Introduction to Medical-Surgical Nursing, 6th ed.
37
Lesson Plans for
Vascular Disorders
CHAPTER LESSON PLANS & OBJECTIVES
Lesson 37.1:
2. Indicate appropriate parameters for assessing a patient with peripheral vascular disease, aneurysm,
and aortic dissection.
3. Discuss tests and procedures used to diagnose selected vascular disorders and the nursing
5. Assist in developing a plan of care for patients with selected vascular disorders
CHAPTER TEACHING FOCUS
• In this chapter, the student is introduced to topics related to vascular disorders, including anatomy and
physiology of the vascular system, nursing assessment of the vascular system, diagnostic tests and
2 Chapter 37 Vascular Disorders _____________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
CHAPTER PRETEST
Have the students answer these questions prior to covering this chapter to understand where they stand
in relation to the content.
1) Vessels that carry blood away from the heart are called __________.
a) veins
b) arteries
c) capillaries
d) lymph vessels
2) Contraction of the muscles that surround the blood vessels causes __________.
a) vasodilatation
b) aneurysms
c) hypoxia
d) vasoconstriction
3) The primary age-related change in the vascular system is __________.
a) decreased heart rate
b) decreased oxygen-carrying capacity
c) arteriosclerosis
d) increased blood viscosity
4) Pain associated with decreased perfusion that is aggravated by exercise is called __________.
a) intermittent claudication
b) aneurysm
c) compression
d) paresthesia
5) A change that would likely be seen when assessing a patient who has peripheral vascular disease is
__________.
a) capillary refill of less than 3 seconds
b) increased muscle mass in the legs
c) hair loss on the affected extremities
d) thin, flexible nails
6) A diagnostic test used to identify venous obstructions that involves injecting dye is __________.
a) Doppler ultrasound
b) angiography
c) plethysmography
d) pressure measurement
7) Which of the following drugs is a platelet aggregate inhibitor used to treat intermittent claudication?
a) Cilostazol (Pletal)
b) Amlodipine (Norvasc)
c) Prazosin (Minipress)
d) Diltiazem (Cardizem)
8) A surgical procedure used to improve vascular circulation in patients with intermittent claudication is
__________.
a) embolectomy
b) endarterectomy
c) vein ligation
d) sympathectomy
9) Which of the following organisms is a common cause of lymphangitis?
a) Streptococcus
b) Enterococcus
c) Pneumococcus
d) Staphylococcus
10) The development of ulcers on the medial malleolus is often a complication of __________.
a) deep vein thrombosis
b) chronic venous insufficiency
c) lymphangitis
d) aortic dissection
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Introduction to Medical-Surgical Nursing, 6th ed.
Chapter Pretest Answers
CHAPTER BACKGROUND ASSESSMENT
Discuss these questions with your students prior to covering this chapter to understand where they stand
in relation to the content.
Question: What is the main function of the vascular system? What are the major components of the
vascular system?
Question: What are two factors that affect blood flow? Explain how each mechanism affects the flow of
blood.
4 Chapter 37 Vascular Disorders _____________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 37.1
Textbook Objectives Covered
1. Identify specific anatomic and physiologic factors that affect the vascular system and tissue
oxygenation.
3. Discuss tests and procedures used to diagnose selected vascular disorders and the nursing
considerations for each.
Lesson Preparation Checklist
• Prepare lecture from TEACH lecture slides available on Evolve.
• Student performance evaluation of all entry-level skills required for student comprehension of
principles underlying vascular disorders including:
• Anatomy and physiology of the vascular system
Materials and Supplies
• computer and PowerPoint
projector
Key Terms
• aneurysm (p. 758)
• thrombosis (p. 741)
Student Preparation
Assignments 2 hours
1
READ – Textbook (pp. 737-740)
REVIEW
• Figure 37-1: Capillary bed (p. 738)
• Figure 37-2: Tissue layers of veins and arteries (p. 739)
• Figure 37-3: Vein valves (p. 739)
ANSWER – Text
• Review Questions for the NCLEX Examination: 1, 2 (pp. 767-768)
ANSWER – Study Guide
• Part IA: 3, 5, 8 (p. 229)
• Part IB: 1-8 (p. 230)
• Part IC: 1-8 (p. 230)
• Part I I: 1-7 (p. 232)
• Part IIK: 1-5, 27 (pp. 233-235)
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Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 37.1
2
READ – Textbook (pp. 740-742)
REVIEW
• Figure 37-4: Palpating distal pulses (p. 743)
• Box 37-1: Assessment of the Patient with Peripheral Vascular Disease or Aneurysm (p. 744)
ANSWER – Text
• Review Questions for the NCLEX Examination: 3, 4 (p. 768)
ANSWER – Study Guide
3
READ – Textbook (pp. 742-752)
REVIEW
• Table 37-1: Diagnostic Tests and Procedures (p. 744)
ANSWER – Text
• Review Questions for the NCLEX Examination: 5, 6, 7, 8 (p. 768)
ANSWER – Study Guide
• Part IF: 1-5 (p. 231)
• Part IG: 1-6 (p. 231)
• Part IH: 1, 2 (p. 231)
• Part IIK: 11, 13-16, 18, 19, 29-31 (pp. 233-235)
• Part IIIL: 4, 11 (pp. 236-237)
6 Chapter 37 Vascular Disorders _____________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 37.1
Lecture Outline 20 minutes
Slide 1
Chapter 37
Vascular Disorders
1
Slide 2
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
TALKING POINTS:
• What is the largest artery in the body?
