Chapter 37: Vascular Disorders Lewis: Medical-Surgical Nursing, 10th Edition

Nursing management for Aortic Dissection

-keep pt in semi-fowlers position opioids and sedatives as ordered. manage anxiety to prevent elevations of HR and BP Pt have to understand they may need to take antihypertensive drugs for the rest of their lives. Follow up with regularly scheduled MRI's and CTs is essential

When assessing a patient with possible peripheral artery disease (PAD), the nurse obtains a brachial blood pressure (BP) of 147/82 mm Hg and an ankle pressure of 112/74 mm Hg. The nurse calculates the patient's ankle-brachial index (ABI) as ________ (round up to the nearest hundredth).

ANS: 0.76 The ABI is calculated by dividing the ankle systolic BP by the brachial systolic BP.

The nurse is developing a discharge teaching plan for a patient diagnosed with thromboangiitis obliterans (Buerger's disease). Which expected outcome has the highest priority for this patient? a. Cessation of all tobacco use b. Control of serum lipid levels c. Maintenance of appropriate weight d. Demonstration of meticulous foot care

ANS: A Absolute cessation of nicotine use is needed to reduce the risk for amputation in patients with Buerger's disease. Other therapies have limited success in treatment of this disease.

Which patient statement to the nurse is most consistent with the diagnosis of venous insufficiency? a. "I can't get my shoes on at the end of the day." b. "I can't ever seem to get my feet warm enough." c. "I have burning leg pains after I walk two blocks." d. "I wake up during the night because my legs hurt."

ANS: A Because the edema associated with venous insufficiency increases when the patient has been standing, shoes will feel tighter at the end of the day. The other patient statements are characteristic of peripheral artery disease.

When evaluating the discharge teaching for a patient with chronic peripheral artery disease (PAD), the nurse determines a need for further instruction when the patient says, "I will a. use a heating pad on my feet at night to increase the circulation." b. buy some loose clothes that do not bind across my legs or waist." c. walk to the point of pain, rest, and walk again for at least 30 minutes 3 times a week." d. change my position every hour and avoid long periods of sitting with my legs crossed."

ANS: A Because the patient has impaired circulation and sensation to the feet, the use of a heating pad could lead to burns. The other patient statements are correct and indicate that teaching has been successful.

The nurse is caring for a patient with critical limb ischemia who has just arrived on the nursing unit after having percutaneous transluminal balloon angioplasty. Which action should the nurse perform first? a. Obtain vital signs. c. Assess pedal pulses. b. Teach wound care. d. Check the wound site.

ANS: A Bleeding is a possible complication after catheterization of the femoral artery, so the nurse's first action should be to assess for changes in vital signs that might indicate hemorrhage. The other actions are also appropriate but can be done after determining that bleeding is not occurring.

After teaching a patient with newly diagnosed Raynaud's phenomenon about how to manage the condition, which action by the patient best demonstrates that the teaching has been effective? a. The patient exercises indoors during the winter months. b. The patient immerses hands in hot water when they turn pale. c. The patient takes pseudoephedrine (Sudafed) for cold symptoms. d. The patient avoids taking nonsteroidal antiinflammatory drugs (NSAIDs).

ANS: A Patients should avoid temperature extremes by exercising indoors when it is cold. To avoid burn injuries, the patient should use warm rather than hot water to warm the hands. Pseudoephedrine is a vasoconstrictor and should be avoided. There is no reason to avoid taking NSAIDs with Raynaud's phenomenon

A patient in the outpatient clinic has a new diagnosis of peripheral artery disease (PAD). Which group of drugs will the nurse plan to include when teaching about PAD management? a. Statins b. Antibiotics c. Thrombolytics d. Anticoagulants

ANS: A Research indicates that statin use by patients with PAD improves multiple outcomes. There is no research that supports the use of the other drug categories in PAD.

