General Human Anatomy

General Human Anatomy Lecture Archives from University of Berkeley

				Mon 8/27	Organization of Body
				Wed 8/29	Skeletal System 1
				Fri 8/31	Skeletal System 2
				Wed 9/5	Skeletal System 3
				Fri 9/7	Skeletal System 4
				Mon 9/10	Skeletal System 5
				Wed 9/12	Skeletal System 6
				Fri 9/14	Skeletal, Muscular Systems
				Mon 9/17	Muscular System 1
				Wed 9/19	Muscular System 2
				Fri 9/21	Muscular System 3
				Mon 9/24	Hematology 1
				Wed 9/26	Hematology 2
				Fri 9/28	Hematology, Cardiology
				Mon 10/1	Cardiology
				Wed 10/3	Blood Vascular System 1
				Fri 10/5	Blood Vascular System 2
				Mon 10/8	Lymphatic System
				Wed 10/10	Respiratory System 1
				Fri 10/12	Review
				Mon 10/15	Exam 1
				Wed 10/17	Respiratory System 2
				Fri 10/19	Neurohistology
				Mon 10/22	Neurohistology, Development of Nervous System
				Wed 10/24	Development of Nervous System
				Fri 10/26	Spinal Cord and Nerves
				Mon 10/29	Peripheral Nerves
				Wed 10/31	Sensory and Motor Pathways
				Fri 11/2	Motor Pathways and Forebrain
				Mon 11/5	Forebrain
				Wed 11/7	Eye
				Fri 11/9	Review
				Fri 11/16	Digestive System 1
				Mon 11/19	Digestive System 2
				Wed 11/21	Digestive System 3
				Mon 11/26	Urinary System
				Wed 11/28	Endocrine System
				Fri 11/30	Endocrine System - Female Reproductive System
				Mon 12/3	Female Reproductive System
				Wed 12/5	Male Reproductive System
				Fri 12/7	Integumentary System
				Mon 12/10	Review

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Introduction to Human Anatomy and Physiology 38 videos

Introduction to Human Anatomy and Physiology 38 videos

Full video episodes: Introduction to Human Anatomy and Physiology, a college course produced by Distance Education at Utah Valley State College in the USA. Instructor: Michael Shively. Producers: John Krutsch, Senior Director. Jared Stein, Director of Instructional Design Services, Travis Begay, Creative Director, Will McKinnon, Technical Director, Channing Lowe, Production Director.

http://www.uvsc.edu/disted/videos/ZOOL1090_rss.xml

If the above link didn'twork use the following links
http://www.uvsc.edu/disted/decourses/zool/1090/tv/shivelmi/media/ZOOL1090-01.mp4
Change 01 to 02, 03 etc upto 38
http://www.uvsc.edu/disted/decourses/zool/1090/tv/shivelmi/media/ZOOL1090-38.mp4

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The Shoulder Exam video

The Shoulder Exam video from University of Virginia


Andrew Lockman, M.D.

Click to view Right click and save as to download

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Cardiac Examination

Cardiac Examination
Lecture Notes & Video

The Cardiac Exam
Introduction
Learning Objectives
Sections of Cardiac Exam
CardiacExamVideo
Inspection: Jugular VenousPulse
Phases of Jugular Venous Pulse
Measuring the Jugular Venous Pulse
Estimating Central Venous Pressure
Diagnosing Complete Heart Block
Locations
Location of Heart in the Chest
Location of Point of Maximum Impulse
The Four Cardiac Listening Areas
Methods and Tools
Palpation of Parasternal Area and Base
Qustion 1
Question 2
Auscultation of the Heart
Auscultation: What Makes Noises in the Heart
S1 and S2
S1
Question 3
S2
S2 Splitting
Rhythm
Gallops: S3 and S4
S3
S4
Question 4
Heart Murmurs
How to Describe Heart Murmur
Heart Murmur Intencity
Heart Murmur Timing
Heart Murmur Quality
Finding the Areas to Auscultate
Common Systolic Murmur
Innocent Flow Murmur
Mitral Regurgitation
Aortic Stenosis
Mitral Valve Prolapse
Evidence Based Lesson
Question 5
Comon Diastolic Murmur: Aortic Insufficiency
Friction Rub
Final Test

http://www.med-ed.virginia.edu/courses/pom1/pexams/CardioExam/

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Examination of the Upper Extremity video

Principles of Musculoskeletal Examination and Examination of the Upper Extremity
Video & Lecture Notes.

