Arterial occlusive disease is such a big deal for society in whole world. The most often occlusion is in upper and lower leg. The challenge is how to do arterial occlusive disease nursing care correctly. Then first of all, let’s have a look to arterial occlusive disease overview.
If someone has arterial occlusive disease, obstuction or constriction of aorta lumen and its mayor brances will interup blood flow, the most often is interruption of blood flow to upper and lower leg.
Arterial occlusive disease can attack carotid, vertebral, innomination, sub-clavia, mesenteric, or celiac artery. Generally, acute or chronic occlusion causes ischemia, skin ulcer, and severe gangrene.
Prognosis of arterial occlusive disease depends on occlusion location, collateral circulation that inhibit blood flow, and if patient has acute arterial occlusive disease between occlusion and recovery.
- Endogenous, it is because embolus or thrombosis formation
- Exogenous, it is because trauma or fracture.
- Predisposing factors
- Aging process
- Condition like hypertension, hyperlipidemia, and diabetes
- Vascular disturbance history like myocardium infarction or stroke
Sign and Symptoms
First steps of arterial occlusive disease nursing care is knowing the sign and symptoms of patient. The sign and symptoms of arterial occlusive disease is depends on occlusion place.
Clinical sign and symptoms of arterial occlusive disease:
Bifurcation aortic (saddle-block occlusion, cardiac embolism)
Sensory deficit and motoric deficits like muscle weakness, paresthesia, and paralysis, and ischemia signs (chest pain attack, tremor, leg pain with weak or without peripheral pulse) in both leg
Carotid system artery
Internal and external carotid artery
Neurology dysfunction (transient ischemic attack-TIA) that is caused by cerebral circulation problem. It makes unilateral sensory and motoric dysfunction (monocular dysarthria and hemiparesis blindness), dysarthria or aphasia, confusion, mental deficits, headache; this recurrent clinical signs usually remains for 5-10 minutes, but it can be for 24 hours and it can be a stroke early signs; pulse is missing with abnormal auscultation sound in the area of arterial occlusion.
Femoral and popliteal Artery (aneurysm formation)
Leg intermittent claudication while using energy; ischemia pain in lower leg; pretropic pain ( necrosis and ulcer pain); pale and cold feeling on upper leg; lower leg become paler while elevate it; gangrene, no palpable pulse in popliteal and femoral area.
Iliac artery (Leriche syndrome)
Intermitten claudication in lower back, bottom, and thigh that can disappear with rest; distal pulse is missing or decreasing; abnormal sound in femoral artery; impotent
Brachiocephalic innomination artery
Neurology dysfunction (sign and symptoms of vertebrobasilar occlusion); ischemia indication (claudication) in right arm; abnormal sound in right neck
Mesenteric artery (Superior, Celiac axis, and Inferior)
Bowel ischemia, infarct necrosis, and gangrene; sudden and acute abdominal pain; nausea and vomit; diarrhea; leucosytosis; and shock caused by loss of intraluminal fluid and plasma
Subclavian steal syndrome (signed by blood regurgitation from brain through same side of occlusion, into distal subclavian artery toward occlusion); clinical effect of vertebrabasilar occlusion and hand claudication that is used for exercise; gangrene.
Vertebrabasilar system (Vertebral and basilar artery
Neurology dysfunction (TIA in medulla and cerebellum make visual binocular, vertigo, disartria, and falling attack (falling without unconsciousness)
Diagnosis examination is like the most important one of the arterial occlusive disease nursing care. It is because you have to make sure that this is real arterial occlusive diseases. To make it sure doctors usually perform some diagnosis examination such as like:
- Arteriography shows types (thrombus or emboli), location, and obstruction degree and collateral circulation. Arteriography is useful for chronic disease or evaluating patient’s readiness toward reconstructive surgery
- Doppler ultrasonography and pletismography are non-invasive diagnosis examination that show blood flow disease toward occlusion
- Oftalmodinamometry helps determain obstruction degree in carotid artery by distinguishing ofalmic artery pressure with brachial artery pressure . more than 20 % ratio shows insufficiency
- EEG and computed tomography scan can be needed to eliminate brain lesion.
