PERIPHERAL CIRCULATORY
surrounding tissue.
SYSTEM AND VASCULAR
SYSTEM
ASSESSMENT
 Health history
 Pain and precipitating factors
 Skin color and temperature
 Characteristics of peripheral
pulse
 Physical assessment
 Intermittent claudication
 Is a muscular, cramp–type
pain in the extremities
consistently reproduced
with the same degree of
exercise / activity and
relieved by rest
(experienced by patients
with peripheral arterial
insufficiency).
 This pain is caused by the
inability of arterial
 System to provide
adequate blood flow to the
tissues.
 Lactic acid isproduced.
 Pain is experienced when
metabolites aggravate the
I. Doppler ultrasound flow studies
nerve endings of the
 I.C. will be experienced
when 50% of the lumen or
75% of the cross-sectional
area is obstructed.
 Changes in skin appearance
and temperature
 RUBOR - reddish
discoloration of the
extremities. Suggests
severe peripheral arterial
damage.
 Cyanosis - bluish
discoloration of the skin.
 Gangrenous changes
appear after prolonged
severe ischemia &
represent tissue necrosis.
 Adequate blood flow
warms the skin & gives a
rosy color.
 Inadequate blood flow
results in cool & pale
extremities.
 Pulse
DIAGNOSTIC EXAMS
 - Type of ultrasound that uses
sound waves to measure the flow
of blood through a blood vessel
- The test takes several minutes to
assess the flow in each blood
vessel being tested, If the test
shows a decreased amount of
blood flow, other testing may be
needed.
Interventions:
- Supine position, w/ the HOB
elevated 20 to 30 degrees
- Acoustic gel isapplied
- Doppler
transducerispositionedat a 45
– to 60-degree angle over the
expected location of the
artery and angle slowly.
It is more useful as a
clinicaltoolwhencombined w/
ankleblood pressures, which are used
to determine the ankle-brachial
index(ABI), alsocalled the ankle arm
index (AAI).
Ankle- brachial index (ABI)
 Ankle- brachial index (ABI)
 Is the ratio of systolic blood
pressurein the ankle to the
systolic blood pressure in the
arm.
 Objective indicator of arterial
disease that allows the examiner
to quantify the degree of
stenosis.
 Used to measure brachial
pressure in both arms.
 To calculate ABI:
 ankle systolic pressure each foot
higher of 2 brachial systolic pressure
 Right brachial = 160 mmHg
 Left brachial = 120 mmHg
 Right posterior tibial= 80 mmHg
 Right dorsalispedis= 60 mmHg
 Left posterior tibial = 100 mmHg
 Left dorsalispedis = 120 mmHg
 Right ankle = 80 / 160 mmHg =
0.50 ABI
 Left ankle = 120 / 160 mmHg =
0.75 ABIO
II. Exercise testing
- is used to determine how long a
patient can walk
- To measure the ankle systolic
blood pressure in response in
walking.
 - The patient walks on a treadmill at - a spiral CT scanner and rapid IV
1.5 mph with a 10% incline for a infusion of contrast agent are used
maximum of 5 minutes. to image very thin sections of the
target area, and the results are
III. Duplex Utrasonography configured in three dimensions so
- involves B-mode gray-scale that the image closely remsembles
imaging of the tissue, organs, and a regular angiogram.
blood vessels and permits - CTA of thoracic or abdominal
estimation of velocity changes by vasculature may be peformed
use of a pulsed Doppler. using 1- 1.5 mm slices.
- It helps determine the level and
VI. Magnetic resonance angiography
extent of venous disease.
- Is used to generate images of the
- Non- invasive, requires no patient
arteries in order to evaluate them
preparation.
for stenosis (abnormal narrowing),
occlusion or aneurysms (vessel
IV. Computed tomography (CT)
wall dilatations, at risk of rupture).
- provides cross-sectional images of
- Used to isolate the blood vessels
soft tissue and visualizes the area
- This study is useful in patients with
of volume changes to an extremity
poor renal function or allergy to
and the compartment where
contrast agent.
changes take place.
*Spiral CT or helical
VII. Angiography
*Multidetector CT (MDCT) – four
- To confirm diagnosis of occlusive
slices or visual
arterial disease when considering
Pictures per x-ray tube
surgery or other interventions.
rotation.
- It involves injecting a radiopaque
contrast agent directly into the
V. Computed tomographic
vascular system to visualize the
angiography (CTA)
vessel.
 - Allergic reaction to iodine;
manifestations include dyspnea,
nausea and vomiting, sweating,
tachycardia, and numbness of the
extremities.
- It may include the administration
of epinephrine, antihistamines, or
corticosteroids.
VIII. Air plethysmograph
- isused to quantifyvenous reflux
and calf muscle pumpejection.
- provides information about
venousfilling time,
functionalvenous volume, ejected
volume, and residual volume
- Useful in evaluating patients with
suspected valvular incompetence
or chronic venous insufficiency but
not used for deep vein thrombosis
IX. Contrast Phlebography
- Also known as venography
- involves injecting a radiopaque
contrast agent into the venous
system.
X. Lyphangiography
- Way of detecting lymph node
involvement resulting from
metastatic carcinoma, lymphoma,
or infection in sites that are
otherwise inaccessible to the
examiner except by surgery.
XI. Lymphoscintigraphy
- is a reliable alternative to
lymphangiography.
- a radioactively labeled colloid is
injected subcutaneously in the
second interdigital space.
LABORATORY EXAMS
 Complete blood count (CBC)
 Bone marrow aspiration
- is used to document infection
or tumor within the marrow
 Hemoglobin electrophoresis
 Coombs test
- also referred to as the direct
antiglobulin test (DAT)
ARTERIAL PROBLEMS
I. Arteriosclerosis
- the common disease of the
arteries; the term means
“hardening of the arteries”
- It is a diffuse process whereby the
muscle fibers and the endothelial
 lining of the walls of small
arterioles become thickened.
