CARE OF CLIENTS WITH PERIPHERAL ● a condition where a blood clot thrombus) forms in a deep vein, usually in the legs.

It
VASCULAR DISORDERS can cause pain, swelling, and redness. If the clot breaks loose, it can travel to the
lungs, causing a life-threatening condition called a pulmonary embolism. Risk factors
Definition and Overview include prolonged immobility, surgery, smoking, and certain medical conditions.
Treatment involves blood thinners and lifestyle changes to prevent complications.
Peripheral vascular disorders (PVDs) refer to conditions affecting blood circulation outside
● It is caused by Virchow's triad:
the heart and brain, including the arteries, veins, and lymphatic system. ○ = Vessel wall injury (e.g., cigarette smoking)
They are categorized as: ○ = Venous stasis (e.g. prolonged bedrest) embolism.
● Peripheral Arterial Disease (PAD): Arterial narrowing due to atherosclerosis. ○ = Hypercoagulability of the blood (e.g., use of contraceptive pills, dehydration,
● Chronic Venous Insufficiency (CVI): Dysfunction of venous valves leading to blood hyperglycemia)
pooling. ● The clinical manifestations of DVT are as follows:
● Deep Vein Thrombosis (DVT): Formation of blood clots in deep veins. ○ Calf- pain (+Homan's sign)
○ Tenderness
Peripheral Vascular Disease (PVD) ○ Palpable induration (redness) along the course of the vein.
● The causes of peripheral vascular disorders are atherosclerosis, thrombosis ○ Edema
embolization, hypercoagulability of blood, hypotension, inflammatory processes ● Collaborative management for DVT:
mechanical or chemical trauma. ○ Medical management:
● These factors cause decreased blood flow, tissue ischemia, tissue hypoxia necrosis, ◆ Thrombolytics
ulceration and gangrene. The most distal parts of the body are: commonly affected, ◆ Anticoagulants: Heparin, Coumadin
especially the lower extremities. ◆ Thrombolytics. Disintegrate blood clot (thrombus).
● The disorders affecting the arteries are arteriosclerosis obliterans, aneurysm, an ◇ Streptokinase (Streptase, Kabikinase)
Raynaud's discase. ◇ Urokinase (Abbokinase)
● The disorders affecting the veins are thrombophlebitis (superficial Peripheral Vascular ● Nursing interventions:
Disorders thrombosis and deep vein thrombosis), and varicosities. ○ Maintaining tissue perfusion:
● The disorder affecting the arteries and veins is Buerger's disease (is a rare disease ◆ Bed rest for 5 to 7 days.
that causes inflammation and thrombosis (clotting) in small and medium-sized blood ◆ Elevate legs to promote venous return and to prevent edema.
vessels, primarily affecting the arms and legs) ◆ Apply compression support stockings. It is applied before getting out of
bed in the morning. It should be inverted to facilitate application.
Peripheral Arterial Disorder ◆ Avoid prolonged standing and sitting.
● Arteriosclerosis is hardening of arteries. It affects the tunica media
◆ Check pulse distal to the site of thrombosis, to assess for circulatory
● Atherosclerosis is narrowing/occlusion of lumen of arteries due to accumulatio of fatty blockage.
plaques in the tunica intima.
◆ Assess presence of edema.
◆ Monitor calf pain.
○ Promoting comfort:
The clinical manifestations of arterial disorders are as follows:
◆ Analgesic to relieve pain
1. Pain. Intermittent claudication. This is leg pain on activity and exercise relieved by ◆ NSAID to reduce edema
rest. Rest improves blood flow and oxygen supply to the legs, the pain is relleved.
2. Coldness or cold sensitivity. This is because of tissue ischemia.
Venous Disorders
3. Impaired arterial pulsations. Indicates decreased blood flow due to arterial spasm.
4. Color changes. Cyanosis on dependency of legs. 1. Superficial Thrombophlebitis (SVT)
5. Ulceration and gangrene. Due to tissue ischemia, hypoxia or trauma. – it is venous thrombosis and inflammation in a superficial vein.
6. Sexual dysfunction. Decreased penile circulation due to occlusion of terminal aorta. – The greater or lesser saphenous veins in the legs are most commonly affecte
This may be experienced as un-sustained erection. – The clinical manifestations of SVT are as follows:
○ Pain in the calf of the leg (Positive Homan's sign). Homan's sign assessed by
flexing the knee and asking the client to dorsiflex the foot.
Deep Vein Thrombosis (DVT)
○ Tenderness
● Formation of blood clots in deep veins. ○ Palpable induration (redness) along the course of the vein.
 ○ Note: There is no leg edema in SVT. Maintaining skin integrity and preventing infection.
– Collaborative Management for SVT ● Skin breakdown and infection may lead to gangrene formation.
○ Bed rest with leg clevation. To prevent dislodgement of thrombus and to promote ● Patient teachings include the following:
venous return ○ Examine the skin for signs of breakdown and infection.
○ Loçal moist heat application on the leg. To relieve pain and reduce blood ○ take daily bath and dry the skin gently.
viscosity, thus preventing thrombus formationNon - narcotic analgesic. ○ Apply moisturizing cream or lotion on the skin.
○ Nonsteroidal anti-inflammatory agents (NSAIDs) ○ Avoid using alcohol. Alcohol causes dryness of the skin.
– Patient teachings include the following (Prevention of venous stasis) ○ Wear comfortable, well -fitted pair of shoes.
○ Avoid prolonged sitting or standing. ○ Avoid direct heat or cold application over the extremities. Diminished sensation
○ Elevate legs when sitting. in the extremities makes the client unable to perceive heat or cold. Heat may
○ Avoid crossing the legs at the knee. cause burns. Cold may cause vasoconstriction that results to further impairment
○ Wear compression support stockings. of circulation.
○ Avoid constriction on legs by tight bonds such as garters. ○ Consult physician for any signs of skin breakdown.
○ Daily exercise and activity.
– Prevention of recurrence of SVT: Promoting activity.
○ Maintain ideal body weight (IBW). Obesity causes venous stasis. ● To promote circulation, maintain vascular tone, and enhance production of chemical
○ Alternate standing with sitting at work or at home.
activators (tissue-type plasminogen activator) that prevent platelet aggregation.
○ Regular pattern of exercise. ● General exercises: aerobic such as walking, swimming, jogging bicycling. Do exercises
30 to 45 minutes, 3 to 4 times a week.
● Special exercises: ankle rotations, ankle pumps, knee extension.
Difference Between Arterial and Venous Disorders ● Buerger-Allen's exercise.
Feature Arterial Disorders Venous Disorders ○ Note: Buerger - Allen's exercise primarily promotes arterial circulation

