CONCEPT ON OXYGENATION

GAS TRANSPORT

CARDIOVASCULAR SYSTEM

CARDIOVASCULAR
means Pertaining to the

HEART
and BLOOD VESSELS

Efficient pumping system Supplies all body tissues with oxygen and nutrients. Transports cellular waste products to the appropriate organs for removal from the body.

Efficient pumping system

Blood cells play important roles in the immune system. Blood cells play important roles in the endocrine system.

HEART BLOOD VESSELS BLOOD

HEART
Hollow muscular organ

Located between the lungs

Above the diaphragm

Furnishes the power to maintain blood flow throughout both the pulmonary and systemic circulatory systems.

HEART
Weight: between 7 and 15 ounces (200 425 grams) Size: A little larger than the size of fist. Average total heart beats per day:100,000

Lifetime average heartbeat: 3.5 billion times

Double-walled membrane sac that encloses the heart.

Pericardial fluid between the layers of the pericardium to prevent friction when the heart beats.

EPICARDIUM external layer of the heart; part of the inner layer of pericardial sac. ENDOCARDIUM lining of the heart; inner surface that comes in direct contact with blood being pumped through the heart. MYOCARDIUM middle and thickest of the three layers; consists of cardiac muscle.

 Highly specialized muscle that beats constantly.

Must have: - continuous supply of oxygen and nutrients - prompt removal of waste
Coronary artery & veins supply the blood needs of the myocardium. If blood supply is disrupted, the myocardium in the affected area dies.

Atria - upper chamber of the heart

- receiving chamber - separated by interatrial septum

Ventricle

lower chamber - all vessels leaving the heart emerge from the ventricles -separated by interventricular septum

Cardiac Apex: narrow tip of the heart

Flow of blood is controlled by the following valves:

Flow of blood is controlled by the following valves:

Valve: A membranous structure in a hollow organ or passage that folds or closes to prevent the return flow of the body fluid passing through it. If any of the heart valves is not working properly, blood does not flow properly through the heart and cannot be pumped effectively throughout the body.

Tricuspid (TV) Controls the opening between the right atrium and right ventricle.

Tricuspid: Having 3 points or cusps

Pulmonary semilunar valve: located between right ventricle and pulmonary artery. Semilunar: half-moon

Mitral Valve (MV): located between left atrium and left ventricle.

Mitral Valve (MV): Bicuspid valve Valve is shaped with two points

Aortic Semilunar Valve: located between the left ventricle and the aorta.

 Valves Atrioventricular valves closure of AV valves = S1 or first heart sound LUB

tricuspid mitral
Semilunar valves closure of SV S2 or second heart sound DUB

pulmonic aortic
EXTRA HEART SOUNDS S3 ventricular gallop CHF S4 atrial gallop MI, HPN

Systemic and Pulmonary Circulation

Makes possible the important function of blood: Bringing oxygen to the cells and removing waste products.

SYSTEMIC CIRCULATION
Includes blood flow to all parts of the body except the lungs. Oxygen-rich blood flows out of the heart from the left ventricle into arterial circulation. Oxygen-poor blood returns to the heart through the veins and flows into the right atrium.

PULMONARY CIRCULATION
Flow of blood between the heart and lungs. Blood flows out of the heart from the right ventricle and through the pulmonary arteries to the lungs. This is the only place in the body where arteries carry oxygen-poor blood. In the lungs, waste material (CO2) from the body is exchanged for oxygen from the inhaled air. The pulmonary veins carry the oxygen-rich blood into the left atrium of the heart. This is the only place in the body where veins carry oxygen-rich blood.

To pump blood effectively throughout the body, the contraction and relaxation (beating) of the heart must occur in exactly the correct sequence.

The rate and regularity of the heartbeat is determined by electrical impulses from nerves that stimulates the myocardium of the chambers of the heart.