Learning Objectives
Instructions
ExamVideo
Principles and Techniques
Inspection
Palpation
Range of Motion
Strength Testing
Special Maneuvers
Quiz
Question 1
Question 2
Question 3
Question 4
Shoulder Joint
Bony Anatomy
Shoulder Surface Anatomy
Inspection
Palpation
Range of Motion
Strength Testing
Special Maneuvers
Quiz
Question 5
Question 6
Elbow Joint
Surface Anatomy
Inspection
Palpation
Range of Motion
Strength Testing
Quiz
Question 7
Question 8
Hand and Wrist
Surface Anatomy
Inspection
Palpation
Range of Motion
Strength Testing
Special Maneuvers
Quiz
Question 9
Question 10
Final Test

http://www.med-ed.virginia.edu/courses/pom1/pexams/UpExtrExamClosed/

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Hematology Laboratory Instructional Videos

Hematology Laboratory Instructional Videos from University of Virginia

Standard Venipuncture Procedure
Click to view or Right click and save as to download


Butterfly Procedure
Click to view or Right click and save as to download


How to Prepare a Blood Smear
Click to view or Right click and save as to download


Automated CBC: What really happens in the lab
Click to view or Right click and save as to download

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Donation After Cardiac Death

Donation After Cardiac Death
Presentation by: Barb Nelson-Agnew, Hospital Liaison
Andrea Tighe, RN, CPTC
Organ & tissue donation & transplantation.

Federally designated organ procurement organization

Transplantation Works…
The Growing Need For Transplantable Organs
HHS - Organ Donation & Transplantation Breakthrough Collaboratives
Conversion/Donation Rates
HRSA Medal of Honor
LifeSource Donation Activity
Organs transplanted from Local Donors
Donation after Cardiac Death Donor Profile
Devastating Brain Injury / Ventilator Dependent
BRAIN DEATH EXAMINATION
Surgical recovery

Patient evaluated as potential DCD candidate
Patient Evaluation for DCD Suitability
Respiratory Drive Assessment
Operating Room Set-up and Instrumentation
Withdrawal of Treatment / Roles
Organ Recovery
Recovery Team
Operating Room Staff
Donation Coordinators
Case Review #1
Case Review #2
Case Review # 3

Donation After Cardiac Death.ppt

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Recent Developments In Allogeneic Hematopoietic Cell Transplantation

Recent Developments In Allogeneic Hematopoietic Cell Transplantation
Presentation by:Steven M Devine M.D.
Director, Blood and Marrow Transplant Program


Annual Numbers of Blood and Marrow Transplantations, 1970-2006

HEMATOPOIETIC STEM CELL TRANSPLANTS AT OSU BY CALENDAR YEAR
Indications for Hematopoietic Stem Cell Transplantation in North America
Allogeneic HSC Transplantation

Definitions

* Allogeneic
o Refers to the use of bone marrow, mobilized blood, or cord blood from a genetically different donor (family member, unrelated volunteer, banked cord blood)
* Autologous
o Refers to the use of the patients own bone marrow or mobilized blood
Allogeneic Versus Autologous Stem Cell
Benefits of Allogeneic Transplantation
Drawbacks of Allogeneic Transplantation
Who are Allogeneic Stem Cell Transplant Candidates?
Complications of Allogeneic Transplantation
Causes of Death after Transplantations Done in 2001-2006
Age of HSCT recipients
Trends in Allogeneic Transplantation
Current Challenges