• How is the distribution of capillaries determined?
Capillaries
• Arterioles branch into progressively smaller vessels, then form the capillaries
TALKING POINTS:
• Red blood cells have to conform to the size of the capillaries by changing their shape to fit
Veins
• The vessels that return blood to the heart
TALKING POINTS:
• The venous system is less sturdy and more passive than the arterial system.
_____________________________________________________________ Chapter 37 Vascular Disorders 7
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 37.1
Slide 5
Veins (cont.)
• Valves
• Allow blood to move in only one direction and prevent backflow of blood in the
extremities
• Innervation
TALKING POINTS:
Slide 6
Lymph Vessels
• Lymph system: small, thin-walled vessels that resemble the capillaries
• Accommodate the collection of lymph fluid from the peripheral tissues and the
TALKING POINTS:
• Because the lymph system interacts with the venous system, it is classified as part of the
cardiovascular system.
Slide 7
Factors That Affect Blood Flow
• Resistance
• Controlled by the diameter of the vessels
• When vascular diameter increases, peripheral resistance falls and blood flow
increases
TALKING POINTS:
• The sympathetic nervous system plays a major role in adjusting vascular resistance.
• What factors cause changes in vascular resistance?
Slide 8
Factors That Affect Blood Flow (cont.)
• Blood viscosity
• Thickness of the blood
• Can be affected by changes in the proportions of the solid or liquid components
TALKING POINTS:
• What is hemoconcentration?
• When the proportion of serum to solid components in the blood is higher than normal,
blood is less viscous and the kidneys excrete excess fluid.
8 Chapter 37 Vascular Disorders _____________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 37.1
Slide 9
Age-Related Changes
• Arteriosclerosis
• Stiffening of the vessel walls
• Delivery of oxygen and nutrients to tissues is compromised; buildup of waste
TALKING POINTS:
• The stiffening of the peripheral vessels associated with aging occurs in both the intima
2
Slide 10
Chief Complaint and History of Present Illness
• Focuses on the six classical “Ps” of peripheral vascular disease: pain, pulselessness,
poikilothermy, pallor, paresthesia, and paralysis
Slide 11
• Document a history of hypertension, coronary artery disease, myocardial infarction, or
Medical History
Slide 12
• Relevant diseases: hypertension, coronary artery disease, myocardial infarction,
Family History
Assessment of the Vascular System
• Review of systems
• Changes associated with peripheral vascular disease (PVD): thick, brittle nails; shiny,
Slide 14
Assessment of the Vascular System (cont.)
• Functional assessment
_____________________________________________________________ Chapter 37 Vascular Disorders 9
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 37.1
Assessment of the Vascular System (cont.)
• Physical examination
• Inspect the skin for color and lesions
3
Slide 16
Diagnostic Tests and Procedures
• Ultrasonography
• Pressure measurements
Slide 17
Therapeutic Measures
• Exercise programs
• Stress management
• Pain management
TALKING POINTS:
• Embolectomy is the removal of a blood clot located in a large vessel.
Therapeutic Measures (cont.)
• Surgical procedures
• Embolectomy
10 Chapter 37 Vascular Disorders _____________________________________________________________
LESSON 37.1
Nursing Care Related to Surgery
• Preoperative nursing care
TALKING POINTS:
• If peripheral pulses disappear, what should be suspected?
Nursing Care Related to Surgery (cont.)
• Postoperative nursing care
TALKING POINTS:
• If peripheral pulses disappear, what should be suspected?
Slide 21
Nursing Care Related to Surgery (cont.)
• Drugs
• Anticoagulants
• Thrombolytics
Nursing Care Related to Surgery (cont.)
• Dietary interventions
• Low-fat diets reduce serum cholesterol levels
TALKING POINTS:
• Why is obesity a concern for the vascular system?
_____________________________________________________________ Chapter 37 Vascular Disorders 11
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 37.1
Slide 23
Question 1
• Which of the following is not a true statement about arteries?
A. Arteries are the vessels that carry the blood toward the heart and away from the
tissues.
