Peripheral Vascular

Disease
3nu01 - Gro 1
Aga , Ban o , Ba t a, Buy & Cal o g
Buerger’s
disease
 overview
● AKA Thromboangiitis Obliterans, is
a recurring inflammation of the
small and medium sized arteries
and veins of the upper and lower
extremities.
● Blood vessels become inflamed,
swell, and can become blocked with
blood clots (thrombi).
● This eventually damages or
destroys skin tissues and may lead
to infection and gangrene.
● Common in men between 20-35 y/o.
Causes
❏ Unknown
❏ Heavy smoking or chewing
of tobacco
❏ Genetics
❏ Autoimmune disorder
 ❖ Pain in the hands and feet or legs
and arms, which may come and go
➢ can be caused by claudication
❖ Inflammation along a vein just below
the skin’s surface
❖ Fingers and toe that turn pale when
exposed to cold (Raynaud’s
Phenomenon)
❖ Painful open sores on fingers and
toes

Signs and
Symptoms
 Pathophysiology
Hypersensitivity Inflammation and
Tobacco use / reaction to vasoconstriction
Tissue
lifestyle tobacco or of arteries and
ischemia
autoimmune veins of
elements extremities

Early
Amputation Gangrene Necrosis signs and
symptoms
Diagnostic test
❏ No specific test to confirm the disease.
❏ However, there are tests to rule out
diseases similar to Buerger’s Disease
like:
❏ Blood Tests: to rule out Lupus,
Diabetes, blood clotting disorders,
and other diseases.
❏ Angiogram: a special dye is injected
into the artery, after which the
patient undergoes a series of rapid
X-rays. The dye helps to delineate any
artery blockages that shows up on the
images.
❏ Allen’s Test: checks the blood flow
through the arteries carrying blood to
your hands.
Nursing Managements
Strongly advise the patient to
completely stop using tobacco.
Implement a plan for the patient
to manage pain.
Encourage the patient to make
lifestyle changes necessary to
adequately manage the disease
including modifications in diet,
activity, and hygiene (skin
care).
Advise patient to avoid limb
exposure to cold temperature.
Ensure that the patient has the
knowledge and ability to assess
for any postoperative
complications such as infection
and decreased blood flow.
Administer antibiotics to treat
any infected ulcers.
Administer analgesics to manage
the ischemic pain.
Teach patients to avoid trauma
to the extremities.
Medical managements
➢ Although there is no cure, the main
objectives are:
○ Improve circulation to the extremities,
○ Prevent the progression and,
○ Protect the extremities from trauma and
infection.
➢ Quit smoking; avoid nicotine replacement
products.
➢ Sympathectomy: the surgical cutting of the
nerves to the affected area to control
severe pain and increase blood flow.
➢ Amputation: if gangrene occurs.
➢ Vasodilators are rarely prescribed.
Raynaud’s
Disease
❏
OVERVIEW
Raynaud’s Disease, or Raynaud’s
Syndrome is a rare disorder of
the arteries, blood vessels
that carry blood from the heart
to various parts of the body
❏ Vessels experience vasospasms,
in which they narrow when you
are exposed to cold or are
feeling stressed
❏ Blood cannot reach the surface
of the skin, causing it to turn
white or blue.
 Primary Raynaud's Disease:

Considered the more common,

milder condition.There is no
underlying disease associated
with the primary
classification. About 75% of

(2) Classification:
all cases diagnosed occur in
women between 15 and 40 years
old.
 Secondary Raynaud's Disease:

Less common, but is considered

the more serious of the two
classifications. It is
associated with an underlying

(2) Classification: disease, most commonly, one of

the connective tissue diseases.
CAUSES
 PATHOPHYSIOLOGY
Small arteries at Become pale, less
Exposure to cold / Warm up (arteries
fingers & toes blood flow and low
triggering factor dilate)
vasospasm 02 supply

Affected area is
Color change to Blood flow increase,
warm and
bright red high 02 supply
throbbing pain
SIGNS & SYMPTOMS:
The attacks can affect the fingers and toes, and rarely the nose,
ears, nipples, or lips. The affected body parts will usually have two
or more of the following changes:
➔ Look pale due to lack of
blood flow
➔ Look bluish due to a lack
of oxygen
➔ Feel numb, cold, or painful
➔ Redden and throb or tingle
as blood returns to the
affected area
 Antinuclear Antibody (ANA) lab test
ANA are unusual antibodies,
detectable in the blood, that have
the capability of binding to certain
structures within the nucleus of the
cells.

