Vascular disorders and anticoagulation

Vascular items ask you to tell arterial from venous disease, keep a clot from traveling, and match each anticoagulant to its lab, teaching line, and stop-the-drug emergency.

Arterial vs venous disease

Peripheral arteries deliver oxygenated blood out to the limb; veins return it. Narrowed arteries (PAD) starve muscle when demand rises, so walking triggers claudication that eases with rest. Severe disease can hurt even at rest. Pulses are weak or absent, the foot is pale and cool, and dependent rubor (red when dangling) reflects how hard gravity and low inflow are fighting for color. Venous disease fails return: blood pools, the leg swells and aches with dependency, and long-standing leakage leaves brown hemosiderin staining on warmer, edematous skin.

Position follows the plumbing. Elevation and compression assist venous return when ordered; they do not fix an arterial bottleneck and can worsen distal ischemia if the stem is PAD. Protect arterial perfusion teaching (activity as tolerated, foot care, smoking cessation cues in the stem) rather than “put the legs up like venous.” Acute coronary occlusion and the MI reperfusion pathway live in Acute coronary syndromes; this chapter owns limb arterial versus venous patterns.

The distractor that looks tidy is applying venous elevation logic to a claudication stem, or treating brown staining and edema as PAD. Edge case: sudden severe limb pain with a cold, pulseless, pale extremity is acute arterial compromise until proven otherwise: escalate perfusion protection, do not start with “elevate and compress.”

DVT safety

Unilateral calf pain, swelling, warmth, and redness suggest DVT. Do not massage the leg. Anticipate diagnostic confirmation and anticoagulation, encourage prescribed activity limits, and watch for PE (sudden dyspnea, chest pain).

• Measure and compare calves when swelling is subtle.
• Early ambulation and prophylaxis strategies prevent clots; massage never treats one that already formed.

Anticoagulation map

HIT in one sentence

Heparin-induced thrombocytopenia is an immune reaction where platelets fall and paradoxically new clots form. Stop heparin products (including heparin flushes) and escalate for an alternate anticoagulation plan.

Injection and discharge teaching

1. Enoxaparin: abdomen subcutaneous site, pinch skin, do not rub afterward.
2. Warfarin: keep vitamin K intake consistent and keep the INR appointments. Clarify and hold before an invasive procedure when the INR is outside the ordered range.
3. DOACs: no INR ritual like warfarin, but missed doses still matter. Follow the specific miss instructions.
4. All anticoagulants: bleeding precautions (soft toothbrush, electric razor, report black stools, hematuria, severe headache).

Hypertensive emergency

Blood pressure in the severe range with end-organ signs (severe headache, blurred vision, new confusion, chest pain, dyspnea) is an emergency pathway: ABCs, close monitoring, and controlled BP reduction per orders. A silent high number without symptoms is urgent too, but neurologic change moves the client to the front of the line.

The nursing priority is recognizing end-organ involvement and starting the ordered urgent pathway, not offering reassurance that “numbers run high sometimes.” Drop pressure in a controlled fashion. Crashing MAP too fast can underperfuse the brain.

Aneurysm, Raynaud, and thrombolysis bleeding

An abdominal aortic aneurysm may present as a pulsatile mass or back/abdominal pain. Rupture is sudden pain with shock. Keep blood pressure controlled as ordered, avoid rough abdominal palpation, and escalate tearing pain immediately. Postoperative graft clients need circulation checks and bleeding watch.

Raynaud phenomenon is episodic digital arterial spasm with cold or stress: white then blue then red fingers. Teach mittens, avoid cold and vasoconstrictors (including some OTCs), and stop smoking. Thrombolytic therapy (alteplase patterns for stroke or selected PE/MI) turns every puncture site into a bleed risk. Avoid unnecessary sticks, watch LOC for intracranial bleed, and know when to stop and notify. Stroke-specific tPA windows live in Stroke and neuro assessment.

• AAA: report sudden severe back or abdominal pain with hypotension now.
• After thrombolysis: neuro checks and puncture-site vigilance beat casual ambulation.
• Varicose vein teaching: elevation, compression as ordered, avoid prolonged standing when the stem is venous.

Priority map