Nursing care of patients with atherosclerosis. What is the nursing process in atherosclerosis? Atherosclerosis of the cerebral arteries
Give the patient and his relatives the necessary information: regimen, diet, examination and treatment
Arrange sparing protective regime
Follow the diet and one regimen: salt and fluid restriction
Explain to the patient that after taking antihypertensive drugs it is necessary 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 virchus
Please don't hide behind aliases, but use simple names. Slow blood flow The slower the blood flows, the better. The beginning of the formation of a thrombus.
Particularly vulnerable groups
Pat with atherosclerosis Deposits on the vessels "Damage to the vascular wall". Goals increase venous return, prevent damage to the vascular wall, and reduce blood clotting.Strengthening the venor, superficial veins constrict so that blood flows faster in the deeper veins. Refractive gymnastics, bed cyclization, leg contours, heparinization, doctor's position.
- Mobilization, storage activation of muscle pumps, increase in venous return.
- Preservation of veins, maintenance of reverse current.
- The function of the venous valve is enhanced.
Ventilate the room regularly
Communicate with the patient, create a sense of security and comfort in him
Follow the bed (flat, but not hard)
Provide the patient with everything necessary for the night
Compliance with the personal hygiene of the patient
Patient monitoring; headache, dizziness, blurred vision, weakness, pain in the heart, sleep, respiratory rate, pulse, blood pressure, diuresis, weight.
Thrombosis is most often found in the venous vessels, in the legs phlebothrombosis. Swelling of the leg. Tension, heaviness in the lower leg. Lower leg discoloration, cyanotic, pale, also red. Pain Knee, under the feet, during the vein, groin, in the tension of the muscles of the lower leg.
The development of thrombosis "Virchow Trias"
The slower the blood flows, the better the platelets can attach to the vein wall and initiate blood clots. Variations Valve failure. As well as persistent vomiting and diarrhea, large scale burns, diuretics. Damage to the inner wall of the vessel causes platelet aggregation.
Monitor response to treatment.
Lecture number 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 vessels of the lower extremities;
d) atherosclerosis of the coronary arteries
Thoracic aortic injury
Atherosclerosis is often the elderly, with obesity. Trauma and vascular inflammation. Normally, clotting occurs in the blood and blood clots dissolve in the blood. Patients with arteriosclerosis on ships originate 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 a compression bandage as an abutment. Venous valves allow blood flow only to the heart, speeding up venous return. Alone, leg elevation increases venous income 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 deposition and accumulation in the intima of plasma atherogenic lipoproteins with another reactive proliferation of connective tissue and the formation of fibrous plaques.
Care Nurse Actions
Leg raise contraindications When caring for the body, the legs are lifted with one hand, and with the other, with gentle pressure and a steady step, it is pulled back. The return of blood is supported. Bed linen and venous congestion slow blood flow and promote thrombosis. In addition, they increase the function of the venous valve. Alternatively, compression can also be achieved with a compression bandage.
Contraindications for compression applications. Special material Compression guaranteed. Color coding Size note. Gumming on the thigh prevents slipping. Knitted heel is better. 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 more often and 10 years earlier suffer from atherosclerosis due to the fact that they have observed pathological high levels in the blood of triglycerides, cholesterol, atherogenic lipoproteins, and they are more susceptible to risk factors.
There are also factors contributing to the development of the disease:
A practical approach to ensure compliance
Documentation about once a week and with leg changes. Like duct tape on the thigh? . Information about good cooperation. Skin care. Observation of the skin at least once a day for bruising, blood circulation. Thrombotic signs, allergic reactions.
Daily Nursing Care
Material control stockings. Compression bandage indication. Apply compression bandages for thrombosis prevention only with short stretch bandages. But they also work while lying down. Pronation rule in opposite compression bandage. Pronation Raise the outer edge of the foot for the last circle.