A patient who is 2 days post femoral popliteal bypass graft to the right leg is being cared for on the vascular unit. Which action by a licensed practical/vocational nurse (LPN/LVN) caring for the patient requires the registered nurse (RN) to intervene? a. The LPN/LVN has the patient to sit in a chair for 2 hours. b. The LPN/LVN gives the prescribed aspirin after breakfast. c. The LPN/LVN assists the patient to walk 40 feet in the hallway. d. The LPN/LVN places the patient in Fowler's position for meals.

ANS: A The patient should avoid sitting for long periods because of the increased stress on the suture line caused by leg edema and because of the risk for venous thromboembolism (VTE). The other actions by the LPN/LVN are appropriate.

The nurse is admitting a patient newly diagnosed with peripheral artery disease. Which admission order should the nurse question? a. Cilostazol drug therapy b. Omeprazole drug therapy c. Use of treadmill for exercise d. Exercise to the point of discomfort

ANS: B Because the antiplatelet effect of clopidogrel is reduced when it is used with omeprazole, the nurse should clarify this order with the health care provider. The other interventions are appropriate for a patient with peripheral artery disease.

While working in the outpatient clinic, the nurse notes that a patient has a history of intermittent claudication. Which statement by the patient would support this information? a. "When I stand too long, my feet start to swell." b. "My legs cramp when I walk more than a block." c. "I get short of breath when I climb a lot of stairs." d. "My fingers hurt when I go outside in cold weather."

ANS: B Crampterm-37ing that is precipitated by a consistent level of exercise is descriptive of intermittent claudication. Finger pain associated with cold weather is typical of Raynaud's phenomenon. Shortness of breath that occurs with exercise is not typical of intermittent claudication, which is reproducible. Swelling associated with prolonged standing is typical of venous disease.

The health care provider prescribes an infusion of heparin and daily partial thromboplastin time (PTT) testing for a patient with venous thromboembolism (VTE). The nurse will plan to a. decrease the infusion when the PTT value is 65 seconds. b. avoid giving IM medications to prevent localized bleeding. c. have vitamin K available in case reversal of the heparin is needed. d. monitor posterior tibial and dorsalis pedis pulses with the Doppler

ANS: B Intramuscular injections are avoided in patients receiving anticoagulation to prevent hematoma formation and bleeding from the site. A PTT of 65 seconds is within the therapeutic range. Vitamin K is used to reverse warfarin. Pulse quality is not affected by VTE.

The nurse who works in the vascular clinic has several patients with venous insufficiency scheduled today. Which patient should the nurse assign to an experienced licensed practical/vocational nurse (LPN/LVN)? a. Patient who has been complaining of increased edema and skin changes in the legs b. Patient who needs wound care for a chronic venous stasis ulcer on the right lower leg c. Patient who has a history of venous thromboembolism and is complaining of dyspnea d. Patient who needs teaching about elastic compression stockings for venous insufficiency

ANS: B LPN education and scope of practice includes wound care. The other patients, which require more complex assessments or education, should be managed by the RN

A patient with a venous thromboembolism (VTE) is started on enoxaparin (Lovenox) and warfarin (Coumadin). The patient asks the nurse why two medications are necessary. Which response by the nurse is most accurate? a. "Taking two blood thinners greatly reduces the risk for another clot to form." b. "Enoxaparin will work right away, but warfarin takes several days to begin preventing clots." c. "Enoxaparin will start to dissolve the clot, and warfarin will prevent any more clots from forming." d. "Because of the risk for a blood clot in the lungs, it is important for you to take more than one blood thinner."

ANS: B Low molecular weight heparin (LMWH) is used because of the immediate effect on coagulation and discontinued once the international normalized ratio (INR) value indicates that the warfarin has reached a therapeutic level. LMWH has no thrombolytic properties. The use of two anticoagulants is not related to the risk for pulmonary embolism, and two are not necessary to reduce the risk for another VTE. Anticoagulants do not thin the blood.