Definition Conditions affecting Conditions affecting

Preventing injury.
arteries, reducing blood veins, leading to ● To prevent gangrene formation especially in the lower extremities.
flow to tissues. impaired blood return to ● Patient teachings include the following:
the heart. ○ Do not go barefooted., Diminished sensation in the lower extremities makes the
client unable to perceive trauma.
Common cause Atherosclerosis, Prolonged immobility, ○ Trim toenails straight across, or follow the contourof the toes. Do not cut lateral
embolism, smoking, varicose veins, obesity, edges of toenails to prevent the growth of ingrowns. Ingrowns may cause trauma
diabetes, hypertension. pregnancy, clotting in the toes.
○ Avoid scratching or rubbing feet.
disorders. ○ Check temperature of water for bathing.
Primary conditions Peripheral Artery Disease Deep Vein Thrombosis ○ Seek medical treatment for deformed nails, corns, calluses and ulceration. Avoid
(PAD), Arterial (DVT), Chronic Venous self- treatment.

Thrombosis Insufficiency (CVI),

Aneurysm
Varicose Veins ● is localized, irreversible dilatation of an artery due to an alteration in the integrity of its
Symptoms Cold, pale, or bluish Swelling (edema), warm, wall.
extremities, weak or reddish or bluish skin, ● The different types of aneurysm are as follows:
○ Fusiform aneurysm. Both sides of the arterial wall are dilated.
absent pulses, pain that pain that improves with ○ Saccular aneurysm. One side of the arterial wall is dilated.
worsens with activity elevation, varicose veins. ○ Dissecting aneurysm. There is separation between the tunica media and tunica
(claudication). intima.
Varicose Veins
● Dilated veins, usually in the lower extremities.
● The most common cause of varicose veins is hereditary weakness of the valves of the
veins.
● Other causes are congenital absence of valves of the veins, prolonged sitting or
standing, wearing of constricting clothing's, obesity, thrombophlebitis, pregnancy,
disease conditions, e.g. right - sided CHF, liver cirrhosis.
● The clinical manifestations of varicose veins are as follows:
○ Dilated, purplish, tortuous veins
○ Leg edema
○ Heaviness in the legs
● Collaborative Management for varicose veins:
○ Elevation of the legs for I5 to 30 minutes at a time,average of 20 minutes.
○ Use of compression or support stockings.
○ Sclerotherapy. Injection of sclerosing agent into the varicose veins.
○ Surgery: vein ligation and stripping.
● Diagnostic Tests
○ Ankle-Brachial Index (ABI): Compares blood pressure in ankle and arm to
assess PAD severity.
○ Doppler Ultrasound: Evaluates blood flow and detects blockages.
○ D-dimer Test: Identifies clot breakdown products (used in DVT diagnosis).
○ Venography and MRI: Advanced imaging for vascular assessment.