1) constitutional predisposition;
2) nutritional factor - malnutrition containing excess fat, carbohydrates and lack of vitamin C;
4) increase in blood pressure;
5) metabolic factor (with diabetes, obesity, decreased function thyroid gland);
6) vascular factor associated with violation nervous regulation vessels, their defeat 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 against the bottom end of the bed while tensing 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 a doctor's prescription.
Name the measures for the prevention of thrombosis and their effect!
Head pressure Pressure which in the rest of the musculature is outside, i.e. from the bandage, comes. Operating pressure pressure, with active muscles from the inside, i.e. short stretch bandage Use in chained patients, low extensibility, causes strong compression with high working pressure and low rest pressure, can be left on at night. Long-term dressing Used mainly in active patients, high elasticity, low working pressure and high pressure rest. Should be deployed at night, as well as in bed rest more than 10 minutes as it limits. Reverse Compensation To balance the anatomical recesses around the protuberances, pieces of foam are cut to size and placed in the recesses. Raising the legs increases venous return.
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 the vessels and aorta, become visible stripes yellowish color. This is the stage of lipoidosis. Gradually around the lipoproteins deposited in the intima grows connective tissue, protruding plaques appear. This is the stage of liposclerosis. Then the center of the plaque disintegrates, manifests itself, 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 its surroundings. fibrous tissue; the plaque becomes even more dense, significantly narrows the lumen of the vessel, preventing the flow of blood in the affected vessel. This is the stage of atherocalcinosis.
In basic grooming, the legs are lifted with one hand and the other, with gentle pressure and a steady motion, is pulled back. In addition, the stockings serve as an abutment and thus enhance the action of the muscular venous pump. When should compression not be performed?
Conditions and diseases
Cause: Vessel shrinks and no longer compresses. Patients with decompensated heart failure. Cause. The fact that venous return flow is increased increases the preload. At the heart more work. Cause: Violation of the healing of shells is disturbed.
3 . Symptoms depends on which arteries are affected.
a) aortic atherosclerosis characterized burning pain behind the sternum with irradiation to the arms, neck, back, upper abdomen. Unlike angina pectoris, pain continues for a long time, sometimes intensifying, sometimes weakening. With a significant expansion of the aortic arch or aneurysm, it is possible to change the voice, difficulty swallowing. Atherosclerosis of the aorta is detected by direct examination of the patient and instrumental methods. Percussion determines the expansion vascular bundle in the second intercostal space; right and left borders relative stupidity hearts are shifted outward; on auscultation, there is a sharp increase in the 2nd heart sound. R-logical research - expansion of the shadow of the aorta. ECHO - expansion of the aorta and thickening of its wall.
What error sources should you consider and disable when putting on medical thrombosis stockings? Put on only after 20 minutes of decontamination of the leg storage. They cannot be worn. What test do you perform after applying a compression bandage to a patient?
Check fit Wrinkle-free, heel, adhesive tape on thigh, leg opening. Perform a circulatory check after 30-60 minutes. Over a thousand liters of blood accumulate in our heart through the bloodstream every day - an imperceptibly healthy young person. However, the elderly feel their heart from time to time, as the carrying capacity is steadily decreasing. Therefore, older people usually have to stop more often, rest and get tired faster. If the stress on the heart becomes too great, heart disease threatens.
Atherosclerosis abdominal aorta different in nature of pain in the abdomen, violations of the functions of internal organs.
b) atherosclerosis of cerebral vessels characteristic of the elderly and old age. Constant decline cerebral circulation leading to sustainable oxygen starvation. It is manifested by a decrease in memory, dizziness, a decrease in mental capacity for work, concentration of attention. With significant damage to the vessels of the brain, it can gradually develop senile dementia. If the clearance cerebral arteries is significantly closed by a plaque, it can develop ischemic stroke. The walls of blood vessels become fragile and burst under the influence of blood pressure, then a hemorrhagic stroke occurs.
