VASCULAR DISORDERS
VASCULAR DISORDERS
Depends on the pump of the heart
Responsiveness of blood vessels
Adequate circulating blood volume
High viscosity blood equals high RBC, high sugar
Vasa vasorum equals blood supplying the blood vessels
Hemoglobin F is what is normally present
In sickle cell, an autosomal recessive disorder, hemophilia, sex-linked
In sickle cell it could cause clumping in capillaries
Albumin equals oncotic pressure for water reabsorption
If not from albumin, lymphatic system will reabsorb it back to vena cava
Veins equals Valves, not found in artery, for pushing blood back
Valves are activated by contraction of skeletal muscles
Lymphatic system drains excess water and for immunity, spleen equals filtering microorganism, thymus equals differentiate T cells, lymph nodes equals filtering lymphs
Artery equals higher pressure, Vein equals lower pressure
If not equals affected tissue perfusion
Flow equals gradient pressure divided by Resistance
Laminar equals pressure in the middle of the artery
Turbulent equals happens with high blood flow, constriction
Lactic acid equals fail, toxic equals pain
Arterial insufficiency due to obstruction equals intermittent obstructions, increase demand and decrease supply aka ischemia
Pain is dull, boring, cramping, aching
Ask how far and how severe before the pain appears to estimate the obstruction
Rest pain: critical limb ischemia, one hundred percent, surgical emergency, tissue necrosis, amputation
At night due to temperature, Raynaud's phenomenon, vasoconstriction
Pain is felt if extremities is elevated, Calf equals femoral, popliteal, Hip, Buttock equals aorta, iliac arteries, Cyanotic, hair loss, arterial ulcerations equals severe arterial insufficiency
Gangrene equals necrosis
Edema equals Venous
Palpate pulse for rate, rhythm, quality, zero to four
Palpate simultaneously, EXPECT carotid
Femoral, popliteal, tibial, dorsalis
Twenty to thirty higher systolic
Duplex Ultrasound: determines blood flow and image of blood vessel
Stenosis narrowing versus atherosclerosis, severity and chronicity, determine the appropriate treatment
For abdominal aorta, NPO for six hours
Ankle-Brachial Index, A B I
Supine position Get the pressure of the highest Use doppler, Ankle B P divided by Brachial B P equals A B I, one point zero to one point three is NORMAL, less than zero point nine or LOWER equals P A D, greater than one point forty noncompressible arteries, calcification, one point zero zero to one point forty Normal, zero point fifty to zero point ninety Claudication, less than zero point fifty Ischemic rest pain, less than zero point forty Ischemic critical limb
<0.50 Ischemic rest pain
No alcohol, smoking
No alcohol, smoking
Exercise Testing
Five minutes; AFTER get B P in lower extremities
Normal: minimal B P changes; Arterial disease: ankle B P drops post-exercise
Visualization of blood vessels equals Angiography
C T scan or M R I
Atherosclerosis
H T N and increase blood viscosity
Reduce B P, sugar, Lipid, weight
Fibric acid inhibitor ALTERNATIVE to statin
Collateral circulation equals at rest
Pain DISTAL to obstruction
Intermittent claudication - persistent and pain relievers not working
Cool skin, pale
Bruits auscultated
Atrophy with chronic ischemia
Cilostazol: vasodilator plus antiplatelet
CONTRAINDICATED in Heart Failure
DUAT
Ballon equals Stent equals Atherectomy
Thru cardiac catheterization
Manage bleeding, flat position, direct pressure
Drag elupting stent is preferred
Endarterectomy equals cutting vessel open to remove clot
Bypass grafting
Aneurysm: localized dilation due to weakness of arterial wall elderly
Smoking, H T N, genetics
Pain radiating to back equals impending rupture
C T-A, Duplex Ultrasound
Aortic Dissection
SUDDEN onset
Chest to back to abdomen, LEFT HIGHER than ten in B P
VENOUS DISORDERS
VENOUS DISORDERS
Deep Vein Thrombosis, D V T
Thrombus formation
Virchow's triad: endothelial damage, venous stasis, hypercoagulable state
MAPAS: metabolic hypercoaguable state
Thrombophlebitis equals clot equals inflammation
Phlebothrombosis equals clot without inflammation
Femoral veins
Effort thrombosis due to repetitive movement equals
P I C C, Peripheral Inserted Central Catheter
Lower chance of infection
Cancer px is at RISK for D V T
Phlegmasia cerulea dolens
Swelling, pain, cyanosis
HIGH RISK of venous gangrene
Can lead to Pulmonary Embolism
Diagnostics: D-dimer, C B C, P T, a P T T, I N R, levels should go DOWN
Checks coagulation
Duplex ultrasound: incompressible vein, visible thrombus
Prevent D V T
Correct venous stasis, Passive leg exercise
Compression stocking, CONTRAINDICATED for arterial insufficiencies tho
Anticoagulants, heparin, warfarin, DOAC, saban
Clotting number ten for COMMON PATHWAY
Intrinsic factors, clotting number seven, clotting number twelve equals clotting number ten, fibrinogen
Thrombolytics equals dissolve clots, plase
Hemophilia, Heparin induced Thromobocythemia, bone marrow to many platelet, CONTRAINDICATED for anticoagulants
I V C filter ALTERNATIVE for anticoagulants
Taking anticoagulation
Maintain medication until advised
Check for bleeding
No contact sports
Follow I N R monitor for warfarin, avoid intake of Vitamin K
ELEVATE lower extremities