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Care of the Patient with Vascular Impairments
Transcript of Care of the Patient with Vascular Impairments
NU236 Fall 2014
Nursing Care of the Patient After Arteriogram
Nursing Care of the Patient Undergoing AAA Repair
Nursing Care of the Patient Undergoing Bypass Surgery
Describe important objective and subjective data to be collected with inspecting patients’ extremities.
Compare and contrast common diagnostic tests for arterial and venous disorders.
Describe primary and secondary prevention strategies for the patients with peripheral vascular disease.
Formulate and prioritize nursing diagnoses for the patient with vascular impairments.
Discuss nursing research related to caring for patients with arterial impairments.
Describe the post-operative nursing care and priorities for patients after an arteriogram, AAA repair, bypass surgery, and amputation.
Nursing Care of the Patient Undergoing Amputation
Phantom Limb Pain
Risks associated with immobility
A balloon is inserted through the catheter
Stents may be placed to support vessel wall
After the procedure contrast dye is again introduced through the catheter to check for increased patency
Nursing Care after percutaneous vascular intervention:
Often an outpatient procedure
PRIORITY: maintaining adequate circulation
moving the extremity, ambulation if possible
frequent neurovascular checks
VS, I&O, physical assessment (heart, lungs, GI)
cool, dusky color
delayed capillary refill
decreased sensory/motor function
If unable to revascularize by angioplasty:
Thrombectomy or embolectomy
Nursing Care after bypass
Assess pulses and neurovascular checks of the lower extremities Q 15 minutes --> Q 30 minutes --> QH --> Q 4H
Assess pulses using the Doppler and compare the results to the baseline preoperative assessment and to the other extremity.
Report any absent pulse immediately to the surgeon.
Assess for pain with vital signs and provide pain medications as ordered.
The ankle-brachial index (ABI) should be assessed every 8 hours for the first 24 hours and then once daily until discharge.
Fluid volume status
Assess incision sites.
Assess for postoperative edema
Observe the patient using the incentive spirometer or PEP device
Administer oxygen as ordered
Ambulation as ordered to assess gait and stability.
Abdominal Aortic Aneurysms
A sac (outpouching) of an artery formed by weakness or stretching of arterial wall
Occur most commonly on aorta
Fusiform - Entire circumference
Saccular - Outpouching on one side
Dissecting - When blood separates the layers of the artery wall
Characteristics of Arterial Aneurysms
Atherosclerosis, HTN, smoking, syphylis, familial risk, trauma, > men
Most often asymptomatic
Constant abdominal or low back pain
SOB or difficulty swallowing
Diminished femoral pulses
On exam pulsating abdominal mass with bruits
Abdominal Aortic Aneurysm (AAA)
Tight control of HTN
Monitor size with frequent CT scans or US
Modifiable risk factors: smoking, BP
Teach early s/s of rupture
Importance of compliance with meds and follow-up visits
AAA Non-Urgent Management
Symptoms vary from “small leak” to “complete rupture”, also depends on size of aneurysm
Severe abdominal or back pain
Abdominal distension (measure girth)
Loss of consciousness
Immediate transfer to OR
Two things alter venous blood flow:
1) Thrombus formation “DVT" “Thrombophlebitis”
2) Defective valves
Vein functioning depends on:
1) Valves prevent backflow of blood (Unidirectional)
2) Also require muscle to help pump (squeeze) blood back to heart
Blood flow and function of valves in veins. Note impaired blood return due to incompetent valve.
Weight-based heparin infusions
Example from CMC
Goal is INR of 2.0 to 2.5
2- Nurses Required!
Type (bovine vs. porcine)
Duration of therapy (>4 days
Monitor Platelet Count!!!
Treatment of DVT/PE
Distended, protruding veins that become tortuous
occupation with prolonged standing (nurses), pregnant, obese, family hx, women, tight clothes
S/S: Pain, fullness in legs, distended firm veins
1) Conservative - wear TEDS, elevate legs often
2) Sclerotherapy - surgeon injects veins
3) Surgical ligation/stripping (removal) - If > 4 mm
4) Light source treatment
Atherosclerosis leads to occlusions
color flow duplex
ABI (Ankle Brachial Index)
Ankle systolic pressure divided by brachial systolic pressure
normal = 1.0 - 1.2
below 1.0 suggests arterial obstruction
0.8 - 1.0 mild
0.5 - 0.7 moderate
< 0.5 severe
CT (with contrast or angiography)
Altered Peripheral Tissue Perfusion
Acute or Chronic Pain
Risk for Impaired Skin Integrity
Major goals include:
increased arterial blood supply
promotion of vasodilatation
prevention of vascular compression
relief of pain
attainment or maintenance of tissue integrity
adherence to self-care program
Maintaining Tissue Integrity
Improving Peripheral Arterial Circulation
Use of antiplatelet agents
ARTERIAL vs VENOUS
Protection of extremities and avoidance of trauma
Regular inspection of extremities
Good nutrition, low-fat diet
Weight reduction as necessary
Exercises and activities: walking, graded isometric exercises.
Temperature; effects of heat and cold
Pneumatic compression devices
Subcutaneous heparin or LMWH, warfarin (Coumadin) for extended therapy
Positioning: periodic elevation of lower extremities
Exercises: active and passive limb exercises, and deep breathing exercises
Avoid sitting/standing for prolonged periods; walk 10 minutes every 1-2 hours.