1. Methodist LeBonheur Healthcare
Management of the Vasculopath
Donna L. Hunn
RN, MSc, MAN, ANP
February 21, 2010
Methodist LeBonheur Healthcare
Germantown, Tennessee

2. Donna L. Hunn, ANP DISCLOSURES
I have no real or apparent conflicts of interest to report.

4. DIY Stents R Us

6. Management of the Train Wreck Patient

7. Juggling co-morbidities
Cerebrovascular Disease
Carotid Disease
Dementia
Alcohol/Drug Dependence
COPD/Asthma
CHF
Gastritis/esophagitis/PUD
HTN DM
AAA
Renal Insufficiency/Failure
Renal Artery Stenosis
PVD
Post-op

8. Clinical Considerations
From
Head To
Toe

9. Clinical Considerations

10. Clinical Considerations
Physical
Examination

11. Clinical Considerations
Management
& Treatment

12. Cerebrovascular Disease
History of previous CVA/TIA
Previous symptoms
Existing deficits
Baseline exam

13. Post-Procedure Cerebrovascular Complications
Brain injury due to abrupt interruption of blood flow to a brain region
Types
TIA
Symptoms lasting less than 24 hours
Ischemic stroke
Arterial occlusion
Produces focal neurological deficits of sudden onset that persists for more than 1 hour
Hemorrhagic
Arterial rupture

14. Stroke Types
85% Ischemic
15% Hemorrhagic

15. Non-Modifiable Age, Gender, Race, Heredity
Stroke Risk Factors
Non-Modifiable
Age, Gender, Race, Heredity

16. Modifiable Stroke Risk Factors
Hypertension
Cardiac Disease
Atrial Fibrillation
Hyperlipidemia
Hypolipidemia (ICH only)
Diabetes Mellitus
Carotid Stenosis
Prior TIA or stroke
Elevated Homocysteine
Cigarette Smoking
Alcohol Abuse
Physical inactivity

17. Stroke Symptoms Sudden onset of the worst headache of life
Sudden onset dimmed vision or blindness
Sudden onset trouble speaking or understanding (Aphasia or dysphasia)
Sudden onset weakness in half of body
Sudden onset numbness in half of body (Paralysis or paresthesia)
Sudden onset imbalance and incoordination (Ataxia or Vertigo)
Confirm that impairments are due to ischemic or hemorrhagic stroke and not due to another systemic or neurologic illness
Determine advisability for acute treatment with thrombolytics in ischemic stroke
Screen for acute medical or neurological complications of stroke
Provide historical data or other information that can be used to establish vascular distribution of stroke and to provide clues about its likely pathophysiology and etiology
Stabilization of ABCs
Assessment of neurologic deficits and possible comorbidities
Exclude stroke mimics
Determine potential causes for early secondary prevention

18. Stroke Treatment Options
TPA
Neuro-radiology interventions
Surgical treatment

19. Carotid Artery Disease
Symptoms
Diagnosis
Treatment Options

20. Dementia

21. Alcohol/Drug Dependence
                                  
          
                                  
          
Alcohol/Drug Dependence

22. COPD/Asthma

23. CHF

24. Gastritis/Esophagitis/PUD

25. Hypertension

26. Diabetes Mellitus

27. Abdominal Aortic Aneurysm
Symptoms
Diagnosis
Treatment

28. Renal Insufficiency/ESRD

29. Peripheral Vascular Disease

30. Vascular Complications
Pseudoaneurysm
AV Fistula
Hematoma
Retro peritoneal bleed
Diagnosis
Treatment Options

31. ACS in the Post-Op Patient

32. Be Prepared!

33. Thank you!