* Reducing Regimen Related Toxicity
* Reducing Risk of GVHD and Rejection
* Enhancing Immune Reconstitution
* Expanding Options for Patients Without Matched Sibling Donors
* Refining Criteria for Transplantation

BMT vs Conventional Tx for AML with poor risk cytogenetics

GVL in Leukemia
Considerations for allograft candidates
Stem cell sources
Summary of randomized trials comparing graft source
Cord Blood Transplantations
Reduced Intensity Stem Cell Transplantation
Allogeneic Transplantations using Reduced Intensity Conditioning by Donor Type Registered
High Intensity versus Low
GVL Effect after non-myeloablative transplantation
Transplantation Considerations in patients with AML
Balancing Regimen efficacy with toxicity
Balancing efficacy and toxicity
Reduced Intensity Allogeneic Transplantation
Considerations for allograft candidates
Acute GVHD Prophylaxis
What are the benefits of T-cell depletion?
What are the drawbacks of T-cell depletion?
Transplantation Considerations in patients with AML
Graft versus Tumor Effects
Current Challenges

* Enhancing Immune Reconstitution
* Reducing Risk of GVHD and Rejection
* Reducing Regimen Related Toxicity
* Expanding Options for Patients Without Matched Sibling Donors
* Refining Criteria for Transplantation

Alternative Donor Allograft Sources
Refining Criteria for Transplantation
Clinical Research Activity in BMT

Recent Developments In Allogeneic Hematopoietic Cell Transplantation.ppt

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Immunology Presentations

Introduction to Immunology

Antibody Structure and B Cell Diversity

Antigen Recognition by T Lymphocytes

Development of B Lymphocytes

Development of T Lymphocytes

T Cell Mediated Immunity (CMI)

Immunity Mediated by B Cells and Antibodies

Defense Mechanisms of Human Host

Failure of Human Defense Mechanisms

HIV Infection and AIDS

Allergy and Hypersensitivity

Autoimmunity and Autoimmune Diseases

Case Studies in Autoimmunity

Rheumatoid Arthritis

Systemic Lupus Erythymatosus

Case Studies in Autoimmunity

Multiple Sclerosis

Myasthenia Gravis

Vaccines and Vaccination

Transplantation of Tissue and Organs

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Umbilical Cord Blood transplantation in acute leukemias

Umbilical Cord Blood transplantation in acute leukemias
Presentation by: Pablo Ramirez, M.D.
DiPersio Lab
Grand Rounds, March 2009

Topics covered are:
Clinical case
High risk cytogenetics: matched donor vs chemo
Impact of HLA mismatch on OS
Unrelated cord donor
Cord blood-derived stem cell source
First human infusion
Collection, processing and storage of UCB
Biology UCBT:
more questions than answers
Transplantation with UCB: children
Outcomes unrelated UCB vs BM: children with acute leukemia CIBMTR-USA
Probability of LFS
Transplantation with UCB: adults
Comparison between UCBT-uBMT:
European database analysis
Neutrophil recovery
Comparison between UCBT-uBMT American database analysis
Neutrophil recovery
Platelet recovery
Comparison of uBM, PB and UCB:
Conclusions from these studies and other databases
Approaches to improve rates and kinetics of engraftment
Transplantation of 2 partially HLA-matched UCB units (U of MN):
Myeloablative
Demographics
Neutrophil engraftment
Always one cord predominated: Potential contributors
GVHD
Hematologic recovery
Netrophils
Platelets
Chimerism
Higher incidence of grade II-IV aGVHD
Risk factors for TRM
Conclusions
Unresolved questions in UCBT


Umbilical Cord Blood transplantation in acute leukemias.ppt

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Immune Modulation for Prevention of Type 1 Diabetes

Immune Modulation for Prevention of Type 1 Diabetes
Presentation by: Peter A. Gottlieb, MD
Barbara Davis Center
University of Colorado Health Sciences Center Denver, CO


Main Points

* Type 1 diabetes is an autoimmune disease
* It is a predictable disease with different phases
* Approaches to prevention and cure are possible.
* New insulins, medications and devices will improve therapy in the coming decade.

