Vascular Disorders Nursing Care | Chapter 41 – Lewis’s Medical-Surgical Nursing (12th)

Описание: Chapter 41 of Lewis’s Medical-Surgical Nursing (12th Edition) explores vascular system disorders involving arteries, veins, and lymphatic vessels, emphasizing perfusion, ischemia, mobility limitations, and nursing management. These include peripheral artery disease (PAD), aneurysms, aortic dissection, thromboangiitis obliterans, Raynaud’s phenomenon, venous thrombosis, varicose veins, and chronic venous insufficiency (CVI).

✨ Peripheral Artery Disease (PAD) – Caused primarily by atherosclerosis, PAD narrows arteries in the extremities, leading to intermittent claudication, paresthesia, diminished pulses, skin changes, rest pain, and risk of critical limb ischemia. Complications include ulcers, gangrene, infection, and amputation. Diagnosis uses ABI, Doppler ultrasound, angiography, and duplex imaging. Management includes risk factor control (smoking cessation, lipid and BP control, diabetes management), antiplatelet therapy (aspirin, clopidogrel), exercise programs, nutrition therapy, supervised walking, and surgical interventions such as angioplasty, stenting, atherectomy, bypass grafts, or amputation. Nursing care focuses on perfusion monitoring, pain control, wound prevention, and patient teaching for foot care and lifestyle modification.

✨ Acute Arterial Ischemia – Sudden arterial obstruction from emboli, thrombosis, or trauma presents with the 6 Ps: pain, pallor, pulselessness, paresthesia, paralysis, and poikilothermia. Emergency interventions include IV heparin, thrombolysis, thrombectomy, bypass, or amputation if tissue death occurs.

✨ Thromboangiitis Obliterans (Buerger’s Disease) – A nonatherosclerotic inflammatory disorder linked to tobacco/marijuana use in young men, causing ischemic pain, ulcers, color changes, and gangrene. Smoking cessation is critical; treatments include prostaglandins, sympathectomy, spinal cord stimulation, and, in severe cases, amputation.

✨ Raynaud’s Phenomenon – Vasospastic disorder of small arteries, primarily in young women, causing color changes (white-blue-red) in fingers and toes, triggered by cold or stress. Management includes avoiding triggers, stress reduction, CCBs (nifedipine), PDE-5 inhibitors, topical nitroglycerin, and patient teaching.

✨ Aortic Aneurysms – Permanent dilation of the aorta (thoracic or abdominal) associated with hypertension, smoking, atherosclerosis, connective tissue disorders, or trauma. Many are asymptomatic but may present as pulsatile masses, back or chest pain, or embolic events. Diagnosis uses ultrasound, CT, MRI, and angiography. Small aneurysms require risk factor control and surveillance, while large (≥5.5 cm) or symptomatic aneurysms require surgical repair via open aneurysm repair (OAR) or endovascular aneurysm repair (EVAR). Complications include rupture, endoleak, renal ischemia, graft occlusion, and infection. Nursing care involves perioperative monitoring, BP control, renal perfusion, infection prevention, and patient teaching.

✨ Aortic Dissection – A life-threatening tear in the aortic intima creates a false lumen, leading to severe chest/back pain, neurologic deficits, diminished pulses, tamponade, and organ ischemia. Risk factors include hypertension, connective tissue disorders (Marfan, Ehlers-Danlos), trauma, and pregnancy. Management requires ICU care, HR/BP reduction (β-blockers, CCBs), morphine, and surgical repair (especially for Type A dissections).



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