Heart failure - when the heart runs out of energy
What is important for the care of the victims. A heart disease common in old age is heart failure. It 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 often stop and choke. As the disease progresses, the patient does not get enough air, even if he is at rest, and has difficulty coping with this.
c) atherosclerosis of the vessels of the lower extremities occurs due to a decrease in the blood supply to these vessels. The main complaints are weakness in the legs, coldness of the feet and fingers. characteristic symptom - moving lameness: coldness of the feet and fingers. characteristic symptom –« intermittent claudication": the occurrence of pain in calf muscles when walking and stopping them when stopped. Over time, trophic ulcers may appear in the lower part of the leg, in severe cases, atherosclerotic gangrene develops.
People with heart failure do not need to be completely shed, but the burden must be balanced. Caution is advised when standing up, as affected people are particularly prone to falling due to dizziness. The upper part of the patient with heart failure should be kept elevated - for example, using sofa cushions, a mattress wedge, or a special back support.
Ischemic heart disease and heart attack - heart in oxygen deficiency
It is important to check your blood pressure and heart rate regularly. If arterial pressure increases, those affected should reduce their salt intake. If the patient has had a heart attack, top part body should be slightly elevated. Thus, he can breathe easier, get more oxygen, the heart calms down. To prevent a recurrence heart attack risk factors such as smoking, physical inactivity or poor diet should be minimized.
d) atherosclerosis of the coronary arteries the heart is manifested by angina attacks and leads to the development of myocardial infarction.
e) atherosclerosis of the mesenteric arteries manifested by violations of the function of the digestive apparatus, abdominal pain, which are well stopped by nitroglycerin. The pain is accompanied by bloating, constipation, 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 colloquially known as "intermittent lameness" as sufferers after a certain amount of walking are often forced to take breaks and stop - similar to window shopping. Only in this case they are suspended due to stressful pain in the legs.
Responsible for impaired blood circulation constrict or even close the vessels. In most cases, this is a consequence of atherosclerosis. Besides, in rare cases injury, inflammatory diseases, embolism or inflammation of large blood vessels can lead to intermittent lameness.
Regardless of the localization of atherosclerotic vascular lesions, a blood test can reveal lipid metabolism disorders: an increased content of cholesterol in the blood, low-density lipoproteins (beta-lipoproteins), and triglycerides.
4 . Principles of treatment.
Treatment of atherosclerosis should be complex. First of all, it is necessary to influence the factors predisposing to the development of the disease. 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, it has a diet, a decrease in the total caloric content of food, a decrease in the diet of fat, cholesterol-retaining products, and sugar. It is necessary to exclude products containing extractive substances ( meat broths, fried foods), limit salt intake to 5g per day. The diet should be rich in vegetables, fruits, low-fat dairy products.
Due to impaired blood 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 every fourth patient over 55 suffers from intermittent clitoral disease. It affects men four times more often than women and is especially at risk for smokers.
Depending on the severity, the progression of intermittent lameness 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 the synthesis of cholesterol are used: clofibrate, lipantil; - Means that improve microcirculation: a nicotinic acid and her preparations; - drugs that reduce the synthesis of cholesterol and its absorption in the intestine: cholestyramine, colestipol;
Drugs that reduce cholesterol deposits in the vascular wall, the so-called angioprotectors: parmidin, prodectin.
Typical symptoms of intermittent claudication
The 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 creep. Only when the affected muscles are no longer supplied enough oxygen, it acquires varying degrees, crampy and stressful pain in the calf, but also in the legs, thighs 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 a violation is occupied by the corresponding vasodilator therapy(stugeron, cavinton), as well as nootropic drugs (nootropil, piracetam).
5. Prevention.
Primary - is to promote healthy lifestyle life, systematic muscle work sufficient exposure to fresh air, balanced diet, rejection of bad habits.
Secondary - dispensary observation, the appointment of periodic courses of drugs that reduce cholesterol in the blood, improve microcirculation and trophism of the walls of blood vessels.
