Medical – Surgical Nursing

(NUR 155) | BATCH 2023

COLLEGE OF NURSING – PHINMA UNIVERSITY OF PANGASINAN

PERIPHERAL VASCULAR DISEASES  Nail beds: capillary refill is greater than 3 seconds
 Peripheral pulses; may be diminished; audible bruit

BURGER’S DISEASE
(THROMOANGIITIS OBLITERANS) DIAGNOSTICS:
 Physical Examination
- A recurring inflammatory infiltration (there is a plaque formation
 Segmental limb pressure
on the intimal wall that causes partial or complete occlusion) of
intermediate and small arteries and veins of the lower (feet) and  Doppler ultrasonography

rarely the upper extremities (hands).  Arteriography or angiography

 Transcutaneous Oximetry
ETIOLOGY:  MRI
- Unknown cause (Autoimmune vasculitis but usually associated PHARMACOLOGICAL MANAGEMENT:
with smoking)
 Anticoagulants
INCIDENCE:
 Thrombolytics or Fibrolytics
- Men
 Vasodilators
- 20-35 years old
NURSING MANAGEMENT:
- All races
 Maintain a warm environment

PATHOPHYSIOLOGY:  Legs in slight dependency and avoid elevating the legs

Thrombus formation  Avoid vigorous massage of extremities

↓  Advise patient to avoid constrictive clothing and avoid
+ Inflammation crossing of legs
= narrowed lumen  Advice to quit smoking
↓
 Promote activity or exercise; general exercise; Buerger-Allen
Artery is unable to transport adequate blood volume to the tissue during
exercise
exercise and rest
 Maintain skin integrity and prevent infection
↓
Total occlusion = appearance of s/sx

MANIFESTATIONS: SURGICAL MANAGEMENT:

Symptoms resulted from occlusion of arteries, leading to  Arterial Bypass Surgery

ischemia, complicated in later stages by infection  Percutaneous Transluminal Angioplasty
(thrombophlebitis)  Amputation

 PAIN with exercise: most common; usually bilaterally symmetric at

the arch of the foot; RAYNAUD’S DISEASE
-It may occur during rest and sometimes persistent (VASOMOTOR ARTERIAL DISEASE)
 Intermittent claudication – most common symptom of - a form of intermittent or episodic arteriolar vasoconstriction,
arterial insufficiency which occurs during exercise predominantly in hands

 Skin color and temperature changes

ETIOLOGY:
 Ulcers and gangrene

PADAWAN, ANGELIKA R.| 3BSN3 1

 Medical – Surgical Nursing
(NUR 155) | BATCH 2023
COLLEGE OF NURSING – PHINMA UNIVERSITY OF PANGASINAN

- Unknown cause (autoimmune) but usually associated with  Vascular Smooth Muscle Relaxants
emotional stress and hypersensitivity to cold.  Vasodilators

INCIDENCE:
NURSING MANAGEMENT:
- Women
 (Same as the Burguer’s disease)
- 20-40 years old
 Advise the patient to wear gloves and warm socks during
- More on winter months
winter months, in cleaning refrigerator and in handling frozen
foods.
PATHOPHYSIOLOGY:
 Avoid occupations that require constant exposure to cold.
Cold stress
SURGICAL MANAGEMENT:
↓
 Sympathectomy
Episodic arterial spasm
 Amputation
↓
Intimal wall thickens because of hypertrophy of medial wall resulting
from constant and repeated spasm or constriction
↓
Sluggish blood flow
↓
Total occlusion = appearance of s/sx

MANIFESTATIONS:
- Symptoms resulted from arterial spasm, leading to ischemia

 PAIN with cold stress; usually at fingertips

 Skin color and
 temperature changes
 Ulcers and gangrene
 Nail beds: capillary refill is greater than 3 seconds

DIAGNOSTICS:
 Physical Examination
 Cold stimulation test – fingers are placed in an iced-water bath
for 20 seconds. (+) for Raynaud’s Phenomenon if the
temperature of the fingers did not return to normal after 20
minutes

PHARMACOLOGICAL MANAGEMENT:
 Calcium Antagonist

PADAWAN, ANGELIKA R.| 3BSN3 2

 Medical – Surgical Nursing
(NUR 155) | BATCH 2023
COLLEGE OF NURSING – PHINMA UNIVERSITY OF PANGASINAN

Other Vascular Disorders:

ANEURYSM SACCULAR ANEURYSM

– a bulbous protrusion of one side of the arterial wall
- Permanent bulging/stretching of an artery in which the dilation
is two times or greater the size of the artery