Regulatory Cells
Cellular Mechanics of Autoimmune Type 1 Diabetes
Progression to Diabetes vs Number of Autoantibodies
Type 1a Diabetes: An Autoimmune Disorder
Prevention of Type 1 diabetes
Secondary Prevention
EDIC: Long Term Benefit of Intensive Treatment
Diabetes Control and Complications Trial
Past Trials in New Onset Type 1
Metabolic Effects of AZA and Prednisone at 1 year in New Onset T1DM
Ongoing and Proposed Non-antigen Specific Immunotherapy Trials in New Onset Type 1 DM
Preservation of Pancreatic Production of Insulin (POPPI) study
(Mycophenolate Mofetil and Zenapax)
Mycophenolate Mofetil (MMF)
MMF (CellCept)
MMF Toxicities
Activated T cell
POPPI Study
Potential Benefits of the Study
Control Group
Before treatment
1 wk after treatment
Induction of IL-10+CD4+ cells in vivo following
Treatment with hOKT3g1(Ala-Ala)
Antigen Specific Therapy
Insulin
Altered Peptide Ligand
Recent and Ongoing Antigen-specific Immunotherapy Trials in T1DM
Prediabetes
Primary Prevention
Rationale for Oral Insulin
Oral Antigen Protocol
Nutritional Intervention to Prevent
Mechanistic Studies
Key Elements of Successful Clinical Trials

Immune Modulation for Prevention of Type 1 Diabetes.ppt

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Pregnancy & Renal Transplantation

Pregnancy & Renal Transplantation
Presentation by:Alicia Notkin

Case Study:

A 30 year old female w/ ESRD, s/p LDRT from her mother 3 years prior, comes to clinic for f/u. She is fully compliant with her regimen of prednisone 5mg daily, tacro 3mg q12h, and MMF 1g q12h. Her renal function has been stable, with a Cr ~ 1.2 mg/dl and a negative UA. She wishes to become pregnant. How should she be advised & managed?


Outline

* Pregnancy in patients with chronic kidney disease
* Pregnancy in patients on dialysis
* Pregnancy in renal transplant patients
* Transplantation medications in pregnancy
* Recommendations
* Other issues: graft dysfunction in pregnancy, donor & pregnancy, male fertility

Pregnancy in patients with chronic kidney disease: patient considerations
Pregnancy in patients with chronic kidney disease: other patient considerations
Pregnancy in patients with chronic kidney disease: fetal outcomes
Pregnancy in patients on dialysis
Pregnancy in renal transplant patients: outcomes
Transplant medications: steroids
Transplant medications: cyclosporine
Transplant medications: tacrolimus
Transplant medications: sirolimus
Transplant medications: mycophenolate mofetil
Transplant medications: azathioprine
AST Consensus Conference on Reproductive Issues & Transplantation 2005
Recommendations: key points
Graft dysfunction in pregnancy
OK to biopsy??
Issues for donor & male recipient

References

Pregnancy & Renal Transplantation.ppt

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RBC Disorders

RBC Disorders
Presentation by: Joyce Smith RN, BSN

* Decreased Production of RBC
* Iron Deficiency Anemia
* Vitamin B12 Deficiency Anemia
* Folic Acid Deficiency Anemia
* Aplastic Anemia

Fe Deficiency Anemia
* Common world wide
* Affects 10-30% of population in US
* Common in premenapausal woman, infants, children, adolescents, & elderly
* Develops slowly

A&P

* Occurs when supply of Fe is too low for optimal RBC formation
* Iron RDA
* 10mg/d M,
* F 12-49 15 mg
* Typical American diet provides 10 to 20 mg/d
* Many woman consume only 12.4mg/d

Cause of Development

* Inadequate absorption or excess Fe loss
* Inadequate dietary intake of foods high in Fe
* Principal cause in adults acute or chronic bleeding
* Secondary to trauma
* Excessive menses
* GI bleeding
* Blood donation

