The Cardiovascular System

1
The Cardiovascular System

• NRS 108-ECC
• Majuvy L. Sulse RN, MSN, CCRN
• Lola Oyedele RN, MSN, CTN

2
SITES FOR PALPATING PERIPHERAL PULSES
From Monahan, F. Neighbors, M. (1998).
Medical-surgical nursing Foundations for
clinical practice, ed 2, Philadelphia W.B.
Saunders
3
VEINS IN THE LEG
From Jarvis, C. (2000). Physical examination and
health assessment, ed 3, Philadelphia W.B.
Saunders
4
VENOUS THROMBOSIS

• DESCRIPTION
• Thrombus can be associated with an inflammatory
  process
• When a thrombus develops, inflammation occurs
  that thickens the vein wall leading to
  embolization

5
TYPES OF VENOUS THROMBOSIS

• THROMBOPHLEBITIS
• A thrombus associated with inflammation
• PHLEBOTHROMBUS
• A thrombus without inflammation
• PHLEBITIS
• Vein inflammation associated with invasive
  procedures such as IVs
• DEEP VEIN THROMBOPHLEBITIS (DVT)
• More serious than a superficial thrombophlebitis
  because of the risk for pulmonary embolism

6
RISKS FACTORS FOR VENOUS THROMBOSIS

• Venous stasis from varicose veins, heart failure,
  immobility
• Hypercoagulability disorders
• Injury to the venous wall from IV injections,
  fractures, trauma
• Following surgery, particularly hip surgery and
  open prostate surgery
• Pregnancy
• Ulcerative colitis
• Use of oral contraceptives

7
PHLEBITIS

• ASSESSMENT
• Red, warm area radiating up an extremity
• Pain and soreness
• Swelling
• IMPLEMENTATION
• Apply warm, moist soaks as prescribed to dilate
  the vein and promote circulation
• Assess temperature of soak prior to applying
• Assess for signs of complications such as tissue
  necrosis, infection, or pulmonary embolus

8
DEEP VEIN THROMBOPHLEBITIS (DVT)

• ASSESSMENT
• Calf or groin tenderness or pain with or without
  swelling
• Positive Homans sign
• Warm skin that is tender to touch

9
DEEP VEIN THROMBOPHLEBITIS (DVT)

• IMPLEMENTATION
• Provide bed rest
• Elevate the affected extremity above the level of
  the heart as prescribed
• Avoid using the knee gatch or a pillow under the
  knees
• Do not massage the extremity
• Provide thigh-high compression or antiembolism
  stockings as prescribed to reduce venous stasis
  and to assist in the venous return of blood to
  the heart

10
DEEP VEIN THROMBOPHLEBITIS (DVT)

• IMPLEMENTATION
• Administer intermittent or continuous warm, moist
  compresses as prescribed
• Palpate the site gently, monitoring for warmth
  and edema
• Measure and record the circumference of the
  thighs and calves
• Monitor for shortness of breath and chest pain,
  which can indicate pulmonary emboli

11
DEEP VEIN THROMBOPHLEBITIS (DVT)

• IMPLEMENTATION
• Administer thrombolytic therapy (t-PA, tissue
  plasminogen activator) if prescribed, which must
  be initiated within 5 days after the onset of
  symptoms
• Administer heparin therapy as prescribed to
  prevent enlargement of the existing clot and
  prevent the formation of new clots
• Monitor APTT during heparin therapy
• Administer warfarin (Coumadin) therapy as
  prescribed when the symptoms of DVT have resolved

12
DEEP VEIN THROMBOPHLEBITIS (DVT)

• IMPLEMENTATION
• Monitor PT and INR during warfarin (Coumadin)
  therapy
• Monitor for the hazards and side effects
  associated with anticoagulant therapy
• Administer analgesics as prescribed to reduce
  pain
• Administer diuretics as prescribed to reduce
  lower extremity edema
• Provide client teaching

13
ASSESSING FOR PERIPHERAL EDEMA
From Black, J., Hawks, J, and Keene, A. (2001).
Medical-surgical nursing, ed 6, Philadelphia
W.B. Saunders
14
DEEP VEIN THROMBOPHLEBITIS (DVT)

