Disorders of the Veins and Arteries Paper

Physicians and advanced nurse practitioners often manage patients with artery and vein disorders such as deep venous thrombosis and chronic venous insufficiency. Despite the fact that the symptoms of these disorders are highly noticeable, they are often mistaken as signs or symptoms of other medical conditions and this increases the difficulty in making an accurate diagnosis. Therefore, it is important for nurses to understand the pathophysiology of each of these conditions before examining a patient’s symptoms to make a prompt and accurate diagnosis. This paper discusses the pathophysiology, epidemiology, clinical presentation, diagnosis and treatment of deep venous thrombosis and chronic venous insufficiency Disorders of the Veins and Arteries Paper.

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Comparison

In chronic venous insufficiency, there is incompetence of the valves in the lower extremities which may be as a result of prolonged standing, pregnancy, genetics or gender. In normal conditions, the superficial and deep veins which have the bicuspid valves prevent blood from flowing backward such that, blood flows in only one direction towards that heart. However, in chronic venous insufficiency, since the valves are incompetent, they allow the reflux of blood towards the feet resulting to varicose veins (Ballard & Bergan, 2014). In all cases, the high venous pressure results to Chronic Venous Insufficiency. It also worth noting that, in healthy conditions, the calf muscles reduce venous pressure by 70% and upon adjusts to normal after 30 seconds of resting. However, ambulation reduces the venous pressure of patients with CVI by 20% and upon resting; there is a gradual increase in the venous pressure after some minutes (Papageorgiou, 2016).

In comparison, deep venous thrombosis is a disorder that results from blood clots which develop deep in the veins of the leg. More often, the blot clot always starts to form from either above or behind a venous valve. It may occur as a result of damage to the walls of a vein, reduced blood flow or stasis (Papageorgiou, 2016). The formation of the clot is promoted by a disruption in the balance of fibrinolytic and coagulative systems. Since blood venous outflow is prevented by the clots, the resultant effect may either be pulmonary embolism or vascular inflammation (Papageorgiou, 2016). This is contrary to normal conditions where a blood clot may spontaneously resolve following the immediate formation of an anti-clotting agent.

The Difference

In arterial thrombosis, blood often coagulates in the walls of an artery leading to obstruction of blood to the heart and other body organs. The resultant effect is a limited supply of oxygen to vital organs and tissues either leading to a heart attack or infarction. On the contrary, in venous thrombosis; blood coagulates in the venous walls resulting to obstruction from organs such as the lungs and kidneys which have an integral role in blood purification (Ballard & Bergan, 2014).

How the Selected Patient Factor Might Impact the Pathophysiology

The patient factor of choice in this case is family history. Patients who are born in families with a positive family history of deep venous thrombosis or chronic venous insufficiency are at high risk of developing either of the conditions during their lifetime. This is associated with genetics where a carrier gene may be passed to offsprings in the form of a homozygous gene of the condition (Papageorgiou, 2016). Therefore, children with this gene are more likely to have the condition Disorders of the Veins and Arteries Paper.

How to Diagnose based on the Selected Patient Factor

Basing on the selected patient factor of family history, I will make a diagnosis of CVI or deep venous thrombosis by asking a patient about a positive familial history of any of the disorders. This would be followed by a thorough systemic exam of all the systems with prioritization of the musculoskeletal system and the cardiovascular system (Papageorgiou, 2016). In this systemic exam I will check for unilateral or bilateral pedal edema and pain, painful blue inflammation/ discoloration of lower extremities.

If positive, I will perform a Doppler ultrasonography to confirm the diagnosis of DVT and a duplex ultrasound to confirm the diagnosis of CVI. In case of a DVT diagnosis, I will treat by prescribing heparin which is an injectable anticoagulant followed until when the size of the clot decreases and start oral anticoagulants (Bryant, 2014). With the Diagnosis of a CVI, I will manage using compression bandages and stockings, advising on leg elevation and probably surgery depending on severity (Papageorgiou, 2016). Besides, I would advise both patients to undertake regular exercise, healthy balanced diet and reduction of dietary sodium.

References

Ballard, J. L., & Bergan, J. J. (2014). Chronic Venous Insufficiency: Diagnosis and Treatment.

London: Springer London.

Bryant, B. E. (2014). Prophylactic modalities for deep venous thrombosis and pulmonary embolism.

Papageorgiou, N. (2016). Cardiovascular diseases: Genetic susceptibility, environmental factors

and their interaction.

United States. (2013). Diagnosis and treatment of deep venous thrombosis and pulmonary

Embolism: Summary. Rockville, Md.: Agency for Healthcare Research and Quality Disorders of the Veins and Arteries Paper.