“There are 100,000 miles of blood vessels in the adult human body” (Vascularcures.org). Our human body depends on these blood vessels to transport the oxygenation and nutrients our tissues need. Vascular disorders are conditions that affect our circulatory system and cause problems like tissue death, internal bleeding, and extreme pain. Our group did a presentation on the following vascular disorders: Buerger’s, Raynaud’s, Aneurysms, DVT’s, and Thrombophlebitis. In the following paragraphs we will explain what each disorder is, how it affects people, what the treatments are, and how we as nurses can help our patients with these disorders.
Buerger’s disease / Thromboangiitis obliterans
The first vascular disorder I will write about is Buerger’s disease also known as Thromboangiitis obliterans. Buerger’s is a rare disease that affects the blood vessels of the hands and feet. The blood vessels become inflamed, swollen, and can narrow or get blocked by blood clots. This disorder affects mostly men who are between twenty and forty five years old who are heavy smokers or chew tobacco. People who are affected by this disorder usually have symptoms in two or more limbs. Some of the symptoms include: “fingers or toes that appear pale, red, or bluish and feel cold to the touch, sudden severe pain in the hands and feet like burning or tingling, the pain may be worse when the hands and feet get cold or during emotional stress, pain in the legs, ankles, or feet when walking, and skin changes or small painful ulcers on the fingers or toes” (medlineplus.gov). There is not a test that diagnoses Buerger’s, but some tests like an plethysmography and a doppler can be done that may show blockage of blood vessels. There is no cure for this disorder, the goal is to control the symptoms and prevent the disease from getting worse. An intervention that we can educate the patient on is to apply warmth and do gentle exercises that can help increase circulation. Aspirin and vasodilator medications may also be prescribed to the patients to help control this disorder. If it gets severe, surgery to cut the nerves called sympathectomy may be needed or amputation of the area if it becomes infected or necrotic. The key to controlling the disease is for these people to stop using tobacco. (medlineplus.gov)
Raynaud’s disease / Raynaud’s phenomenon
Next, I will explain Raynaud’s disease also called Raynaud’s phenomenon. This is another rare disorder of the blood vessels, that affects the fingers and toes. With this disorder the blood vessels narrow due to cold temperature or stress. When the vessels narrow due to cold or stress, the blood can’t get to the surface of the skin and the area turns white and blue. When the blood flow returns, the skin turns red and throbs or tingles. In severe cases, the loss of blood flow can cause sores or tissue death. There are two different classifications of causes. The first one is known as Primary Raynaud’s, which happens on its own. The second classification is known as “Secondary Raynaud’s”, which is caused by injuries, other diseases, or certain medicines. This disorder is more common in women who are over the age 30, people with a family history, and people who live in colder climates. Some of the tests that will be used to help diagnose this disorder are an antinuclear antibody test and the erythrocyte sedimentation rate. Treatment for Raynaud’s includes vasodilator medications like alpha blockers and calcium channel blockers. Other interventions that we can educate the person with this disorder are to do things such as: “soaking hands in warm water, keeping hands and feet warm in cold weather, and avoiding triggers, such as certain medicines and stress”. (Medlineplus.gov).
While I was doing some research on this disorder, I found a journal article from Pubmed, that described how Rosemary essential oil helped a fifty three year old woman with systemic sclerosis and Raynaud’s. The oil had a vasodilator and warming effect on the woman. According to the article, Nitroglycerin gel is the only proven topical therapy to help, but the essential oil had a positive effect for this woman.(Pubmed.gov) I found this interesting because some people prefer trying nonpharmacologic treatments before having to take medications and this study showed a positive effect for using this essential oil.