• CLIENT EDUCATION
• Hazards of anticoagulation therapy
• Signs and symptoms of bleeding
• Avoid prolonged sitting or standing, constrictive
  clothing, or crossing legs when seated
• Elevate the legs for 10 to 20 minutes every few
  hours each day
• Plan a progressive walking program

15
DEEP VEIN THROMBOPHLEBITIS (DVT)

• CLIENT EDUCATION
• Inspect the legs for edema and how to measure the
  circumference of the legs
• Antiembolism stockings (hose) as prescribed
• Avoid smoking
• Avoid any medications unless prescribed by the
  physician
• Importance of follow-up physician visits and
  laboratory studies
• Obtain and wear a Medic Alert bracelet

16
ANTIEMBOLISM HOSE
From Elkin MF, Perry AG, Potter PA Nursing
interventions and clinical skills, ed. 2, St.
Louis, 2000, Mosby.
17
VENOUS INSUFFICIENCY

• DESCRIPTION
• Results from prolonged venous hypertension that
  stretches the veins and damages the valves
• The resultant edema and venous stasis causes
  venous stasis ulcers, swelling, and cellulitis
• Treatment focuses on decreasing edema and
  promoting venous return from the affected
  extremity
• Treatment for venous stasis ulcers focuses on
  healing the ulcer and preventing stasis and ulcer
  recurrence

18
VENOUS INSUFFICIENCY

• ASSESSMENT
• Stasis dermatitis or discoloration along the
  ankles extending up to the calf
• Edema
• The presence of ulcer formation

19
PERIPHERAL VASCULAR DISEASE
From Bryant RA (1992) Acute and chronic wounds
nursing management, St. Louis Mosby. Courtesy of
Abbott Northwestern Hospital, Minneapolis, MN.
20
VENOUS INSUFFICIENCY

• WOUND CARE
• Provide care to the wound as prescribed by the
  physician
• Assess the clients ability to care for the
  wound, and initiate home care resources as
  necessary
• If an Unna boot (a dressing constructed of gauze
  moistened with zinc oxide) is prescribed, it will
  be changed by the physician weekly

21
VENOUS INSUFFICIENCY

• WOUND CARE
• The wound is cleansed with normal saline prior to
  application of the Unna boot providone-iodine
  (Betadine) or hydrogen peroxide is not used
  because they destroy granulation tissue
• The Unna boot is covered with an elastic wrap
  that hardens, to promote venous return and
  prevent stasis
• Monitor for signs of arterial occlusion from an
  Unna boot that may be too tight
• Keep tape off of the clients skin

22
VENOUS INSUFFICIENCY

• MEDICATIONS
• Apply topical agents to wound as prescribed to
  debride the ulcer, eliminate necrotic tissue, and
  promote healing
• When applying topical agents, apply an oil-based
  agent as petroleum jelly (Vaseline) on
  surrounding skin, because debriding agents can
  injure healthy tissue
• Administer antibiotics as prescribed if infection
  or cellulitis occur

23
VENOUS INSUFFICIENCY

• CLIENT EDUCATION
• Wear elastic or compression stockings during the
  day and evening as prescribed
• Put on elastic stockings upon awakening before
  getting out of bed
• Put a clean pair of elastic stockings on each day
  and that it will probably be necessary to wear
  the stockings for the remainder of life

24
VENOUS INSUFFICIENCY

• CLIENT EDUCATION
• Avoid prolonged sitting or standing, constrictive
  clothing, or crossing legs when seated
• Elevate the legs for 10 to 20 minutes every few
  hours each day
• Elevate legs above the level of the heart when in
  bed

25
VENOUS INSUFFICIENCY

• CLIENT EDUCATION
• The use of an intermittent sequential pneumatic
  compression system, if prescribed instruct the
  client to apply the compression system twice
  daily for 1 hour in the morning and evening
• Advise the client with an open ulcer that the
  compression system is applied over a dressing

26
VARICOSE VEINS

• DESCRIPTION
• Distended protruding veins that appear darkened
  and tortuous
• Vein walls weaken and dilate, and valves become
  incompetent
• ASSESSMENT
• Pain in the legs with dull aching after standing
• A feeling of fullness in the legs
• Ankle edema