Erythrocyte Sedimentation Rate (ESR)

blood test
This blood test determines the rate
at which red blood cells settle to
the bottom of a tube. A

Diagnostic test
faster-than-normal rate may signal
an inflammatory or autoimmune
disease.
 Nailfold Capillaroscopy Test
A drop of oil is put on the nail
folds and then looked at under a
magnifying glass to see whether

Diagnostic test
there are changes in the capillaries
which are indicative of connective
tissue disease.
 Cold Stimulation Test
A heat sensor is taped to your
fingers and the temperature is
recorded. Your hand is then immersed
in ice water for 20 seconds. Then it
is removed from the bath and the

Diagnostic test
temperature recorded every 5 minutes
until your finger temperature is the
same as it was before the bath.
 DIAGNOSTIC CRITERIA
Primary Raynaud's Disease:
➔ Periodic vasospastic attacks of
pallor (whiteness) or cyanosis Secondary Raynaud's Disease:
(blueness)
➔ Normal nailfold capillary ➔ Periodic vasospastic attacks of
pattern pallor (whiteness) and cyanosis
➔ Negative antinuclear antibody (blueness)
test (ANA)
➔ Abnormal nailfold capillary
➔ Normal erythrocyte
pattern
sedimentation rate (ESR)
➔ Positive antinuclear antibody
➔ Absence of pitting scars or
test (ANA)
ulcers of the skin, or gangrene
➔ Abnormal erythrocyte
(tissue death) in the fingers
sedimentation rate (ESR)
or toes
➔ Presence of pitting scars or
ulcers of the skin or gangrene in
the fingers or toes
➔ Assist the client to identify
and avoid precipitating factors
such as cold.
➔ Instruct the client to wear warm
clothing, socks and gloves in
cold weather.
➔ Avoid repetitive hand movements
and stressful situations.
➔ Understand and cope with stress:
◆ Regular Exercise
◆ Yoga/Mediation
◆ Therapy/Counseling
Nursing
management
➔ Quit smoking and avoids
secondary smoke as nicotine is
potent vasoconstrictor.
➔ Assist in alleviating some
distress from the condition.
Calcium channel blockers:
Drugs that relax and open small
blood vessels in your hands and
feet, stabilizing blood flow

Alpha blockers:
Act as antagonists to

Medical
norepinephrine, a
neurotransmitter that causes the
constriction of blood vessels

management
Vasodilators:
Relaxes blood the vessels (e.g.
nitroglycerin cream)
Nerve surgery:
Through small incisions in the affected
hands or feet, a doctor strips away these
tiny nerves around the blood vessels. The
surgery, called sympathectomy, may reduce
the frequency and duration of attacks.

Chemical injection:

Surgical
Doctors can inject chemicals to block
sympathetic nerves in affected hands or
feet.

Amputation:

management
Sometimes, doctors need to remove tissue
damaged from a lack of blood supply. This
may include amputating a finger or toe
affected by Raynaud's in which the blood
supply has been completely blocked and the
tissue has developed gangrene.
SUMMARY
Bone malignancies
3nu01 - Gro 1
Aga , Ban o , Ba t a, Buy & Cal o g
Osteoma
 Overview
● The most common benign neoplasm
of the nose and paranasal
sinuses.
● A new piece of bone usually
growing on another piece of
bone, typically the skull.
● When the bone tumor grows on
other bone it is known as
"homoplastic osteoma"
● When it grows on other tissue
it is called "heteroplastic The prevalence of osteoma is
osteoma".
3% in general population.
 CAUSES
·The osteoma is still
unknown.