Atherosclerosis
- affects the intima of the large and
medium-sized arteries.
- Intermittent claudication (pain,
weakness, numbness, or
cramping in muscles due to
decreased blood flow)
Atherosclerotic lesions:
1. Fatty streaks
2. Fibrous plaques
Surgical Management
Vascular Surgical procedures:
• Inflow Procedures – which
improve blood supply from the
aorta into the femoral artery
• Outflow Procedures – which
provide blood supply to vessels
below the femoral artery.
Radiologic Interventions
• Angioplasty – also called
percutaneous transluminal
angioplasty (PTA).
- A balloon-tipped catheter is
maneuvered across the area
of stenosis.
- It widens the arterial lumen
by “cracking” and flattening
the plaque against the vessel
wall.
• Dissection – separation of the
vessel, and bleeding
- Stents may be inserted to
support the walls of blood
vessels and prevent collapse
immediately after the balloon
inflation.
II. Peripheral Arterial Occlusive
disease
- Peripheral vascular disease (PVD),
commonly referred to as
peripheral arterial disease (PAD)
or peripheral artery occlusive
disease (PAOD), refers to the
obstruction of large arteries not
within the coronary, aortic arch
vasculature, or brain.
- Arterial insufficiency of the
extremities occurs most often in
men and is a common cause of
disability.
- Obstructive lesions are
predominantly confined to
segments of the arterial system
extending from the aorta below
 the renal arteries to the popliteal
artery.
Signs and symptoms:
 Intermittent claudication
 coldness or numbness of
extremities
 decreased ability to walk
 ischemic rest pain.
Nursing Management:
 Maintaning circulation
 Avoid leg cross and prolong
extremity dependency
Medical Management:
 Pentoxifylline (Trental)
 Cilostazol (pletal)
 Vascular grafting or
endarterectomy - is a surgical
procedure to remove the
atheromatous plaque material,
or blockage, in the lining of an
artery constricted by the buildup
of soft/hardening deposits.
 Bypass graft – to reroute the
blood flow around the stenosis
or occlusion.
 Distal anastomosis
 Thromboangitisobliterans
(Buerger’s disease)
is a recurring progressive inflammation
and thrombosis (clotting) of small and
medium arteries and veins of the
hands and feet. It is strongly
associated with use of tobacco
products, primarily from smoking, but
also from smokeless tobacco.
III.UPPER EXTREMITY ARTERIAL
OCCLUSIVE DISEASE
- arterial occlusions occur less
frequently in the upper extremities
than in the legs and cause less severe
symptoms because the collateral
circulation is significantly better than
in the arms.
- stenosis and occlusions in the upper
extremity result from atherosclerosis
or trauma.
Signs and symptoms:
 coolness and pallor of the
affected extremity
 Decreased capillary refill
 Difference in arm blood
pressures of more than 20mmHg
Nursing Management:
• Arm kept at heart level or
elevated, with the fingers at the
highest level.
• BP assessment every hour for 8
hours.
 • Doppler assessment of the  Absence of pedal pulse
arterial flow every hour for 8  Paresthesias
hours. Nursing Management:
Medical Management:  Advise to stop using tobacco
PTA – if a focal lesion is identified Medical Management:
  Same treatment of Buerger’s
disease
IV. Buerger’s Disease
 Regional sympathetic block or
(THROMBOANGIITIS OBLITERANS)
ganglionectomy – to produce
- is characterized by recurring
vasodilation and increase blood
inflammation of the
flow.
intermediate and small arteries
 Amputation
and veins of the lower and upper
extremities.
V. Raynaud’s Disease
- The cause is unknown, but it is
 is a vasospastic disorder causing
believed to be an autoimmune
discoloration of the fingers, toes,
vasculitis
and occasionally other areas.
- occurs in men between 20 and 35
Also known as "Primary
years of age.
Raynaud's phenomenon"
- Superficial thrombophlebitis may
Causes of Reynaud’s Disease
be present.
 Scleroderma
Pathophysiology:
 Carpal Tunnel Syndrome
 Cause is UNKNOWN
 Injury
 Probably an Autoimmune
 Nerve Problems
disease
 Artery Diseases
 Inflammation of the arteriesà
 Arteriosclerosis
thrombus formationà occlusion
 Stress
of the vessels
 Cold temperature
Signs and symptoms:
Signs and Symptoms
 Rubor (reddish-blue
 Cyanosis
discoloration)
  Numbness the tertiary stage of syphilis
 Pain infection
 Reduce sensation in the fingers Treatment
and toes Management appears to include the
 Finger Tingling following treatment priorities; stop
 Rubor the inflammation, treat complications,
 Gangrene prevent and monitor for re-
Treatment: occurrence.
 vasodilators VII. AORTOILIAC DISEASE
 prevent cold -also known as Leriche's syndrome
 keep warm and Leriche syndrome, is
 analgesics atherosclerotic occlusive disease
 clean wound involving the abdominal aorta
 surgery (symphatectomy) and/or both of the iliac arteries.
- Classically, it is described in male
VI. Aortitis patients as a triad of symptoms
- is the inflammation of the aorta. consisting of:
Two Types: • claudication of the buttocks
1. Takayasu’s disease (occlusive and thighs
thromboaortopathy) • atrophy of the musculature of
- a chronic inflammatory disease the legs
of the aortic arch and its • impotence (due to paralysis of
branches, primarily affects young the L1 nerve)
or middle-aged women and is Nursing Management:
more common in those of Asian • Assessment of the different sites
descent. of pulses
- nonatherosclerotic • Monitor for signs of thrombosis
2. Syphilitic aortitis- A pathological • Monitoring of urine output
state of the aorta associated with Medical Management:
 • Sametreatmentwithatherosclero
ticperipheralarterial occlusive
disease.