27
NORMAL VEINS AND VARICOSITIES
From Monahan, F. Neighbors, M. (1998).
Medical-surgical nursing Foundations for
clinical practice, ed 2, Philadelphia W.B.
Saunders
28
VARICOSE VEINS
From Mosbys Medical, Nursing, and Allied Health
Dictionary, ed 6, (2002). St. Louis Mosby
29
VARICOSE VEINS

• TRENDELENBURG TEST
• Place the client in a supine position with the
  legs elevated
• When the client sits up, if varicosities are
  present, veins fill from the proximal end veins
  normally fill from the distal end

30
TRENDELENBURG TEST
From Jarvis, C. (2000). Physical examination and
health assessment, ed 3, Philadelphia W.B.
Saunders
31
VARICOSE VEINS

• IMPLEMENTATION
• Assist with the Trendelenburg test
• Emphasize the importance of antiembolism
  stockings as prescribed
• Instruct the client to elevate the legs as much
  as possible
• Instruct the client to avoid constrictive
  clothing and pressure on the legs
• Prepare the client for sclerotherapy or vein
  stripping, as prescribed

32
SCLEROTHERAPY

• DESCRIPTION
• A solution is injected into the vein followed by
  the application of a pressure dressing
• An incision and drainage of the trapped blood in
  the sclerosed vein is performed 14 to 21 days
  after the injection, followed by the application
  of a pressure dressing for 12 to 18 hours

33
VEIN STRIPPING

• DESCRIPTION
• Varicose veins are removed if they are larger
  than 4 mm in diameter or if they are in clusters
• PREOPERATIVE
• Assist the physician with vein marking
• Evaluate pulses as a baseline for comparison
  postoperatively

34
VEIN STRIPPING

• POSTOPERATIVE
• Maintain elastic (Ace) bandages on the clients
  legs
• Monitor the groin and leg for bleeding through
  the elastic bandages
• Monitor the extremity for edema, warmth, color,
  and pulses
• Elevate the legs above the level of the heart

35
VEIN STRIPPING

• POSTOPERATIVE
• Encourage range-of-motion exercises of the legs
• Instruct the client to avoid leg dangling or
  chair sitting
• Instruct the client to elevate the legs when
  sitting
• Emphasize the importance of wearing elastic
  stockings after bandage removal

36
PERIPHERAL ARTERIAL DISEASE (PAD)

• DESCRIPTION
• A chronic disorder in which partial or total
  arterial occlusion deprives the lower extremities
  of oxygen and nutrients
• Tissue damage occurs below the level of the
  arterial occlusion
• Atherosclerosis is the most common cause of PAD

37
ARTERIES IN THE LEG
From Jarvis, C. (2000). Physical examination and
health assessment, ed 3, Philadelphia W.B.
Saunders
38
PERIPHERAL ARTERIAL DISEASE (PAD)

• ASSESSMENT
• Intermittent claudication (pain in the muscles
  resulting from an inadequate blood supply)
• Rest pain, characterized by numbness, burning or
  aching in the distal portion of the lower
  extremities, that awakens the client at night and
  is relieved by placing the extremity in a
  dependent position
• Lower back or buttock discomfort

39
PERIPHERAL ARTERIAL DISEASE (PAD)

• ASSESSMENT
• Loss of hair and dry scaly skin on the lower
  extremities
• Thickened toenails
• Cold and gray-blue color of skin in the lower
  extremities
• Elevational pallor and dependent rubor in the
  lower extremities
• Decreased or absent peripheral pulses

40
PERIPHERAL ARTERIAL DISEASE (PAD)

• ASSESSMENT
• Signs of arterial ulcer formation occurring on or
  between the toes, or on the upper aspect of the
  foot, that are characterized as painful
• Blood pressure measurements at the thigh, calf,
  and ankle are lower than the brachial pressure
  (normally BP readings in the thigh and calf are
  higher than those in the upper extremities)

