1. Peripheral Vascular System Disorders Metropolitan Community College NURS 1110

2. Objective 1: Review the normal structure and function of the peripheral vascular system.

3. Anatomy and Physiology of the Vascular System

4. Arteries Vessels that carry blood away from the heart toward the tissues Thick-walled structures with three layers: intima, media, and adventitia Smooth muscles encircle and control the diameter

5. Capillaries Arterioles branch into progressively smaller vessels, then form the capillaries A single layer of endothelial cells that allow the efficient delivery of nutrients and oxygen into the tissues and the removal of metabolic wastes from the tissues Tiny vessels that receive blood from the capillaries are venules, the smallest veins

6. Figure 36-1

7. Figure 36-2

8. Veins The vessels that return blood to the heart Formed as capillaries organize into larger and larger vessels Composed of the same layers as the arteries and arterioles, but the layers are less defined

9. Veins Valves Allow blood to move in only one direction and prevent backflow of blood in the extremities Innervation The sympathetic nervous system acts on the musculature of the veins to stimulate venoconstriction Blocking of sympathetic nerve stimulation permits venodilation

10. Figure 36-3

11. Lymph Vessels Lymph system: small, thin-walled vessels that resemble the capillaries Accommodate the collection of lymph fluid from the peripheral tissues and the transportation of the fluid to the venous circulatory system Lymph fluid is composed of plasma-like fluid, large protein molecules, and foreign substances Movement by the contraction of muscles that encircle the lymphatic walls and surrounding tissues

12. Factors That Affect Blood Flow Resistance Controlled by the diameter of the vessels When vascular diameter increases, peripheral resistance falls and blood flow increases When vascular diameter decreases, peripheral resistance increases, thereby reducing blood flow

13. Factors That Affect Blood Flow Blood viscosity Thickness of the blood Can be affected by changes in the proportions of the solid or liquid components Capillary permeability affects blood viscosity If capillary permeability altered, the amount and direction of fluid movement changes; results in change in viscosity

16. Objective 2. Describe age related changes of the vascular system.

17. Vascular changes common in elderly and diabetics • Can cause peripheral vascular disease (PVD) • Arterial or venous

18. Blood flow decreases because • Arteriosclerosis, atherosclerosis which affect intima & media lining • Thrombosis or embolism • Venous disease • Insufficiency from incompetent valves

19. Objective 3. Perform a nursing assessment of the peripheral vascular system.

20. Assessment: finds circulation deficit which creates complications • Arterial disease: leg pain upon elevation, activity • Intermittent claudication

21. Venous disease: pain when legs dependent • Blood pools at ankles • Venous claudication

22. Subjective data • Reported risk factors • Arterio/atherosclerosis • Smoking • Diabetes mellitus • Hypertension • Hyperlipidemia • Family history: DM, HTN, CAD, PVD

23. Objective assessment • Head to toe • Peripheral pulses check pulses at same time

24. Pulse amplitude • 0-+4 scale • Capillary refill • Edema • 1+-4+ • Compare extremities

25. Decreased circulation • Coolness • Pallor • Paresthesia • Paralysis • Rubor • Brown pigment

26. Objective 4. Compare diagnostic tests and procedures of the peripheral vascular system.

27. Peripheral vascular stress test • Walk 5 minutes, 1.5 MPH • Pulse volume measurements • Assess response to activity

28. Doppler Ultrasound • Sound waves to assess blood flow • Reduced sound: reduced blood flow • Non-invasive

29. Plethysmography • Blood volume/blood flow changes measured • Diagnose DVT • Screens for PVD • Raise leg 30 degrees • Pressure cuff inflated, distends veins • Venous changes are recorded

30. Angiography • Arterial or venous • Dye injected • Tests for blockage; may be heart, brain, etc • Invasive • Prep needed

31. Prep for artiography • Allergy • Informed consent • NPO 4 hours • Assess post procedure

32. Post procedure assessment • VS • Allergic reactions • Hemorrhage • Obstruction of vessel

33. Magnetic Resonance Imaging (MRI • Three dimensional image • All parts can be visualized • Non-invasive, prep still needed • Claustrophobia? Anxious? • Machine makes a lot of noise • Any metal implants? • Open MRI is available

34. Computed Tomography (CT) Scan • Most accurate test for anterior-posterior length • Cross-section diameter of aneurysm • Identify any thrombus

35. Ankle-brachial Blood Pressure Index • Determines pressure in upper and lower extremities • Pressures should be equal (arms and legs)

36. Risk assessment • BP in arm • BP for ankle • Divide ankle systolic by brachial systolic • 0.75 or less = arterial disease • Normal: 0.90-1.30 • Mild to moderate PVD = 0.41-0.89 • Severe = 0.040

37. Objective 5. List common therapeutic measures for the client with peripheral vascular disease (PVD).

38. If arterial or venous problem detected: nursing diagnosis is Ineffective Tissue perfusion (peripheral) RT…

39. Goal • Prevent a thrombus • If thrombus: prevent embolus

40. Interventions aimed at • Identify clients at risk • Assess lower extremities • Evaluate lifestyle factors • Teach and prevent further problems

41. Therapeutic Measures • 1. Exercise • Walking stimulates movement of blood • Bed rest if ulcers, gangrene, acute thrombosis • Buerger-Allen Exercises

43. Stress Management • Stress causes vasoconstriction • Reduce stress with lifestyle changes, massage, relaxation, other stress-reducing activities

44. Pain Management • Immobility makes problems worse • Promote circulation • Analgesics • Rest if intermittent claudication • Avoid restrictive clothing

45. Smoking Cessation • Smoking = vasoconstriction • “Quit Kits” • Medication: bupropion, Nicotine patches

46. Elastic Stockings • Sustained, evenly distributed pressure • Compress superficial veins, improved blood flow • Must apply correctly • Stockings off 10-20 min. a day; in bed or legs non- dependent position

47. Intermittent Pneumatic Compression • Use for clients confined to bed • Post major surgery • Prevent DVT as stockings sequentially inflate from ankles, calves, thighs, then deflate

48. Positioning • If in bed: position changes vital • Lower extremities = increased arterial flow • Raising extremities = increased venous flow • If able to be up, legs non-dependent position

49. Thermotherapy • Warm: increases blood flow (vasodilation) • Cold: decreases blood flow (vasoconstriction) • Caution with warm: can burn the client

50. Protection • Must protect from injury: no scratching, vigorous rubbing • Proper shoes, clean socks • Nails trimmed • No walking barefoot