The nurse has started discharge teaching for a patient who is to continue warfarin (Coumadin) after hospitalization for venous thromboembolism (VTE). The nurse determines that additional teaching is needed when the patient says which of the following? a. "I should get a Medic Alert device stating that I take warfarin." b. "I should reduce the amount of green, leafy vegetables that I eat." c. "I will need routine blood tests to monitor the effects of the warfarin." d. "I will check with my health care provider before I begin any new drugs."

ANS: B Patients taking warfarin are taught to follow a consistent diet with regard to foods that are high in vitamin K, such as green, leafy vegetables. The other patient statements are accurate.

Which instructions should the nurse include in a teaching plan for an older patient newly diagnosed with peripheral artery disease (PAD)? a. "Exercise only if you do not experience any pain." b. "It is very important that you stop smoking cigarettes." c. "Try to keep your legs elevated whenever you are sitting." d. "Put elastic compression stockings on early in the morning."

ANS: B Smoking cessation is essential for slowing the progression of PAD to critical limb ischemia and reducing the risk of myocardial infarction and death. Circulation to the legs will decrease if the legs are elevated. Patients with PAD are taught to exercise to the point of feeling pain, rest, and then resume walking. Support hose are not used for patients with PAD.

After receiving change of shift report, which patient admitted to the emergency department should the nurse assess first? a. A 67-yr-old patient who has a gangrenous left foot ulcer with a weak pedal pulse b. A 50-yr-old patient who is complaining of sudden sharp and severe upper back pain c. A 39-yr-old patient who has right calf tenderness, redness, and swelling after a plane ride d. A 58-yr-old patient who is taking anticoagulants for atrial fibrillation and has black stools

ANS: B The patient's presentation of sudden sharp and severe upper back pain is consistent with dissecting thoracic aneurysm, which will require the most rapid intervention. The other patients also require rapid intervention but not before the patient with severe pain.

Which actions could the nurse delegate to unlicensed assistive personnel (UAP) who are providing care for a patient who is at risk for venous thromboembolism? a. Monitor for any bleeding after anticoagulation therapy is started. b. Apply sequential compression device whenever the patient is in bed. c. Ask the patient about use of herbal medicines or dietary supplements. d. Instruct the patient to call immediately if any shortness of breath occurs.

ANS: B UAP training includes the use of equipment that requires minimal nursing judgment, such as sequential compression devices. Patient assessment and teaching require more education and critical thinking and should be done by the registered nurse (RN).

The nurse performing an assessment of a patient who has chronic peripheral artery disease (PAD) of the legs and an ulcer on the right second toe would expect to find a. dilated superficial veins. b. swollen, dry, scaly ankles. c. prolonged capillary refill in all the toes. d. serosanguineous drainage from the ulcer

ANS: C Capillary refill is prolonged in PAD because of the slower and decreased blood flow to the periphery. The other listed clinical manifestations are consistent with chronic venous disease

A 46-yr-old service-counter worker undergoes sclerotherapy for treatment of superficial varicose veins at an outpatient center. Which instructions should the nurse provide to the patient before discharge? a. Sitting at the work counter, rather than standing, is recommended. b. Exercise, such as walking or jogging, can cause recurrence of varicosities. c. Elastic compression stockings should be applied before getting out of bed. d. Taking an aspirin daily will help prevent clots from forming around venous valves.

ANS: C Elastic compression stockings are applied with the legs elevated to reduce pressure in the lower legs. Walking is recommended to prevent recurrent varicosities. Sitting and standing are both risk factors for varicose veins and venous insufficiency. An aspirin a day is not adequate to prevent venous thrombosis and would not be recommended for a patient who had just had sclerotherapy.