Diagnostics

* Hgb Panic value < 5g/dl
* Hgb level can drop to 3.6g/dl
* Total RBC count rarely below 3 million/dl
* MCH < 27 pg
* MCHC 20 to 30 g/dl
* Serum Fe as low as 10mcg./dl
* HCT < 47 ml/dl M
* HCT < 42 ml/dl F
* Fe binding capacity 
* Serum ferritin level 
* Bone marrow may also be indicated

Symptoms

* Pallor, glossitis
* Dizziness, irritability, numbness & tingling in limbs, fatigue, decreased concentrated & HA
* Tachycardia & dyspnea on exertion
* Sensitivity to cold, brittle hair & nails
* Atrophic glossitis, stomatitis, dysphagia

Treatment
Nursing Care
Folic Acid Deficiency
Food Sources
Clinical Manifestations
Treatment
Aplastic Anemia
Clinical manifestations
Treatment of Aplastic Anemia
Treatment
RBC Disorders
Polycythemia
Clinical Manifestations
Diagnostic Tests
Management

Hematology.ppt

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Hematology

Hematology
By: Joyce Smith RN BSN
Introduction

* Red Blood Cell Disorders
* White Blood Cell Disorders
* Coagulation Disorders
* Clotting Factor Disorders

RBC Destruction
Sickle Cell Disease
Sickle Cell Crisis
Diagnostic Tests
Clinical Manifestations
Health History
Assess
General Management
Drug Therapy
Immunohemolytic Anemia
or Autoimmune Hemolytic Anemia
Immunohemolytic Anemia
or Autoimmune Hemolytic Anemia
Treatment
Vitamin B 12 Deficiency
Diagnostic Tests
Treatment
Folic Acid Deficiency
Food Sources
Clinical Manifestations
Treatment

Hematology.ppt

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Hematological System

Hematological System
Presentation by:Joyce Smith RN BSN

Functions of Blood
Bone Marrow
Blood Components
Spleen
Lymph System
Liver
Normal Clotting Mechanism
Gerontological Considerations
Anticoagulants
Thrombolytic
Key Symptoms
Health History
Physical Assessment
Skin
Head & Neck
Respiratory
Cardiovascular
Renal & Urinary
Musculoskeletal
CNS
Psychosocial
Complete Blood Count (CBC)
Reticulocyte Count
Hemoglobin Electrophoresis
Coombs’ Test
Serum Ferritin
Bleeding Time
Prothrombin Time
International Normalized Ratio
Partial Thromboplastin Time
Bone Marrow Aspiration
Nursing Responsibilities

Hematological System.ppt

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Coronary Artery Disease and Acute Myocardial Infarction

Coronary Artery Disease and Acute Myocardial Infarction
Presentation by: Joyce Smith RN, BSN

Coronary Artery Disease
Signs and Symptoms
Medical Treatment
Myocardial Infarction
Complications of an MI
Risk Factors
Causes
Assessment for Chest Pain
EKG Changes of an MI
Medical Treatment
Angioplasty
Nursing Interventions For MI
Cardiopulmonary Arrest
Objective Symptoms
Diagnostic Tests

* History
* Physical
* EKG
* Enzymes after emergency treatment
Implementation

* CPR
* ABC’s
* IV for administration of drugs
* ABG’s frequently
* Give Lidocaine, etc.
* Watch for hypoxia, arrythmias, acidosis, and hypokalemia
* Monitor labs
* Assess LOC, skin color, temp, pulses, seizures, pupil changes
* Observe for complications (rib fractures, tamponade, pneumothorax)
* Give emotional support to the family

Coronary Artery Disease and Acute Myocardial Infarction.ppt

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Disorders of Venous Circulation

