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Management of a

person with a vascular


disorder
MSN2
2012

Lecture Objectives

At the end of this lecture you should be able


to:
1. Discuss the nursing management of clients
with common vascular disorders (venous
and arterial), such as Deep Vein
Thrombosis (DVT), aneurysms and ulcers.
2. Discuss collaborative care management in
the above clients

Vascular Disorders
Arterial versus Venous
Also consider
Thrombosis
Structural changes
Vasospasm
Acute or Chronic
Congenital
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Vascular Assessment
Inspection
Bruising, discolouration, skin texture
Varicosities
Ulcers, lesions
Oedema, cyanosis
Distended neck veins
Percussion, palpation
Pulses, BP, capillary return
Bruits
Cool peripheries
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Diagnostic tests

X-ray
Angiography
Doppler ultrasound
Ankle-brachial index:

http://www.carolinaveincenter.com/du
plex.html

ankle SBP/brachial SBP (0.9-1.3 normal)

Duplex imaging

Duplex

Doppler

http://www.umm.edu/features/
vascular_disease.htm

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http://www.carolinaveincent
er.com/duplex.html

Deep Vein Thrombosis (DVT)

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http://www.lymphedemapeople.com/thesite/lymphedema_de
ep_venous_thrombosis.htm

DVT: Clinical Signs & Risk


factors
SIGNS
Often subtle
Swelling or pain to
the limb
Redness & Temp
Diagnosis via
ultrasound

RISK FACTORS

Prolonged bed rest


Immobilisation
Surgery (orthopaedic,
abdominal: 5% incidence)
Obesity
MI, CHF

Ca, MS
Oral contraceptive pill
Altered coagulability states
Pregnancy
Age over 50 years

Nursing ManagementPrevention
compression stockings (TEDS)
encourage early ambulation
active & passive ROM exercises
deep breathing exercises
intermittent calf compressors
administration of prophylaxis low-dose
heparin therapy or daily S/C Clexane.
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Nursing ManagementTreatment
Administer Clexane (Low molecular
weight Heparin) &/ or Warfarin
Bed Rest,
Elevation of the extremity
Education
Neurovascular Observations
Monitor for S& S of complications
REMEMBER COMPLICATIONS OF DVT
PULMONARY EMBOLIS
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Other treatment options


Thrombolytics
Venous thrombectomy
Insertion of a vena cava filter
(umbrella)

http://www.clinicalresearch.nl/epidemiology/
wright/venous%20thrombosis.htm

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Neurovascular Observations
Movement- Can they
move the limb?

Colour - can be subjective


(pink)

Warmth Cold , Cool,


Warm, Hot

Capillary refill - < 2-3


secs

Pulse - rate, rhythm,


amplitude & symmetry

Sensation any

paraesthesia, numbness?
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Chronic Venous Insufficiency


Common in the elderly, obesity
Caused by vein incompetence, DVT,
congenital malformation, AV fistula or calf
muscle fatigue

http://www.unchealthcare.org/site/woundma
nagement/images/SC000301.JPG/view
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http://www.vnus.com/navigation/patvenousdisease.htm

Clinical Signs and


Symptoms
Brownish or brawny appearance to
lower leg
Persistent oedema
Eczema or (stasis) dermatitis
Pruritus
Wound / Ulcer

margins are irregularly shaped,


often over medial malleolus
Wound bed red
Painful
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Nursing Management
Treatment: compression bandaging.
Elevate legs while resting & during sleep
Encourage walking but not standing
Avoid crossing legs
Maintain nutritional status
Keep skin clean, soft & dry and avoid trauma

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Compression bandaging

(Jones, 2002, p. 10)

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(Phillips, 2001, p. 615)

Chronic Arterial Insufficiency


Risk factors
Smoking
Diabetes mellitus
Signs and symptoms
Intermittent claudication
Paraesthesia
Skin thin, shiny, taut, loss of hair
Dependent rubor, elevation pallor
Wound / Ulcer:
Margin round, punched out
Often found on toe tips, lateral malleolus
Pain - may or may not be present
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PAD: Treatment

Cease smoking
Control Diabetes, hypertension
Antiplatelets eg aspirin
Nutrition
Exercise program-walking
Care of foot, do not elevate limb
Intervention / Surgery
Stents, balloon angioplasty
Endarterectomy +/- Patch graft
angioplasty
Femoral-popliteal bypass
Amputation
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Aneurysms
An aneurysm is a localized dilation or

outpouching of a vessel wall or cardiac


chamber. (Huether & McCance, 2004, p. 651)

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intensivecare.hsnet.nsw.gov.au/.../AAA.jpg

AAA
Diagnosis and Treatment
Diagnosis most often occurs from routine
abdominal X-ray, Ct Scans or ultrasound
MRI can also be used for diagnosis
Generally surgical intervention is required,
(normally when a AAA is > 4cm )
Conservative management in small
aneurysms

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Nursing Management
Pre Op
Assessment of tissue perfusion (peripheral
pulses)
Pain relief
Reduce anxiety (patient & family)
Abdominal girth measurement
Monitoring haemodynamic statusparticularly BP
For HDU/ ICU post-op

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Nursing Management
Post Op

Prevention of infection
Maintaining normal BP
Monitoring Neurovascular obs
Maintaining adequate urine output
Wound management
Early ambulation
Chest physiotherapy
Pain management
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Bibliography
Brown, D., & Edwards, H. (2008). Lewiss medical-surgical
nursing: Assessment and management of clinical problems
(2nd ed). Sydney: Elsevier.
Crisp, J., & Taylor, C. (2009). Potter and Perry's fundamentals of
nursing (3rd ed.). Sydney: Mosby.
Huether, S., & McCance, K. (2004). Understanding
pathophysiology (3rd ed.). St Louis: Mosby.
Jones, J. (2002). Use of compression hosiery in venous leg
ulceration. Nursing Standard, 16(16), 10.
Judge, N. (2007). Neurovascular assessment. Nursing Standard,
21(45), 39-44. Retrieved September 9, 2008, from
http://www.snjourney.com/ClinicalInfo/Systems/PDF/NeuroVas
%20Assessment.pdf

Lemone, P., & Burke, K. et al (2011). Medical surgical nursing:


Critical thinking in client care. Upper Saddle River, New
Jersey: Prentice Hall.
Phillips, T. J. (2001). Current approaches to venous ulcers and
compression. Dermatologic Surgery, 27(7), 611621.
Porth, C. M. & Matfin, G. (2009). Pathophysiology: Concepts of
altered health states (8th ed.). Philadelphia: Lippincott.
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