In every nursing care, including arterial occlusive disease nursing care, the nursing care plans colaborate with medical treatment. Some of the medical treatments are:
- Effective treatment is depend on causes, location, and obstruction size
- For chronic disease, supportive treatment are like limiting bad smoking activity, controlling hypertension, and excercising program
- For carotid artery occlusion, antiplatelet therapy can be done with dipyridamole and aspirin or clipidogrel
- For intermittent claudication in chronic occlusion disease, pentoxifylline can increase blood supply in the capillary, especially for patient with improper to do surgery
- Acute arterial occlusive disease needs surgery to restore blood supply to occlusion artery area. The procedures that can be done are embolectomy, thromboendarterectomy, graft, artrectomy graft bypass
- Thrombolytic therapy with urokinase, streptokinase, or alteplase can be prescribed
- Angioplasties balloon will suppress the obstruction
- Laser angioplasty can be done (it will evaporate the obstruction)
- Stent to prevent recurrence of artery obstruction
- All of therapy above can be combined
- Sympatectomy can be considered as adjuvant operation depend on simpatetic nervous system condition
- Amputation can be done if there is no recovery after surgery and a present of gangrene, persistent infection, or chronic pain
- Heparin can be prescribed to prevent embolus
- Intestine resection can be done after restoring blood supply
Arterial Occlusive Disease Nursing Care
Now, we are here, arterial occlusive disease nursing care. After all of the assessment of the patient by knowing the sign and symptoms, nurses could perform nursing care based on the medical and nursing diagnosis. Here are some of the nursing care plan:
- Give patient comprehensive teaching about how to take leg care. Explain about diagnosis examination procedure. Suggest patient to stop smoking and avoid all of contra medication activity
- Pre-operative care (acute period)
- Assess patient’s circulation by assessing distal pulse and assessing skin color and temperature
- Give patient an analgesic
- Give heparin as needed in infusion drops. Use a tool that can determine and maintain drops in infusion
- Change patient’s leg to prevent decubitus or pressure ulcer; do not lift up the leg or compress with warm compress
- Look and pay attention toward fluid and electrolyte balance, monitor intake and output of patient to know patient’s kidney condition (probably urine can decrease about 30 ml/hour)
- If patient has carotid artery occlusion, innomination, vertebra, and subclavia, monitors the sign and symptoms of stroke like paralysis on both hand or half body, and intermittent blindness
- Post-operative nursing care
- Monitor patient’s vital signs. Assess the circulation status continuously by checking skin color and temperature, and assessing the distal pulse. Compare the result before and after surgery. Check the hemorrhage signs like tachycardia and hypotension, and check the bandage to know the patient’s excessive bleeding
- If patient has carotid artery occlusion, innomination, vertebral, or subclavian, always assess the patient’s mental status to know changes in consciousness, muscle strength, and pupil size
- If patient has mesenteric occlusion, use nasogastric pipe to suck the lower part of gaster. Monitor intake and outpur of patient ( low urine output indicate renal artery damage after surgery). Assess the bowel sound to know peristaltic restoration. Abdominal distention indicates intestine ischemia that makes gangrene, so that will need more excision or it can indicate peritonitis
- If patient has aorta bifurcation (saddle block), check distal pulse to know the blood supply. Look at kidney failure or mesenteric artery occlusion like severe abdominal pain, and if cardiac arrhythmia that can increase embolus formation
- If patient has iliac artery occlusion, monitor urine output to know kidney failure after surgery. Do catheter care carefully
- If patient has femoral or femoral artery occlusion , suggest patient not to sit for long time
- After amputation, check the point of leg drainage , note the color, amount, and time of checking. Lift up the point of patient’s leg and give patient an analgesic. Generally, patient will feel pain, explain this condition to him / her.
- If patient is ready to go home, ask patient to know the sign and symptoms of recurrence occlusion. Its sign and symptoms are like pain, pale, paralysis, no pulse that is caused by graft occlusion or other occlusion in certain places. Remind the patient no to use tight clothes.