Disorders of Venous Circulation

Presentation contains:
Venous Thrombosis, Chronic Venous Insufficiency,
Varicose Veins
Pathophysiology: Virchow’s Triangle
Deep Vein Thrombosis (DVT)
DVT Manifestations
Homan’s Sign
Major Complications of Thrombophlebitis
Chronic venous insufficiency
Pulmonary embolism
Superficial Vein Thrombosis (SVT)
SVT Manifestations
Collaborative Care: Thrombophlebitis
Lab & Diagnostics
Conservative Therapy: SVT
Conservative Therapy: DVT
Medications
Anti-inflammatories
Anticoagulants
Thrombolytics
Antibiotics
Anti-inflammatories
Surgery
Nursing Process
Nursing Diagnoses
Pain
Ineffective Tissue Perfusion
Impaired Physical Mobility
Other Nursing Dx
Chronic Venous Insufficiency
Clinical Manifestions
Complication: Ulcer development
Assessment: Lab & Diagnostics
Possible Nursing Diagnoses
Nursing Interventions/Teaching
Other Interventions
Medications: Topical Agents &/or Antibiotics
Varicose Veins
Pathophysiology
Normal vs Abnormal
Collaborative Interventions


Disorders of Venous Circulation.ppt

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Drugs for Circulatory Disorders

Drugs for Circulatory Disorders

Presentation covered the following topics.

* Drugs used are to maintain, preserve or restore circulation
* Anticoagulants & antiplatelets (antithrombotics), thrombolytics, antilipemics, peripheral vasodilatiors
* Anticoagulants - prevent formation of clots that inhibit circulation
* Antiplatelets - prevent platelet aggregation
* Thrombolytics (clot busters) - attack/dissolve formed clots
* Antilipemics - decrease bld. lipid concentration
* Peripheral vasodilators - promote dilation of vessels narrowed by vasospasm

Thrombus Formation
Risk Factors for Deep Vein Thrombophlebitis and Thromboembolism
Anticoagulants
Heparin
Circulatory - LMWH
LMWHs
Warfarin
Antiplatelet Drugs
Thormbolytics
Circulatory - Thrombolytics
Antilipemics
Circulatory - Antilipemics
Peripheral Vasodilators

Drugs for Circulatory.ppt

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Hypertension and Peripheral Vascular Disease

Hypertension and Peripheral Vascular Disease
Presentation by:EMS Professions, Temple College

Following topics are discussed in this presentation
Hypertension
Epidemiology
Primary Hypertension
Secondary Hypertension
Hypertension Pathology
Signs/Symptoms
HTN Medical Management
Categories of Hypertension
Hypertensive Crisis
Causes
Signs/Symptoms
Hypertensive Crisis Can Cause
Hypertensive Crisis Management
Drug Therapy Possibilities
Hypertensive Crisis Management
Syncope
Vasovagal Syncope
Cardiogenic Syncope
Postural Syncope
Tussitive Syncope
Micturation Syncope
Syncope History
Syncope Management
Peripheral Vascular Disease
Deep Vein Thrombophlebitis
Varicose Veins
Peripheral Atherosclerosis
Deep Vein Thrombophlebitis
Varicose Veins
Aortic Aneurysm
Thoracic Aortic Aneurysm
Dissecting Aortic Aneurysm
Abdominal Aortic Aneurysm
Aortic Aneurysm Management
Pulmonary Embolism
Causes

Hypertension and Peripheral Vascular Disease.ppt

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Peripheral Vascular System

Peripheral Vascular System
Presentation by:Joyce Smith RN, BSN

Following topics are covered in this presentation
Peripheral Vascular Disease
Patho
Data Collection for PVD
Diagnosis

* Arteriography – (not widely used), inject dye onto arterial system
* Segmental systolic B/P measurements – noninvasive, inexpensive method which uses measurements of B/P at intermittent segments of the lower extremities
* Doppler ultrasound – sound waves to identify changes in the walls of the blood vessels
* Plethsmography – used to determine venous thrombus and blood flow through the veins
Interventions