• Aortoiliacbypassgraft
• Axillofemoraland femoral-
femoral bypass (sometimes
abbreviated "ax-fem fem-fem")
VIII. AORTIC ANEURYSM
- general term for any swelling
(dilation or aneurysm) of the aorta
Types of Aortic Aneurysm
 Abdominal Aortic Aneurysm -
localized dilatation (ballooning)
of the abdominal aorta
exceeding the normal diameter
by more than 50 percent.
 Thoracic Aortic Aneurysm - a
widening (bulging) of part of the
wall of the aorta, the body's
largest artery.
Causes:
• Age 55 years or older  and force the layers apart.
• Male sex
• High blood pressure
• Smoking
• DM
• High Serum Cholesterol
• Genetic
• Atherosclerosis
Inherited diseases that cause
weakening of the blood vessels, with
emphasis on Marfan's syndrome
Signs and symptoms:
• A pulsating bulge or a strong
pulse in the abdomen
• Feeling of fullness after minimal
food intake
• Nausea
• Pain in the chest
• Shortness of breath
• Hoarseness
• Difficulty or pain while
swallowing
• Signs of shock
• Extreme drop in blood pressure
• Vomiting
IX. AORTIC DISSECTION
- Tear in the wall of the aorta that
causes blood to flow between
the layers of the wall of the aorta
- Aortic dissection is a medical
emergency and can quickly lead
to death.
Causes of Aortic Dissection
- Hypertension
- Vasculitis
 - 50 to 70 years old •  Biochemical markers
- Pregnancy •  Transesophageal
- Chest Trauma echocardiography
Signs and Symptoms of Aortic •  Aortogram
Dissection •  Computed tomography
- Severe Pain angiography
- Hypertension •  MRI
- Syncope Treatment:
- CHF / MI • Open abdominal or open chest
- Ischemia surgery
- Aortic insufficiency • Endovascular surgery
- Pleural effusion
Classification of Aortic Dissection • X. Diseases
- DeBakey
X.ARTERIAL THROMBOSIS
- Type I - Originates in ascending
- a blood clot (thrombus) adheres to
aorta, propagates at least to the
the wall of a vessel (artery) and
aortic arch and often beyond it
blocks the flow of blood.
distally.
Causes:
- Type II – Originates in and is
• Arterial thrombosis usually
confined to the ascending aorta.
affects individuals who already
- Type III – Originates in
haveatherosclerosis, or
descending aorta, rarely extends
narrowing of the arteries.
proximally but will extend
Atherosclerosis causes the walls
distally.
of the arteries to 'fur up' with
- Stanford
deposits of atheroma, a
- A = Type I and IIDeBakey
porridge-like substance.
- B = Type IIIDeBakey
Symptoms:
Diagnosis:
• Heart disease 
•  Chest X-ray
• Heart attack
•  ECG
ARTERIAL EMBOLISM
- occlusion of blood flow by a
foreign particle (embolus) other than a
blood clot within the vessel
Symptoms:
• Cold arm or leg
• Decreased or no pulse in an arm
or leg
• Fingers or hands feel cool
• Lack of movement in the arm or
leg
• Muscle pain in the affected area
• Muscle spasm in the affected
area
• Numbness and tingling in the
arm or leg
• Pale color of the arm or leg
(pallor)
• Weakness of an arm or leg
• Diseases
Later symptoms:
• Blisters of the skin fed by the
affected artery
• Shedding (sloughing) of skin
• Skin erosion (ulcer)
• Tissue death (necrosis; skin is
dark and damaged)
Symptoms of a clot in an organ vary
with the organ involved but may
include:
• Pain in the part of the body that
is involved
• Temporarily decreased organ
function
• Exams or test:
• Angiography of the affected
extremity or organ
• Doppler ultrasound exam of an
extremity
• Duplex Doppler ultrasound exam
of extremity
• Echocardiogram
• MRI
• Myocardial contrast
echocardiography (MCE)
• Plethysmography
• Transcranial Doppler exam of
arteries to the brain
• Transesophageal
echocardiography (TEE)
• Diseases
This disease may also affect the results
of the following tests:
• Euglobulinlysis time (ELT)
• Factor VIII assay
• Isotope study of the affected
organ
• Plasminogen activator inhibitor-1
(PAI-1) activity
• Platelet aggregation test
 • Tissue-type plasminogen
activator (t-PA) levels
• Diseases
 Treatment:
• Medications include:
• Anticoagulants (such as warfarin
or heparin) can prevent new
clots from forming
• Antiplatelet medications (such as
aspirin, ticlopidine, and
clopidogrel) can prevent new
clots from forming
• Painkillers given through a vein
(by IV)
• Thrombolytics (such as
streptokinase) can dissolve clots
• Some people need surgery.
Procedures include:
• Bypass of the artery (arterial
bypass) to create a second
source of blood supply
• Clot aspiration (thromboaspiratio
n)
• Clot removal through a balloon
catheter placed into the affected
artery or through open surgery
on the artery (embolectomy)
• Opening of the artery with a
balloon catheter (angioplasty)
with or without a stent
implanted
VENOUS PROBLEM
I. THROMBOSIS
 obstructing the flow of blood
through the circulatory system.
Classification of Thrombosis
 Venous thrombosis - formation
of a thrombus (blood clot) within
a vein
 Deep vein thrombosis - Deep
vein thrombosis (DVT) is the
formation of a blood clot within
a deep vein. It most commonly
affects leg veins, such as the
femoral vein
Causes
 Hyper coagulability
 Endothelial cell injury
 Disturbed blood flow
Signs and Symptoms
 Swelling of the leg or along a
vein in the leg
 Pain or tenderness in the leg,
which you may feel only when
standing or walking
 Increased warmth in the area of
the leg that's swollen or in pain
 Red or discolored skin on the leg
  stasis from prolonged
THROMBOPHLEBITIS immobilization
 is phlebitis (vein inflammation)  idiopathic thrombocytopenia
related to a thrombus (blood purpura
clot)  blood dyscrasias
Causes of Thrombophlebitis Signs and Symptoms
 thrombus in the vein  Calf pain
 prolonged sitting  Tenderness
 deep venous thrombosis  positive Homans’ sign (calf pain
Signs and Symptoms of on foot dorsiflexion)
Thrombophlebitis  Edema
 pain in the part of the body  increased size of involved
affected extremity
 skin redness or inflammation  redness and warmth over vein
(not always present) site
 swelling (edema) of the
extremities (ankle and foot) CHRONIC VENOUS INSUFFIECIENCY
 a medical condition where the
veins cannot pump enough
PHLEBOTHROMBOSIS oxygen-poor blood back to the
 thrombosis of a vein without heart.
