_____________________________________________________________ Chapter 37 Vascular Disorders 17
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 37.2
5
READ – Textbook (pp. 752-766)
REVIEW
• Nursing Care Plan 37-1 (p. 765)
ANSWER – Study Guide
• Part IH: 1 (p. 231)
• Part IIK: 8, 21, 28 (pp. 233-235)
50-Minute Lesson Plan
Lecture Outline 20 minutes
4
Slide 25
Arterial Embolism
• Pathophysiology
• Usually forms in the heart, but a roughened atheromatous plaque in any artery also
can lead to thrombus formation
TALKING POINTS:
• The development of an arterial embolism is a potentially life-threatening event.
• What do the effects of arterial occlusion depend on?
Slide 26
Arterial Embolism (cont.)
• Signs and symptoms
• Severe, acute pain
• Gradual loss of sensory and motor function in the affected areas
• Pain aggravated by movement or pressure
Slide 27
Arterial Embolism (cont.)
• Medical and surgical treatment
• Intravenous anticoagulants and thrombolytic agents
• Embolectomy
TALKING POINTS:
5
Slide 28
• Impaired skin integrity
Interventions
• Ineffective tissue perfusion
• Fear
• Impaired physical mobility
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LESSON 37.2
4
Slide 29
Peripheral Arterial Occlusive Disease of Lower Extremities
• Pathologic changes in the arteries, typically plaque formations that arise where the
arteries branch, veer, arch, or narrow
• Common sites for arterial occlusion are the distal superficial femoral and the popliteal
arteries
• Occlusions prevent delivery of oxygen and nutrients to the tissues
• Hypoxia affects all tissues distal to the occlusion
• Compensatory mechanism is collateral circulation
diabetes mellitus, hypertension, cigarette smoking, and stress
TALKING POINTS:
• Peripheral nerves and muscles are more susceptible to harm from hypoxia than the skin
and subcutaneous tissues.
Slide 30
Peripheral Arterial Occlusive Disease (cont.)
• Signs and symptoms
• Intermittent claudication
• Absence of peripheral pulses below occlusive area
TALKING POINTS:
Slide 31
Peripheral Arterial Occlusive Disease (cont.)
• Medical diagnosis
• Duplex imaging
• Segmental blood pressures
• Angiography
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Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 37.2
Slide 32
Peripheral Arterial Occlusive Disease (cont.)
• Medical and surgical treatment
• Lifestyle changes
• Smoking cessation, exercise, weight management
• Treatment for hypertension, hyperlipidemia, or diabetes
• ACE inhibitor ramipril
TALKING POINTS:
• What frequency of exercise programs have been found to be most successful with
peripheral arterial disease?
• An endarterectomy with a graft is the surgical replacement of a diseased segment of an
artery with a graft of some type—either synthetic or from another blood vessel.
• Percutaneous transluminal angioplasty (PTA) is used to enlarge the interior diameter of
the blood vessel.
Slide 33
Peripheral Arterial Occlusive Disease (cont.)
• Assessment
• Assess the pulses distal to the surgical site and compare with the same pulses in the
unaffected extremity
TALKING POINTS:
• Cessation of a pulse suggests possible arterial occlusion, and the surgeon must be
notified immediately.
5
Slide 34
Peripheral Arterial Occlusive Disease (cont.)
• Interventions
• Activity intolerance
• Chronic pain
• Impaired skin integrity
• Disturbed body image
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LESSON 37.2
4
Slide 35
Thromboangiitis Obliterans
• Also called Buerger disease
• Inflammatory thrombotic disorder of arteries and veins in lower and upper extremities
• Cause is unknown, but it occurs only in smokers
• Signs and symptoms: intermittent claudication, rest pain, skin color/temperature changes
Slide 36
Raynaud Disease
• Pathophysiology
• Intermittent constriction of arterioles; affects hands primarily, but it can affect the toes
and tip of the nose
• Signs and symptoms
• Chronically cold hands, numbness, tingling, and pallor
vascular disease
TALKING POINTS:
• The cause of this condition is unknown, but it may be related to hypersensitivity to cold or
release of serotonin.