Which assessment finding for a patient who has been admitted with a right calf venous thromboembolism (VTE) requires immediate action by the nurse? a. Erythema of right lower leg c. New onset shortness of breath b. Complaint of right calf pain d. Temperature of 100.4°F (38°C)

ANS: C New onset dyspnea suggests a pulmonary embolus, which will require rapid actions such as O2 administration and notification of the health care provider. The other findings are typical of VTE

A young adult patient tells the health care provider about experiencing cold, numb fingers when running during the winter, and Raynaud's phenomenon is suspected. The nurse will anticipate teaching the patient about tests for a. hyperglycemia. c. autoimmune disorders. b. hyperlipidemia. d. coronary artery disease.

ANS: C Secondary Raynaud's phenomenon may occur in conjunction with autoimmune diseases such as rheumatoid arthritis. Patients should be screened for autoimmune disorders. Raynaud's phenomenon is not associated with hyperlipidemia, hyperglycemia, or coronary artery disease.

Which action by a new nurse who is giving fondaparinux (Arixtra) to a patient with a lower leg venous thromboembolism (VTE) indicates that more education about the drug is needed? a. The nurse avoids rubbing the injection site after giving the drug. b. The nurse injects the drug into the abdominal subcutaneous tissue. c. The nurse ejects the air bubble from the syringe before giving the drug. d. The nurse does not check partial thromboplastin time (PTT) before giving the drug

ANS: C The air bubble is not ejected before giving fondaparinux to avoid loss of drug. The other actions by the nurse are appropriate for subcutaneous administration of a low molecular weight heparin (LMWH). LMWHs typically do not require ongoing PTT monitoring and dose adjustment.

Which topic should the nurse include in patient teaching for a patient with a venous stasis ulcer on the left lower leg? a. Need to increase carbohydrate intake b. Methods of keeping the wound area dry c. Purpose of prophylactic antibiotic therapy d. Application of elastic compression stockings

ANS: D Compression of the leg is essential to healing of venous stasis ulcers. High dietary intake of protein, rather than carbohydrates, is needed. Prophylactic antibiotics are not routinely used for venous ulcers. Moist dressings are used to hasten wound healing

A patient at the clinic says, "I always walk after dinner, but lately my leg cramps and hurts after just a few minutes of starting. The pain goes away after I stop walking, though." The nurse should a. look for the presence of tortuous veins bilaterally on the legs. b. ask about any skin color changes that occur in response to cold. c. assess for unilateral swelling, redness, and tenderness of either leg. d. palpate for the presence of dorsalis pedis and posterior tibial pulses.

ANS: D The nurse should assess for other clinical manifestations of peripheral arterial disease in a patient who describes intermittent claudication. Changes in skin color that occur in response to cold are consistent with Raynaud's phenomenon. Tortuous veins on the legs suggest venous insufficiency.term-29 Unilateral leg swelling, redness, and tenderness indicate venous thromboembolism.

An older patient with chronic atrial fibrillation develops sudden severe pain, pulselessness, pallor, and coolness in the right leg. The nurse should notify the health care provider and immediately a. apply a compression stocking to the leg. b. elevate the leg above the level of the heart. c. assist the patient in gently exercising the leg. d. keep the patient in bed in the supine position.

ANS: D The patient's history and clinical manifestations are consistent with acute arterial occlusion, and resting the leg will decrease the O2 demand of the tissues and minimize ischemic damage until circulation can be restored. Elevating the leg or applying an elastic wrap will further compromise blood flow to the leg. Exercise will increase oxygen demand for the tissues of the

The health care provider has prescribed bed rest with the feet elevated for a patient admitted to the hospital with venous thromboembolism. Which action by the nurse to elevate the patient's feet is best? a. The patient is placed in the Trendelenburg position. b. Two pillows are positioned under the affected leg. c. The bed is elevated at the knee and pillows are placed under the feet. d. One pillow is placed under the thighs and two pillows are placed under the lower legs.

