UT Arlington NURS 3366 - peripheral circulation notes (15 pages)

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peripheral circulation notes



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peripheral circulation notes

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Pages:
15
School:
University of Texas at Arlington
Course:
Nurs 3366 - Pathophysiologic Processes: Implications for Nursing
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1 Nursing 3366 Pathologic Processes Implications for Nursing Lecture Notes Disorders of the Circulatory System Objectives outcomes for entire circulatory system lecture DESCRIBE DISCUSS IDENTIFY 1 influences upon and results of appropriate forward effective oxygenated blood flow through the heart and peripheral system such as normal cardiac structure cardiac cycle cardiac output preload afterload AKA vascular resistance contractility neuroelectrical status of the heart status of peripheral vessels perfusion of tissues 2 relationship between derangements of the above structural and hemodynamic processes and the etiological factors clinical manifestations diagnostics and basic treatment modalities of disorders such as arteriosclerosis and atherosclerosis peripheral arterial disease venous disorders hypertension coronary artery disease stable angina and acute coronary syndrome valvular disorders heart failure cardiogenic shock Outline I Overview of circulatory system Potentially confusing terms and A Potentially confusing terms Key overarching concepts can be B Some key overarching conceptsfound in the cardiac portion of the circulation notes II Venous disorders A A P of veins B Peripheral venous disorders C Treatment nursing implications of venous problems III Arterial disorders A A P of arteries B Pathogenesis of arterial disorders C Specific arterial diseases D Treatment nursing implications of arterial problems KNOW THE BASIC PATH OF BLOOD FORWARDS AND BACKWARDS a See cardiac portion of the circulation notes b parts II III of this lecture mostly focus on issues of flow outside the heart or peripheral flow aorta major arteries in legs ileac femoral popliteal pedal arteries D P P T arterioles of tissue beds of legs and feet capillary beds gas exchange here O2 from blood to tissue CO2 from tissue to blood venules veins of feet legs inferior vena cava 2 arteries oxygenated blood out and away from heart veins deoxygenate d blood in and towards the heart II A Venous disorders A P of veins 1 veins are thin walled vessels that take deoxygenated blood from tissue beds all over the body back to the right side of the heart 2 this flow back to the heart is often called venous return and also sometimes called venous drainage of tissues a proper functioning valves in leg veins 3 conditions that leg veins have numerous valves which facilitate good venous return work like this i e good drainage of body s tissues 1 and prevent backflow ie prevent gravity from pulling blood downwards away from normal return to heart include Arm veins most other veins in the body have valves as well but since there is not such a gravity problem to fight against it is not as common to have venous disease in the arms thus we will be concentrating on LEG vein disease Important note don t confuse the valves in the veins with the valves in the heart two very different entities b during systole when blood is being pushed into arteries by the heart the systolic pressure is also helping to push venous blood back towards the heart vein valves in the legs are OPEN during this time 2 during diastole the leg vein valves CLOSE so that blood doesn t back muscle flow succumb to well toned working tissue around the veins which massage the veins helping to direct flow towards the heart during systole and also helping to prevent backflow during diastole 3 B Peripheral venous disorders chronic venous insufficiency DVT 1 overview of venous problems a most venous disorders occur in the legs and usually have to do with some degree of failure to keep entire amount of venous blood flowing in its proper direction that is upward towards the heart b as a result some venous blood tends to stay and settle out in the veins of the leg and foot tissues this is known as venous congestion think of CONGESTION of peripheral tissues when you think of venous issues c factors contributing to venous congestion include 1 gravity winning a ex simply being on one s feet too long can cause gravity to pull fluid downward into distal leg tissues b unless severe this is a type of venous congestion that is within normal experience ie not necessarily a pathologic process 2 valve incompetence when this is the problem a pathology is involved and the disorder is called venous insufficiency 2 chronic venous insufficiency CVI a pathogenesis S S 1 CVI is most often caused by leg vein valves wearing out and becoming floppy they don t close tightly during diastole review of allowing backflow into distal veins of legs feet venous hydrostatic congestion pressure in blood vessels force 2 this congestion can be pictured as a pool of non moving blood in exerted by a fluid the veins blood against the wall of the this is called venous and results in increased hydrostatic pressure inside the affected veins 3 this increased pressure pushes fluid into tissues of legs and feet causing in the affected area a the edema causes mild to moderate discomfort but over time can also cause dry tight skin often with brownish Mini summary concept map discolorations Floppy valves increased hydrostatic pressure distal to the bad valves because venous blood can t return up to heart properly engorged peripheral veins pushes fluid out to tissues edema Edema essentially causes the main S S of CVI swollen tight dry discolored skin which can 4 b sometimes the area becomes so engorged with edema that the skin cells cannot function properly the tissue easily breaks down especially over bony prominences such as heels ankles coccyx causing venous increased hydrostatic pressure can also cause such backflow pressures to surface veins that they can become twisted distorted varicose veins these are not usually a health hazard but can become painful and cosmetically distressing to your patients FYI remember in assessing caring for your patients that there are many causes of edema it may be caused by venous insufficiency but not always other disease processes cause edema too ex hypoosmolar problems HTN right sided heart failure kidney disease an injury lymphatic problems etc many of these processes have been covered or will be covered in the course b contributing factors to development of CVI 4 1 aging inherited predisposition obesity sometimes pregnancy especially multiple and job related issues such as years of standing AND OR 2 lack of assistance from musculature such as when there is poor muscle tone due to immobility and or inactivity 3 deep vein thrombosis a a DVT is a clot that develops on the wall of


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