8/8/2019 For Mam Juls
1/33
Raynaud's
disease
8/8/2019 For Mam Juls
2/33
Raynauds disease
Vasospasms of arterioles and arteriesof the upper and lower extremities.
Vasospasm causes constriction of thecutaneous vessels.
Attacks are the intermittent and occur
with exposure to cold or stress. Affects primarily fingers, toes, earsand cheeks.
8/8/2019 For Mam Juls
3/33
assessment
Blanching of the extremity, followed bycyanosis during vasoconstriction.
Reddened tissue when the vasospasm isrelieved.
Numbness, tingling, swelling and a cold
temperature at the affected body part.
8/8/2019 For Mam Juls
4/33
interventionso Monitor pulses.o Administer vasodilators as prescribed.
o Instruct the client regarding medicationtherapy.
o Assist the client to identify and avoidprecipitating factors such as cold and stress.
o Instruct the client to avoid smoking.
o Instruct the client to wear warm clothing,socks and gloves in cold water
o Advise the client to avoid injuries to fingersand hands.
8/8/2019 For Mam Juls
5/33
Buergers
disease
8/8/2019 For Mam Juls
6/33
Buergers disease
An occlusive disease of the media and smallarteries and veins.
The distal upper and lower limbs are affectedmost commonly
8/8/2019 For Mam Juls
7/33
assessment
Intermittent claudication.
Ischemic pain occurring in the digits while atrest
Aching pain that is more severe at night. Cool, numb or tingling sensation.
Diminished pulses in the distal extremities.
Extremities that are cool and red in thedependent position.
Development of ulcerations in the extremities
8/8/2019 For Mam Juls
8/33
interventions
Instruct the client to stop smoking.
Monitor pulses.
Instruct the client to avoid injury to theupper and lower extremities.
Administer vasodilators as prescribed.
Instruct the client regarding medication
therapy.
8/8/2019 For Mam Juls
9/33
Aortic
aneurysms
8/8/2019 For Mam Juls
10/33
Aortic aneurysms
An abnormal dilation of the arterial wallcaused by localized weakness and stretchingin the medial layer or wall of an artery.
The aneurysm can be located anywhere alongthe abdominal aorta.
The goal of treatment is to limit the
progression of the disease by modifying riskfactors, controlling the BP to prevent strainon the aneurysm, recognizing symptoms earlyand preventing rupture.
8/8/2019 For Mam Juls
11/33
Types of aorticaneurysm
8/8/2019 For Mam Juls
12/33
1. fusiform
Diffuse dilation that involves the entireof the arterial segment.
8/8/2019 For Mam Juls
13/33
2. saccular
Distinct localized outpouching of theartery wall.
8/8/2019 For Mam Juls
14/33
3. dissecting
Created when blood separates thelayers of the artery wall, forming a
cavity between them.
8/8/2019 For Mam Juls
15/33
4. False (pseudoaneurysm)
Occurs when the clot and connectivetissue are outside the arterial wall.
Occurs as a result of vessel injury ortrauma to all three layers of thearterial wall.
8/8/2019 For Mam Juls
16/33
assessment
a. THORACIC ANEURYSM Pain extending to neck, shoulders, lower back or
abdomen.
Syncope Dyspnea
Increased pulse
Cyanosis
Weakness Hoarseness, difficulty swallowing because of
pressure from the abeurysm
8/8/2019 For Mam Juls
17/33
b. ABDOMINAL ANEURYSM
Prominent pulsating mass in abdomen at arabove umbilicus.
Systolic bruit over the aorta.
Tenderness on deep pulsation Abdominal or lower back pain.
8/8/2019 For Mam Juls
18/33
c. RUPTURING ANEURYSM
Severe abdominal and back pain
Lumbar pain radiating to the flank and groin
Hypotension
Increased pulse rate
Hematoma at flank area
Signs of shock
8/8/2019 For Mam Juls
19/33
DIAGNOSTICTESTS
Diagnostic tests are done to confirm thepresence, size and location of aneurysm.
Tests includes abdominal ultrasound,
computed tomography scan and arteriography.
8/8/2019 For Mam Juls
20/33
interventions Monitor vital signs.
Assess risk factors for arterial disease process.
Obtain information regarding the sensation ofpalpation in the abdomen.
Inspect the skin for the presence of vasculardisease breakdown.
Check peripheral circulation, including pulses,temperature and color.
Observe for signs of rupture.