inflammation of the vein  sometimes referred to as an
(phlebitis). impaired Musculovenous pump''
 Deep venous thrombosis can Causes of CVI
occur without the presence of  Deep vein thrombosis
phlebitis. However most of the  Family history
veins that develop thrombosis  Obesity
also have phlebitis.  Pregnancy
Causes of Phlebothrombosis  Prolonged standing
 intimal damage to the vein  Smoking
  Thrombophlebitis
 Varicose veins
Symptoms of CVI
 Dull aching, heaviness, or
cramping in legs
 Itching and tingling
 Pain gets worse when standing
 Pain gets better when legs are
raised
 Swelling of the legs
VT, DVT, THROMBOPHLEB,
PHLEBOTHROM
Diagnostics
• intravenous venography
• X-rays
• Blood tests (D-dimer)
Management
• Elevate the affected area to
reduce swelling.
• Keep pressure off of the area to
reduce pain and decrease the
risk of further damage.
• Apply moist heat to reduce
inflammation and pain.
• Support stockings and wraps to
reduce discomfort
Treatment
• analgesics
• anticoagulants e.g. warfarin or
heparin to prevent new clot
formation
• thrombolytics to dissolve an
existing clot such as intravenous
streptokinase.
• nonsteroidal anti-inflammatory
medications (NSAIDS) such as
ibuprofen to reduce pain and
inflammation
• antibiotics
• Surgical removal, stripping, or
bypass of the vein is rarely needed
but may be recommended in some
situations.
II. CHRONIC VENOUS INSUFFICIENCY/
POSTTHROMBOTIC SYNDROME
-Venous insufficiency results from
obstruction of the venous valves in the
legs or aa reflux of blood through the
valves. Superficial and deep legs veins
can be involved. Resultant venous
hypertension can occur whenever
there has been a prolonged increase in
venous pressure, such as occurs with
DVT.
S&S:
• Edema
• Altered pigmentation
 • Pain
• Stasis dermatitis
The patient may notice the symptoms
less in the morning and more in
the evening
Management:
• Directed at reducing venous stasis
and preventing ulceration.
• Elevating the leg
DAY:
at least 15-30 minutes every 2 hours
NIGHT:
Sleep with the foot of the bed
elevated about 15cm (6 inches)
• Compression of superficial veins
with graduated compression
stockings
• Walking
• When sitting, avoid placing
pressure on popliteal spaces
Treatment:
• Compression
using bandages, stockings, and
pneumatic devices
• Wound Care
should be done initially and with
each dressing change; ordinary
soap and water (not hot) is
usually best. Cleaning often
involves irrigation with saline
solution at pressures sufficient to
remove bacteria without
traumatizing tissue
• Surgery:
venous ligation, stripping, valve
reconstruction
Diagnostics:
• Duplex ultrasongraphy
III. LEG ULCER
 Tissue breakdown on the leg or
foot due to any cause.
 They occur in association with a
range of disease processes, most
commonly with venous and/or
arterial disease.
Causes of Leg Ulcer
 Poor blood circulation in the legs.
 Injuries - traumatic ulcers
 Diabetes - because of poor blood
circulation or loss of sensation
(nerve damage) resulting in
pressure ulcers
 Infection
Symptoms of Leg Ulcer
 Hyper pigmentation
 Leg pain
 A 'heavy' feeling in the affected
leg
 Aching
  Itching • Body detox can also help to purify
 Swelling the blood and cleanse the
 Venous eczema system.
 Diseases Diagnostics:
Management: • Doppler
• Pharmacologic Therapy • Duplex ultrasound studies
Antibiotic therapy is prescribed • Arteriography
when the ulcer is infected. • Venography
• Compression Therapy
Adequate compression therapy IV. VARICOSE VEINS
involves the application of -Veins that have become enlarged
external or counter pressure to and tortuous.
the lower extremity to facilitate - The term commonly refers to the
venous return to the heart. veins on the leg
• Debridement - Varicose veins are most common
Flush the area with normal saline in the superficial veins of the legs
solution or clean it with Causes of Varicose Veins
aanoncytotoxic wound-cleansing  Pregnancy
agent.  Obesity
• Topical Therapy  Menopause
• Wound Dressing  Aging
• Stimulated healing  Prolonged Standing
• Hyperbaric Oxygenation Signs & Symptoms of Varicose Veins
• Negative Pressure Wound  Aching, heavy legs
Therapy  Appearance of spider veins
Treatment: (telangiectasia)
• weight loss if you are overweight  Ankle swelling
• regular exercise to promote good  A brownish-blue shiny skin
circulation. discoloration near the affected
veins
  Whitened, irregular scar-like
patches can appear at the ankles
AVOID:
- activities that cause venous stasis,
such as wearing socks that are too
tight at the top or that leaves marks
on the skin.
- crossing the legs at the thighs
- sitting and standing for long periods
• Changing position frequently
• Elevating legs
• Walk 1 or 2 miles each day if
there are no contraindication
• Graduated compression
stockings
Treatment:
• Ligation and stripping
Requires that the deep veins be
patent and functional
• Thermal ablation
Non surgical approach using
thermal energy
• Sclerotherapy
Injection of an irritating chemical
into a vein to produce localized
phlebitis and fibrosis, thereby
obliterating the lumen of the
vein.
