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Vol. XIII
No. 3
JOURNAL OF VASCULAR NURSING
PAGE 95
Visceral I s c h e m i a
A 47-year-old m a n was a d m i t t e d to the medicine service with complaints o f nausea a n d vomiting and a 10-pound weight loss over 5 weeks. The patient claimed to have p o s t p r a n d i a l nausea and vomiting, with epigastric abdominal p a i n occurring 30 m i n u t e s after each meal. His a b d o m e n was minimally t e n d e r to palpation. The patient lost pulses to bilateral lower extremities and was s c h e d u l e d for an a o r t o g r a m a n d evaluation of runoff. Access was o b t a i n e d through the left axillary artery b e c a u s e the pulses in the groin w e r e absent. The a o r t o g r a m (Figure 1) revealed c o m p l e t e occlusion o f the aorta distal to the inferior m e s e n t e r i c artery a n d occlusion o f the s u p e r i o r m e s e n t e r i c artery. The inferior m e s e n t e r i c artery was e n l a r g e d likely as a result of the fact that it was collateralizing the territory of the superior m e s e n t e r i c artery and possibly the l o w e r extremities. The celiac access and its b r a n c h e s a p p e a r e d normal. The patient was referred to the Vascular Surgery D e p a r t m e n t for a revascularization procedure. S u b m i t t e d by D o n n a Collins, RN, BSN Clinical Research Nurse D e p a r t m e n t of Veterans Affairs Medical Center, San Francisco
Figure 1. Aortogram demonstrates (a) complete occlusion of aorta, (b) inferior mesenteric artery enlargement, (c) occlusion o f the superior mesenteric artery distal to its origin, and (d) normal celiac access and branches.
Recent Vascular Nursing Publications ~ ArrantsJ. H y p e r i n s u h n e m i a a n d cardiovascular risk. H e a r t Lung 1994;23:118-22. * Barnes D, Eribes C, J u a r b e T, et al. Primary health care a n d p r i m a r y care: :a confusion o f philosophies. Nurs O u t l o o k 1995;43:7-16. . C a m p Y, Davis T, Sailer J, Pierce L. Stop and look: two a p p r o a c h e s to m a n a g e stroke patients. J Neurosci Nuts 1995;27:24-8. 9 Counsell C, Snively C, Gilbert M. Nimodipine: a d r u g for t r e a t m e n t o f vasospasm. J Neurosci Nurs 1995;27:53-5. 9 De Sepulveda L. Effective coping ~ t h stroke disability in a c o m m u n i t y setting: the d e v e l o p m e n t o f a causal model. J Neurosci Nuts 1994;26:193-203. 9 Gallichan M. T r e a t m e n t options for m a n a g i n g diabetes mellitus. Nursing Times 1995;91(8):410-11. 9 Gilchrist B. Treating bacterial w o u n d infection. Nurs Times 1994;90(50):55-6. ~ H ~ e t t A. Vital ingredients. Nurs Times 1994;90(50):64, 66, 68.
9 Hatswell E. Abdominal aortic a n e u r y s m surgery, part 1: an overview and discussion o f i m m e d i a t e perioperative complications. H e a r t Lung 1994;23:228-39. 9 Hatswell E. A b d o m i ~ aortic a n e u r y s m surgery, p a r t 2: m a j o r complications a n d nursing implications. H e a r t Lung 1994;23:337-41. 9 Higgins C. Pathology testing o f b l o o d glucose levels. Nuts Times 1995;91(3):42-4. * Hollinworth H. Diagnosis o f leg ulcers. Nurs Times 1995;91(5):72, 74, 76. - H y d o B. Designing an effective clinical p a t h w a y for stroke. Am J Nuts 1995;95(3):44-51. 9 Jackson L. Q u i c k r e s p o n s e to h y p o t h e r m i a a n d frostbim. Am J Nurs 1995;95(3):52. 9 Meagher-Stewart D. The role of social s u p p o r t in recovery f r o m cardiovascular illness. Can J Cardiovasc Nuts 1994; 5(2):19-29. 9 Messina B. Pulse oximetry: assuring accuracy. J Post Anesth Nurs 1994;9:228-31.
