Raynaud's disease

Raynauds 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.

Buergers disease

Buergers 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.

 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.

interventions

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.

 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

Postoperative interventions

 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.

Thats all