CONDUCTION SYSTEM:
sinoatrial node (S-A node) atrioventricular (A-V) node Bundle of His
Bundle of His

Sinoatrial Node (S-A node)

Located in the posterior wall of the right atrium near the entrance of the superior vena cava.
Establishes the basic rhythm of the Bundle of His heartbeat.

NATURAL PACEMAKER

 Electrical impulses from the S-A node start each wave of muscle contraction in the heart. Impulse in the right atrium spreads over the muscles of both atria, causing them to contract simultaneously.

Sinoatrial Node

The contraction forces blood into the ventricles.

Bundle of His

(DIASTOLE)

Atrioventricular Node
Impulses from the S-A node travel to the A-V node or atrioventricular node. It is located on the floor of the right atrium near the interatrial septum. The A-V node transmits the electrical impulses on to the Bundle of His Bundle of His.

Bundle of His
Named for Wilhelm His, Jr., a 19th century Swiss physician. Located within the interventricular septum.

Branches of the Bundle of His carry the impulse to the right and left ventricles and the Purkinje fibers.
Bundle of His

Purkinje Fibers
Named for Johannes Purkinje, a 19th century physiologist. Simulation of Purkinje fibers causes the ventricles to contract simultaneously forcing blood into the aorta and pulmonary arteries.

SYSTOLE

Bundle of His

Activities of the electrical conduction system of the heart can be visualized as wave movements on a monitor or an electrocardiogram.

P wave is due to the

contraction (stimulation) of the atria.

QRS complex shows the

contraction (stimulation) of the ventricles. The atria relax as the ventricles contract.

T wave is the relaxation

(recovery) of the ventricles.

When a stethoscope is used to listen to the hearbeat, two distinct sounds are heard. They are called the lubb-dupp sounds. Lubb sound: Caused by the tricuspid and mitral valves closing between the atria and the ventricles.

Dupp sound: Caused by the closing of the semilunar valves in the aorta and pulmonary arteries as blood is pumped out of the heart. - Shorter and higher pitched sound.

Arteries Capillaries Veins

Lumen: Opening within the vessels through which blood flows.

Arteries
Large blood vessels that carry blood away from the heart to all regions of the body. High oxygen content: bright red color of arterial blood Endarterial: pertaining to the interior or lining of an artery. end: within arteri: artery al: pertaining to

Aorta
Aorta: Main trunk of the arterial system and begins from the left ventricle of the heart

Coronary Artery
Coronary artery: branches from the aorta and supplies blood to the myocardium

Arterioles
Arterioles: Smaller, thin branches of arteries. Carry blood to the capillaries.

Capillaries
Serve as the anatomic units connecting the arterial and venous circulatory systems. Smallest vessel in the body (thinner than hair). Slower blood flow through the capillaries allows for the exchange of oxygen, nutrients, and waste materials between tissue fluids and surrounding cells.

 Form a low-pressure collecting system to return the waste-filled blood to the heart.

Veins

Thinner walls and are less elastic than arteries.

Have valves that allow blood to flow toward the heart but prevent it from flowing away from the heart. Venules: small veins that join to form the larger veins.

The Venae Cavae

Two large veins that enter the heart. Superior vena cava (SVC) brings blood from the upper portion of the body. Inferior vena cava (IVC) brings blood from the lower portion of the body.

PULSE: Rhythmic expansion and contraction of an artery produced by the pressure of the blood moving through the artery.

BLOOD PRESSURE: Measurement of the amount of pressure exerted against the walls of the arteries.

DIASTOLIC: Occurs when the ventricles RELAX LOWEST pressure against the walls of the vessels.

 SYSTOLIC: Occurs when the ventricles CONTRACT HIGHEST pressure against the walls of the vessels.

Normal seated adult: 134/84 mm Hg.

Blood tests chapter 15

Test for blood oxygen levels can be obtained through a monitor attached to a finger pulse oxymeter Normal value 95%

Angiography
- Radiographic study of blood vessels after the injection of a dye; resulting film is an angiogram. -Considered to be the most accurate method of obtaining anatomic & pathologic vascular anatomy. -Performed through arterial puncture, commonly, the femoral artery

Coronary Angiography: -performed to detect obstruction in the coronary arteries of the heart.

