PAD

Question 1

PAD: Definition

Answer 1

issue of thickening of artery wall

progressive narrowing of arteries

lot of effects on lower extremities

ex of PAD) burger’s disease and reynauds

Question 2

PAD: Risk Factors

Answer 2

• HTN
• Hyperlipidemia
• DM
• Smoking
• Obesity
• Sedentary Lifestyle

Lower Extremity PAD risk factors:

• 70yo old or older
• smoking and/or DM
• known CAD, Carotid or renal artery stenosis

multiple risk factors increase risk dramatically

Question 3

Atherosclerosis

Answer 3

1 leading cause of PAD

causes narrowing of lumen leading to decreased blood flow

progressive stiffening of the arteries which leads to loss of elasticity

with loss of elasticity, arteries can longer constrict or dilate which is how BP is regulated

Question 4

PAD: S/O

Answer 4

• intermittent claudication
• paresthesia in feet when in bed
• pain, improved w/ feet in dependent position
• CR > 3 seconds
• decreased or nonpalpable pulses
• loss of hair in lower extremities
• dry, scaly, mottled, thin, shiny, taut skin
• thick toenails
• cold/cyanotic
• pallor of extremity when elevated
• dependent rubor
• muscle atrophy
• dry ulcers
• gangrene of toes
• CLI (critical limb ischemia)

Question 5

CLI

Answer 5

characterized by 3 things:

• chronic resting pain for more than 2 weeks
• dry arterial leg ulcers
• gangrenous lower extremity

Question 6

PAD: Dx Test

Answer 6

• Segmental Systolic BP
• Doppler
• Ultrasound
• Exercise tolerance testing
• Angiography/arteriography
• Lipid Panal
• Check BG
• ABI: <0.9=PAD, <0.4 = severe PAD

*hyperlipidemia and diabetes can contribute to PAD

Question 7

PAD: Interventions (Pre-Surgery)

Answer 7

• exercise to increase collateral circulation (circulation in smaller vessels surrounding narrowing or blockage)
• avoid crossing leg/restrictive garments as this causing more clamping down on blood vessels and restricts more
• do not elevate above heart (as this causes heart to have to also have to work against gravity to supply blood)
• avoid cold environments, nicotine, caffeine (also cause vasoconstriction)
• medications: anti-platelets (ASA), ACE Inhibitors (cause vasodilation), Plavix (anti-aggregate)

Question 8

PAD: Interventions (Surgery)

Answer 8

If meds aren’t working, move to angioplasty intervention.

Angioplasty: transluminal, laser-assisted, stents placed to widen/open occlusion

Nursing: assess for bleeding at puncture site, check/monitor distal pulses and CR.

Anticoagulant therapy during perioperative period then antiplatelet therapy for 1-3 months to keep clot form forming around stent.