·The possibility of a
reactive mechanism,
triggered by Trauma
or Infection, has
also been suggested.
 Pathophysiology
There is increase
Abnormal growth of cells
pressure within the Increased prostaglandin
in the cortex of bones
bones that stimulate E2 and COX 1 and 2.
that lead to forming of
Prostaglandin.
mass.

Increased number and

Increased the size and
size of the myelinated
Pain flow of vessels in the
nerve fibers within the
bony lesion.
nidus.
Signs and symptoms
·Often Asymptomatic
·Headaches
·Hearing or vision problems
·Cranial nerve palsies
Large or situated in a strategic
location:
·Painless swelling
·Facial asymmetry and symptoms secondary
to nasal or paranasal sinus obstruction
such as sinusitis, nasal discharge and
mucocele formation
For Osteoid Osteoma
·Patients typically complain of
severe localized pain that is often
worse at night
 Diagnostic Exam Bone scan – A bone scan is an
imaging test that uses a small,
safe amount of radioactive dye as a
·Routine examine – Your doctor will tracer to locate osteomas in the
ask you questions about your head, skull or neck.
symptoms and perform a physical
exam to check for osteomas.

·CT scan – Also known as a CAT

scan, this diagnostic test produces
high-resolution pictures of the
insides of your head and neck.
Similar to an X-Ray but more
powerful, a CT scan reveals the
location of a benign osteoma so
your doctor can see its size and
placement within the body.
 Medical Surgical Management:

Endoscopic Endonasal Approach

Management
(EEA).

This state-of-the-art,
minimally invasive approach allows
surgeons to access the tumor
NSAIDs, Aspirin through the natural corridor of
the nose, without making an open
incision. Surgeons then remove the
osteomas through the nose and
nasal cavities.
·Assesses the patient’s
understanding of the disease
process, how the patient and
Nursing
the family have been coping,
and how the patient has Management
managed the pain.

·The nurse encourages the

patient and family to
verbalize their fears,
concerns, and feelings.
When the patient undergone
excision of mass:
Nursing
Management
·Monitor the vital signs.

·The affected part is

elevated to reduce edema.

·The neurovascular status of

the extremity is assessed.
Osteosarcoma
 Overview
also called Osteogenic Sarcoma
- Type of bone cancer of the
cells that forms an outer
covering of the bone
- Most common and fatal in
children and males between
10-25 years old
- 5% of all childhood cancers
- Common sites: long bones,
knee, upper leg, thigh bone,
lower and upper arm
➔ Unknown
CauseS
➔ DNA changes (mutation)
inherited or acquired
after birth
➔ Radiation therapy (damaged
DNA)
➔ Metabolic or hormonal
disturbances
➔ Injury
➔ Infection
➔ No known lifestyle-related
or environmental causes
 Risk Factors
• Age
- Highest between the ages of
10-30 (during
growth spurt), and over
60 years old.
• Height
- Rapid bone growth
- Children are tall for their age
• Gender
- more common in males
- females develop it earlier
 Risk Factors
• Race/Ethnicity
- African Americans
- Hispanic/Latinos
• Radiation to Bones
- People treated with radiation
therapy
for another cancer might have
higher risk
of later developing
osteosarcoma in the
area that was treated.
 Risk Factors
• Paget Disease of the Bone
- abnormal bone tissue forms
in one or more bones
- affects people older than 50
years old
- bones are heavy and thick
but are weaker and more likely to
break than normal bones
- develop in 1% of people with
Paget disease (when many bones
are affected)
PATHOPHYSIOLOGY
Signs & symptoms
• Pain and swelling - 1st sign, most common sign
• Bone fractures/breaks
Other symptoms:
• Difficulty with normal activities
• Limping, tenderness
• Tiredness
• Anemia
Diagnostic
Examination
➔ Medical History and
Physical Examination
➔ Bone X-Rays
➔ Magnetic Resonance
Imaging (MRI) Scan
➔ Computed Tomography
(CT) Scan
➔ Bone Scan
➔ Positron Emission
Tomography (PET)
Scan
Diagnostic
Examination
➔ Complete Blood Count (CBC)
➔ Blood Chemistry
➔ Urinalysis
➔ Sternal Marrow Puncture
➔ Biopsy ( 2 types):
- Needle Biopsy : CT-Guided Needle
biopsy (deep)
○ Core Needle biopsy
(tissue)
○ Fine Needle Aspiration
(FNA)
biopsy (fluid and cells)
- Surgical (open) Biopsy
Subtypes:
High-grade
• Does not look like normal bone and
has many cells
• Most osteosarcoma in children and
teens are high-grade

