For Mam Juls

8/8/2019 For Mam Juls

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Raynaud's

disease


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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.


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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.


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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.


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Buergers

disease


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Buergers disease

An occlusive disease of the media and smallarteries and veins.

The distal upper and lower limbs are affectedmost commonly


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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


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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.


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Aortic

aneurysms


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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.


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Types of aorticaneurysm


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1. fusiform

Diffuse dilation that involves the entireof the arterial segment.


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2. saccular

Distinct localized outpouching of theartery wall.


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3. dissecting

Created when blood separates thelayers of the artery wall, forming a

cavity between them.


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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.


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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


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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.


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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


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DIAGNOSTICTESTS

Diagnostic tests are done to confirm thepresence, size and location of aneurysm.

Tests includes abdominal ultrasound,

computed tomography scan and arteriography.


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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.


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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.


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Instruct the client with a thoracicaneurysm to report immediately theoccurrence of chest or back, shortnessof breath, difficulty swallowing orhoarseness.


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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.


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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.


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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.


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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


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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.


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Instruct the client not to drive a vehicle untilapproved by the physician.


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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.


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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


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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.


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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.


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For Mam Juls

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