41
ARTERIAL OBSTRUCTIONS AND CORRESPONDING AREAS OF
CLAUDICATION
From Monahan, F. Neighbors, M. (1998).
Medical-surgical nursing Foundations for
clinical practice, ed 2, Philadelphia W.B.
Saunders
42
ARTERIAL INSUFFICIENCY
From Lemmi FO, Lemmi CAE Physical assessment
findings CD-ROM, Philadelphia, 2000, W.B.
Saunders.
43
GANGRENE
From Auerbach PS Wilderness Medicine Management
of wilderness and environmental emergencies, ed.
3, St. Louis, 1995, Mosby.
44
PERIPHERAL ARTERIAL DISEASE (PAD)

• IMPLEMENTATION
• Assess pain
• Monitor the extremities for color, motion and
  sensation, and pulses
• Obtain BP measurements
• Assess for signs of ulcer formation or signs of
  gangrene
• Assist in developing an individualized exercise
  program that is initiated gradually and slowly
  increased

45
PERIPHERAL ARTERIAL DISEASE (PAD)

• IMPLEMENTATION
• Encourage prescribed exercise, which will improve
  arterial flow through the development of
  collateral circulation
• Instruct the client to walk to the point of
  claudication, stop and rest, then walk a little
  further

46
PERIPHERAL ARTERIAL DISEASE (PAD)

• IMPLEMENTATION
• As swelling in the extremities prevents arterial
  blood flow, instruct the client to elevate his or
  her feet at rest, but to refrain from elevating
  them above the level of the heart, because
  extreme elevation slows arterial blood flow to
  the feet
• In severe cases of PAD, clients with edema may
  sleep with the affected limb hanging from the bed
  or they may sit upright in a chair for comfort

47
PERIPHERAL ARTERIAL DISEASE (PAD)

• CLIENT EDUCATION
• Avoid crossing the legs, which interferes with
  blood flow
• Avoid exposure to cold (causes vasoconstriction)
  to the extremities and to wear socks or insulated
  shoes for warmth at all times
• Never to apply direct heat to the limb such as
  with a heating pad or hot water, because the
  decreased sensitivity in the limb may result in
  burning

48
PERIPHERAL ARTERIAL DISEASE (PAD)

• CLIENT EDUCATION
• Inspect the skin on the extremities daily and to
  report any signs of skin breakdown
• Avoid tobacco and caffeine because of their
  vasoconstrictive effects
• Use of hemorrheologic and antiplatelet
  medications as prescribed
• Importance of taking all medications prescribed
  by the physician

49
PERIPHERAL ARTERIAL DISEASE (PAD)

• PROCEDURES TO IMPROVE ARTERIAL BLOOD FLOW
• Percutaneous transluminal angioplasty
• Laser-assisted angioplasty
• Atherectomy
• Bypass surgery (aortofemoral or
  femoral-popliteal)

50
RAYNAUDS DISEASE

• DESCRIPTION
• Vasospasms of the arterioles and arteries of the
  upper and lower extremities
• Vasospasm causes constriction of the cutaneous
  vessels
• Attacks are intermittent and occur with exposure
  to cold or stress
• Affects primarily fingers, toes, ears, and cheeks

51
RAYNAUDS DISEASE

• ASSESSMENT
• Blanching of the extremity, followed by cyanosis
  during vasoconstriction
• Reddened tissue when the vasospasm is relieved
• Numbness, tingling, swelling, and a cold
  temperature at the affected body part

52
RAYNAUDS PHENOMENON
From Barkauskas VH et al (1998) Health and
physical assessment (2nd ed.). St. Louis Mosby.
53
RAYNAUDS DISEASE

• IMPLEMENTATION
• Monitor pulses
• Administer vasodilators as prescribed
• Assist the client to identify and avoid
  precipitating factors such as cold and stress
• CLIENT EDUCATION
• Medication therapy
• Avoid smoking
• Wear warm clothing, socks, and gloves in cold
  weather
• Avoid injuries to fingers and hands

54
BUERGER'S DISEASE

• DESCRIPTION
• An occlusive disease of the median and small
  arteries and veins
• The distal upper and lower limbs are most
  commonly affected
• Also known as thromboangiitis obliterans

55
BUERGER'S DISEASE

• ASSESSMENT
• Intermittent claudication
• Ischemic pain occurring in the digits while at
  rest
• Aching pain that is more severe at night
• Cool, numb, or tingling sensation
• Diminished pulses in the distal extremities
• Extremities are cool and red in the dependent
  position
• Development of ulcerations in the extremities