ANS: D The purpose of elevating the feet is to enhance venous flow from the feet to the right atrium, which is best accomplished by placing two pillows under the feet and one under the thighs. Placing the patient in the Trendelenburg position will lower the head below heart level, which is not indicated for this patient. Placing pillows under the calf or elevatiterm-33ng the bed at the knee may cause blood stasis at the calf level.

vericose veins -dilated tortuous superficial veins primary varicose veins -due to a weakness of the vein walls and are more common in women secondary varicose veins -result from direct injury, a previous VTE, excessive vein distension -may also occur in the esophagus, vulva, spermatic cords, anorectal area Congenital varicose veins -result from chromosomal defeccts which cause abn development of the enous system Reticular veins are smaller vericose veins that appear flat, less tortuous and blue-green in color telangiectasias -small visible vessels that appear bluish black, purple or red

Etiology The superficial veins in the lower extremities become dilated and tortuous in response to backward blood flow and increased venous pressure clinical manifestations heavy, aching feeling pain after prolonged standing or sitting which is relieved by walking or limb elevation leg cramps may also occur itchy, burning, throbbing Drug therapy venoactive drugs -derived from plant extracts are powerful antioxidants

complications of VTE -PE -chronic thromboembolic pulmonary HTN -post thrombotic syndrome -plegmasia cerulea dolens post thrombotic syndrome (PTS) -results from chronic inflammation and chronic venous HTN Interprofessional care cont...

Interprofessional care fr VTE -early mobilization based on the pt condition is the easierst and most cost effective method to decrease VTE risk -Pt on bed rest should change position every 2 hours and flex and extend their feet, knees and hips every 2-4 hours -compression stockings -SCDs Drug therapy -anticoagulants -vit k antagonists -warfarin (coumadin) -thrombin inhibitors -heparin -low molecular weight heparin -enoxaparin (lovenox) -dalteparin (fragmin) -thrombin inhibitors : direct hirudin derivatives -bivalirudin (angiomax) -desirudin -synthetic thrombin inhibitors -argatroban -dabigatran -factor Xa inhibitor -fondaparinux (arixtra) -rivaroxaban (xeralto) -apixaban (eliquis) -edoxaban (savaysa)

INR aPTT ACT Anti-factor Xa

Normal 0.75-1.25 Therapeautic level 2-3 aPTT normal 25-35 sec Therapeautic value 46-70 ACT (activated clotting time) Normal 70-120 sec therapeautic value >300 Anti-factor Xa normal 0 therapeautic level 0.6-1.0

Vascular disorders in Men -thromboangitis obliterans (Buergers disease) occurs predominantly in men <40 yrs -Abd aortic aneurysms (AAAs) are more common im men than women -Men with AAAs are more likely to undergo endovascular aneurysm repair or open aneurysm repair than women -aortic disection affects men more than women -sexual dysfunction in male pt is common after aortic surgery cont...

Women -peripheral artery disease PAD prevalence is higher in women -women with low lifetime recreational activity are at greater risk for PAD than similar men -Older women experience the classic signs of intermmittnet claudication less often than men -women with PAD experience faster functional decline and greater mobility loss than men with PAD -Raynauds phenomenon occurs primarily in women between 15-40 yrs -Risk for venous thromboembolism is greater in women over the age of 35 who use tobacco and oral contraceptives or hormone therapy -primary varicose veins are more common and more symptomatic in women than men -risk for varicose veins is greater in multiparous women -women with AAAs are at highter risk for rupture -in hospital mortality is higher in women undergoing revascularization than men -women develop surgical site infections more often than men