B. Arteries are normally elastic and have greater tensile strength than the veins.
C. Arteries that branch from the aortic arch supply the head and arms.
D. Arteries branch into progressively smaller vessels as they travel away from the aorta.
Slide 24
Question 2
• Which of the following is not an age-related change in the body’s blood vessels?
A. The connective and elastic tissue fibers in the media become calcified.
B. Decreased left ventricular workload.
C. Increased resistance to blood flow.
D. The intima is thickened and hardened by the proliferation of cells.
TALKING POINTS:
12 Chapter 37 Vascular Disorders _____________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 37.1
Activities
Classroom Choose from below to make 30 minutes
Online
1
ASSESS BASELINE
• Have the class complete the Pretest. Collect
their work and use the results to guide how
you teach the class.
DISCUSS
• Discuss the functions of the arteries,
capillaries, veins, and lymph vessels.
• Discuss factors that affect blood flow,
including resistance and blood viscosity.
PRACTICE
• Divide the class into groups. Assign each
group a part of the vascular system (arteries,
veins, capillaries, lymph vessels). Have each
ASSESS BASELINE
• Post the Pretest and the Background
Assessment online and have your class
complete them. Use the results to guide how
you teach the class.
POST AND COMMENT
• Post the following discussion topic online
and have students comment. Discuss how
the changes occurring in the peripheral
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Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 37.1
2
DISCUSS
• Discuss nursing assessment of the vascular
system, including the various elements of
the health history.
• Discuss the elements of the physical
examination. Describe the palpation of
affected areas and evaluation of the
peripheral pulses.
• Discuss the purpose of the Allen test and
explain how it is performed.
PRACTICE
• Divide the class into three groups. Assign
POST AND COMMENT
• Post the following discussion topic online
and have students comment. Ask students
to post a video describing the nursing
assessment of the peripheral pulses. Ask
students to post constructive comments on
each other’s videos.
14 Chapter 37 Vascular Disorders _____________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 37.1
3
DISCUSS
• Discuss the purpose, patient preparation,
and postprocedure nursing care for
diagnostic tests used for patients with
peripheral vascular disease.
• Discuss how exercise, stress management,
pain management, and smoking cessation
can help the patient with peripheral vascular
disease.
• Discuss common therapeutic measures
such as elastic stockings and intermittent
pneumatic compression and positioning.
• Discuss preoperative and postoperative
nursing care related to surgery for patients
with peripheral vascular disease.
• Discuss the different classes of drugs used
to treat peripheral vascular disease and the
uses, action, side effects, and nursing
interventions for each.
PRACTICE
• Divide the class into five groups. Assign
each group one of the following procedures
for diagnosing vascular disorders.
• Doppler ultrasound
• Plethysmography
POST AND COMMENT
• Post the following discussion topic online
and have students comment. Ask students
to prepare and post a video of a nurse
providing patient/family education on
prevention and treatment of peripheral
vascular disease. Ask students to post
constructive comments on each other’s
videos.
• Post the following discussion topic online
and have students comment. Discuss
specific assessments and nursing
interventions for a patient who has had
peripheral vascular surgery. Ask students to
post constructive comments on each other’s
postings.
_____________________________________________________________ Chapter 37 Vascular Disorders 15
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 37.1
Critical Thinking Question
A 64-year-old man complains of severe pain in his lower extremities that he says results
whenever he exercises. The pain usually improves with rest and elevation of his extremities.
He is overweight and smokes one pack of cigarettes a day. He also complains of aching and
swelling in his legs at night. Furthermore, he has hypertension and a family history of
cardiovascular disease. What assessment data should the nurse collect that would indicate
the presence of peripheral vascular disease (PVD)? What are the patient’s risk factors? What
are some steps that this patient can take to improve his symptoms?
Discussion Guidelines: In this patient, the nurse would likely see shiny, hairless, dry skin on his
Instructor Notes/Student Feedback
16 Chapter 37 Vascular Disorders _____________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 37.2
Textbook Objectives Covered
4. Describe the pathophysiology, signs and symptoms, complications, and medical or surgical
Lesson Preparation Checklist
• Prepare lecture from TEACH lecture slides available on Evolve.
• Student performance evaluation of all entry-level skills required for student comprehension of
principles underlying vascular disorders including:
• Anatomy and physiology of the vascular system
Materials and Supplies
• computer and PowerPoint
projector
Key Terms
• aneurysm (p. 758)
• bruit (p. 742)
• thrombosis (p. 741)
• vasoconstriction (p. 740)
Student Preparation
Assignments 2 hours
4
READ – Textbook (pp. 752-766)
REVIEW
• Table 37-3: Comparison of Arterial and Venous Disease in the Legs (p. 754)
ANSWER – Text
• Review Questions for the NCLEX Examination: 9, 10 (p. 768)
ANSWER – Study Guide