Nursing care for patients with atherosclerosis. What is the nursing process in atherosclerosis? Atherosclerosis of cerebral arteries
Provide the patient and his relatives with the necessary information: regimen, diet, examination and treatment
Organize a gentle protective regime
Monitor compliance with the diet and one regimen: limiting salt and liquid
Explain to the patient that after taking antihypertensive drugs you need to lie down, teach him to get up from the pastel gradually, turn on his side, lower his legs, sit down, stand up
Development of thrombosis Triassic Virchow
Please do not hide behind pseudonyms, but use simple names. Slow blood flow The slower the blood flows, the better. The formation of a blood clot begins.
Particularly vulnerable groups
Pat with atherosclerosis Deposits on vessels “Damage to the vascular wall.” The goals increase venous return, prevent damage to the vascular wall, and reduce blood clotting.Strengthening Venor, superficial veins contract so that blood flows faster in the deeper veins. Refractive exercises, bed cyclization, leg contours, heparinization, physician location.
- Mobilization, activation of storage muscle pumps, increase in venous return.
- Preserving veins, maintaining reverse flow.
- The function of the venous valve is enhanced.
Ventilate the room regularly
Talk to the patient, make him feel safe and comfortable
Maintain the bed (flat, but not hard)
Provide the patient with everything necessary for the night
Maintaining patient personal hygiene
Patient monitoring; headache, dizziness, blurred vision, weakness, pain in the heart area, sleep, respiratory rate, pulse, blood pressure, diuresis, weight.
Thrombosis most often occurs in the venous vessels, phlebothrombosis in the legs. Swelling of the lower leg. Tension, heaviness in the lower leg. Changes in color of the lower leg, cyanotic, pale, also redness. Pain Knee, under the legs, along the veins, groin, in the tension of the lower leg muscles.
Development of thrombosis "Virchow Trias"
The slower the blood flows, the better the platelets can attach to the vein wall and initiate the formation of blood clots. Variations Valve insufficiency. As well as constant vomiting and diarrhea, large-scale burns, diuretics. Damage to the inner wall of the vessel causes platelet aggregation.
Monitor response to treatment.
Lecture No. 5.
"Nursing care for atherosclerosis"
Lecture plan.
1. The essence of the concept.
2. Predisposing factors.
3. Symptoms:
a) atherosclerosis of the aorta;
b) atherosclerosis of cerebral vessels;
c) atherosclerosis of the vessels of the lower extremities;
d) atherosclerosis of the coronary arteries
Damage to the thoracic aorta
Atherosclerosis is common in old people and in obesity. Injuries and inflammation of blood vessels. Normally, the blood clots and dissolves blood clots. Patients with arteriosclerosis on ships occur here. Patients after surgery increase the tendency to coagulate, thrombokinase is released to enhance coagulation.
Increase venous return. Decreased readiness for blood coagulation. When walking, the muscles are tense, and the veins are literally squeezed out by the compression bandage as an abutment. Venous valves allow blood flow only to the heart, speeding up venous return. Alone, leg elevation increases venous return by 20-30%. In patients with disorders arterial circulation The leg should not be stored under any circumstances.
e) atherosclerosis of mesenteric vessels.
4. Principles of treatment.
5. Prevention.
6. Patient problems.
1. Atherosclerosis - chronic illness predominantly elastic or muscular arteries - elastic type, which is characterized by the deposition and accumulation of plasma in the intima atherogenic lipoproteins with another reactive proliferation of connective tissue and the formation of fibrous plaques.
Nurse actions related to care
Contraindications to leg lifts. When grooming the body, the legs are lifted with one hand, and the other is pulled back with gentle pressure and a steady step. Blood return is supported. Bed linen and venous stasis slow blood flow and promote thrombosis. In addition, they increase the function of the venous valve. Alternatively, compression can also be achieved through a compression bandage.
Contraindications for compression applications. Special material Compression guaranteed. Color coding Note on size. Gumming on the thigh prevents slipping. A knitted heel is a better fit. The size is always exactly according to our own specifications.
2. Contributing Factors .
The development of atherosclerosis begins at the age of 40-50 years and older. Men suffer from atherosclerosis more often and 10 years earlier due to the fact that they have pathological high levels in the blood of triglycerides, cholesterol, atherogenic lipoproteins, and they are more susceptible to risk factors.
Factors contributing to the development of the disease are also identified:
A practical approach to ensure compliance
Documentation about once a week and with leg changes. Like duct tape on your thigh? . Information about good cooperation. Skin care. Observe the skin at least once a day for bruises and blood circulation. Thrombotic signs, allergic reactions.
Daily nursing care
Material control of stockings. Compression bandage indication. Apply compression bandages to prevent thrombosis using short stretch bandages only. But they also work while lying down. Rule of pronation in the opposite compression bandage. Pronation Lift the outer edge of the foot for the last circle.
