold,
immunologic factors; sympathetic innervation,
emotional stress
 Incidence – women, teenagers
 Raynaud’s Phenomenon
 Signs and Symptoms
 coldness

 numbness

 tingling in one or more digits

 pain precipitated by exposure to cold, emotional
stress and tobacco use
 intermittent color changes – pallor, cyanosis,
rubor
 small ulceration and gangrene at tips of digits.
 Raynaud’s Phenomenon
 Diagnostic Assessment:
 Cold stimulation – patient’s hands submerged
in ice water bath in 20 seconds
 Nursing Management
 Stop smoking
 Maintain warmth especially in cold weather, use
gloves
 Pharmacotherapeutics – anti-hypertensive
drugs and vasodilators
Common Peripheral Vascular Diseases

 Aneurysm – sac formed by dilation of an artery

secondary to weakness and stretching of
artery wall
 Fusiform – entire circumference of the artery
 Sacular – outpouching on one side only
 Dissecting – separation of artery wall layers to form a
cavity that fills with blood
 Etiology – hypertension, trauma, infection,
syphilis
 Incidence – men above 50 years
 Aneurysm
 Management:
 Surgery – Resection of aneurysm with
replacement of Teflon or Dacron graft
 Pharmacotherapeutics
 *Anticoagulants- heparin (antidote:protamine sulfate)
and coumadin (antidote: vitamin K)
 *Fibrinolytics – streptokinase (synthetic) and

urokinase (human)
Venous Disorders
 Varicose veins (varicosities) dilated and tortuous veins
because the valves become stretched and incompetent
with resultant venous pooling or stagnation edema.
 Etiology:
 Congenital absence of valves
 Acquired valve incompetence
 Sites:
 Lower extremities (most common)
 Anal – hemorrhoids
 Esophagus
 Vulva
 Spermatic veins (variocele)
 Varicose veins
 Prevention:
 Ifpositive family history, wear support
stockings especially when pregnant or in long
standing
 Prevent venous congestion – elevated legs
when sitting, avoid prolonged standing
 No continuous pressure on veins – no
constricting clothing, no round garters, no tight
girdles, no crossing of legs
 Varicose veins
 Management:
 Sclerosing agents (Na murrhate, Natetradecyl
SO4)
 Surgery – ligation and stripping

 Nursing management post-op:

 unwrap and rewrap plastic bandage on lower
extremities
 check circulation sensation and mobility of the
affected extremitity
Venous Disorders
 Thrombolphlebitis – inflammation of vessel
wall with cloth formation.
 Phlebitis – inflammation of vein wall secondary
to injury, prolonged pressure or infection
 Phlebothrombosis – formation of blood clot
within a vein with no associated inflammation.
 Embolism – thrombus carried and lodged in
the blood stream.
 Thrombolphlebitis
 Frequent sites – saphenous, femoral and
popliteal vein
 Superficial – redness, warmth, tenderness, vein
hard and sensitive to pressure
 Deep vein thrombosis – pain, edema, increased
circumference on thigh of calf, positive Homan’s
sign (pain during dorsiflexion)
 Thrombolphlebitis
 Nursing management:
 Bedrest with leg elevated
 Moist heat

 Elastic stockings (anti-embolytic)

 Anticoagulants, fibrinolytics, vasodilators

 Surgery – embolectomy, thrombectomy