* Non-surgical
* Elastic stockings/intermittent pneumatic compression
* Teach client to avoid tissue trauma – wear shoes, inspect feet, trim nail straight across
* Exercise
* Positioning
* Promoting vasodilation
* Drug therapy
* PCTA
* Laser assisted angioplasty
* Anthrectomy
* Surgical
* Arterial revascularization – surgically bypassing the occlusion with a saphenous vein or synthetic material
* Pre-op care
+ NPO, vitals, pulses, IV, Foley, A-line, etc
* Post-op care
+ Watch circulation and B/P
+ May need anticoagulation
+ No crossing legs, no ROM of limb, may be on bed rest
+ No dependent position for extended period
+ May elevate extremity
+ Pain RX, may need vasodilators, nitroglycerine, NSAIDS

Arterial Embolism

* More common in the lower extremity
* Life threatening
* May break loose and travel, causing other occlusions
* 6 P’s or S/S
* Pain
* Pallor
* Pulselessness
* Paresthesia
* Paralysis
* Poikilothermia (coolness)
* Immediate treatment to prevent permanent damage or loss of extremity
* 1st intervention is Heparin
* May need embolectomy
* Can be done with arthroscopy
* May need to open and remove embolus
* Post-op care involves watching for color changes and signs of occlusion
* May have spasms and swelling
* Also may develop compartment syndrome

Raynaud’s Disease

* Caused by vasospasms of the arterioles and arteries of the upper and lower extremities
* Affects hands but can be on toes and tip of nose
* S/S – chronic, intermittent, numbness, coldness, pain and pallor
* Women 16-40 years of age
* Cause is unknown
* After spasm the skin becomes reddened and hyperemic
* Diagnosis is based on symptoms
* Treatment involves relieving the vasospasms and prevent pain
* Vasodilators
* Topical nitroglycerine
* Calcium channel blockers
* ACE inhibitors
* Nursing care
* Pain control
* Teach client to avoid stimuli which may trigger episode (stress, cold air temp, smoking)
* Keep extremity warm
* Use hair dryer, warm H2O, etc
* Protect area from trauma

Buerger’s Disease
(Thromboangiitis Obliterans)

* Uncommon occlusive disease of the medium and small arteries and veins
* The distal upper and lower limbs are most frequently affected
* In young adult men who smoke
* May result in fibrosis and scarring of the perivascular system
* Pain in the arch of the foot is the first clinical indicator
* Pain may be ischemic in nature
* Clients have increased sensation to cold
* Pulses may be diminished in the distal extremities and are cool and red or cyanotic
* Ulcerations and gangrene may occur
* Treatment is same as with Raynaud’s

Aneurysms

* Permanent localized dilation of an artery
* Area stretches and weakens, and balloons out
* As it enlarges the risk of rupture increases
* Can be acquired or congenital
* Acquired are caused by trauma, arteriosclerosis, or infection
* Abdominal aorta is most prevalent site –(AAA are about 75%)
* S/S
* Most are asymptomatic
* May be discovered on routine exam
* Pain may be caused by the pressure on organs surrounding the aneurysm
* May notice a pulsation in the upper abdomine or by hearing a bruit
* Clients with a rupturing AAA are critically ill
* Will go into hemorrhagic shock (hypovolemic)
* Hypotension
* Diaphoresis, mental confusion, oliguria, dysrhythemias
* Retroperitioneal hemorrhage produces flank bruising
* Abdominal distention may occur
* Shortness of breath, hoarseness, and difficulty swallowing may be signs of a thoracic aneurysm
* Diagnosis
* Abdominal or lateral of the spine
* CT scan
* Ultrasound
* Interventions
* Nonsurgical
+ Monitor growth
+ Maintain B/P
+ Frequent CT scans
* Surgical
* Elective mortality = 2-5%
* Emergency = 50%
* AAA resection with graph
* Preop – as described for vascular surgery
* Postop –client in ICU
+ Monitor vitals, A-line, EKG, etc.
+ Watch for
# MI, graph occlusion, hypovolemia, renal failure, respiratory distress, paralytic ilius
* Symptom
* Pain which is a tearing, ripping, stabbing that tends to move from the point of origin
* Pain may be in the anterior chest, back, neck, throat, jaw or teeth
* Emergency care
* Elimination of pain
* Control B/P – 100 to 120 systolic or lower
* If uncomplicated may be conservative treatment
* If dissection is in the proximal aorta, require CPB

