The varicose vein or Varicosity

The varicose vein or varicosity is an abnormally dilated, tortuous superficial vein caused by an incompetent venous valve.
varicose veins are permanently distended veins that develop from the loss of valvular competence faulty valves elevated venous pressure causing distention and tortuosity of superficial veins.

Introduction | Etiology or Risk factor | Clinical Manifestation | Diagnostic Evaluation | Management |

 

Introduction:-

  • The varicose vein or varicosity is an abnormally dilated, tortuous superficial vein caused by an incompetent venous valve.
  • varicose veins are permanently distended veins that develop from the loss of valvular competence faulty valves elevated venous pressure causing distention and tortuosity of superficial veins.
  • a varicose vein is divided into two types according to cause:-
  1. Primary
  2. Secondary

1. Primary varicose vein:-  vein after resting from congenital, genetic, or familial predisposition that leads to loss of elasticity of the veins valve.

2. Secondary varicose vein:- it occurs when trauma, obstruction deep vein thrombosis, or inflammation cause damage of valves.

Etiology and Risk factor of Varicose vein or Varicosity:-

  • Prolong standing
  • Genetic predisposing factor
  • A weakness of vein valves
  • Congenital deformities
  • Pregnancy

Clinical manifestation of Varicose vein or Varicosity:-

  • Dull-ache
  • weakness
  • moderate swelling
  • malaise
  • fever
  • nocturnal cramps
  • edema
  • Pigmentation
  • Ulceration
  • susceptibility to injection
  • The unsightly appearance of legs

Diagnostic evaluation of Varicose vein or Varicosity:-

  • Duplex scan:- to assess or find out anatomy of veins
  • Venous blood pressure
  • Venography

Management of Varicose vein or Varicosity:-

  1. General management:-

  • the patient is instructed to avoid activity that causes venous stasis such as wearing light shocks or constructive griddles crossing. the legs at the thigh or sitting or standing in a long period. Instruct the client for changing the position frequently, elevating the legs which feel tired & getting up to walk for several minutes of every hour to promote circulation.
  • the patient should be encouraged to walk 1-2 miles per day.
  • The elastic wrap needs to be wrapped twice daily so that the greatest pressure is at the ankle with lessor pressure gradually applied at the level of the knee.

2.  Surgical management:-

  • Sclerotherapy:- (using a fine therapy):-  Sclerotherapy is the injection of a sclerosis agent into a varicose vein. The agent damage the vein and endothelial causing to swell the blood to clot. the vein turns into sear tissue that many eventually fade from view. It is used for spider veins of varicose veins up to 15 millimeters in diameter and has been treated successfully.
  • Vein ligation and Stripping:-surgical management of varicose vein consists of ligation of a greater saphenous vein with its tributaries at the saphenofemoral junction. Combined with the removal of the saphenous vein (stripping) & ligation of incompetent performance vein. Removal of a vein is performed through multiple short incisions. An increase made at the ankle over the saphenous vein and a nylon wire is threaded up vein to the groin.
  • Saphenofemoral ligation:- some client requires only typing of the junction of the saphenous  & femoral vein at the groin. this involves one short incision often local anesthesia & no hospital stay.

Nursing management of Varicose vein or Varicosity:-

  • Maintain firm elastic pressure over the whole limb.
  • Promote regular movement &exercise of legs.
  • Elevate the foot to bed 6-9 inches so the legs are above the heart level which the client is in bed rest.
  • Instruct the client to walk rather than stand or sit.
  • Assess for any signs of complications such as infection, hemorrhage, nerve damage, etc.

Aneurysm: Causes, Symptoms, Diagnosis, and Treatment

The aneurysm is defined as a permanent localized dilation, stretching, and ballooning of an artery or blood vessels to around 50% increases in the size. The exact cause of aneurysm is unknown. Aneurysm is classified into 7 types according to location, Etiological factor, appearance, saccular, fusiform, dissecting, and false aneurysm.

