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Lecture

Chapter 8.docx

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Department
Nursing
Course
NURS 201
Professor
Marywyatt Sindlinger
Semester
Winter

Description
Chapter 8 PERIPHERAL ARTERIAL DISEASE  Peripheral arterial disease (PAD) is a progressive narrowing and degeneration of the arteries of the neck, abdomen, and extremities. In most cases, it is a result of atherosclerosis.  PAD typically appears in the sixth to eighth decades of life. It occurs at an earlier age in persons with diabetes mellitus and more frequently in African Americans.  The four most significant risk factors for PAD are cigarette smoking (most important), hyperlipidemia, hypertension, and diabetes mellitus.  The most common locations for PAD are the coronary arteries, carotid arteries, aortic bifurcation, iliac and common femoral arteries, profunda femoris artery, superficial femoral artery, and distal popliteal artery. ANEURYSMS  Aortic aneurysms are outpouchings or dilations of the arterial wall.  The primary causes of aortic aneurysms can be classified as degenerative, congenital, mechanical, inflammatory, or infectious.  Aortic aneurysms may involve the aortic arch, thoracic aorta, and/or abdominal aorta, but most are found in the abdominal aorta below the level of the renal arteries.  Thoracic aorta aneurysms are often asymptomatic, but the most common manifestations are deep, diffuse chest pain that may extend to the interscapular area; hoarseness as a result of pressure on the recurrent laryngeal nerve; and dysphagia from pressure on the esophagus.  Abdominal aortic aneurysms (AAAs) are often asymptomatic but symptoms may mimic pain associated with abdominal or back disorders.  The most serious complication related to an untreated aneurysm is rupture and bleeding.  Diagnostic tests for AAAs include chest x-ray, electrocardiogram (to rule out myocardial infarction), echocardiography, CT scan, and magnetic resonance imaging scan.  The goal of management is to prevent the aneurysm from rupturing.  Surgical repair of AAA involves (1) incising the diseased segment of the aorta, (2) removing intraluminal thrombus or plaque, (3) inserting a synthetic graft, and (4) suturing the native aortic wall around the graft.  Minimally invasive endovascular grafting is an alternative to conventional surgical repair of AAA and involves the placement of a sutureless aortic graft into the abdominal aorta inside the aneurysm via a femoral artery cutdown.  Preoperatively, the patient is monitored for indications of aneurysm rupture.  Preoperative teach
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