Diagnostics:
• Duplex ultrasound studies
• Air Plethysmography
• Venography
LYMPH PROBLEMS
I. CELLULITIS
-a diffuse inflammation of
connective tissue with severe
inflammation of dermal and
subcutaneous layers of the skin
Causes of Cellulitis
 Group A Streptococcus
 Staphylococcus
 Insect bites
 Tattoos
 Athlete's foot
Signs and Symptoms of Cellulitis
 Pain and tenderness
 Edema (swelling caused by fluid
in the tissues)
 Redness of the skin
 Skin that is warm to the touch
 Fever
 Chills
II. LYMPHANGITIS
- an inflammation of the lymphatic
channels that occurs as a result
of infection at a site distal to the
channel
 - Lymphangitis is also sometimes - is a condition of localized fluid
called "blood poisoning". retention and tissue swelling
Causes of Lymphangitis caused by a compromised
 Streptococcus pyogenes (Group A lymphatic system.
strep) - also known as lymphatic
 Stap. Aureus obstruction
 Pseudomonas Causes of Lymph edema
Signs and Symptoms of Lymphangitis  Inherited (primary)
 Deep reddening of the skin  Injury to the lymphatic vessels
 Warmth (secondary)
 Lymphadenitis  Parasitic infection
 Moderate pain  Burns
 Swelling  Trauma
 Radiation
III. LYMPHADENITIS Signs and Symptoms of Lymph Edema
Causes of Lymphadenitis  Severe fatigue
 Bacteria  Heavy swollen limb
 Virus  discoloration of the skin
 Fungi overlying the lymph edema
 Cancer Cells
 Inflammation V. ELEPHANTIASIS
Symptoms of Lymphadenitis - is a disease that is characterized
 Swelling by the thickening of the skin and
 Painful Lump underlying tissues, especially in
 Fever the legs, male genitals.
 Axillary Pain Causes of Elephantiasis
 Lymphadenitis  Wuchereriabancrofti
 Brugiamalayi
 Brugiatimori
IV. LYMPH EDEMA  Repeated streptococcal infection
  Hereditary
 Surgical removal of lymph nodes
(usually to prevent the spread of
cancer)
Signs and Symptoms of Elephantiasis
 Gross enlargement of a limb or
areas of the trunk or head
 Abnormal accumulation of
watery fluid in the tissues
 Skin usually develops a
thickened, pebbly appearance
and may become ulcerated and
darkened
 General feeling of ill health
(malaise) may be present
HEMATOLOGIC DISORDERS
ANEMIA
• A condition in which the
hemoglobin concentration is
lower than normal, reflects the
present of fewer than normal
erythrocytes within the
circulation.
Signs and symptoms:
• Shortness of breath
• Dizziness
• Headache
• Coldness in the hands and feet
• Pale skin
• Chest pain
Management:
Increase fluid intake
Increased in dietary supplements
 Iron
Spinach and other dark green leafy
vegetables
Peanuts, peanut butter, and almonds
Eggs
Peas; lentils; and white, red, and
baked beans
Dried fruits, such as raisins, apricots,
and peaches
Prune juice
 Vitamin C
Medicines
• Antibiotics to treat infections.
Procedures
• Blood Transfusion
A blood transfusion is a safe,
common procedure in which
blood is given to you through
an intravenous (IV) line in one
of your blood vessels.
Transfusions require careful
 matching of donated blood
with the recipient’s blood.
• Blood and Marrow Stem Cell
Transplant
• A blood and marrow stem cell
transplant replaces your
abnormal or faulty stem cells
with healthy ones from another
person (a donor). Stem cells are
found in the bone marrow. They
develop into red and white blood
cells and platelets.
• Surgery
• If you have serious or life-
threatening bleeding that’s
causing anemia, you may need
surgery. For example, you may
need surgery to control ongoing
bleeding due to a stomach ulcer
or colon cancer.
• If your body is destroying red
blood cells at a high rate, you
may need to have your spleen
removed. The spleen is an organ
that removes worn-out red blood
cells from the body. An enlarged
or diseased spleen may remove
more red blood cells than
normal, causing anemia.
Diagnostic findings:
• MCV (mean corpuscular volume)
• RDW ( red cell distribution width)
Classification
• Hypoproliferative anemia
• Hemolytic anemia
• Bleeding
HYPOPROLIFERATIVE
I. IDA (iron deficiency anemia)
• Is the most common type of
anemia in all age groups, and it is
the most common anemia in the
world.
• Typically result when the intake
of dietary iron is inadequate for
hemoglobin synthesis.
Signs and Symptoms:
if the deficiency is severe or
prolonged they may also have a
smooth, sore tongue; brittle and
ridged nails; and angular cheilosis
( an ulceration of the corner of the
mouth).
Nursing management
• Food sources high in iron
• Taking iron-rich foods with a
source of Vit.C
• Nutritional counseling
• Iron therapy
Medical management
 • Iron supplements
• Vitamin C
Diagnosis
• Bone marrow aspiration
• MCV
II. APLASTIC ANEMIA
- Aplastic anemia is a rare disease
caused by a decrease in or
damage to marrow stem cells,
damage to the
microenvironment within the
marrow, and replacement of the
marrow with fat.
Signs and symptoms:
 Pallor
 Fatigue
 Dyspnea
 purpura (bruising )- may
developed later
Nursing management
 Assessed carefully for signs of
infection and bleeding
Medical management
 Bone marrow transplant (BMT)
 Peripheral blood stem cell
transplant
 Immunosuppressive therapy
III. MEGALOBLASTIC ANEMIA
- In the anemias caused by
deficiencies of vitamin B9 or folic
acid, identical bone marrow and
peripheral blood changes occur
because both vitamins are
essential for normal DNA
synthesis. In the either anemia,
the erythrocytes that are
produced are abnormally large
and are called megaloblastic red
cells.