Note any tenderness on the abdomen
Monitor for abdominal distention.
8/8/2019 For Mam Juls
21/33
Nonsurgical interventions
Modify risk factors. Instruct the client regarding the procedure
for monitoring BP.
Instruct the client on the importance ofregular physician visits to follow the size ofthe aneurysm.
Instruct the client that if severe back or
abdominal pain or fullness, soreness over theumbilicus, sudden development ofdiscoloration in the extremities elevation ofBP occurs to notify the physician immediately.
8/8/2019 For Mam Juls
22/33
Instruct the client with a thoracicaneurysm to report immediately theoccurrence of chest or back, shortnessof breath, difficulty swallowing orhoarseness.
8/8/2019 For Mam Juls
23/33
Pharmacological interventions
Administer antihypertensive to maintain theBP within normal limits and to prevent strainon the aneurysm.
Instruct the client about the side effects andschedule of medication.
8/8/2019 For Mam Juls
24/33
Abdominal aortic aneurysm resection
Surgical resection of excision of theaneurysm; the excised section is replacedwith a graft that is sewn end.
PREOPERATIVE INTERVENTIONS Assess all peripheral pulses as a baseline for
postoperative comparison.
Instruct the client in coughing and deepbreathing exercises.
8/8/2019 For Mam Juls
25/33
POSTOPERATIVE INTERVENTIONS
Monitor vita signs. Monitor peripheral pulses distal to the graft
site.
Monitor for signs of graft occlusion, includingchanges in pulses, cool to cold extremitiesbelow the graft, white or blue extremities orflanks, severe pain or abdominal distention
Limit elevation of the head of the bed to 45degrees to prevent flexion of the graft.
Monitor for hypovolemia and renal failureresulting from significant blood loss during
surgery.
8/8/2019 For Mam Juls
26/33
Monitor urine output hourly and notify thephysician if it is the lower than 30 to 50ml/hr.
Monitor serum creatinine and blood, ureanitrogen levels daily.
Monitor respiratory status and auscultatebreath sounds to identify respiratorycomplications.
Encourage turning, coughing and deep
breathing and splinting the incision Ambulate as prescribed.
Maintain nasogastric tube to low suction untilbowel sounds return
8/8/2019 For Mam Juls
27/33
Assess for bowel sounds and report their returnto physician.
Monitor for pain and administer medications asprescribed.
Assess incision site for bleeding or signs of
infection. Prepare the client for discharge by providinginstructions regarding pain management, woundcare and activity restrictions.
Instruct client not to lift objects heavier than15 to 20 lbs for 6 to 12 weeks.
Advise the client to avoid activities requiringpushing, pulling, or straining.
8/8/2019 For Mam Juls
28/33
Instruct the client not to drive a vehicle untilapproved by the physician.
8/8/2019 For Mam Juls
29/33
Thoracic aneurysm repair
A thoracotomy or median sternotomyapproach is used to enter the thoracic cavity.
The aneurysm is exposed and excised and a
graft or prosthesis is sewn onto the aorta. Total cardiopulmunary bypass is necessary forexcision of aneurysms in the ascending aorta.
Partial cardiopulmunary bypass is used for
clients with an aneurysm in the descendingaorta.
8/8/2019 For Mam Juls
30/33
Postoperative interventions Monitor vital signs and neurological and renalstatus.
Monitor for signs of hemorrhage such as a dropin BP and increased pulse rate and respirations
and report to the physician immediately. Monitor chest tubes for an increased in chest
drainage which may indicate bleeding orseparation of the graft site.
Assess sensation and motion of all extremitiesand notify the physician if deficits occur becauseof lack of blood supply to the spinal cord during
surgery
8/8/2019 For Mam Juls
31/33
Monitor respiratory status and auscultatebreath sounds to identify respiratory
complications. Encourage turning, coughing and deep
breathing while splinting the dysrhythmias.
M
onitor for pain and administer medication asprescribed.
Assess the incision site for bleeding or signsof infection.
prepare the client for discharge by providinginstructions regarding pain management ,wound care and activity restrictions.
8/8/2019 For Mam Juls
32/33
Instruct the client not to lift objects heavier
than 15 to 20 lbs for 6 to 12 weeks. Advise the client to avoid activities requiring
pushing, pulling or straining.
Instruct the client not to drive a vehicle untilapproved by the physician.
8/8/2019 For Mam Juls
33/33
Thats all
Top Related