Module 2: Vascular Conditions Flashcards
Peripheral Arterial Disease (PAD)
Progressive, chronic obstruction of blood flow through large peripheral arteries causing arterial occlusion
Risk factors:
- Atherosclerosis (most common)
- Age
- Gender
- Ethnicity
- FHX
CMs:
- Vary depending on tissue involvement and severity of impaired blood flow
- May be asymptomatic
- Identified by a reduced ankle BP
- May present as symptoms of intermittent claudication (ache, cramp, numbness or fatigue that occurs during exercise and is relieved at rest)
Ankle-Brachial Index (ABI)
Interpreting ABI values (Ankle BP/Brachial BP):
1. >1.30 = Non-compressible (stiff) arteries
- 1-1.29 = Normal
- 0.91-0.99 = Borderline PAD
- 0.41-0.9 = Mild to moderate PAD
- 0-0.4 = Severe PAD
PAD: Staging
Stage I (Asymptomatic PAD):
- No claudication/pain experienced
- Bruit may be heard
- Pedal pulses decreased/absent
Stage II (Claudication):
- Muscle pain, burning, and cramping experienced with exercise, and relieved by rest
- Pain is reproducible with the same degree of exercise
Stage III (Rest pain):
- Pain experienced at rest
- Pain often awakens at night
- Pain described as numbness and burning, usually occurring in the distal portion of the extremity
- Pain relieved by putting the extremity in dependent position
Stage IV (Necrosis or gangrene):
- Ulcers and blackened tissue occur on toes, forefoot, or heel
- Gangrenous odor may be present
PAD: Complications
Complications:
- Critical limb ischemia
- Acute limb ischemia (“six P’s)
“Six P’s” of acute limb ischemia:
- Pain
- Pallor
- Pulselessness
- Paresthesia
- Paralysis
- Poikilothermia (cool)
PAD: Management
Medical management of patients with PAD:
- Provide relief of symptoms
- Prevent progression of disease and complications
- Improve quality of life
Meds.:
- Pentoxigylline (Trental) — decreases blood viscosity
- Anti-hypertensives
- Platelet inhibitors (i.e. Aspirin, plavix)
- Statins
- ACE inhibitors
Nonsurgical management:
- Percutaneous transluminal angioplasty: catheter with ballon on end is used to widen narrowed/obstructed arteries
- Laser-assisted angioplasty
- Rotational atherectomy: removes atherosclerotic plaque by forward advancement of a rotating abrasive burr
Surgical management: Revascularization
PAD: Nursing Assessment & Interventions
Nursing assessment of patients with PAD:
- Palpate or doppler all pulses bilaterally
- Visual assessment of feet and limbs
- Temp. of extremities
- Assess muscle tone
Assessment findings:
- Delayed capillary refill
- Decreased or absent pulses
- Loss of hair on lower calf, ankle, foot
- Dry, scaly, mottled skin
- Thick toenails
- Cold, cyanotic extremities
- Pallor of extremity with elevation
- Rubor of the extremity when dependent
- Muscle atrophy
- Ulcers leading to possible gangrene
Interventions of patients with PAD:
- Med. admin. as ordered
- Keep extremities dependent to facilitate arterial blood flow
- Meticulous skin care and prevention
- Encourage activity
- Maintain bleeding precautions
- Maintain open discussion about quality of life
- Refer to palliative care
PAD: Education
Monitoring PAD progression:
- Green (Good): Patient is at baseline (determined by provider)
- Yellow (Call provider): Progressively worse pain, weak pulses, decreased ability to perform ADLs, and S/S of infection
- Red (Emergency): Absent pulses and sensation
Education:
- Avoid crossing legs
- Inspect feet daily
- Report chest discomfort or neurological symptoms immediately
Lifestyle changes:
- DASH diet
- Limit alcohol
- Smoking cessation
- Moderate exercise
Peripheral Vascular Disease (PVD)
Pathophysiology of PVD:
- Inadequate muscle pump function
- Incompetent venous valves
- Pooling of blood, causing dilation of veins
CMs:
- Dilated veins
- Leg edema
- Stasis dermatitis: brown discoloration along the ankles that extends up the calf (relative to the level of insufficiency)
- Stasis ulcers
PVD: Assessment & Management
Assessment of patients with PVD:
- Skin/tissue assessment
- Edema
Management of patients with PVD:
- Elevate legs for 20 min., 4-5 times/day
- Exercise
- Compression stockings
- Topical dermatologic agents
Arterial Leg Ulcers
S/S (Due to hypoxia):
- Pale/cyanotic
- Cool to touch
- Hairless
- Little to no exudate
Gangrene (tissue death caused by lack of oxygen supply):
- Black in color
- Cool temp.
- Malodorous
- Dry
Venous Leg Ulcers
S/S (Due to pooling of blood/fluid overload):
- Dark in color
- Exudative
- Edematous
Cellulitis (inflammation and possibly infection):
- Red in color
- Warm-hot temp.
- Exudative
- Can be malodorous
Leg Ulcers: Management
Management of patients with leg ulcers:
1. Prevent progression
- Wound care as ordered — Consult wound care specialist; wound vac, hyperbaric oxygen (especially for arterial ulcers)
- Chemical (enzymatic) or surgical debridement
- Pain med. admin.
- Manage expectations