Introduction | Risk Factor | Classification of Aneurysm | Pathophysiology | Clinical Manifestation | Diagnostic Evaluation | Complication Of Aneurysm | Management |

Aneurysm: Causes, Risk factor, Diagnosis and Treatment

Introduction:-

The aneurysm is defined as a permanent localized dilation, stretching, and ballooning of an artery or blood vessels to around 50% increases in the size.

Etiology of Aneurysm:-

The exact cause is unknown.

The risk factor of Aneurysm:-

  • Atherosclerosis.
  • a congenital defect is an arterial wall.
  • Genetically weakness of the wall.
  • Hypertension.
  • Trauma or injury.
  • Micro-tic infection.
  • Elevated cholesterol level.
  • Impaired nutrition.

Classification of Aneurysm:-

  1. According to the location:- They are described according to specific vessels in which they develop. Example: Aortic aneurysm, iliac aneurysm, thoracic aneurysm, lastly more preciously according to the area of vessels they affect.
  2. According to Etiological factor:- Aneurysm is classified according to cause such as atherosclerotic aneurysm, microtia, aneurysm, hypertension aneurysm, traumatic aneurysm.
  3. According to Appearance: Classification of the aneurysm is sometimes based on the shape and anatomic feature or size.
  4. Saccular Aneurysm:- Saccular aneurysm involves all three layers of the artery. An outpouching of an artery at the point where the media is thin.
  5. Fusiform Aneurysm:- Fusiform aneurysm involves the entire circumference of the vessels. It is a localized uniform dilation of an artery.
  6. Dissecting Aneurysm:- In dissecting aneurysm hematoma is present in the arterial wall that separates the layers of the arterial wall.
  7. False Aneurysm:- False aneurysm results from the development of a sac around a hematoma that maintain communication with the lumen of an artery where the wall has been ruptured or penetrated.

Pathophysiology of Aneurysm:-

Abdominal aortic aneurysm four types more often than the thoracic aneurysm. the Natural cause of an untreated aneurysm is to expand or rupture. The aorta is under greater stress than the rest of the arterial system because of its large diameter and its exposure to the high pressure during each systolic ejection of blood.

Clinical Manifestation of Aneurysm:-

  • Awareness of pulsation mask in the abdomen.
  • Abdominal pain and back pain.
  • Pain in lower abdomen, groin, and genitalia.
  • Decrease hemoglobin.
  • Sign of hemorrhage.
  • Shock.
  • Abdominal Distension.

Diagnostic Evaluation of Aneurysm:-

  • Physical Examination.
  • USG.
  • CT Scan.
  • Abdominal Aortography.

The complication of Aneurysm:-

  • Coronary artery disease.
  • Pulmonary obstructive disease.
  • Pre-renal failure.
  • Spinal cord ischemia.
  • Change in sexual function.
  • Severe bleeding.

Management of Aneurysm:-

  1. Surgical Management:- Surgery is usually not performed on clients with a less symptomatic abdominal aortic aneurysm smaller than 4-5 cm. Every six months a USG is indicated to determine whether any change in the size occurred.
  • Endovascular Procedure:- It is a newer method for lower emergency treatment to repair abdominal aneurysms. small incisions are made in the groin and avascular into the aorta. deflated balloon and tightly wrapped polyester cloth graft are placed, when properly position the graft is securely place by inflation the balloon and opening the graft of the diameter needed to prevent a blood clot in the aneurysm then the balloon is deflated and removed along with the catheter at each end of the graft hooks are present that help secures it to the inner walls of the aorta.
  • Aneurysm Repair:- Surgical repair is usually recommended for all aneurysm greater than 6 cm. find.

Rheumatic Heart Disease: Sign and Symptoms, Pathophysiology

Rheumatic Heart Disease usually affects the children and it is still the most common cause of acquired heart disease in childhood and adolescence. R.H.D. is usually affected by 5-15 years of the child. 1-2 case/lakh in developed countries. 100 case/ lakh in developing countries. 3% of people affected after the beta-hemolytic streptococci infection.

