Arterial Disorders Medical Management

Peripheral Arterial 1. Exercise (walking)

Occlusive Disease program, unsupervised
walking exercise
 Blockage or narrowing of programs
an artery in the legs. 2. Exercise + weight
Symptoms are reduction + smoking
dependent on the cessation
affected artery and how 3. Pentoxifylline and
severe in the blockage cilostazol, antiplatelets,
 Occurs most often in statins
men and common cause 4. Endovascular
of disability management
 Legs are most frequently o Balloon angioplasty,
affected sten graft,
atherectomy
Clinical manifestations
Surgical Management
1. Intermittent claudication
2. Rest pain – critical 1. For severe/disabling
ischemia claudication
2. Endarterectomy, bypass
Diagnostic exams grafts
a) History and assessment [Unsupervised walking done only at
b) Continuous – wave home
dopple, ABI, treadmill Meds: pampapayat to avoid further
complications
testing for claudication, Angioplasty: butangan balloon
duplex ultrasonography Stent: naay plastic
Stent graft: mag kuhag ugat
[Intermittent claudication: Changes in Atherectomy: removal of]
color pag gamiton ang affected na
limb; first kay pain, pale, erythema. Nursing Management
pale, cyanotic, erythema; mag change
color kay nag vasoconstrict man.
Rest pain: persist pag rest; mas taas
1. Nursing care of the
na part mas painful. postoperative patient
Definitive: Duplex ultrasonography] 2. Maintaining circulation
3. Monitoring and
managing potential
complications
4. Home care
Aortic Aneurysm
 Weakened area in the
upper part of the aorta
 Commonly caused by
atherosclerosis
 High morbidity and
mortality rates
Risk factors
a) Men: race (caucasian),
age (65yo and above),
genetics, tobacco use,
hypertension
Diagnostic Exam
a. Imaging studies
b. Atherosclerosis: naay
narrowing kay naay blocked;
mag accumulate ang blood
c. Asymptomatic; possible
mag craniectomy
d. Men: lifestyle; female:
after menopause
Thoracic Aortic Aneurysm
Clinical Manifestations
1. Depends on how rapidly
aneurysm dilates and
how pulsating mass
affects surrounding
structures
2. Pain – during supine
3. Dyspnea, cough, stridor,
hoarseness or aphonia
dysphagia
4. Key hallmark sign: pain
during supine; ang
aneurysm gina suppressed ang
spine.
5. Dyspnea: suppressed
airways
Abdominal Aortic
Aneurysm
Clinical Manifestations
 Only 40% are
symptomatic
 “feel their heart beating
in their abdomen when
lying down”
 Systolic bruit
 Signs of impending
rupture
o Severe back or
abdominal pain
 Signs of rupturing
aneurysm
o Constant
intense back
pain, falling BP,
decreasing
hematocrit
 Rupture to peritoneal
cavity
o FATAL –
hematomas in
lower thorax
[Systolic bruit: kung asa nag start
ang blockage
Impending rupture: abd pain;
creates pressure going upward;
kabuthon
Rupturing: nibuto na; falling BP: bc
ga leak na ang blood pa gawas sa
vessel
Hematomas: all lower quadrants
Sodium: med for heart failure;
controlled beating of the heart; gina
parelaxed blood vessel so mag Clinical Manifestations
expand mag result- vasodilation.
Vascular graft: ugat fr other area
then bypass; stents: plastic na tubings
1. Pallor due to sudden
e bypass vasoconstriction
CSF: b4 or gina drain to lessen pain 2. Cyanosis and hyperemia
Pre OP care: no smoking, no anti- 3. White – blue – red with
coagulant]
numbness, tingling, and
Raynaud Phenomenon burning pain
4. Bilateral and symmetric
 Intermittent arteriolar involving toes and
vasoconstriction that fingers
results in coldness, pain 5. Acrocyanosis differs by
and pallor of the persistence of skin color
fingertips or toes changes, symmetry and
 Primary or idiopathic and non-paroxysmal
secondary raynaud’s
o SLE, RA, Medical Management
trauma, a. Avoiding stimuli that
obstructive provoke vasoconstriction
arterial lesions b. Calcium – channel
 Triggered by emotions or blockers,
sensitivity to cold sympathectomy
c. Avoidance to cold and
Risk factors
measure to improve
a. Women, age (<30) circulation for
b. Acrocyanosis – variant acrocyanosis
c. Variable prognosis – [Numbness: white
some slowly improve, Tingling: blue
some become Burning pain: red
Fast progression]
progressively worse,
others no change Nursing Management
[Secondary raynauds: caused by SLE
Emotions: vasoconstriction 1. Avoid stress, cold
Women: emotions, hormones mas 2. Education about
frequent ang vasoconstriction complications that are
Less than 30 bc of the activities; and
emotions sd kay uncontrolled uncommon, side effects
Worsen overtime] or medications
3. Avoid nicotine
4. Nicotine:
vasoconstriction effect
Buerger’s Disease Clinical Manifestation