56
BUERGER'S DISEASE

• IMPLEMENTATION
• Instruct the client to stop smoking
• Monitor pulses
• Instruct the client to avoid injury to the upper
  and lower extremities
• Administer vasodilators as prescribed
• Instruct the client regarding medication therapy

57
AORTIC ANEURYSMS

• DESCRIPTION
• Abnormal dilation of the arterial wall, caused by
  localized weakness and stretching in the medial
  layer or wall of an artery
• The aneurysm can be located anywhere along the
  abdominal aorta
• The goal of treatment is to limit the progression
  of the disease by modifying risk factors,
  controlling the BP to prevent strain on the
  aneurysm, recognizing symptoms early, and
  preventing rupture

58
ARTERIAL OCCLUSION AND ANEURYSMS
From Monahan, F. Neighbors, M. (1998).
Medical-surgical nursing Foundations for
clinical practice, ed 2, Philadelphia W.B.
Saunders
59
TYPES OF ANEURYSMS

• FUSIFORM
• Diffuse dilation that involves the entire
  circumference of the arterial segment
• SACCULAR
• Distinct localized outpouching of the artery wall

60
TYPES OF ANEURYSMS

• DISSECTING
• Created when blood separates the layers of the
  artery wall forming a cavity between them
• FALSE (PSEUDOANEURYSM)
• Occurs when the clot and connective tissue are
  outside the arterial wall
• Formed after complete rupture and subsequent
  formation of a scar sac

61
TYPES OF ANEURYSMS
From Monahan, F. Neighbors, M. (1998).
Medical-surgical nursing Foundations for
clinical practice, ed 2, Philadelphia W.B.
Saunders
62
THORACIC AORTIC ANEURYSM

• ASSESSMENT
• Pain extending to neck, shoulders, lower back, or
  abdomen
• Syncope
• Dyspnea
• Increased pulse
• Cyanosis
• Weakness

63
ABDOMINAL AORTIC ANEURYSM

• ASSESSMENT
• Prominent, pulsating mass in abdomen, at or above
  the umbilicus
• Systolic bruit over the aorta
• Tenderness on deep palpation
• Abdominal or lower back pain

64
RUPTURING ANEURYSM

• ASSESSMENT
• Severe abdominal or back pain
• Lumbar pain radiating to the flank and groin
• Hypotension
• Increased pulse rate
• Signs of shock

65
RUPTURED ABDOMINAL AORTIC ANEURYSM
From Cotran RS, Kumar V, Collins T Robbins
pathologic basis of disease, ed. 6, Philadelphia,
1999, W.B. Saunders.
66
AORTIC ANEURYSMS

• DIAGNOSTIC TESTS
• Done to confirm the presence, size, and location
  of the aneurysm
• Includes abdominal ultrasound, CT scan, and
  arteriography

67
AORTIC ANEURYSMS

• IMPLEMENTATION
• Monitor vital signs
• Obtain information regarding back or abdominal
  pain
• Question the client regarding the sensation of
  palpation in the abdomen
• Inspect the skin for the presence of vascular
  disease or breakdown

68
AORTIC ANEURYSMS

• IMPLEMENTATION
• Check peripheral circulation including pulses,
  temperature, and color
• Observe for signs of rupture
• Note any tenderness over the abdomen
• Monitor for abdominal distention

69
AORTIC ANEURYSMS

• NONSURGICAL IMPLEMENTATION
• Modify risk factors
• Instruct the client regarding the procedure for
  monitoring BP
• Instruct the client on the importance of regular
  physician visits to follow the size of the
  aneurysm

70
AORTIC ANEURYSMS

• NONSURGICAL IMPLEMENTATION
• Instruct the client that if severe back or
  abdominal pain or fullness, soreness over the
  umbilicus, sudden development of discoloration in
  the extremities, or a persistent elevation of BP
  occurs, to notify the physician immediately
• Instruct the client with a thoracic aneurysm to
  immediately report the occurrence of chest or
  back pain, shortness of breath, difficulty
  swallowing, or hoarseness