Aneurysms
Next I will explain what aneurysms are and the different types that exist. An aneurysm is an abnormal bulge or ballooning in the wall of a blood vessel that can later rupture, causing internal bleeding and can often lead to death (“Aneurysms,” 2016). Aneurysms can develop in several parts of the body, but for the sake of this assignment, I will be focusing on the signs and symptoms, risk factors, and treatment options of only abdominal aortic aneurysms and brain aneurysms. According to the Brain Aneurysm Foundation, unruptured brain aneurysms are typically completely asymptomatic and typically small in size, less than one half inch in diameter, however, large unruptured aneurysms can occasionally press on the brain or the nerves stemming out of the brain and may result in various neurological symptoms. Some signs and symptoms of brain aneurysms that should be reported immediately are localized headaches, dilated pupils, blurred or double vision, pain above and behind eye, weakness and numbness, and difficulty speaking (“Warning Signs/ Symptoms,” n.d.). Some of the risk factors that are believed to lead to the formation brain aneurysms include smoking, high blood pressure or hypertension, a family history of brain aneurysms, age over 40, gender because women compared with men have an increased incidence of aneurysms at a ratio of 3:2, drug use, particularly cocaine, and traumatic head injuries (“Warning Signs/ Symptoms,” n.d.). Now abdominal aortic aneurysms often grow slowly and usually without symptoms, also making them difficult to detect. Predicting how fast an abdominal aortic aneurysm may enlarge is difficult, however as an abdominal aortic aneurysm enlarges, some people may notice a pulsating feeling near the navel, deep, constant pain in your abdomen or on the side of your abdomen, and severe back pain (“Abdominal aortic aneurysm,” 2018). Some of the risk factors associated with AAA’s include age because they occur most often in people age 65 and older, tobacco use because smoking can be damaging to the aorta and weaken the aorta’s walls, being male, a family history of AAA, and high blood pressure (“Abdominal aortic aneurysm,”2018).
I will now discuss the diagnostics available to detect aneurysms and different approaches of treatment. According to Mayo Clinic, to diagnose an aneurysm, doctors will review your medical and family history and conduct a physical examination. If your doctor suspects that you have an aneurysm, specialized tests such as an abdominal ultrasound for an AAA, computerized tomography (CT) scan, or a magnetic resonance imaging (MRI) can confirm it (“Abdominal aortic aneurysm,” 2018). The options for treatment of your aneurysm will depend on a variety of factors, including location and size of the aneurysm, your age, and other existing conditions that may increase your risk of surgery or endovascular repair. Your doctor will discuss with you the most appropriate treatment for you (“Abdominal aortic aneurysm,” 2018). There are open abdominal/brain surgery options that include removing the damaged section of the aorta and replacing it with a graft which is sewn into place or surgical clipping of an aneurysm. Endovascular surgery is a less invasive procedure used more frequently today to repair an aneurysm where the doctor can also place a graft, coiling, or both into your aorta (“Abdominal aortic aneurysm,” 2018). It is very important that patients with aneurysms have an understanding of how critical and life threatening a rupture could be to them. As nurses is it our job to educate them about signs and symptoms of different aneurysms, risk factors, and even treatment options and lifestyle changes that should be considered.
Deep Vein Thrombosis
Multiple vascular disorders exist in today’s century but I will only be focusing on Deep Vein Thrombosis and Thrombophlebitis. According to the Mayo Clinic, “ Deep vein thrombosis (DVT) occurs when a blood clot (thrombus) forms in one or more of the deep veins in your body, usually in your legs. Deep vein thrombosis can cause leg pain or swelling, but also can occur with no symptoms” (Mayo Clinic). DVT’s are very dangerous and can be life threatening. Risk factors that are associated with DVT’s are as follows: “smoking, obesity, pregnancy, orthopedic surgery or any surgery that requires limited ambulation, sedentary lifestyle, oral contraceptives, inherited blood disorders, family history of DVT’s, and prolonged periods of immobility” (Mayo Clinic). Patients who are symptomatic usually present with the affected lower extremities to be swollen, red with warmth, pain, some skin discoloration may be present, rarely will there be bilateral swelling of lower extremities but it is possible. In order to diagnose a DVT, Mayo Clinic recommends, ‘’ a Assessment by the doctor, Ultrasound ,Blood Tests (d-dimer) , MRI or CT Scan , or a Venography” (Mayo Clinic).