CARDIAC CATHETERIZATION (CC)

-catheter is passed into a vein or artery and guided to the heart (arm, neck, groin). -when catheter is in place, contrast medium is introduced to produce an angiogram to determine how well heart is working (angiography) -Coronary arteries are viewed -O2 concentration can be measured across all chambers and walls of the heart.

CARDIAC CATHETERIZATION (CC)

- Abnormal results will mean 1. presence of coronary artery disease 2. valvular heart disease 3. ventricular aneurysm 4. ventricular enlargement.

ANGIOCARDIOGRAPHY -uses contrast medium and chest x-rays to visualize the dimensions of the heart and large blood vessels. -resulting film is an angiogram

PHLEBOGRAPHY - Venography - Technique of preparing an x-ray image of veins injected with a contrast medium material. - Uses: diagnose deep vein thrombosis, distinguish blood clots and other obstructions such as tumors, or locate suitable vein for coronary bypass graft. - Resulting film is a phlebogram.

ELECTROCARDIOGRAPHY
- Process of recording electrical activity of the myocardium. - Record of the electrical activity is known as the electrocardiogram.

HOLTER MONITOR
- Uses electrodes attached similarly to an ECG but is worn by the patient over a 24-hour period to record heart rates and rhythms of the heart.

STRESS TESTS - ECGs used to assess cardiovascular health and function during and after application of stress such as exercise on a treadmill.

THALLIUM STRESS TESTS - flow of blood through the heart during activity is assessed through the use of thallium during a stress test.

ECHOCARDIOGRAPHY (ECHO) -ultrasonic diagnostic procedure used to evaluate structures and motion of the heart. - may be performed transthoracically (device tranducer on the chest). -Echo: sound -Cardio: heart -Graphy: to record

ULTRASONIC DIAGNOSTIC PROCEDURES

TRANSESOPHAGEAL ECHOCARDIOGRAPHY (TEE) -ultrasonic procedure that images the heart from inside the esophagus

ULTRASONIC DIAGNOSTIC PROCEDURES

CARDIOLOGIST: specializes in diagnosing and treating abnormalities and disorders of the heart. HEMATOLOGIST: specializes in diagnosing and treating diseases and disorders of the blood and bloodforming tissues.

CORONARY ARTERY DISEASE

Stages:
I. Myocardial Injury Atherosclerosis II. Myocardial Ischemia Angina Pectoris III. Myocardial Necrosis Myocardial infarction

CORONARY ARTERY DISEASE

CORONARY ARTERY DISEASE (CAD)

-Atherosclerosis of the coronary arteries that may cause: angina pectoris myocardial infarction sudden death

CORONARY ARTERY DISEASE

CORONARY ARTERY DISEASE ATHEROSCLEROSIS Hardening and narrowing of the arteries due to a buildup of cholesterol plaques. athero: plaque or fatty substance sclerosis: abnormal hardening

CORONARY ARTERY DISEASE

ATHEROMA: Plaque (fatty deposit) within the arterial wall; characteristic of atherosclerosis. ather: plaque oma: tumor

CORONARY ARTERY DISEASE

ATHEROSCLEROSIS Narrowing of artery Lipid and fat deposits Tunica intima ARTERIOSCLEROSIS Hardening of an artery CHON and Ca deposits Tunica media

ATHEROSCLEROSIS
A. PREDISPOSING FACTORS
Sex men Race Black Smoking Hyperlipidemia Obesity Sedentary lifestyle Diet high in saturated fats DM Hypothyroidism

ATHEROSCLEROSIS
B. SIGNS AND SYMPTOMS Chest pain Dyspnea Tachycardia Palpitations Diaphoresis

ATHEROSCLEROSIS
C. TREATMENT
Percutaneous Transluminal Coronary Angioplasty (PTCA) done in patients with single occluded vessel
Revascularize myocardium Prevent angina Increase survival rate

Coronary Artery Bypass and Graph Surgery (CABG)

Single or 2 or more occluded vessels

CLEARING BLOCKED ARTERIES

Percutaneous Transluminal Coronary Angioplasty (PTCA) PERCUTANEOUS through the skin TRANSLUMINAL within the lumen of an artery STENT metal mesh implanted in a coronary artery to provide support to the arterial wall to prevent restenosis.