Peripheral artery disease PAD clinical manifestations

classic sx is : intermittent claudication (ischemic muscle pain) resolves within 10 minutes or less with rest and is reproducable. PAD of the iliac arteries produces claudication in the buttocks and thighs popliteal artery will have pain in the Calf

dissections are also classified as acute (first 14 days) or chronic (greater than 90 days) Etiology Non traumatic aortic dissection is caused by degeratedelastic fibers in the arterial wall. chronic HTN assists this process. In the aortic dissection a tear develops in the inner layer of the aorta. Blood surges through the tear into the middle layer of the aorta causing th inner and middle layers to separate. If the blood-filled channel ruptures through the outside aortic wall, a aortic dissection is often fatal cont... clinical manifestations

clinical manifestations Type A dissection -abrupt onset of excrutiating chest pain Type B -pain located in the back, abdomen or legs. If the aortic arch is involved, the pt may have neurologic defecits. -ALOC -weakened carotid/temporal pulses -dizziness.

clinical manifestations of aneurysm thoracic aortic anerysms (TAA) ar often asymptomatic when present sx include deep, diffuse chest pain that may extend to the inerscapular area Ascending aorta and aortic arch aneurysms can cause -angina from decreased blood flow to the coronary arteries -tia from decreased blood flow to the carotid arteries and -coughing, SOB, hoarsness and/or dysphagia. (difficulty swallowing) from the pressure on the laryngeal nerve. If the aneurysm presses on the superior vena cava, decreased venous return can result in JVD and edema of the face and arms AAAs are often asymptomatic -a pulsatile mass i the periumbilical area slightly to the left of the midline may be present. -bruits can be auscultated cont..

complications of an aneurysm -if rupture occurs into the retroperitoneal space, bleeding may be contrlled by surrounding anatomic structures preventing exsanguination and death. IN this case the pt often has severe back pain and may or may not have back or flank echymosis (grey turners sign) if rupture occurs in the thoracic or abd cavity, patients can die from massive hemorrhage. The pt who reaches the hospital will be in hypovolemic shock with tachycardia, hypotension , pale clammy skin, decreased urine output, ALOC, and abd tenderness.

Raynaud's phenomenon

episodic vasospastic disorder of small cutaneous arteries , most often involving the fingers and toes. Ours primarily in women 15-40 yrs. characterized by -vasospasm -color changes of fingers, toes, ears and nose (white, blue, and red) -decreased perfusion results in pallor (white) -the digits then appear cyanotic -these changes are followed by rubor (red) caused by the hyperemic response that occurs when blood flow is restored. Pt usually describes coldness and numbness in the vasoconstrictive phase, followed by throbbing, aching pain, tingling and swelling in the hyperemic phase. Exposure to cold, emotional upset, tobacco use, and caffeine often bring on sx.

venous thrombosis -formation of a thrombus in association with inflammation of the vein. classified as -supervicial vein thrombosis: formatio of a thrombus in a superficial vein -or deep vein thrombosis: thrombus in a deep vein. most likely iliac and femoral Venous thromboembolism (VTE) is the preferred terminology and represents the spectrum of pathology from DVT to pulmonary embolism (PE) etiology

etiology 1. venous stasis: occurs when the valves( in the veins) are dysfunctional or the muscles of the extremities are inactive. 2. endothelial damage: may be caused by diret or indirect injury to the vessel. damaged endothelium stimulates platelet activation and starts the coagulation cascade. this predisposes the pt to thrombus developent 3. hypercoagulability of blood: occurs in many disorders.

chronic venous insufficiency (CVI) -long-standing functional abnormalities of the venous system that result in advanced venous signs and symptoms such as edema skin changes and/or venous leg ulcers Etiology long standing primary varicose veins and PTS can progress to CVI As a result of ambulatory venous HTN serous fluid and RBCs leak from capillaries and venules into the tissue producing edema and chronic inflammatory changes. clinical manfestations skin in lower leg is leathery "bownish" edema for long period eczema (itching) venous ulcers located above the medial malleolus cont..

interprofessional care -compression -evaluate nutritional status of pt with venous ulcer nursing management compression stockings moisturize extremities to avoid cracked flaky skin

a severe life threatening complication of an acute ascending aortic dissection is -cardiac tamponade. goal for therapy for acute aortic dissection are

management of HR and BP and Contractility IV beta blocker is titrated to target a HR of 60 bt/min systolic between 100-110 CCB used if BB is contraindicated morphine is the analgesic used to decrease SNS and relieve pain

