Chapter 26: Managing Vascular Disorders & Peripheral Circulation

Managing Vascular Disorders & Peripheral Circulation begins by establishing the hemodynamic principles governing blood flow, including the roles of blood pressure, resistance, and the regulatory mechanisms of the sympathetic nervous system and hormones like angiotensin II. A significant portion of the text focuses on the assessment of vascular insufficiency, detailing the calculation and interpretation of the Ankle-Brachial Index (ABI), the use of Doppler ultrasonography, and the identification of clinical signs such as intermittent claudication, rest pain, rubor, and pallor. The chapter rigorously differentiates between arteriosclerosis (hardening of the arteries) and atherosclerosis (plaque accumulation), outlining risk factors such as nicotine use, diabetes, and hypertension. It explores Peripheral Artery Disease (PAD) in depth, covering pharmacologic interventions like statins and cilostazol, as well as surgical and endovascular management including bypass grafts, angioplasty, and stenting. Critical arterial emergencies are addressed, including the pathophysiology and management of aortic aneurysms (thoracic and abdominal), aortic dissection, and acute arterial occlusion characterized by the six Ps (pain, pallor, pulselessness, paresthesia, paralysis, and poikilothermia). Vasospastic disorders like Raynaud’s phenomenon are also explained. The text transitions to venous disorders, emphasizing Venous Thromboembolism (VTE), which encompasses Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE). It elucidates Virchow’s triad (endothelial damage, venous stasis, and altered coagulation) and details preventive measures and anticoagulant therapies involving heparin, warfarin, and direct oral anticoagulants. Chronic venous insufficiency and postthrombotic syndrome are analyzed alongside the management of venous stasis ulcers, distinguishing them from arterial and neuropathic ulcers based on location, appearance, and pain characteristics. Finally, the chapter covers lymphatic disorders such as lymphedema and lymphangitis, as well as soft tissue infections like cellulitis, emphasizing nursing interventions that promote circulation, skin integrity, and patient education on self-care and risk modification.