*Folic acid deficiency
• eat uncooked vegetables
• Alcoholism
• Increased in patients with
chronic hemolytic anemias
• Women who are pregnant
*Vitamin B9
• Inadequate dietary intake
• Vegetarians
• Faulty absorption from the GI
tract
• Diseases
Nursing management
• Inspection of the skin and
mucous membranes
• Physical and occupational
therapy
 • Eat small amounts of bland, soft
food frequently
Medical management
• Increased amount of Folic acid
• Vitamin B12 replacement
• Oral supplements with vitamins
or fortified soy milk
Diagnosis
• Schilling test
IV. MYELODYSPLASTIC SYNDROME
- Is a group of disorders of the
myeloid stem cell that causes
dysplasia in one or more types of
cell lines
Nursing management
• Instruction about infection risk
• Chelation therapy
 
Medical management
• BMT
• Chemotherapy
HEMOLYTIC ANEMIA
is anemia due to hemolysis the
abnormal breakdown of redblood
cells(RBCs) either in the blood vessels
(intravascular hemolysis) or elsewhere
in the body (extravascular). It has
numerous possible causes, ranging
from relatively harmless to life-
threatening. The general classification
of hemolytic anemia is either inherited
or acquired. Treatment depends on
the cause and nature of the
breakdown.
Types
– Sickle cell
– Thalassemia
– G6PD
I. SICKLE CELL ANEMIA
• Is a severe hemolytic anemia
that results from inheritance of
the sickle hemoglobin gene. This
gene causes the hemoglobin
molecule to be defective
• The sickle hemoglobin acquires a
crystal lie formation when
exposed to low oxygen tension.
 
Sickle cell Crisis
• 3 types of sickle cell crisis
• Sickle crisis – results from tissue
hypoxia and necrosis due to
inadequate blood flow to a
specific region of tissue or organ
• Aplastic crisis – results from
infection with the human
parvovirus
 • Sequestration crisis - results
when other organs pool the
sickled cells.
Medical management
• Medication with antisickling
properties
• Antiadhesion treatment
• HydroxyureaArginine
Treatment
• Pharmacologic therapy
• Hydroxyurea (Hydrea) – a
chemotherapy agent increasing
hemoglobin F in patient with
sickle cell anemia.
• Transfusion therapy
Chronic RBC transfusion
II. THALASSEMIAS
• Associated with defective
synthesis of the hemoglobin
chain
• The production of one or more
globulin chains within the
hemoglobin molecule is reduced
Two major group
• Alpha-thalassemia – milder than
beta thalassemia and often occur
without symptoms
• Beta-thalassemia – varies
depending on the extenet to
which the hemoglobin chains are
affected
III. Glucose 6 Phosphate
Dehydrogenase deficiency
• Is the source of the abnormality
in this disorder; this gene
produces an enzyme within the
erythrocyte that essential for
membrane stability
Nursing management
• The patient is educated about
the disease and given a list of
medications to avoid
Medical management
• Stop offending medication
• Transfusion
Diagnosis
• Screening test
IV. POLYCYTHEMIA
-“too may cells in the blood”
 
*Polycythemia Vera
-Proliferative disorder in which
the myeloid stem cells seem to have
escaped normal contolr mechanisms
Nursing management
• Instruct the patient to avoid Iron
supplements
Medical management
 • Phlebotomy • Bacterial Infections
• Anagrelide • Diseases
• Allopurinol Nursing Management
• Patient teaching
Secondary Polycythemia Medical Management
• Caused by excessive production • Antibiotics/Antifungal
of erythropoietin • Corticosteroids
• Reduced amount of oxygen
• It can results from certain Diagnostics
hemoglobinopathies • CBC
• Culture of blood, urine and
LEUKOPENIA sputum
I. NEUTROPENIA • CXR
- Results from decreased
production of neutrophils or increased LEUKEMIA
destruction of neutrophils. Is a neoplastic proliferation of one
  particular cell type.
Production of Neutrophils  
• Aplastic Anemia (due to Classification 
medications or toxins) • According to the stem cell line:
• Metastatic cancer, lymphoma. • Lymphoid
leukemia • Myeloid
• Myelodysplastic syndromes  Based on the time it takes for
• Chemotherapy symptoms to evolve:
• Radiation therapy • Acute
Destruction of Neutrophils • Chronic
• Hypersplenism  Common symptoms of chronic or
• Medication Induced acute leukemia may include:
• Immunologic disorders • Swollen lymph nodes
• Viral Disease • Fevers
 • Frequent infections – Pain
• Weakness – hyperplasia
• Bleeding Nursing Management
• Swelling – Low microbial diets
• Weight loss – Nutritional supplements
• Pain in the bones or joints – Daily body weight
Nursing Management – OFI
– Physical exam – Activity & rest
 Medical Management – Maintaining F&E balance
• Chemotherapy Medical Management
• Radiation therapy • Chemotherapy
• Interferon therapy • Antineoplastic tx
• Stem cell transplantation(SCT) • ATRA
• Surgery • Administering blood products
 Diagnostics • PBSCT
• Blood tests Diagnostics
• Biopsy • CBC
• CXR
II. CHRONIC MYELOID LEUKEMIA
I. ACUTE MYELOID LEUKEMIA – Arises from a mutation in
- Results from a defect in the the myeloid stem cell.
hematopoietic stem cell that Signs & Symptoms
differentiates into all myeloid cells. – Enlarged spleen
  – Malaise
– Low-grade fever
– Gout
Signs & Symptoms: – Infection
– Neutropenia – Anemia
– Weakness – Thrombocytopenia
– Fatigue – Splenomegaly
– Bleeding
Nursing Management
• Preventing infection
• Bed rest
• Personal hygiene
• Patient teaching
Medical Management
• Chemotherapy
• Allopurinol
 
Diagnostics
• CBC
• Biopsy
III. ACUTE LYMPHOCYTIC LEUKEMIA
- Results from an uncontrolled
proliferation of immature cells
derived from lymphoid stem
cells.