Incidence | Pathophysiology | Clinical Manifestation | Diagnostic Evaluation | Management |

Rheumatic Heart Disease

Rheumatic Heart Disease usually affects the children and it is still the most common cause of acquired heart disease in childhood and adolescence.

Incidence of Rheumatic Heart Disease:-

  • R.H.D. is usually affected by 5-15 years of the child.
  • 1-2 case/lakh in developed countries.
  • 100 case/ lakh in developing countries.
  • 3% of people affected after the beta-hemolytic streptococci infection.

Pathophysiology of Rheumatic Heart Disease:-

  • due to the etiological factor.
  • persistent infection of through streptococci.
  • The antigen of beta-hemolytic streptococci reacts.
  • cross-react with myosin and sarcolemma membrane.
  • bind the receptor on the heart.
  • The inflammatory response in the cardiac muscle.
  • severe & permanent heart damage.

Clinical Manifestation of Rheumatic Heart Disease:-

  • carditis
  • cardiomegaly
  • murmur
  • pericarditis
  • chest pain
  • AV defect
  • Arterial fibrillation
  • fever
  • dysrhythmia
  • Pneumonia signs
  • Involuntary movement or speech after 3 months of disease.

Diagnostic Evaluation of Rheumatic Heart Disease:-

  • blood test
  • throat swab
  • chest x-ray
  • ECG
  • 2D echo

Management of Rheumatic Heart Disease:-

Medical management:-

  • Anti-biotics
  • Aspirin
  • Corticosteroid
  • Bed rest & Supporting therapy

Nursing Management:-

  • Chronic pain related to an inflammatory response.
  • Activity intolerance related to reducing cardiac pressure and enforced bed-rest.
  • Imbalanced nutrition less the body requirement related to severe inflammation & fatigue.
  • The risk for ineffective therapeutic regimen management related to the need for life long therapy.

Related Post:-

Myocardial Infarction

Coronary Heart Disease

Angina Pectoris

Raynaud’s Disease

Myocardial Infarction (Heart Attack): Causes, Sign, and Symptoms

M.I. is defined as Damage or Death of myocardial muscle due to Abrupt blood flow to the Heart. the blockage may be caused by the formation of thrombus in the coronary artery, a sudden progression of atherosclerosis, prolong narrowing of arteries….

Define | Etiology | Risk Factor | Pathophysiology | Sign and Symptoms | Diagnostic Evaluation | Early Management | Late Management | Nursing Management |

Myocardial Infarction or Heart Attack

*What is the definition of myocardial infarction?

Define:-

M.I. is defined as Damage or Death of myocardial muscle due to Abrupt blood flow to the Heart. the blockage may be caused by the formation of thrombus in the coronary artery, a sudden progression of atherosclerosis, prolong narrowing of arteries.

*What is the Etiology of myocardial infarction?

Etiology:-

  • atherosclerosis
  • arteries prolong narrowing
  • thrombus
  • Agonist

*What are the risk factors of myocardial infarction?

Risk factors:-

  • genetic cardiac disorder
  • smoking
  • alcohol consumption
  • diet – like high cholesterol, high fat
  • activity – low physical exercise

*Explain the pathophysiology or what is the pathophysiology of myocardial infarction?

Pathophysiology:-

  • due to etiological factor
  • myocardial ischemia
  • decrease myocardial oxygen supply
  • increase cellular hypoxia
  • decrease myocardial contractility
  • decrease arterial pressure
  • stimulation of baroreceptor and chemo-receptor sympathetic response
  • increase myocardial contractility
  • increase heart rate
  • increase myocardial oxygen demand further myocardial ischemia
  • necrosis of myocardial cells
  • myocardial infarction or Heart Attack

*what are the clinical manifestation of myocardial infarction?

Clinical Manifestation:-

  • severe chest pain(more than angina pectoris )
  • pain may radiant to the chest, shoulder, neck, jaw, back
  • nausea
  • unexplained anxiety
  • dizziness
  • dyspnoea
  • sweating

*Write the diagnostic evaluation of myocardial infarction?