Types of High-grade osteosarcomas:

• Osteoblastic
• chondroblastic
• Fibroblastic
• Telangiectatic
• High-grade surface (juxtacortical)
• Small cell
Subtypes:
Intermediate-grade osteosarcoma
• Uncommon tumor
• Treated the same as low-grade
osteosarcomas

Type:
• Periosteal (juxtacortical)
Subtypes:
Low-Grade Osteosarcoma
• Slowest-growing osteosarcoma
• Looks like normal bone and
have few dividing cells

Types:
• Parosteal (juxtacortical
low-grade)
• Intramedullary or intraosseous
well differentiated (low-grade
central)
Subtypes:
 Other high-grade osteosarcoma
• Pagetoid: a tumor that develops with
Paget disease of the bone

• Extraskeletal: a tumor that starts in a

part of the body other than a bone (but
still makes bone tissue)

Subtypes:
• Post-radiation: a tumor that starts in
a bone that had once been treated with
radiation
 Stages
➔ Localized
- Resectable: all visible tumors can be
removed by surgery
- Unresectable (non-resectable): tumors
cannot be removed completely by surgery

Staging
➔ Metastatic
- spread to other parts of the body
- harder to treat
- improved cure rate if chemotherapy is
also given
 Musculoskeletal Tumor Society (MSTS) Staging
System
• Enneking System
- Grade (G):
a. Low-grade (G1): normal looking cells
b. High-grade (G2): abnormal looking
cells
- Extent of Primary Tumor (T):
a. Intracompartmental (T1): remained

Staging
within the bone
b. Extracompartmental (T2): extended
beyond the bone
- Metastasized (M):
a. Not spread (M0)
b. Spread (M1)
Staging
 Medical management
➔ Chemotherapy
- First treatment for this cancer
- Before (neoadjuvant) and after (adjuvant)
surgery up to 1 year
- Shrinks tumor to become resectable
➔ Surgery
- to remove the tumor or cancer
➔ Radiation Therapy
- High energy rays or particles that kill
cancer cells
- slow tumor growth and control symptoms like
pain and swelling
➔ Monitor for any signs of bleeding and febrile
episodes. Check lab findings.
➔ Inform parents to avoid exposure to people
with upper respiratory infection because
patients are more susceptible to infection.
➔ Maintain aseptic technique such as
handwashing.
➔ Provide comfort measures such as change of
position and use of heat or cold application
➔ Assess oral cavity for painful burning
sensation erythema ulcerations and difficulty
eating and drinking to provide information
about the effect of chemotherapy.
➔ Encourage avoidance of contact sports to
decrease chances of injury.
➔ Encourage diversional activities.
➔ Administer analgesics as
indicated to maximal dose as
needed.
➔ Encourage the client to increase
fluid intake.
➔ Encourage rest periods to prevent
fatigue.
➔ Assess muscle strength, gross and
fine motor coordination.
➔ Provide quiet environment and
calm activities to prevent or
lessen pain.
➔ Provide pillows for cushion and
support.
The End!