As nurses we are taught that patients will usually report pain in the lower extremity with warmth and sometimes may be dorsiflexing their lower extremity. Nurses should immediately assess the patient and stabilize the patients affected leg to prevent dislodgement of the clot, which can lead to severe life threatening complications. The CDC has found that, “-The precise number of people affected by DVT/PE is unknown, although as many as 900,000 people could be affected (1 to 2 per 1,000) each year in the United States. Estimates suggest that 60,000-100,000 Americans die of DVT/PE (also called venous thromboembolism), 10 to 30% of people will die within one month of diagnosis. Sudden death is the first symptom in about one-quarter (25%) of people who have a PE” (CDC) .
Pulmonary Embolism and Post-Phlebitic Syndrome
Two major complications are Pulmonary Embolism and Post-Phlebitic Syndrome. A Pulmonary Embolism is when the clot dislodges itself from its place of origin and travels to the lung causing sudden SOB, pain while taking deep breaths that only gets worse, a rapid pulse, lightheaded, and possible hemoptysis. This is a life threatening complication that requires immediate intervention by medical professionals. The second major complication is known as Post-Phlebitic Syndrome, Mayo Clinics describes its pathophysiology as, “Damage to your veins from the blood clot reduces blood flow in the affected areas” (Mayo Clinic) The signs and symptoms of this complication include, “persistent swelling of the affected leg or legs, leg pain, skin discolorations and skin sores” (Mayo Clinic). The treatment required for DVTs often requires medications like anticoagulants like heparin, clot buster like streptokinase or TPA, filters that are surgically placed in case a patient cannot take any of the above medications, compression stockings to increase circulation and prevent thrombosis. There are a variety of methods to prevent DVT’s, nurses can encourage a change in their dietary habits, exercising more, stop smoking, early ambulation if indicated after surgery, and taking medications as directed by the physician.
Thrombophlebitis
Thrombophlebitis correlates a lot with DVT’S in the sense of their signs and symptoms, treatment course (which may vary), risk factors, and complications. The Evidence-Based Medicine guidelines defines Thrombophlebitis as, “ common disease of the superficial veins that most commonly occurs in the lower extremities (especially in the great saphenous vein [vena saphena magna]) and often is connected with varicose veins. It can also occur elsewhere, e.g. on the neck (external jugular vein), on the chest (Mondor’s disease) or in the upper extremities. (EBM) The main difference between Thrombophlebitis and DVT according to the Evidence-Based Medicine guidelines, “As opposed to deep vein thrombosis (DVT), an inflammatory process of the venous wall is almost always present in addition to thrombosis. The prognosis of superficial thrombophlebitis is usually good (EBM). Signs and symptoms for Superficial Thrombophlebitis include, warmth and tenderness with pain around the affected area, possible redness and swelling of the affected leg. Risk factors include; obesity, smoking, prolonged immobility, varicose veins, surgery, inherited-blood disorders, trauma to veins (IV catheters), oral contraceptive use and old age (>60yrs). Major complications rarely occur with Superficial Thrombophlebitis but in case it transitions into a DVT then then patient is susceptible to acquire a Pulmonary Embolism or Post-phlebitic Syndrome. Diagnostic tools that are used are a ultrasound, blood tests specifically a d-dimer, and a assessment by the caring physician. Treatment for Superficial Thrombophlebitis as stated by the Mayo Clinic is, “ doctor might recommend applying heat to the painful area, elevating the affected leg, using an over-the-counter nonsteroidal anti-inflammatory drug (NSAID) and possibly wearing compression stockings. The condition usually improves on its own” (Mayo Clinic). If the condition does not resolve the more intense medications may be involved as commented by the Mayo Clinic, “anticoagulants, clot-busting medications, filters, or varicose vein stripping (ablation).