Slide 37
Raynaud Disease (cont.)
• Medical and surgical treatment
• Drugs
• Calcium channel blockers, transdermal nitroglycerin, an endothelin receptor
antagonist, phosphodiesterase inhibitors, and intravenous prostaglandins
• Sympathectomy
TALKING POINTS:
5
Slide 38
Interventions
• Pain
• Ineffective tissue perfusion
• Fear
_____________________________________________________________ Chapter 37 Vascular Disorders 21
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 37.2
4
Slide 39
Aneurysms
• Pathophysiology
• A dilated segment of an artery caused by weakness and stretching of the arterial wall; can
be congenital or acquired
TALKING POINTS:
• What conditions are associated with congenital aneurysms?
• Acquired aneurysms can be caused by arteriosclerosis, trauma, or infection.
• The most common cause of aneurysms is atherosclerosis.
Slide 40
Aneurysms (cont.)
• Signs and symptoms
• Thoracic aneurysms usually have no symptoms, though some report deep, diffuse
chest pain
Slide 41
Aneurysms (cont.)
• Complications
• Rupture, thrombus formation that obstructs blood flow, emboli, pressure on
surrounding structures
• Medical diagnosis
• Physical findings, echocardiography, ultrasonography, computed tomography,
aortography
• Medical and surgical treatment
• Repair of aneurysms done by replacing the dilated segment of the artery with
TALKING POINTS:
• Repair is usually done as soon as possible but may be delayed until the patient is
evaluated for other problems that increase surgical risk.
Slide 42
Aneurysms (cont.)
• Preoperative nursing care
• It is important to document chronic conditions, such as emphysema or heart disease,
that increase the risk of postoperative complications
Postoperative Nursing Care
• Assessment
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Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 37.2
Slide 44
Postoperative Nursing Care (cont.)
• Interventions
• Impaired urinary elimination
• Risk for injury
• Ineffective breathing pattern
• Decreased cardiac output
• Ineffective peripheral tissue perfusion
Slide 45
Aortic Dissection
• A small tear in the intima permits blood to escape into the space between the intima and
the media
• Blood accumulates between the layers, causing the media to split lengthwise
• The split may extend up and down the aorta, where it can occlude major arteries
Aortic Dissection (cont.)
• If no complications, patient managed with antihypertensives and drugs to decrease the
Slide 47
Varicose Vein Disease
• Pathophysiology
• Varicosities are dilated, tortuous, superficial veins, often the saphenous veins in the
lower extremities
TALKING POINTS:
• What are the risk factors of varicose vein disease?
• In addition to peripheral veins, varicosities can occur in other areas such as the
esophageal and hemorrhoidal veins. Incompetent valves cannot be repaired.
Varicose Vein Disease (cont.)
• Signs and symptoms
• Oversized, discolored (purplish), and tortuous veins
TALKING POINTS:
• The onset of varicose vein disease is gradual, but the condition is progressive.
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Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 37.2
Slide 49
Varicose Vein Disease (cont.)
• Varicose vein disease
• Medical diagnosis
• Based on their appearance and duplex ultrasonography
• Medical and surgical treatment
• Avoid restrictive garments, prolonged standing or sitting, crossing the legs or
knees, and injury to compromised areas
TALKING POINTS:
• Conservative treatments of varicosities are used whenever possible.
• When would surgery be recommended for varicose vein disease?
Slide 50
Varicose Vein Disease (cont.)
• Assessment
• Health history determines pain, edema, cramps, and muscle fatigue
Slide 51
Varicose Vein Disease (cont.)
• Interventions
• Improve activity tolerance and manage pain
• Surgical patient
• Patient teaching
5
Slide 52
Venous Thrombosis
• Pathophysiology
• Phlebitis
• Inflammation of the vein wall
• Complication is pulmonary embolism
24 Chapter 37 Vascular Disorders _____________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 37.2
Slide 53
Venous Thrombosis (cont.)