Aortic Dissection

* Not a rupturing aneurysm
* Dissecting hematoma or aortic dissection
* Caused by a sudden tear in the aortic intima
* Hypertension is a contributing factor
* Relatively common - 2000/year in the US
* Ascending aorta and the descending thoracic aorta are the most common sites

Varicose Veins

* Dilated, tortuous leg veins with back flow of blood caused by incompetent valve closure, which results in venous congestion and vein enlargement
* Usually affects the saphenous vein and its branches
* Causes
* Unknown but may be R/T congenital weakness of valve
* Thrombophlebitis
* Venous stasis – pregnancy, prolonged standing
* Familial tendency
* Data Collection
* Subjective
+ Aching
+ Cramping and pain
+ Feeling of heaviness
* Objective
+ Palpable nodules
+ Ankle edema
+ Dilated veins
+ Pigmentation of calves and ankles
* Diagnosis
* History and physical
* Venogram
* Trendelburg’s test –demonstrates the backward flow of the blood in the venous system
* Treatment
* Conservative
* Avoid standing or sitting for long periods of time
* Weight reduction
* Support hose
* No restrictive clothing
* Surgical treatment
* Vein stripping, ligation or sclerosing
* Postop care
+ Pain RX
+ Elevate leg
+ Watch for bleeding
+ May need to rewrap leg q shift from toes to thigh
+ Watch for CMS

Venous Thrombosis
(plebitis, thrombophlebitis, deep vein thrombosis)
* Phlebitis is inflammation
* Thrombophlebitis is a clot in the vein
* DVT is presence of a clot in a deep vein rather than a superficial vein
* Risk factors
* Bedrest
* Surgery
* Leg trauma with cast
* Venous insufficiency
* Obesity
* Oral contraceptives
* Malginancy
* Treatment
* Anticoagulant, bedrest, elevate extremity, warm soaks, TED hose
* Nursing care
* Control pain
* Watch skin
* Help anxiety
* Assess tissue perfusion
* Watch respiratory status for embolus
* S/S
* May not have any signs
* With obstruction:
+ Edema
+ Warmth
+ Pain, tenderness
+ Positive Homans’ sogn
* Diagnosis
* Venogram
* Doppler

Peripheral Vascular System

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Caring For Clients With Infectious & Inflammatory Disorders

Caring For Clients With Infectious & Inflammatory Disorders Of The Heart & Blood Vessels

Presentation by:Jeanette Hollub, BSN, RN

Rheumatic fever & rheumatic carditis
Infective endocarditis
Myocarditis
Cardiomyopathy
Pericarditis
Thrombophlebitis
Thromboangiitis obliterans
General nutritional considerations
General pharmacological considerations
General gerontologic considerations

Infectious & Inflammatory Disorders Of The Heart & Blood Vessels.ppt

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Peripheral Vascular Disease

Peripheral Vascular Disease
Presentation by: Cynthia Bartlau, MSN, RN, PHN

Topics discussed in this presentation.
Peripheral Vascular Disorders - PVD
DOPPLER
Physical Assessment of PVD
Risk Factors-PVD
Raynaud’s & Buerger’s DZ
Buerger’s dz (arterial/venous)
TX-management of Buerger’s Disease
Buerger-Allen exercises
Varicose Veins-dilated tortuous veins, with incompetent valves
TX & Management of Varicosities
Disorders of veins-most common is thrombophlebitis formation of a thrombus (clot)in association with inflammation of vein
Thrombophlebitis- superficial or deep (DVT)?
Dx- thrombophlebitis-Various ( venogram, non-invasive doppler studies, coagulation studies PT,PTT,platelet ct., bleeding time, INR, arteriogram, Lung scan if emboli?
More general guidelines
Lab values for Coumadin/Heparin


Peripheral Vascular Disease.ppt

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