1) constitutional predisposition;
2) nutritional factor - poor nutrition, containing excess fat, carbohydrates and lack of vitamin C;
4) increased blood pressure;
5) metabolic factor (with diabetes mellitus, obesity, decreased function thyroid gland);
6) vascular factor related to violation nervous regulation vessels, their damage in various infectious and infectious-allergic diseases.
Supination Raising the inner edge of the foot Lowering the outer edge of the foot. Press the soles of your feet into the bottom of the bed while contracting your calf muscles. Thigh muscle tension. If there are no measures or there is a significant risk of thrombosis, patients receive heparin in addition to the doctor's prescription.
Name measures to prevent thrombosis and their effect!
Pressure Pressure The pressure that is in the rest of the muscle outside, i.e. from the bandage, comes. Operating pressure pressure, with active muscles from the inside, i.e. short stretch bandage Use in confined patients, low elongation, causes high compression with high operating pressure and low resting pressure, can be left on at night. Long-term dressing Used mainly in active patients, high elasticity, low operating pressure and high pressure peace. Must be deployed at night and also in bed rest more than 10 minutes because it limits. Backward Compensation To balance the anatomical grooves around the protuberances, pieces of foam are cut to size and placed into the grooves. By raising your legs, venous return increases.
On early stages there is a violation of the permeability of the endothelium and intima (the inner lining of the arteries) for fat-protein complexes (lipoproteins), which are deposited and accumulate in the intima of blood vessels and the aorta, becoming visible stripes yellowish color. This is the stage of lipoidosis. Gradually, it grows around the lipoproteins deposited in the intima. connective tissue, protruding plaques appear. This is the stage of liposclerosis. Then the center of the plaque disintegrates, bulges, and the plaque protrudes significantly into the lumen of the vessel, narrowing it. Under the plaque, the underlying layers of the vascular wall are destroyed, and the plaque penetrates into muscle layer. This is the stage of atheromatosis. Finally, calcium salts (lime) are deposited into the plaque and surrounding area. fibrous tissue; the plaque becomes even denser, significantly narrows the lumen of the vessel, preventing blood flow in the affected vessel. This is the stage of atherocalcinosis.
In basic care, the legs are lifted with one hand while the other is pulled back with gentle pressure and a steady movement. In addition, the stockings serve as an abutment and thus enhance the action of the muscular venous pump. In what cases should compression not be performed?
Conditions and diseases
Cause: The vessel narrows and no longer contracts. Patients with decompensated heart failure. Cause. The fact that venous return flow increases increases preload. At the heart more work. Cause: The healing of shells is impaired.
3 . Symptoms It depends which arteries are affected.
a) atherosclerosis of the aorta characterized burning pain behind the sternum with irradiation to the arms, neck, back, upper abdomen. Unlike angina, the pain continues for a long time, sometimes intensifying and sometimes weakening. With a significant expansion of the aortic arch or an aneurysm, a change in voice and difficulty swallowing may occur. Aortic atherosclerosis is detected through direct examination of the patient and instrumental methods. During percussion, expansion is determined vascular bundle in the second intercostal space; right and left borders relative stupidity hearts are shifted outward; On auscultation, a sharp increase in heart sound is observed. R logic research - expansion of the aortic shadow. ECHO - expansion of the aorta and thickening of its wall.
What error sources should you consider and eliminate when putting on medical thrombosis stockings? Put on only after 20 minutes of decontamination of the feet. They cannot be worn. What check do you perform after applying a compression bandage to a patient?
Check the correct fit Wrinkle free, heel, adhesive tape on thigh, leg hole. Check your circulation after 30-60 minutes. More than a thousand liters of blood accumulate in our hearts through the bloodstream every day - unnoticed by a healthy young person. However, older people feel their hearts out from time to time as the carrying capacity steadily decreases. Therefore, older people usually have to stop and rest more often and get tired more quickly. If the tension on the heart becomes too great, heart disease threatens.
Atherosclerosis abdominal aorta characterized by different types of abdominal pain and dysfunction of internal organs.
b) atherosclerosis of cerebral vessels typical for elderly and old age. Constant decline cerebral circulation leads to sustainable oxygen starvation. Manifested by decreased memory, dizziness, decreased mental performance, and decreased concentration. With significant damage to the blood vessels of the brain, it may gradually develop senile dementia. If the clearance cerebral arteries becomes significantly covered by a plaque, it may develop ischemic stroke. The walls of the blood vessels become fragile and rupture under the influence of blood pressure, then a hemorrhagic stroke occurs.