 Thromboangitis 1. Distal extremity ischemia

obliterans – medium (claudication, pain at
vessel vasculitis rest, ischemic ulcers,
 Segmental thrombosing gangrene)
inflammation 2. Thrombophlebitis,
 Strongly associated with paresthesia, impaired
heavy tobacco use distal pulses
 Moderate – to – severe 3. Ulcerations, gangrene
claudication that quickly (auto-amputations)
progress to critical limb
Diagnostic exams
ischemia
a. Arteriography on all 4
Risk factors
limbs (unaffected first)
1. 20 - 40 yo male b. Echo, CT, angiography
2. Indian, Korean,
Medical Management
Japanese
3. Tobacco use 1. Smoking cessation
[Reynaus: less to progress to 2. Pharmacologic therapy
ischemia;] not effective
3. Amputations
[Pain at rest: dec blood flow
Ulcerations: auto-amputations
recommended
Echo (not much needed);
angiography: confirmatory]

Hypertension

[Even if mag rest dli maka back to
normal bc naay thrombus formation]
 N: <120/180; 120/80 to
139/89 as preHTN:
140/90<asHTN
 preHT = at risk of HTN;
slight increases in BP
also has increase risks of
other comorbids

prHTN = lifestyle
changes
 HTN S1 = lifestyle sleep apnea, pregnancy,
changes + medications cardiovascular conditions
d. Key to hypertension:
HTN S2 = same but comply to medication
more frequent regimen
consultations e. Kidney: sensitive to high
bp; affect the filtration of
 Primary hypertension = kidney
unidentified cause
 Secondary hypertension Pathophysiology
= identifiable cause
 Contraction of the heart.
[Normal: 120/80- 90/60] pressure transfer from
heart muscle to the
blood. Blood exerts the
same pressure to the
blood vessels
 Increase in cardiac
output or increase in
peripheral
resistance/increase in
 Pregnancy =
pressure
preeclampsia
 “Silent killer” Clinical Manifestations

a. Elevated vlood pressure

alone
Signs and risk factors
b. Retinal chanes, vascular
Risk factors damage, left ventricular
hypertrophy
a. Race, gender, Age, c. Heart failure, nocturia,
Family history TIA or CVA
b. Alcohol intake, obesity, d. Retinal changes: most
high salt diet, sedentary common- naay blood
lifestyle, tobacco use, shot eyes (usually isa lg
stress ka mata)
c. CKD, renal artery
[Epistaxis: mas common pajud; lisod
stenosis, e stop.pag involved na nag vessel sa
hyperaldosteronism, ilong chronic hypertension na
pheochromocytoma,
Nocturia: seg filter ang kidney kay
sige man sya received dugo so sige
ihi-ihi]

Diagnostic exams

1. Routine: UA, blood

chemistry, ECG
2. Echo
3. Add: creatinine
clearance, renin level,
urine test, 24-hour urine
protein
4. Risk factor assessment

Medical Management

Goal: prevent complications

by maintaining BP

1. Lifestyle modifications
2. Pharmacologic therapy
a. Decrease
peripheral
resistance,
blood volume,
and strength &
rate of
contraction
3. Calcium-channel blocker
+ thiazide (60<)
4. ACEi and ARB (<60)
5. Small dosage and
simplest treatment
[Routing: ua: damages sa kidney:
ECG: ischemia sa heart

Echo: pag naan a heart failure

24 hr urine: to check if naay protein sa

urine

Goal: to give the smallest dosage and

simplest treatment]