RESTENOSIS describes the condition when an artery that has been opened by angioplasty closes again.

CLEARING BLOCKED ARTERIES

(PTCA) - STENT

Deflated balloon catheter and vascular stent is being led through artery.

Balloon catheter carrying stent is approaching narrowed area of artery.

(PTCA) - STENT

CLEARING BLOCKED ARTERIES

Balloon catheter carrying stent is in place in narrowed section of artery prior to inflation.

Vascular stent has been fully extended through the inflation of the balloon catheter. Lumen of artery has been widened.

(PTCA) - STENT

CLEARING BLOCKED ARTERIES

Vascular stent has been fully extended and the balloon catheter is being removed. Expanded stent keeps artery lumen open.

CLEARING BLOCKED ARTERIES

CORONARY ARTERY BYPASS GRAFT (CABG)

Requires opening the chest. Piece of vein from the leg is implanted on the heart. Bypass a blockage in the coronary artery and improve flow of blood to the heart.

CORONARY ARTERY BYPASS GRAFT (CABG)

Autologous veins are grafted between the aorta and just below the occlusion in the coronary arteries to provide adequate blood flow to the heart.

ANGINA PECTORIS
clinical syndrome characterized by paroxysmal chest pain that is usually relieved by rest or by taking NTG d/t temporary myocardial ischemia

CORONARY ARTERY DISEASE

ANGINA PECTORIS: Severe episodes of spasmodic choking or suffocating chest pain. Due to interference of oxygen supply to the myocardium.

ANGINA PECTORIS
A. PREDISPOSING FACTORS
Sex men Race Black Smoking Hyperlipidemia Obesity Sedentary lifestyle Diet high in saturated fats DM Hypothyroidism

ANGINA PECTORIS
B. PRECIPTATING FACTORS Excessive strenuous physical exertion Extreme emotional response Exposure to cold environment Excessive intake of foods rich in saturated fats

ANGINA PECTORIS
C. SIGNS AND SYMPTOMS
LEVINES SIGN hand clutching of heart Chest pain sharp, stabbing, excruciating, crushing substernal pain
Usually radiates from back, shoulder, arms, axilla, and jaw muscles Usually relieved by rest or by taking NTG

Dyspnea Tachycardia Palpitations Diaphoresis

ANGINA PECTORIS
D. DIAGNOSTICS ECG ST segment depression, T wave inversion Stress test abnomal ECG Elevated serum uric acid and cholesterol

NURSING MANAGEMENT
1. Enforce CBR. 2. Administer medication as ordered.
1. 2. 3. 4. Nitroglycerin (NTG) Beta-blockers propanolol ACE inhibitors captopril Ca-channel blockers - nefedipine

NURSING MANAGEMENT
3. 4. Administer O2 inhalation as ordered Place client on semi-fowlers position to promote lung expansion Monitor strictly VS, IO, ECG tracing Provide a dietary intake low in Na, Saturated fat and caffeine (stimulant)

5. 6.

NURSING MANAGEMENT
7. Provide health teaching and discharge planning concerning: Avoidance of precipitating factors Prevent complications MI Take medications before activity/exercise to achieve maximum therapeutic effect Importance of ffup care

MYOCARDIAL INFARCTION (MI)

The terminal stage of CAD characterized by permanent malocclusion leading to necrosis and scarring
TYPES
Transmural most dangerous type; both R and L Coronary arteries are blocked Subendocardial occlusion of 1 coronary artery

CORONARY ARTERY DISEASE

MYOCARDIAL INFARCTION (MI)

HEART ATTACK Occlusion (closing off) of a coronary artery resulting in an infarct of the affected myocardium. Damage to the myocardium impairs the hearts ability to pump blood through the body.

MI due to blood clot

CORONARY ARTERY DISEASE

MYOCARDIAL INFARCTION (MI)

HEART ATTACK INFARCT: Localized area of necrosis (tissue death) caused by an interruption of the blood supply.

MI due to blood clot

MYOCARDIAL INFARCTION (MI)

A. PREDISPOSING FACTORS
Sex men Race Black Smoking Hyperlipidemia Obesity Sedentary lifestyle Diet high in saturated fats DM Hypothyroidism

MYOCARDIAL INFARCTION (MI)

B. SIGNS AND SYMPTOMS
Chest pain excruciating, visceral pain, substernal, rarely precordial
Radiates from back, shoulder, arms, axilla, jaws and abdominal muscles Not relieved by rest or NTG

dyspnea hypothermia initial rise in BP cool, moist, ashen skin mild apprehension, restlessness occasional findings:
split S1 and S2 Pericardial friction rub Rales/crackles S4 atrial gallop

MYOCARDIAL INFARCTION (MI)

C. DIAGNOSTICS
Cardiac Enzymes
CPK-MB Creatinine Phosphokinase LDH lactic acid dihydrogenase SGPT (ALT) Serum Glutamic Pyruvate Transaminase SGOT (AST) Serum Oxaloacetic Pyruvate Transaminase

Treponin test increased levels ECG

ST segment elevation Widening of QRS complexes arrhythmia Peaked T waves

Serum uric acid and cholesterol elevated CBC WBC elevated

MYOCARDIAL INFARCTION (MI)

D. NURSING MANAGEMENT (Goal : decrease myocardial workload)
1. 2. 3. 4. Administer medication as ordered (narcotics) Administer O2 inhalation at low flow, 2-3LPM Enforce CBR without BRP Instruct client to avoid force of valsalva maneuver 5. Place client on semi-fowlers position

MYOCARDIAL INFARCTION (MI)

D. NURSING MANAGEMENT (Goal : decrease myocardial workload)
6. Diet: GL to soft diet low in Na, saturated fats and caffeine 7. Monitor v/s, I&O, ECG strictly 8. Encourage patient to take 20-30cc/week of whisky or brandyinduces vasodilation 9. Assist I surgical procedure CABG

MYOCARDIAL INFARCTION (MI)

D. NURSING MANAGEMENT
10. Resumption of ADLs especially sexual activity 2-4 weeks post cardiac rehabilitation which includes: - sex as appetizer rather than a dessert - assume non-weightlifting position 11. Administer medication as ordered.

ACE Inhibitors Beta-blockers Calcium channel blockers Diuretics

ANTIHYPERTENSIVE MEDICATIONS

Additional Medications: Statins Digoxin Nitroglycerin Anticoagulant Antiarrhytmic Tissue plasminogen activator Vasoconstrictor Vasodilator

Administered to lower blood pressure

ANTIHYPERTENSIVE MEDICATIONS
ACE Inhibitors (Angiotensin Converting Enzyme) - treat hypertension and CHF - interfere with action of kidney hormone renin that causes the heart muscles to squeeze. Beta-blockers slow the hearbeat

Calcium channel blockers - treat hypertension, angina and arrythmia - reduce the contraction of the muscles that squeeze blood muscles tight
Diuretics - treat hypertension and CHF - increase urine secretion to rid the body of excess sodium and water.

ANTIHYPERTENSIVE MEDICATIONS
Statins - cholesterol-lowering drug - reduce LDL or other lipids in the blood Digoxin - also known as digitalis - treatment of atrial fibrillation - slows and strengthens heart contractions Nitroglycerin - vasodilator - relieve pain of angina - may be administered sublingually, through the skin (patch), or orally as a spray.

ANTIHYPERTENSIVE MEDICATIONS
Anticoagulant - also known as thrombolytic agent - slows blood clotting - prevents new clots from forming Antiarrythmic - administered to control irregularities of the heart

Tissue plasminogen activator (TPA - clot dissolving enzyme - immediate treatment of heart attack victims
Vasoconstrictor - constricts (narrows) blood vessels Vasodilator - dilates (expands) blood vessels

CONGESTIVE HEART FAILURE

Inability of the heart to pump blood towards systemic circulation

I. LEFT-SIDED HEART FAILURE

A. PREDISPOSING FACTORS
90% - mitral valve stenosis
RHD Aging

MI IHD HPN Aortic valve stenosis

I. LEFT-SIDED HEART FAILURE

B. SIGNS AND SYMPTOMS
Pulmonary edema/congestion
Dyspnea, 2-3 pillow orthopnea Productive cough (blood tinged) Rales Bronchial wheezing

Pulses alternans Anorexia and general body malaise S3 (ventricular gallop)

I. LEFT-SIDED HEART FAILURE

C. DIAGNOSTICS
CXR cardiomegaly PAP pulmonary arterial pressure
Measures pressure in right ventricle Reveals cardiac status

PCWP pulmonary capillary wedge pressure

Measures end-systolic and end-diastolic pressure

Echocardiograph reveals enlarged heart chamber ABG analysis reveals elevated PCO2 and decreased PO2 (respiratory acidosis)

II. RIGHT-SIDED HEART FAILURE

A. PREDISPOSING FACTORS
Tricuspid valve stenosis COPD Pulmonary embolism (char by chest pain and dyspnea) Pulmonic stenosis left sided heart failure

II. RIGHT-SIDED HEART FAILURE

B. SIGNS AND SYMPTOMS (Venous congestion)
jugular vein distention pitting edema ascites weight gain hepatosplenomegaly jaundice pruritus/ urticaria esophageal varices anorexia generalized body malaise

II. RIGHT-SIDED HEART FAILURE

C. DIAGNOSTICS
CXR cardiomegaly CVP measures pressure in right atrium; N = 4-10cc H2O Echocardiography reveals enlarged heart chamber Liver enzymes SGPT and SGOT elevated

II. RIGHT-SIDED HEART FAILURE

D. NURSING MANAGEMENT

(Goal: increase myocardial contraction increase CO; Normal CO is 3-6L/min; N stroke volume is 60-70ml/h2o
Administer medications as ordered
Cardiac glycosides Digoxin Loop diuretics Lasix Bronchodilators Aminophylline Narcotic analgesics Morphine SO4 Vasodilators NTG, xylocaine

II. RIGHT-SIDED HEART FAILURE

D. NURSING MANAGEMENT Administer O2 at 3-4 LPM via NC as ordered high-flow High-Fowlers Restrict Na and fluids Monitor v/s, I&O, and breath sounds Weigh patient daily and assess for pitting edema Abdominal girth daily and notify MD

II. RIGHT-SIDED HEART FAILURE

D. NURSING MANAGEMENT Provide meticulous skin care Diet low in saturated fats and caffeine Institute a bloodless phlebotomy
ROTATING TORNIQUET ROTATED EVERY 15 MINUTES TO PROMOTE A DECREASE IN VENOUS RETURN.

PERIPHERAL VASCULAR DISORDERS

Arterial ulcers Thromboangitis obliterans /Buergers disease (feet) Reynauds Phenomenon (hand) Venous Ulcers Varicose veins Thrombophlebitis/DVT

THROMBOANGITIS OBLITERANS (TAO)

acute inflammatory condition affecting the smaller and medium sized arteries and veins of the lower extremities

THROMBOANGITIS OBLITERANS (TAO)

A. PREDISPOSING FACTORS
High risk group men 30 years old above Chronic smoking

B. SIGNS AND SYMPTOMS Consistent to all arterial diseases

Intermittent claudication leg pain upon walking cold sensitivity and skin color changes
white/pallor bluish/cyanosis red/rubor (+) especially post smoking

decreased peripheral pulses volume particularly in dorsalis pedis and posterior tibial Trophic changes ulceration gangrene formation