Heart failure - when the heart runs out of energy
What is important for caring for victims? A heart disease common in old age is heart failure. This is said when the heart is too weak to pump enough blood to the organs. First of all, it is only felt during strenuous efforts such as climbing stairs - the person affected must frequently stop and gasp. As the disease progresses, the patient does not get enough air, even if he is at rest, and has difficulty coping.
c) atherosclerosis of the vessels of the lower extremities occurs due to a decrease in blood supply to these vessels. The main complaints are weakness in the legs, coldness of the feet and fingers. Characteristic symptom - moving lameness: cold feet and toes. Characteristic symptom –« intermittent claudication": the occurrence of pain in calf muscles when walking and stopping them when stopping. Over time, trophic ulcers may appear in the lower part of the leg, and in severe cases, atherosclerotic gangrene develops.
People with heart failure do not need to be eliminated completely, but the burden must be balanced. Caution is advised when standing up, as affected people are especially prone to falling due to dizziness. The upper part of a patient with heart failure should be kept elevated - for example, using sofa cushions, a mattress wedge, or a special back support.
Coronary heart disease and heart attack - the heart is oxygen deficient
It is important to check your blood pressure and heart rate regularly. If arterial pressure increases, those affected should reduce their salt intake. If a patient has had a heart attack, he top part the body should be slightly elevated. Thus, he can breathe easier, receive more oxygen, and the heart calms down. To prevent recurrence heart attack, it is necessary to minimize risk factors such as smoking, physical inactivity or poor diet.
d) atherosclerosis of the coronary arteries heart disease is manifested by attacks of angina pectoris and leads to the development of myocardial infarction.
e) atherosclerosis of mesenteric arteries manifested by dysfunction of the digestive system, abdominal pain, which is easily relieved by nitroglycerin. The pain is accompanied by bloating, constipation, and belching. Possible reflex pain in the heart, palpitations, interruptions, shortness of breath.
Their colloquial name, intermittent claudias, sounds relatively harmless. With the right measures, it is very easy to gain control. They are also known colloquially as "intermittent claudication" as sufferers are often forced to take breaks and stop after a certain walk - similar to window shopping. Only in this case they are suspended due to stress pain in the legs.
Those responsible for impaired blood circulation narrow or even close the blood vessels. In most cases, this is a consequence of atherosclerosis. Besides, in in rare cases injuries, inflammatory diseases, embolism or inflammation of large blood vessels may lead to intermittent claudication.
Regardless of the location of atherosclerotic vascular lesions, blood tests can reveal lipid metabolism disorders: increased levels of cholesterol, low-density lipoproteins (beta-lipoproteins), and triglycerides in the blood.
4 . Principles of treatment.
Treatment of atherosclerosis must be comprehensive. First of all, factors that predispose to the development of the disease should be influenced. A significant place in this is given to general hygienic measures: the patient’s refusal to bad habits(alcohol, smoking), adequate sleep, staying on fresh air, moving image life. Great importance in the treatment of atherosclerosis has a diet, reducing the total calorie content of food, reducing fat in the diet, foods that retain cholesterol, as well as sugar. It is necessary to exclude products containing extractives ( meat broths, fried foods), limit salt intake to 5g per day. The diet should be rich in vegetables, fruits, and low-fat dairy products.
Due to poor circulation, the muscles of the affected limbs are no longer supplied with oxygen. If the disease is already at a more advanced stage, complaints may also occur at rest. Especially in the second half of life, because one in four patients over 55 years of age suffers from intermittent clitoral disease. It affects men four times more often than women, and smokers are especially at risk.
Depending on the severity, the progression of intermittent claudication causes various complaints among those affected. In the early stages, an intermittent clitoris is usually discovered incidentally during vascular examination. Lack of blood flow to the extremities can lead to tissue death and amputation.
Drugs that inhibit cholesterol synthesis are used: clofibrate, lipantil; - products that improve microcirculation: a nicotinic acid and its drugs; - drugs that reduce cholesterol synthesis and absorption in the intestine: cholestyramine, colestipol;
Drugs that reduce cholesterol deposits in the vascular wall, so-called angioprotectors: parmidine, prodectin.
Typical symptoms of intermittent claudication
Symptoms of intermittent claudication depend on the four stages described above. Initially, the disease is asymptomatic and painless, since atherosclerosis and associated circulatory disorders often develop creeping. Only when the affected muscles are no longer supplied sufficient quantity oxygen, it acquires varying degrees, cramping and stress pain in the calf, but also in the legs, hips or buttocks.
- More cold temperature skin compared to the opposite limb.
- Density of affected limbs.
- No pulse.
- Muscle weakness during exercise.
- Ulcers and wounds no longer heal.
A significant place in the treatment of signs of disorder is occupied by appropriate vasodilator therapy(stugeron, cavinton), as well as nootropic drugs (nootropil, piracetam).
5. Prevention.
Primary - lies in propaganda healthy image life, systematic muscle work, sufficient exposure to fresh air, balanced diet, rejection of bad habits.
Secondary - dispensary observation, prescription of periodic courses of drugs that reduce cholesterol in the blood, improve microcirculation and trophism of the walls of blood vessels.