No. 3
JOURNAL OF VASCULAR NURSING
PAGE 95
Visceral I s c h e m i a
A 47-year-old m a n was a d m i t t e d to the medicine service with complaints o f nausea a n d vomiting and a 10-pound weight loss over 5 weeks. The patient claimed to have p o s t p r a n d i a l nausea and vomiting, with epigastric abdominal p a i n occurring 30 m i n u t e s after each meal. His a b d o m e n was minimally t e n d e r to palpation. The patient lost pulses to bilateral lower extremities and was s c h e d u l e d for an a o r t o g r a m a n d evaluation of runoff. Access was o b t a i n e d through the left axillary artery b e c a u s e the pulses in the groin w e r e absent. The a o r t o g r a m (Figure 1) revealed c o m p l e t e occlusion o f the aorta distal to the inferior m e s e n t e r i c artery a n d occlusion o f the s u p e r i o r m e s e n t e r i c artery. The inferior m e s e n t e r i c artery was e n l a r g e d likely as a result of the fact that it was collateralizing the territory of the superior m e s e n t e r i c artery and possibly the l o w e r extremities. The celiac access and its b r a n c h e s a p p e a r e d normal. The patient was referred to the Vascular Surgery D e p a r t m e n t for a revascularization procedure. S u b m i t t e d by D o n n a Collins, RN, BSN Clinical Research Nurse D e p a r t m e n t of Veterans Affairs Medical Center, San Francisco
Figure 1. Aortogram demonstrates (a) complete occlusion of aorta, (b) inferior mesenteric artery enlargement, (c) occlusion o f the superior mesenteric artery distal to its origin, and (d) normal celiac access and branches.
Recent Vascular Nursing Publications ~ ArrantsJ. H y p e r i n s u h n e m i a a n d cardiovascular risk. H e a r t Lung 1994;23:118-22. * Barnes D, Eribes C, J u a r b e T, et al. Primary health care a n d p r i m a r y care: :a confusion o f philosophies. Nurs O u t l o o k 1995;43:7-16. . C a m p Y, Davis T, Sailer J, Pierce L. Stop and look: two a p p r o a c h e s to m a n a g e stroke patients. J Neurosci Nuts 1995;27:24-8. 9 Counsell C, Snively C, Gilbert M. Nimodipine: a d r u g for t r e a t m e n t o f vasospasm. J Neurosci Nurs 1995;27:53-5. 9 De Sepulveda L. Effective coping ~ t h stroke disability in a c o m m u n i t y setting: the d e v e l o p m e n t o f a causal model. J Neurosci Nuts 1994;26:193-203. 9 Gallichan M. T r e a t m e n t options for m a n a g i n g diabetes mellitus. Nursing Times 1995;91(8):410-11. 9 Gilchrist B. Treating bacterial w o u n d infection. Nurs Times 1994;90(50):55-6. ~ H ~ e t t A. Vital ingredients. Nurs Times 1994;90(50):64, 66, 68.
9 Hatswell E. Abdominal aortic a n e u r y s m surgery, part 1: an overview and discussion o f i m m e d i a t e perioperative complications. H e a r t Lung 1994;23:228-39. 9 Hatswell E. A b d o m i ~ aortic a n e u r y s m surgery, p a r t 2: m a j o r complications a n d nursing implications. H e a r t Lung 1994;23:337-41. 9 Higgins C. Pathology testing o f b l o o d glucose levels. Nuts Times 1995;91(3):42-4. * Hollinworth H. Diagnosis o f leg ulcers. Nurs Times 1995;91(5):72, 74, 76. - H y d o B. Designing an effective clinical p a t h w a y for stroke. Am J Nuts 1995;95(3):44-51. 9 Jackson L. Q u i c k r e s p o n s e to h y p o t h e r m i a a n d frostbim. Am J Nurs 1995;95(3):52. 9 Meagher-Stewart D. The role of social s u p p o r t in recovery f r o m cardiovascular illness. Can J Cardiovasc Nuts 1994; 5(2):19-29. 9 Messina B. Pulse oximetry: assuring accuracy. J Post Anesth Nurs 1994;9:228-31.