Signs & Symptoms:
 Weakness/fatigue
 Anemia
 Fever & infections
 Weight loss & loss of
appetite
 Bruising
 Bone pain
 Breathlessness
 Enlarged liver, lymph
nodes, and spleen
 Pitting edema
 Petechiae
Nursing Management
– All interventions for Acute
Myeloid Leukemia
Medical Management
• Chemotherapy
• Bone marrow transplant
 
Diagnostics
• Physical Examination
• CBC
• Biopsy
• Ultrasound/CT scanning
IV. CHRONIC LYMPHOCYTIC
LEUKEMIA
 Is a blood and bone
marrow disease.
 Common in adults, often
occurs during or after
middle age; it rarely occur
in children.
Signs & Symptoms:
 Enlarged, but painless,
lymph nodes
 Fatigue
 Fever
 Night sweats
 Weight loss
 Frequent infections
Medical Management
• Chemotherapy VI. HODGKIN LYMPHOMA
• Biopsy – Is a relatively rare
Diagnostics malignancy that has an
• Physical examination impressive cure rate.
• Biopsy – Unknown cause.
Signs & Symptoms:
V. LYMPHOMA – Painless swelling
– Is a type of cancer involving – Fevers
cells of the immune system, – Night sweats
called lymphocytes. – Weight loss
Signs & Symptoms: – Itchy skin
 Painless swelling Nursing Management
 Enlargement of spleen – Patient teaching
 Abdominal pain  
 Discomfort
 Fevers Medical Management
 Chills • Chemotherapy
 Weight loss • Radiation Therapy
 Night sweats • Stem cell transplant
 Lack of energy • Biological therapy
 Itching  Diagnostics
Medical Management • Physical examination
• Chemotherapy • Blood test
• Radiation Therapy • CXR
 Diagnostics • CT scan
• Blood test • Bone marrow aspiration
• Biopsy • Biopsy
• Imaging Studies • CBC
• Bone marrow Examination
VII. NON-HODGKIN LYMPHOMAS – Broken bones
• It is a heterogenous group of – Weakness
cancers that originate from the – Fatigue
neoplastic growth of lymphoid – Weight loss
tissue. – Repeated infections
  – Nausea & Vomiting
Signs & Symptoms: – Constipation
• Abdominal bloating – Problem with urination
• Change in bowel habits Nursing Management
• Fever – Pain management
• Sweating – Activity restrictions
• Weight loss – Infection prevention
Nursing Management – Antiembolic stockings
– Patient teaching Medical Management
Medical Management • NSAIDs
• Chemotherapt • Opoiod analgesics
• BMT or PBSCT • Raditaion Therapy
Diagnostics • Chemotherapy
• Physical examination Diagnostics
• CT scan • Serum Protein electrophoresis
• Biopsy • Urinr Protein electrophoresis
• CBC • Serum free light chain analysis
• CXR
BLEEDING DISORDERS
VIII. MULTIPLE MYELOMA I. THROMBOCYTOPENIA - medical
– Is a malignant disease of the term for a low blood platelet count;
most mature form of B medical term for a low blood platelet
lymphocyte, the plasma cell. count. 
Signs & Symptoms: Signs & Symptoms:
– Bone pain • - Easy or excessive bruising
 • - Superficial bleeding into the
skin that appears as a rash of
pinpoint-sized reddish-purple
spots (petechiae), usually on the
lower legs
• - Prolonged bleeding from cuts
• - Spontaneous bleeding from
your gums or nose
• - Blood in urine or stools
• - Unusually heavy menstrual
flows
• - Profuse bleeding during surgery
or after dental work
II. HAEMOPHILIA - an inheritable
disease, usually affecting only males
but transmitted by women to their
male children, characterized by loss or
impairment of the normal clotting
ability of blood so that a minor wound
may result in fatal bleeding
• Haemophilia A – clotting factor
VIII deficiency (most common);
Classic Haemophilia
• Haemophilia B – clotting factor IX
deficiency; Christmas Disease
Signs & Symptoms:
• - Bleeding
• - Bruising
III. VON WILLEBRAND’S DISEASE
- most common
hereditary coagulation abnormality
described in humans, although it can
also be acquired as a result of other
medical conditions.
Type 1
• In type 1 VWD, you have a low
level of von Willebrand factor,
and you may have lower than
normal levels of factor VIII. This
is the mildest and most common
form of VWD. About 3 out of 4
people who have VWD have type
1.
Type 2
• In type 2 VWD, the von
Willebrand factor doesn't work
the way it should. Type 2 is
divided into subtypes: 2A, 2B,
2M, and 2N. Different gene
mutations (changes) cause each
type, and each is treated
differently. So it's important to
know the exact type of VWD that
you have.
Type 3
• In type 3 VWD, you usually have
no von Willebrand factor and low
levels of factor VIII. Type 3 is the
 most serious form of VWD, but
it's very rare.
Signs & Symptoms:
• Frequent, large bruises from
minor bumps or injuries
• Frequent or hard-to-stop
nosebleeds
• Extended bleeding from the
gums after a dental procedure
• Heavy or extended menstrual
bleeding in women
• Blood in your stools from
bleeding in your intestines or
stomach
• Blood in your urine from
bleeding in your kidneys or
bladder
• Heavy bleeding after a cut or
other accident
• Heavy bleeding after surgery
IV. ACQUIRED COAGULATION
DISORDERS
DISSEMINATED INTRAVASCULAR
COAGULATION
- also known as consumptive
coagulopathy, is a pathological
activation of coagulation (blood
clotting) mechanisms that happens in
response to a variety of diseases. DIC
leads to the formation of small blood
clots inside the blood vessels
throughout the body.
Signs & Symptoms:
• Chest pain and shortness of
breath due to blood clots
forming in the blood vessels in
your lungs and heart.
• Pain, redness, warmth, and
swelling in the lower leg due to
blood clots forming in the deep
veins of your leg.
• Headaches, speech changes,
paralysis (an inability to move),
dizziness, and trouble speaking
and understanding due to blood
clots forming in the blood vessels
in your brain. These signs and
symptoms may suggest a stroke.