71
AORTIC ANEURYSMS

• PHARMACOLOGICAL IMPLEMENTATION
• Administer antihypertensives to maintain the BP
  within normal limits and to prevent strain on the
  aneurysm
• Instruct the client in the purpose of the
  medications
• Instruct the client about the side effects and
  schedule of the medication

72
ABDOMINAL AORTIC ANEURYSM RESECTION

• DESCRIPTION
• Surgical resection or excision of the aneurysm
• The excised section is replaced with a graft that
  is sewn end-to-end

73
ANEURYSM RESECTION WITH GRAFT
From Monahan, F. Neighbors, M. (1998).
Medical-surgical nursing Foundations for
clinical practice, ed 2, Philadelphia W.B.
Saunders
74
ABDOMINAL AORTIC ANEURYSM RESECTION

• PREOPERATIVE
• Assess all peripheral pulses as a baseline for
  postoperative comparison
• Instruct the client on coughing and
  deep-breathing exercises
• Administer bowel preparation as prescribed

75
ABDOMINAL AORTIC ANEURYSM RESECTION

• POSTOPERATIVE
• Monitor vital signs
• Monitor peripheral pulses distal to the graft
  site
• Monitor for signs of graft occlusion, including
  changes in pulses, cool to cold extremities below
  the graft, white or blue extremities or flanks,
  severe pain, or abdominal distention
• Limit elevation of the head of the bed to 45
  degrees to prevent flexion of the graft

76
ABDOMINAL AORTIC ANEURYSM RESECTION

• POSTOPERATIVE
• Monitor for hypovolemia and renal failure due to
  significant blood loss during surgery
• Monitor urine output hourly, and notify the
  physician if it is less than 50 ml per hour
• Monitor serum creatinine and BUN daily
• Monitor respiratory status and auscultate breath
  sounds to identify respiratory complications

77
ABDOMINAL AORTIC ANEURYSM RESECTION

• POSTOPERATIVE
• Encourage turning, coughing and deep breathing,
  and splinting the incision ambulate as
  prescribed
• Maintain nasogastric tube to low suction until
  bowel sounds return
• Assess for bowel sounds and report their return
  to the physician
• Monitor for pain and administer medication as
  prescribed
• Assess incision site for bleeding or signs of
  infection

78
ABDOMINAL AORTIC ANEURYSM RESECTION

• POSTOPERATIVE
• Prepare the client for discharge by providing
  instructions regarding pain management, wound
  care, and activity restrictions
• Instruct the client not to lift objects greater
  than 15 to 20 pounds for 6 to 12 weeks
• Advise the client to avoid activities requiring
  pushing, pulling, or straining
• Instruct the client not to drive a vehicle until
  approved by the physician

79
THORACIC AORTIC ANEURYSM REPAIR

• DESCRIPTION
• A thoracotomy or median sternotomy approach is
  used to enter the thoracic cavity
• The aneurysm is exposed, excised, and a graft or
  prosthesis is sewn onto the aorta
• Total cardiopulmonary bypass is necessary for
  excision of aneurysms in the ascending aorta
• Partial cardiopulmonary bypass is used for
  clients with an aneurysm in the descending aorta

80
THORACIC AORTIC ANEURYSM REPAIR

• POSTOPERATIVE
• Monitor vital signs
• Monitor for signs of hemorrhage such as a drop in
  BP, increased pulse rate and respirations, and
  report to the physician immediately
• Monitor chest tubes for an increase in chest
  drainage, which may indicate bleeding or
  separation at the graft site

81
THORACIC AORTIC ANEURYSM REPAIR

• POSTOPERATIVE
• Assess sensation and motion of all extremities
  and notify the physician if deficits occur, which
  can be due to a lack of blood supply during
  surgery
• Monitor respiratory status and auscultate breath
  sounds to identify respiratory complications
• Encourage turning, coughing, and deep breathing,
  splinting the incision
• Monitor cardiac status for dysrhythmias

82
THORACIC AORTIC ANEURYSM REPAIR

• POSTOPERATIVE
• Monitor for pain and administer medication as
  prescribed
• Assess the incision site for bleeding or signs of
  infection
• Prepare the client for discharge by providing
  instructions regarding pain management, wound
  care, and activity restrictions

