Peipheral arterial diease and venous insufficiency Flashcards
risk factors for atherosclerosis and PAD
nicotine diabetes diet HTN obesity stress sedentary lifestyle high cholesterol age > 60 gender familial predisposition
intermittent claudication
pain with walking
pain in arterial insufficiency
intermittent claudication to sharp, unrelenting constant
pain in venous insufficiency
aching, throbbing, cramping
pulses in arterial insufficiency
absent or diminished
pulses in venous insufficiency
present, but may be difficult to palpate through edem
skin in arterial insufficiency
dependent rubor; elevation pallor of foot; shiny skin; cool/cold temperature; loss of hair over toes and foot; nails thickened
skin in venous insufficiency
pigmentation in gaiter area; skin thickened and tough; may be reddish blue (dermatitis)
location of ulcer in arterial insufficiency
tips of toes, toe webs, heel or other pressure areas if confined to bed
location of ulcer in venous insufficiency
medial malleolus, lateral malleolus, or anterior tibial area
pain of ulcer in arterial insufficiency
very painful
pain of ulcer in venous insufficiency
minimal pain if superficial or may be very painful
depth of ulcer in arterial insufficiency
deep, often involving joint space
depth of ulcer in venous insufficiency
superficial
shape of ulcer in arterial insufficiency
circular
shape of ulcer in venous insufficiency
irregular border
ulcer base in arterial insufficiency
pale to black and dry gangrene
ulcer base in venous insufficiency
beefy red to yellow fibrinous in chronic long-term ulcer
leg edema in arterial insufficiency
minimal unless extremity kept in dependent position constantly to relieve pain
leg edema in venous insufficiency
moderate to severe
ankle-brachial index
taking BP in two places and getting a ratio; in PAD there’s a large decrease in BP
nicotine causes
vasoconstriction and potential endothelial damage
ways to prevent PAD
smoking cessation diet, weight management, and exercise lipid modification and statin therapy prevention and management of diabetes prevention and management of HTN antiplatelet therapy
clinical manifestations of PAD
intermittent claudication changes in peripheral pulses signs and symptoms of perfusion and atrophy bruit wounds
signs and symptoms of perfusion and atrophy
temperature intolerance (cold) color changes skin, hair, and nail changes
consequences of PAD
limb ischemia - can lead to wounds and amputations
pharm goals of PAD
symptom management and risk reduction
symptom management of PAD
vasodilator/antiplatelet (cilostazol) – for intermittent claudication
antiplatelets (aspirin, clopidogrel)
HMG-COA reductase inhibitors (statin)
angioplasty and stents
tube goes into femoral artery (opposite)
monitor perfusion lower than stent
make sure there’s no hematoma
bypass surgery
if stent doesn't work monitor BP (low BP can collapse graft)
nursing management for PAD
increased arterial blood supply promotion of vasodilation prevention of vascular compression relief of pain maintenance of tissue integrity adherence to self-care
assessment and monitoring of PAD
round shape, dry, necrotic, uniform
rubor (blood starting to flow with gravity); pt will be sitting with feet up because there’s a lot of burning pain with feet down (want them in a dependent position)
maintaining tissue integrity in PAD
prevention - wear sturdy shoes, don’t wear compression stockings
limit cause of vasoconstriction (cold, caffeine, chocolate)
don’t put feet directly on heating pad
regular inspection of extremities and f/u
good nutrition, low-fat diet
weight reduction
encourage activity in PAD
supervised exercise program (walking) offered to people with intermittent claudication; 2 hours of supervised exercise a week for 3 months; encourage exercise to point of pain
exercise increases ________ ________
collateral circulation
chronic venous insufficiency is a result of
incompetent valves or venous obstruction
venous insufficiency leads to
edema, tissue congestion, tissue impairment
goal of venous stasis wounds
get the fluid out of the legs
risk factors of venous insufficiency
DVT varicose veins obesity pregnancy smoking extended periods of sitting or standing female age > 50
clinical manifestations of venous insufficiency
edema (bilateral) pain, aching hyperpigmentation skin atrophy stasis dermatitis (brown thickness) venous ulcers
management of venous insufficiency
avoid long periods of sitting/standing regular exercise (walking) maintain BMI position legs (elevation) compression therapy practice skin hygiene improved diet for wound healing
restoring skin integrity in venous insufficiency
cleansing wound compression therapy avoiding trauma and injury positioning wounds are not uniform, draining, macerated
improving physical mobility
activity is usually restricted to promote healing
gradual progression of activity
activity to promote blood flow in bed and exercise upper extremities
diversional activities
pain med before activities
promoting adequate nutrition
protein vit C and A iron zinc iron intake for anemic patients
improving peripheral arterial circulation
exercises (walking), isometric positioning - feet down during day temp - cold feet stop smoking stress reduction limit caffeine rubor, wound is round and uniform need aspirin to prevent blood clots most likely to see gangrene
improving peripheral vascular circulation
compression stockings elevate dependent limbs weight loss nutrition dermatitis stasis - brown coloring pulses should be present risks for DVT
risks for DVT
post-op women overweight any type of stasis DVT can travel to lungs (pulmonary embolism)