• Heart attack and lung and kidney
problems due to blood clots
lodging in your heart, lungs, or
kidneys. These organs may even
begin to fail.
Internal Bleeding
• Blood in your urine from
bleeding in your kidneys or
bladder.
• Blood in your stools from
bleeding in your intestines or
 stomach. Blood in your stools
can appear red or as a dark, tarry
color. (Taking iron supplements
also can cause dark, tarry stools.)
• Headaches, double vision,
seizures, and other symptoms
from bleeding in your brain.
External Bleeding
• Prolonged bleeding, even from
minor cuts.
• Bleeding or oozing from your
gums or nose, especially
nosebleeds or bleeding from
brushing your teeth.
• Heavy or extended menstrual
bleeding in women.
LIVER DISEASE - (also called hepatic
disease) is a broad term describing any
single number of diseases affecting
the liver. Many are accompanied
byjaundice caused by increased levels
of bilirubin in the system. The bilirubin
results from the breakup of
the hemoglobinof dead red blood
cells; normally, the liver removes
bilirubin from the blood and excretes
it through bile.
Diseases:
• Hepatitis,
• Non-alcoholic fatty liver disease
• Cirrhosis
• Haemochromatosis
• Cancer of the Wilson's disease,
a hereditary disease which
causes the body to retain copper.
• Primary sclerosing cholangitis
• Primary biliary cirrhosis
• Budd-Chiari syndrome-
obstruction of the hepatic vein.
• Gilbert's syndrome- a genetic
disorder of bilirubin metabolism
• Glycogen storage disease type II -
the build-up of glycogen causes
progressive muscle weakness
throughout the body and affects
various body tissues
Signs & Symptoms:
• Jaundice
• Drop of appetite & poor
digestion
• Light coloration of stool
• Polydypsia& polyuria
• Headache
• Problem of skin
• Allergy
• Feeling of Dizziness
• Tinnitus
• Ticks, Spasms and Tremors
• Sudden Seizures
 • Stroke
• Redness and itchiness of eyes
• Short temperedness and
constant irritation
• Tension and pain in the back
• Hypochondriac pain
• Loss of flexibility of tendons and
ligaments
• Depression
• Mood Swings
VITAMIN K DEFICIENCY-  is a form
of avitaminosis resulting from
insufficient vitamin K
Signs & Symptoms:
• - ecchymosis
• - petechiae
• - hematomas
• - oozing of blood at surgical or
puncture sites
• - stomach pains; risk of massive
uncontrolled bleeding
• - cartilage calcification
• - severe malformation of
developing bone or deposition of
insoluble calcium salts in the
walls of arteries
Treatments
SPLENECTOMY
• - is the total or partial surgical
removal of the spleen, an organ
that is part of the lymphatic
system.
Procedure:
A. COMPLETE SPLENECTOMY
REMOVAL OF ENLARGED SPLEEN. 
A splenectomy is performed
under general anesthesia. The most
common technique is used to remove
greatly enlarged spleens. After the
surgeon makes a cut (incision) in the
abdomen, the artery to the spleen is
tied to prevent blood loss and reduce
the size of the spleen. Tying the
splenic artery also keeps the spleen
from further sequestration of blood
cells. The surgeon detaches the
ligaments holding the spleen in place
and removes the organ. In many cases,
tissue samples will be sent to a
laboratory for analysis.
REMOVAL OF RUPTURED
SPLEEN. When the spleen has been
ruptured by trauma, the surgeon
approaches the organ from its
underside and ties the splenic artery
before removing the ruptured organ.
B.PARTIAL SPLENECTOMY
• In some cases, the surgeon
removes only part of the spleen.
This procedure is considered by
some to be a useful compromise
that reduces pain caused by an
enlarged spleen while leaving the
patient less vulnerable to
infection.
C. LAPAROSCOPIC SPLENECTOMY
-Laparoscopic splenectomy, or
removal of the spleen through several
small incisions, has been performed
more frequently in recent years.
Laparoscopic surgery, which is
sometimes called keyhole surgery, is
done with smaller surgical instruments
inserted through very short incisions,
with the assistance of a tiny camera
and video monitor. Laparoscopic
procedures reduce the length of
hospital stay, the level of
postoperative pain, and the risk of
infection. They also leave smaller
scars.
APHERESIS
- A procedure in which blood is
drawn from a donor and separated
into its components, some of which
are retained, such as plasma or
platelets, and the remainder returned
by transfusion to the donor. Also
called hemapheresis.
Procedure:
• Involve connecting the blood in
the patient/donor's veins
through tubing to a machine that
separates the blood
components. The separation is
done by either a centrifuge
process or a filtration process on
the blood in the machine. After
the separation, the desired
component of the blood is
removed, while the remainders
of the blood components are re-
infused back into the patient.
The entire procedure is painless
and typically takes about two
hours, or only slightly longer
than a conventional blood
donation.
PHLEBOTOMY
- The act or practice of opening a
vein by incision or puncture to remove
blood as a therapeutic treatment. Also • Donated blood is nearly always
called venesection. separated into components. A
Procedure: person rarely receives a whole-
– Select Site blood transfusion. Usually, a
• Apply the tourniquet above the blood component such as plasma
elbow. Choose a vein that is or red blood cells is given.
prominent when the patient Patients also may receive a
closes their fist. Never use an combination of components. The
artery vein for venipuncture. type of component patients
– Prepare Yourself receive depends on their medical
• Wash hands and put on gloves. condition.
Clean the puncture site with an
alcohol pad in a circular motion.
– Perform the Venipuncture
• Pull the skin tight above the
puncture site. Holding the needle
in line with the vein, use a quick
thrust to break the skin and
enter the vein in one movement.
Insert the tube to collect the
blood sample. When the sample
is collected, cover puncture with
a gauze pad and remove needle.

BLOOD & BLOOD COMPONENT

THERAPY
- transfusion of one or more of
the components of whole blood.
Procedure: