Arteriosclerosis obliterans

Document Sample
Arteriosclerosis obliterans Powered By Docstoc
					Arteriosclerosis
  obliterans
    Maria Arteaga
                 Etiology
Disorder accompanied by a narrowing or an
occlusion of the intima and media of the blood
vessel wall.

Plaque formation: as a result of the
arteriosclerotic process, form on the internal wall
of the blood vessels, causing partial or complete
occlusion of the blood vessel.

Result: is little or no blood flow to the affected
extremity. The artery is unable to supply blood
and oxygen to the tissue.
      Clinical Manifestations
Pain is the first symptom that occurs in from tissue
ischemia.
Pain generally occurs in the affected extremity in
conjunction w/sustained activity. This is due to the
demand of the tissue exceeding the available blood
supply.
Claudication is the process of activity to ischemia to pain
in an affected extremity.
Symptoms are coldness, numbness, and tingling may be
associated w/pain.
Signs and symptoms to watch for are the 5 P’s pain,
pulslessness, pallor, paresthesia and paralysis.
                  Assessment
   Subjective data- focuses on pain associated with
   intermittent caudication.
Does the pain occur w/activity ?
Is it relived at rest ?
Or is the pain occurring at rest ?

  Objective data- includes assessment of pulses in the
  affected extremity, which may be weak or absent,
  compare to unaffected extremity. Other assessment
  factors may include pallor and hairless, shiny skin that is
  dry and cool to touch, cyanosis, arterial ulcers, cellulitis,
  or gangrenous changes in the affected extremity.
           Diagnostic Tests
Treadmill testing- form of monitoring hearts capability.
The patient is put through a limit of exertion to evaluate
ischemia.
Digital subtraction angiography- is the procedure to
visualize blood vessels with contrast medium in a bony
environment by subtracting the pre-contrast image from
the image with contrast medium.
Doppler ultrasound- used to measure your blood
pressure at various points along your arms or legs.
These measurements can help your doctor gauge the
degree of any blockage, as well as the speed of blood
flow in your arteries.
MRI are also obtained.
Doppler ultrasound
 Magnetic Resonance Image showing a vertical
sagittal (divides the body into sinister and dexter
(left and right) portions. ) cross section through a
                    human head.
             Medical Management

 Is focused on preventing complete arterial occlusion.

 Frequently used medications are anticoagulants- used to prolong
 clotting time (heparin and warfarin).
Fibrinolytics or thrombolitics are useful in dissolving existing thrombi
 (urokinase)

 Surgery is used for advanced disease. Includes embolectomy (the
 removal of embolism)

 endolectomy (the surgical removal of the lining of an artery).

 An arterial bypass operation is done to treat a blockage in a major
 artery that is causing symptoms due to lack of sufficient blood flow.
  Targeted, color-enhanced, 3D volume-rendering reconstruction of the distal
arterial bypass graft confirms the normal appearance of the distal anastomoses
  (thin white arrows). Note postoperative clip material (white arrowheads) and

      additional interposed short new graft segment (thick white arrow).
 Arterial bypass
Percutaneos transluminal
      angioplasty
         Nursing Interventions

 Activity intolerance
Related to ischemic pain or immobility.

  Prevent hazards of immobility by turning
  positioning
  deep breathing
  ROM
  promote exercise for circulation
Nursing interventions continued
 Ineffective tissue perfusion
Related to decreased arterial blood flow.

  Avoid raising feet above heart,

  keep extremities warm to promote
  vasodilatation.

  Administer medications
           Patient teaching
teach patient importance in not smoking to
prevent vasoconstriction

also avoid caffeine or chilling.

Not crossing their legs

Not to wear constrictive cloths such as garters,
tight stockings, or belts.