1. Last Lecture Cardiovascular Diseases

2. Alterations inBlood Flow in the Systemic Circulation

3. ANEURYSM Dilation involving an artery formed at a weak point in the vessel wall

4. ANEURYSM Saccular= when one side of the vessel is affected Fusiform= when the entire segment becomes dilated

5. ANEURYSM RISK FACTORS Atherosclerosis Infection= syphilis Connective tissue disorder Genetic disorder= Marfan’s Syndrome

6. ANEURYSM PATHOPHYSIOLOGY Damage to the intima and media  weakness  outpouching Dissecting aneurysm  tear in the intima and media with dissection of blood through the layers

7. ANEURYSM ASSESSMENT Asymptomatic Pulsatile sensation on the abdomen Palpable bruit

9. CT scan

10. Ultrasound

11. X-ray

13. Anti-hypertensives

15. Administer medications

16. Emphasize the need to avoid increased abdominal pressure

17. No deep abdominal palpation

19. Usually found in males age 50 and above

21. Non-Modifiable

22. 1. Age

23. 2. gender

25. Modifiable

26. 1. Smoking

27. 2. HPN

28. 3. Obesity

29. 4. Sedentary lifestyle

30. 5. DM

33. 1. INTERMITTENT CLAUDICATION- the hallmark of PAOD

35. 1. INTERMITTENT CLAUDICATION- the hallmark of PAOD

36. This pain is RELIEVED by REST

38. 2. Progressive pain on the extremity as the disease advances

40. 4. Skin is pale when elevated and cyanotic/ruddy when placed on a dependent position

42. 1. Unequal pulses between the extremities

43. 2. Duplex ultrasonography

45. 1. Drug therapy

46. Pentoxyfylline (Trental) reduces blood viscosity and improves supply of O2 blood to muscles

47. Cilostazol (Pletaal) inhibits platelet aggregation and increases vasodilatation

49. 1. Maintain Circulation to the extremity

50. Evaluate regularly peripheral pulses, temperature, sensation, motor function and capillary refill time

52. 2. Monitor and manage complications

53. Note for bleeding, hematoma, decreased urine output

54. Elevate the legs to diminish edema

55. Encourage exercise of the extremity while on bed

57. Buerger’s Disease Also known as Thromboangiitisobliterans Usually a disease of heavy cigarette smoker/tobacco user men, 25-40y/o Inflammatory arterial disorder that causes thrombus formation often extends to adjacent veins & nerves

58. Affects medium-sized arteries (usually plantar & digital vessels in the foot or lower legs) unknown pathogenesis but it had been suggested that: tobacco may trigger an immune response or unmask a clotting defect; -> these 2 can incite an inflammatory reaction of the vessel wall

60. Intermittent claudication in the arch of foot & digits

61. Increased sensitivity to cold (due to impaired circulation

63. Thick malformed nails (chronic ischemia)

66. Cause: unknown

67. Usually affects young women

68. Precipitated by exposure to cold & strong emotions

70. Return to normal color Note: although all of the fingers are affected symmetrically, only 1-2digits may be involved Severe cases: arthritis may arise (due to nutritional impairment) Brittle nails Thickening of the skin of fingertips Ulceration & superficial gangrene of fingers (rare occasions)

72. Immersion of hand in cold water to initiate attack aids in the Dx

73. Doppler flow velocimetry – used to quantify blood flow during temperature changes

75. PRIORITIES: Abstinence in smoking & protection from cold

76. Avoidance of emotional stress (anxiety & stress may precipitate vascular spasm)

77. Meds: avoid vasoconstrictors (i.e.. Decongestants) -Calcium channel blockers (Diltiazem, Nifedipine, Nicardipine) – decrease episodes of attacks

78. Care Plan for Clients with Altered Cardiovascular Oxygenation Goals: Relief of pain & symptoms Prevention of further cardiac damage Nursing Interventions: Pain control Proper medications Decrease client’s anxiety Health teachings (meds, activities, diet, exercise, etc) Assessment: Hx of symptoms (pain, esp. chest pain; palpitations; dyspnea) v/s Nursing Dx: ineffective tissue perfusion (cardiopulmonary) Impaired gas exchange Anxiety due to fear of death (clients with MI or Angina)

79. Thank you for listening!