- 3 sites commonly affected:

a) Aortic Arch

b) Thoracic Aorta

c) Abdominal Aorta

THORACIC AORTIC ANEURYSM

- Approximately 70% of all cases of thoracic aortic aneurysm are
caused by atherosclerosis.
- They occur most frequently in men between the ages of 50 to 70
years, and are estimated to affect 10 of every 100,000 older adults.
- The thoracic area is the most common site for a dissecting
aneurysm.
FALSE ANEURYSM
– actually, a pulsating hematoma
DISSECTING ANEURYSM
– this is usually a hematoma that splits the layers of the arterial wall
ETIOLOGIC CLASSIFICATION OF ANEURYSMS
• Congenital – primary connective tissue disorders (Marfan
Syndrome, Ehlers-Danlos Syndrome) and other diseases (focal
medial agenesis, tuberous sclerosis, Turner syndrome, Menkes
syndrome).
• Mechanical (hemodynamic) – post stenotic and arteriovenous
fistula and amputation related
• Traumatic (pseudoaneurysm) – penetrating arterial injuries,
blunt arterial injuries,
• Inflammatory (non-infectious) – associated with arteritis

TRUE ANEURYSM (Takayasu disease, giant cell arteritis, SLE, Behcet syndrome,
– one, two, or three Arteries are involved. Kawasaki disease) and periarterial inflammation (i.e. pancreatitis)
• Infectious (mycotic) – bacterial, fungal, spirochetal infection
• Pregnancy-related degenerative – non- specific,
inflammatory variant
• Anastomotic (post arteriotomy) and graft aneurysms –
infection, arterial wall failure, suture failure, and graft failure

CLINICAL MANIFESTATIONS

FUSIFORM ANEURYSM • Some patients are asymptomatic.

– symmetric spindle-shaped expansion of entire circumference • Pain is constant and occurs when person is in supine position.
of involved vessel
• Dyspnea
• Paroxysmal cough
• Hoarseness, stridor, weakness or complete loss of voice
(aphonia) – resulting from a pressure in the laryngeal nerve

PADAWAN, ANGELIKA R.| 3BSN3 3

 Medical – Surgical Nursing
(NUR 155) | BATCH 2023
COLLEGE OF NURSING – PHINMA UNIVERSITY OF PANGASINAN

• Dysphagia • Postimplantation syndrome – typically begins within 24

ASSESSMENT AND DIAGNOSTIC FINDINGS hours of stent graft placement and consists of

• CXR spontaneously occurring fever, leukocytosis, and

• CT Angiography occasionally transient thrombocytopenia.

• MRA (Magnetic Resonance Angiogram) • Check for signs of hemorrhage

• TEE (Transesophageal echocardiography)

MEDICAL/SURGICAL MANAGEMENT
• Controlling BP through anti-hypertensive drugs (e.g. Beta-
blockers, ARBs, ACE inhibitors)
• Repair of aneurysms using endovascular grafts (through CC)
VARICOSE VEINS
- Dilation of veins because of lack of muscle support – results from
prolonged venous stasis

COMMON SITES/RELATED CONDITIONS:

 Saphenous vein
 Leg vein
 Hemorrhoids
 Esophageal varices

NURSING MANAGEMENT
• Place patient in supine position after an endovascular
repair.
• V/S and Doppler assessment of peripheral pulses are
monitored every 15 minutes.
• Assess for bleeding, pulsation, swelling, pain and
hematoma formation at the access site.
PREVENTION AND MEDICAL/SURGICAL MANAGEMENT
• Check for signs of embolization such as extremely tender,
• Pt should avoid activities that cause venous stasis such as
irregularly shaped, cyanotic areas, as well as changes in
wearing socks that are too tight at the top, crossing the legs at
v/s, pulse quality, bleeding, swelling, pain, or hematoma.
the thighs, and sitting or standing for long periods.
• Temperature is monitored every 4 hours, and check for
• Change position frequently elevating the legs 3-6 inches
signs of postimplantation syndrome.
higher than the heart.
• Pt is encouraged to walk 30 minutes each day.

PADAWAN, ANGELIKA R.| 3BSN3 4

 Medical – Surgical Nursing
(NUR 155) | BATCH 2023
COLLEGE OF NURSING – PHINMA UNIVERSITY OF PANGASINAN

• Graduated compression stockings, especially knee-high

stockings are useful.

NURSING MANAGEMENT
• Advise patient that procedures are OPD.
• Patient is advised to walk every hour for 5-10 minutes once
the sedation has worn off.
• Advise the patient that graduated compression stockings are
worn about 1 week after vein stripping.
• Foot of the bed should be elevated.
• Standing and sitting are discouraged.

THERMAL ABLATION

SCLEROTHERAPY

PADAWAN, ANGELIKA R.| 3BSN3 5

 Medical – Surgical Nursing
(NUR 155) | BATCH 2023
COLLEGE OF NURSING – PHINMA UNIVERSITY OF PANGASINAN

PADAWAN, ANGELIKA R.| 3BSN3 6

 Medical – Surgical Nursing
(NUR 155) | BATCH 2023
COLLEGE OF NURSING – PHINMA UNIVERSITY OF PANGASINAN

PADAWAN, ANGELIKA R.| 3BSN3 7