THROMBOANGITIS OBLITERANS (TAO)

C. DIAGNOSTICS
oscillometry reveals a decrease in peripheral pulse volume Doppler utz decrease in blood flow to affected extremity angiography site and extent of malocclusion

THROMBOANGITIS OBLITERANS (TAO)

D. NURSING MANAGEMENT
encourage slow progressive physical activity
walking 3-4x/day out of bed 3-4x/day

medications as ordered
analgesics vasodilators anticoagulants

instruct patient to avoid smoking and exposure to cold environment institute foot care management
avoid barefoot walking straight nails lanolin cream for feet (-) constricting clothes

Assist in surgery: BKA

REYNAUDS DISEASE
characterized by acute episodes of arterial spasms involving the digits of hands and fingers

REYNAUDS DISEASE
A. PREDISPOSING FACTORS
high risk group women 40 years old up smoking collagen diseases
SLE RA

direct hand trauma

piano playing EXCESSIVE TYPING (tsk tsk! Lagot!) Carpal tunnel syndrome Operating chainsaw (nyek!) Writing (tsk tsk, kaya dapat may module eh! Grr!)

REYNAUDS DISEASE
B. SIGNS AND SYMPTOMS
Intermittent claudication leg pain upon walking cold sensitivity and skin color changes
white/pallor bluish/cyanosis red/rubor (+) especially post smoking

Trophic changes ulceration gangrene formation

REYNAUDS DISEASE
C. DIAGNOSTICS
oscillometry reveals a decrease in peripheral pulse volume angiography site and extent of malocclusion

D. NURSING MANAGEMENT
Administer medications as ordered
Analgesics Vasodilators

encourage pt to wear gloves instruct: avoid smoking and exposure to cold environment

VARICOSE VEINS abnormal dilation of the veins of the lower extremities d/t incompetent valves leading to increased venous pooling and venostasis decreased venous return

VARICOSE VEINS

Abnormally swollen veins usually occurring in the legs A varicosity is one area of swelling. varices: plural

VARICOSE VEINS
A. PREDISPOSING FACTORS
Hereditary congenital weakness of veins thrombophlebitis cardiac diseases pregnancy obesity prolonged immobility prolonged standing and sitting

VARICOSE VEINS
B. SIGNS AND SYMPTOMS
pain after prolonged standing dilated tortous skin veins which are warm to touch heaviness in the legs

C. DIAGNOSTICS

Venography trendelenburgs test reveals that veins distend quickly < 35 seconds incompetent valves

VARICOSE VEINS
D. NURSING MANAGEMENT (consistent to all venous ulcers)
elevate legs above heart level increased venous return (2-3 pillow elevation) measure circumference of leg to determine swelling antiembolic stocking, full support panty hose medications as ordered analgesics assist in surgery
vein stripping and ligation

THROMBOPHLEBITIS/DEEP VEIN THROMBOSIS (DVT)

A. PREDISPOSING FACTORS
smoking obesity chronic anemia diet high in saturated fats DM CHF MI post-cannulation (insertion of various catheters) post-surgical operation sedentary lifestyle

THROMBOPHLEBITIS/DEEP VEIN THROMBOSIS (DVT)

B. SIGNS AND SYMPTOMS

pain at the affected extremity presence of cyanosis dilated tortous veins (+) HOMANS pain on calf on dorsiflexion

THROMBOPHLEBITIS/DEEP VEIN THROMBOSIS (DVT)

C. DIAGNOSTICS
venography Doppler utz angiography

THROMBOPHLEBITIS/DEEP VEIN THROMBOSIS (DVT)

D. NURSING MANAGEMENT
elevate the legs above heart level apply warm moist pack to relieve lymphatic congestion measure circumference of leg muscles to determine if it is swollen anti-embolic stockings administer medications as ordered
analgesics anticoagulants heparin

prevent complications
pulmonary embolism