• Risk factors
• Prescribed bedrest
• Surgery for people older than 40 years of age
TALKING POINTS:
• What is Virchow’s triad?
Venous Thrombosis (cont.)
• Signs and symptoms
• Deep vein
Venous Thrombosis (cont.)
• Medical diagnosis
• Venography, Doppler ultrasonography, and duplex ultrasonography
Slide 56
Venous Thrombosis (cont.)
• Medical and surgical treatment
• Anticoagulant or thrombolytic therapy, or both
• Patient teaching about the disease; ongoing assessment for pulmonary emboli;
TALKING POINTS:
• What are the goals of treatment for venous thrombosis?
Slide 57
Venous Thrombosis (cont.)
• Interventions
• Impaired skin integrity
• Acute pain
• Anxiety
_____________________________________________________________ Chapter 37 Vascular Disorders 25
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 37.2
4
Slide 58
Chronic Venous Insufficiency
• Pathophysiology
• Culmination of long-standing pressure that stretches the veins and damages the
valves
• Signs and symptoms
• Edema around the lower legs, pain, brownish skin discoloration (stasis dermatitis),
and stasis ulcerations
TALKING POINTS:
• Ulcers may form because of the pressure exerted by edema or as a result of trauma.
• Where do ulcers most often develop?
Slide 59
Chronic Venous Insufficiency (cont.)
• Medical diagnosis
• Physical examination
Slide 60
Chronic Venous Insufficiency (cont.)
• Medical and surgical treatment
• Compression
• Elastic or compression stockings and pneumatic compression device
TALKING POINTS:
• Unna boots are medicated dressings used to allow the patient to be ambulatory while
5
Slide 61
Chronic Venous Insufficiency (cont.)
• Assessment
• Inspect the lower extremities for rubor and stasis dermatitis, palpate skin temperature,
and determine the presence of pain in the affected extremity
Chronic Venous Insufficiency (cont.)
• Interventions
• Ineffective tissue perfusion
4
Slide 63
Lymphangitis
• Pathophysiology
• Acute inflammation of the lymphatic channels
• The inflammation is the result of an infectious process, usually caused by streptococci
26 Chapter 37 Vascular Disorders _____________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 37.2
Lymphangitis (cont.)
• Signs and symptoms
• Enlargement of the lymph nodes along the lymphatic channel
TALKING POINTS:
• Where are the lymphatic nodes located?
• The infectious material can localize into an abscess with necrotic, suppurative discharge
from the area.
Lymphangitis (cont.)
• Medical diagnosis
Slide 66
Lymphangitis (cont.)
• Medical and surgical treatment
• Antimicrobials
• Abscess is incised to drain the suppurative material
• Rest and elevation of the limb; warm, wet dressings; and elastic support hose
5
Lymphangitis (cont.)
• Assessment
• Inspect skin for open wounds, inflammation, and red streaks along the paths of
_____________________________________________________________ Chapter 37 Vascular Disorders 27
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 37.2
Activities
Online
4
DISCUSS
• Discuss arterial embolism, including
pathophysiology, signs and symptoms,
medical diagnosis, and medical and surgical
treatment.
• Discuss peripheral arterial occlusive
disease, including pathophysiology, signs
and symptoms, medical diagnosis, and
RESEARCH
• Divide the class into four groups. Assign
each group one of the following vascular
disorders:
• Arterial embolism
• Peripheral arterial occlusive disease
• Thromboangiitis obliterans
• Raynaud disease
28 Chapter 37 Vascular Disorders _____________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 37.2
5
DISCUSS
• Discuss aneurysms, including
pathophysiology, signs and symptoms,
medical diagnosis, and medical and surgical
treatment.
• Discuss aortic dissection, including
pathophysiology, signs and symptoms,
medical diagnosis, and medical and surgical
treatment.