Diagnostic Evaluation:-

ECG (elevated S & T segment)

laboratory test: serum creatinine kinase, myoglobin, cardiac troponin, ESR, (all level is increased)

*Write the complete management of myocardial infarction?

Early management:-

  • morphine sulfate
  • Anti-hematic: Domperidone, Alizapride
  • Acute de perfusion therapy
  • Primary percutaneous coronary intervention
  • Maintaining vessel potassium
  • Adjunctive therapy

late management:-

  • lifestyle modification: Diet control, stop smoking, regular exercise
  • Secondary prevention: Anti-platelets, beta-blocker

Nursing management:-

The probable nursing diagnosis will be :

  • pain related to an imbalance in oxygen supply and demand.
  • Anxiety-related to chest pain, fear of death, threatening environment.
  • Decrease cardiac output related to impaired contractility.
  • Activity intolerance related to insufficient oxygenation to perform ADL and deconditioning effect of bed-rest.
  • The risk for injury related to the dissolution of the protective clot.

Related Post:-

Coronary Heart Disease

Angina Pectoris

Raynaud’s Disease

Coronary Heart Disease: Causes, Symptoms, Diagnosis, Treatment

In coronary heart, disease atherosclerosis develops in coronary arteries causing them to become narrow and block this leads to decrease or stop the blood supply to the heart muscles. CHD has modifiable and non-modifiable factors. CHD is also known as coronary artery disease.

Etiology | Pathophysiology | Types of CHD | CLinical Manifestation | Complication | Diagnostic Evaluation | Management|

Coronary Heart Disease-Coronary Artery Disease

In coronary heart, disease atherosclerosis develops in coronary arteries causing them to become narrow and block this leads to decrease or stop the blood supply to the heart muscles.

Etiology of coronary heart disease:-

  1. Non-modifiable:-

  • Genetic Heredity:- Children whose parents had heart disease are at a higher risk of C.H.D.
  • Race:- The African & American have 45% greater chances of developing CHD.
  • Age:- with increasing age risk & severity of CHD are increases.
  • Gender:- males of younger age and females after menopause is at high risk of CHD.

2. Modifiable factor:-

  • Elevated serum lipid level
  • A habitual diet high in fat and cholesterol
  • Obesity
  • Cigarette smoking
  • Heavy alcohol consumption
  • Personality types
  • Sedatory live
  • Psychological stream
  • Improper lifestyle

Pathophysiology of coronary artery disease:-

  • Due to the etiological factor
  • Localized accumulation of lipid, fibrous tissue, or thrombus
  • Arterial narrowing or occlusion
  • vascular changes occur that affect the functional ability or coronary arterial
  • The deficit in myocardial oxygen supply
  • Angina pectoris M.I. / cardiac arrest
  • Death

Types of coronary artery disease:-

  • Type 1 st:- fatty, streaks lipid deposit in the int em of the arterial wall.
  • Type 2 nd:- Inflammatory response takes macrophage to ingest lipid.
  • Type 3rd:- Smooth muscle cell proliferate and form a fibrous cap are the deal fatty cell.
  • Type 4th:- Fibrotic layer and plaque formation.
  • Type 5th:- Distributed internal structure along with moderate disease that causes a decrease in the size of the lumen.
  • Type 6th:- Rupture of plaque producing cavity thrombus with partial occlusion of the lumen.

Clinical Manifestation of coronary artery disease:-

  • Dysrhythmia
  • Restlessness
  • Fatigue
  • Malaise

Complication:-

  • Heart Failure
  • Heart block
  • Angina Pectoris

Diagnostic Evaluation of coronary artery disease:-

  • ECG
  • 2D Echo
  • Angiography
  • Blood Investigation
  • LFT

Management of coronary artery disease:-

  1. Reduce Risk Factor:-

  • Primary and secondary prevention causes are used for all major risk factors.
  • Health professionals provide guidance & counseling related to disease conditions.
  • The health professional team motivates the client to stop smoking and alcohol consumption.
  • maintain ideal body weight through the physical exercise
  • Dietary modification according to disease condition & according to dietitian prescription.
  • Encourage the client to perform physical activity and participate in the exercise.
  • Behavioral therapy or diversional therapy to reduce stress.