Thromboangiitis Obliterans

nonatherosclerotic, segmental , recurrent inflammatory disorder of the small and medium arteries and veins of the upper and lower extremities. Acute phase: An inflammatory thrombus forms and blocks the vessel. Eventually the inflammation subsides Chronic phase: thrombosis and fibrosis occur in the vessel causing tissue ischemia. (sx often confused with PAD ) Pt may have intermittant claudication of the feet , hands, or arms. As the disease progresses , rest pain and ulcers form. Occurs in mostly young men (under 45) who have a long hx of tobacco or marijuana use. TX is often complete cessation of tobacco and marijuana

clinical manifestations of acute arterial ischemia

pain pallor pulslessness paresthesia paralysis piokilothermia without immediate intervention ischemia may progress to tissue necrosis and gangrene within a few hours. Paralysis is a late sign of acute arterial ischemia and signals of death of nerves supplying the extremity.

Phlebitis acute inflammation of the walls of small canulated veins of the hand or arm clinical manifestations include

pain/tenderness warm erythema swelling palpable cord

acute arterial ischemia

sudden interruption in the arterial blood supply to a tissue, an organ or an extremity that , if left untreated, can result in tissue death

Pt teaching for Raynaud's phenomenon

tell pt to wear loose, warm clothing as protection from the cold. gloves when handing cold objects. At all times pt should avoid temp extremes. immersing hands in warm water often decreases the vasospasm stop using tobacco and avoid caffeine. and avoid medications that have vasoconstrictive effects.

Peripheral Artery Disease of the Lower Extremities Lower ext PAD may affect the iliac, femoral, popliteal, tibial or peroneal arteries or any combination of these arteries. THe femoral poplitial is the most common site in nondiabetic pts. Pts with PAD tend to develop PAD in the arteries below:

the knee

One of the most common problems affecting the aorta is an aneurysm, which is a permanent, localized outpouching or dilation of the vessel wall. Etiology -may involve aortic arch, thoracic or abd aorta. Primary causes are -degenerative, congenital, mechanical (penetrating or blunt trauma) infectous classified as true or false aneurysm:

true: the wall of the artery forms the aneurysm with at least one vessel layer still intact True aneurysms ar further subdivided in fusiform and saccular fusiform: circumferential and relatively uniform in shape saccular: pouchlike with a narrow neck connecting the bulge to one side of the arterial wall false or pseudoaneurysm: is not an aneurysm but a disruption of all arterial wall layers with bleeding that is contained by surrounding anatomic structures. may result from trauma, infection, peripheral artery bypass graft

Aortic dissection dissection results from the creation of a false lumen between the intima (inner lining) and the middle layer of the arterial wall. is classified based on the location of the dissection and duration TYPE A dissection TYPE B dissection

type A dissection -affects th ascending aorta ad arch Type B dissection -begins in the descending aorta

surgical interventions for VTE

venous thrombectomy -removal of the thrombus through an incision in the vein vena cava interuption devices -placed percutaneously through the right femoral or right internal jugular veins -as blood travels up the vena cava clots are trapped in the filter

clinical manifestations of superficial vein thrombosis -palpable , firm, sub q cordlike vein -surrounding area of the vein may be itchy, tender or painful to the touch -redened and warm -lower exxtremity superficial vein thrombosis often invoves one or more varicose veins Nursing iterventions -compression stockings -elevate the limb above the level of the heart cont

venous thromboembolism clinical manifetations -edema, pain, tenderness with palpation -dilated superficial veins -sense of fullness of the thigh or calf -parasthesia, -warm skin, erythema, systemic temp greater than 100.4 -If the VTE involves the upper extremity veins and may extend into the internal jugular vein or superior vena cava and symptoms involve the arms, neck, back and face