• Discuss chronic venous insufficiency,
including pathophysiology, signs and
symptoms, medical diagnosis, and medical
and surgical treatment.
• Discuss lymphangitis, including
pathophysiology, signs and symptoms,
medical diagnosis and medical and surgical
treatment.
• Discuss a nursing care plan for a patient
PRACTICE
• Divide the class into four groups. Assign
each group one of the following disorders:
• Aneurysms
• Aortic dissection
• Varicose vein disease
• Venous thrombosis
• Chronic venous insufficiency
• Lymphangitis
Have each group research the particular
disease and develop a presentation about
the disease. They should include
pathophysiology, signs and symptoms,
diagnostic testing, and medical or surgical
treatment. Have each group present its
information to the class.
POST AND COMMENT
• Post the following discussion topic online
and have students comment. Ask students
to conduct an online image search for
abdominal and thoracic aneurysms, aortic
dissection, venous thrombosis, chronic
venous insufficiency and lymphangitis. Ask
students to post comments comparing signs
and symptoms depicted in the images with
_____________________________________________________________ Chapter 37 Vascular Disorders 29
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 37.2
Critical Thinking Question
A 68-year-old patient is admitted to the emergency department complaining of severe pain in
his right arm. The nurse finds that the patient’s hand is pale and mottled and his arm is cold
to the touch from the elbow down to the fingertips. The nurse also finds that the patient
does not have a palpable radial pulse. Angiography confirms an arterial embolism in his
radial artery. What is the likely course of treatment for this patient and what are some
nursing interventions that would be appropriate in caring for this patient?
Discussion Guidelines: This patient will most likely be started on anticoagulant and thrombolytic
drugs to treat the embolism. This treatment would be contraindicated if the patient has active
Instructor Notes/Student Feedback
30 Chapter 37 Vascular Disorders _____________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
37
Assessments for
Vascular Disorders
CHAPTER OBJECTIVES
Lesson 37.1:
2. Indicate appropriate parameters for assessing a patient with peripheral vascular disease, aneurysm,
and aortic dissection.
Lesson 37.2:
5. Assist in developing a plan of care for patients with selected vascular disorders.
Assessments by Lesson & Objective
Lesson 37.1
1
Study Guide
• Part IA: 3, 5, 8 (p. 229)
• Part IB: 1-8 (p. 230)
• Part IC: 1-8 (p. 230)
Evolve Instructor Resources
• Test Bank: 1, 28, 30, 31
2
Study Guide
• Part IA: 1, 2, 4, 7, 9, 11 (p. 229)
• Part ID: 1-9 (p. 230)
• Part IE: 1-3 (pp. 230-231)
Evolve Instructor Resources
• Test Bank: 4, 5, 6, 7, 8, 9, 29
• Open Book Quiz: 1, 2, 3, 4, 5, 6
Evolve Student Resources
_____________________________________________________________ Chapter 37 Vascular Disorders 31
Introduction to Medical-Surgical Nursing, 6th ed.
Assessments by Lesson & Objective
3
Study Guide
• Part IF: 1-5 (p. 231)
• Part IG: 1-6 (p. 231)
Evolve Instructor Resources
• Test Bank: 11, 12, 14, 17, 19, 20, 21, 22
• Open Book Quiz: 7
Evolve Student Resources
Lesson 37.2
4
Study Guide
• Part IA: 6, 10 (p. 229)
• Part IJ: 1-4 (pp. 232-233)
Evolve Instructor Resources
• Test Bank: 2, 3, 10, 18, 23, 24, 25, 26, 27
• Open Book Quiz: 8, 9
Evolve Student Resources
• NCLEX Review: 1, 7, 8
• Prioritization: 5
5
Study Guide
• Part IH: 1 (p. 231)
Evolve Instructor Resources
• Test Bank: 13, 15, 17
Evolve Student Resources
Instructor’s Notes/Student Feedback