2. Restore blood supply:-

  • PTCA
  • PCA
  • Intra coronary stent
  • laser ablation

3. Pharmacological management:-

  • Analgesics to relieve pain
  • Vasoldilatiors
  • ACE inhibitors

Angina Pectoris: Symptoms, Causes, Diagnosis, Evaluation

Angina pectoris occurs when myocardial demands exceed, myocardial oxygen supply decreased usually caused by obstruction of the coronary artery.chest pain due to an inadequate supply of oxygen to the heart muscle is characterized by a feeling of suffocation.

Etiology  | Risk factor  | Clinical Manifestation | Pattern of Angina | Diagnostic Evaluation | Management | Nursing management |

 

Angina Pectoris – Chest Pain – Risk factor, Clinical Manifestation

Introduction:-

  • Angina pectoris occurs when myocardial demands exceed, myocardial oxygen supply decreased usually caused by obstruction of the coronary artery.
  • chest pain due to an inadequate supply of oxygen to the heart muscle is characterized by a feeling of suffocation.

Etiology of Angina Pectoris:-

  • atherosclerosis
  • prolong narrowing

The Risk factor of Angina Pectoris:-

  • Thromboangiitis obliterans (inflammation of a small and medium vein and thrombosis of extremities.
  • Polycythemia Vera (thickness of blood)
  • Polyarteritis nodosa (inflammation of artery due to infiltration of eosinophils.)

{Note: Angina can be triggered by exercise, cold, or anything that increases the workload of heart}

Clinical manifestation of Angina Pectoris:-

  • Pain:-  location: 90% of the clients experience pain slightly left to the sternum.

duration:- Angina usually lasts for 10 min. however, attacks precipitate by emotional disturbance last for 15-20 min.

Severity: the pain is described as mild or moderate or often called as Discomfort.

  • Dyspnea, weakness, light headache, nausea, vomiting, emptiness, restlessness.

The pattern of Angina Pectoris:-

  1. Stable Angina:-It is an acute chest pain triggered by exercise or emotion.
  2. Unstable Angina:- It is also acute pain but unpredictable degree or cause.
  3. Variant Angina:- It is also called Prinzmetal’s angina and it is for a longer duration.
  4. Nocturnal angina:- It is possibly associated with rapid eye movement during sleeping or dreaming.
  5. Angina Decubitus:It is proximal chest pain that occurs when the client stands up.
  6. Post-Infarction Angina:-pain occurs after a heart attack.

Diagnostic Evaluation of Angina Pectoris:-

  • ECG
  • Coronary Angiography
  • Blood test
  • Echocardiogram
  • Electron beam computed domography [EBCD]

Management of Angina Pectoris:-

  • The objective of the medical management in angina is to decrease the oxygen demand of the myocardial and to increase the oxygen supply.
  • Medically these objectives are met through pharmacological therapy and control of risk factors. Medical management focus on these three points:-
  1. Relieve acute pain.
  2. Risk of coronary blood flow.
  3. Prevent further attack to reduce the risk of myocardial infarction.

A: Aspirin and antianginal therapy

B: beta-blocker and blood pressure control

C: cigarette smoking and cholesterol control

D: Dietary modification

E: Education and exercise.

  • Restore blood supply
  • PTCA
  • Intracoronary strain
  • Laser ablation
  • CABG (coronary artery bypass grafting)

Nursing management of Angina Pectoris:-

Nursing Diagnosis:-

  • Acute chest pain related to decreasing blood supply to the heart resulting from coronary artery obstruction,
  • Ineffective tissue perfusion related to decreased cardiac output as evidence by cyanosis, decrease arterial oxygen, and dyspnea.
  • Risk of heart failure related to the disease process.
  • Anxiety and fear are related to hospital admission, fear of death, fear of treatment procedure, and disease process.
  • Risk of impaired skin integrity related to bed rest, edema, and decrease tissue perfusion.