83
THORACIC AORTIC ANEURYSM REPAIR

• POSTOPERATIVE
• Instruct the client not to lift objects greater
  than 15 to 20 pounds for 6 to 12 weeks
• Advise the client to avoid activities requiring
  pushing, pulling, or straining
• Instruct the client not to drive a vehicle until
  approved by the physician

84
EMBOLECTOMY

• DESCRIPTION
• Removal of an embolus from an artery using a
  catheter
• A patch graft may be required to close the artery

85
EMBOLECTOMY

• PREOPERATIVE
• Obtain a baseline vascular assessment
• Administer anticoagulants as prescribed
• Administer thrombolytics as prescribed
• Place a bed cradle on the bed
• Avoid bumping or jarring the bed
• Maintain the extremity in slightly dependent
  position

86
EMBOLECTOMY

• POSTOPERATIVE
• Assess cardiac, respiratory, and neurological
  status
• Monitor affected extremity for color,
  temperature, and pulse
• Assess sensory and motor function of the affected
  extremity
• Monitor for signs and symptoms of new thrombi or
  emboli
• Administer oxygen as prescribed
• Monitor pulse oximetry

87
EMBOLECTOMY

• POSTOPERATIVE
• Monitor for complications caused by reperfusion
  of the artery, such as spasms and swelling of the
  skeletal muscles
• Monitor for signs of swollen skeletal muscles,
  such as edema, pain on passive movement, poor
  capillary refill, numbness, and muscle tenseness
• Maintain bed rest initially, with the client in
  semi-Fowlers position
• Place a bed cradle on the bed

88
EMBOLECTOMY

• POSTOPERATIVE
• Check the incision site for bleeding or hematoma
• Administer anticoagulants as prescribed
• Monitor laboratory values related to
  anticoagulant therapy
• Instruct the client to recognize the signs and
  symptoms of infection and edema
• Instruct the client to avoid prolonged sitting or
  crossing the legs when sitting

89
EMBOLECTOMY

• POSTOPERATIVE
• Instruct the client to elevate the legs when
  sitting
• Instruct the client to wear antiembolism
  stockings as prescribed and how to remove and
  reapply the stockings
• Instruct the client to ambulate daily
• Instruct the client about anticoagulant therapy
  and the hazards associated with anticoagulants

90
VENA CAVAL FILTER AND LIGATION OF INFERIOR VENA
CAVA

• VENA CAVAL FILTER
• Insertion of an intracaval filter (umbrella) that
  partially occludes the inferior vena cava and
  traps emboli to prevent pulmonary emboli
• LIGATION
• Suturing or placing clips on the inferior vena
  cava to prevent pulmonary emboli

91
VENA CAVAL FILTERS
From Black, J., Hawks, J., Keene, A. (2001).
Medical-surgical nursing Clinical management for
positive outcomes, ed 6, Philadelphia W.B.
Saunders
92
VENA CAVAL FILTER AND LIGATION OF INFERIOR VENA
CAVA

• POSTOPERATIVE
• Monitor vital signs
• Assess cardiac and respiratory status
• Administer oxygen as prescribed
• Monitor pulse oximetry
• Maintain semi-Fowlers position
• Avoid hip flexion
• Maintain antiembolism stockings as prescribed

93
VENA CAVAL FILTER AND LIGATION OF INFERIOR VENA
CAVA

• PREOPERATIVE
• If the client has been taking an anticoagulant,
  consult with the physician regarding
  discontinuation of the medication to prevent
  hemorrhage

94
VENA CAVAL FILTER AND LIGATION OF INFERIOR VENA
CAVA

• POSTOPERATIVE
• Provide activity as prescribed
• Check the insertion site for bleeding and
  hematoma
• Assess for peripheral edema
• Monitor laboratory values related to
  anticoagulant therapy

95
VENA CAVAL FILTER AND LIGATION OF INFERIOR VENA
CAVA

• CLIENT EDUCATION
• Signs and symptoms of infection and edema
• Avoid prolonged sitting or crossing legs when
  sitting
• Elevate the legs when sitting
• Wear antiembolism stockings as prescribed and how
  to remove and reapply the stockings
• Ambulate daily
• About anticoagulant therapy and the hazards
  associated with anticoagulants