PERIPHERAL ARTERIAL DISEASE (PAD)

Question 1

it is the narrowing or blockage of vessels in the extremities that carry blood from the heart to the legs; lower extremities are commonly affected.

Answer 1

PERIPHERAL ARTERIAL DISEASE (PAD)

Question 2

Having PAD puts a person 2 to 6 times greater risk of dying of a

Answer 2

Heart Attack of Brain Attack due to blockage of lipids in the arteries.

Question 2

is a common underlying cause of PAD

Answer 2

Atherosclerosis

Question 2

EXPLAIN

→ Diabetes Mellitus

Answer 2

Glucose is not absorbed due to lack of insulin making the blood viscous and can affect the circulation.

Question 3

It involves the buildup of plaque in the arteries, leading to narrowing and reduced blood flow to the extremities.

Answer 3

Atherosclerosis

Question 3

RISK FACTORS

Answer 3

Hypertension
Diabetes Mellitus
Smoking
High Homocystine Levels

Question 4

EXPLAIN

→ Cigarette Smoking

Answer 4

The nicotine causes vasoconstriction which narrows the artery resulting to increase blood pressure and reduce blood flow to the extremities.

Question 4

EXPLAIN

→ High Homocystine Levels (meat)

Answer 4

It is a sulfur containing amino acid that is synthesize during protein breakdown.

➢ makes the blood viscous
➢ can cause adhesiveness of the platelets leading to clot formation
➢ enhances the LDL to be deposited in the arteries
➢ causes low flexibility (dilation and constriction) of the blood vessels
———————————————-
common to meat eaters
- makes blood viscous
- sulfur contain uric acid
- protein breakdown ___
++ egg, chicken, beef, cheddar cheese
- if have high homocysteine level causes stickiness of platelets that leads to clot formation that goes to the brain and lungs

• if have high meat intake, and high homocysteine
  – enhance LDL
  — bad cholesterol to arteries
• causes loss of flexibility of blood vessels
  –vascular motor tone
  – must be able to dilate and constrict
  – if have high, promote clotting

Question 4

lack of adequate blood supply can
damage or destroy nerve endings

Question 4

PVD interferes with Arterial Blood Flow to the lower extremities, risk for (3):

Answer 4

→ Neuropathy and Paresthesia
→ Ulcers that do not heal, Necrosis, Gangrene
→ Amputation

Question 5

It is a sudden pain, tingling sensation,
usually only one leg is involved

one of the clinical manifestation of PAD

Answer 5

Intermittent Claudication

Question 5

Example of Intermittent Claudication

Answer 5

The patient is walking, and
after 30 minutes, he feels pain, which is
relieved when resting

Question 5

blood vessel affected in PAD

Answer 5

Artery

Question 5

most common symptoms of PAD

Answer 5

Intermittent Claudication

Question 5

how can resting relieved pain after walking

Answer 5

Engaging in activities increases the metabolism of cells, demanding more blood. However, due to the obstruction of arteries, less oxygenated blood is circulated. Consequently, aerobic metabolism shifts to anaerobic metabolism. As a result, the tissues produce lactic acid, which irritates the nerve endings and causes pain.

Question 6

Rubor, Cyanosis, Pallor is Visible particularly when the extremity is in

one of the clinical manifestation of PAD

Answer 6

Dependent Position

Question 7

how can elevating the legs causes pallor
because

Answer 7

it further reduces the amount
of blood

Question 7

ASSESSMENT

When the blood supply to the distal areas are
diminished or absent, the cells in those areas die, leading to

Answer 7

ulcer formation and gangrene in the digits.

Question 7

other clinical manifestation of PAD

Answer 7

Thin, Shiny, Hairless-Skin and Thick, Brittle, Slow
Growing-Nails

Question 7

An ________ is uncommon in a client
diagnosed with arterial occlusive disease.

Answer 7

absent pulse

Question 7

→ Five Ps of PAD

Answer 7

Pain, Pallor, Pulselessness, Paresthesia , & Paralysis

Question 8

ASSESSMENT

Shoes should be purchased in the afternoon
when the feet are the

Answer 8

largest.

▪ The feet enlarge at the end of the day due to prolonged sitting or standing because the blood accumulates at the lower extremities by gravity.

Question 8

ASSESSMENT

The nurse must ensure that the feet can be moved and are warm, which indicates

Answer 8

adequate blood supply to the feet.

Place your fingers at:
1. Dorsalis Pedis Artery
2. Posterior Tibial Artery

▪ always compare the pulses in both legs to ensure a proper evaluation.
▪ Affected leg – less pulsation

Question 8

ASSESSMENT

Poikilothermia

Answer 8

Ischemic tissue is pale in appearance and cool to touch compared to other areas of the body

Question 8

❖ NEUROVASCULAR ASSESSMENT

Answer 8

→ Determine if the client has any numbness or tingling. → Determine if the client has pulses, the presence of which indicates there is no circulatory compromise. → Determine if the client can move the feet and legs. → Determine if the client’s feet are pink or pale. → Assess the feet to determine if they are cold or warm. ▪ Cold – artery is affected ▪ Warm – vein is affected

Question 8

ASSESSMENT is a test used to examine the blood flow

Answer 8

CW Doppler

Question 8

ASSESSMENT Return of color after more than 3 seconds indicates a slow arterial inflow.

Answer 8

Capillary Refill

Question 8

EXPLAIN FUNCTION → Cilostazol (Pletal)

Answer 8

▪ Platelet inhibitor with vasodilator properties and improves claudication.

Question 9

PAD MEDICATIONS

Answer 9

→ Aspirin or Clopidogrel → Cilostazol (Pletal) → Pentoxifylline (Trental)

Question 9

EXPLAIN FUNCTION → Aspirin or Clopidogrel

Answer 9

▪ To inhibit platelet aggregation. ▪ To reduce the risk of arterial thrombosis.

Question 9

EXPLAIN FUNCTION → Pentoxifylline (Trental)

Answer 9

▪ Decreases blood viscosity and increases blood flow to the lower extremities ▪ The patient should have improved circulation in the legs as evident by less pain.

Question 10

examine drug flow of major artery and veins to visualize blood flow in upper and lower

Answer 10

DUPLEX ULTRASONOGRAPHY

Question 10

EXPLAIN → AVOID Gingko (herb)

Answer 10

▪ It can increase bleeding when taken with an antiplatelet. ▪ It has been shown to have a beneficial effect of increasing blood flow to the brain, but in this case, the risk of bleeding warrants the nurse’s intervention.

Question 11

❖ NURSING INTERVENTIONS FOR PAD

Answer 11

→ Smoking Cessation is vital because smoking can impair wound healing & cause vasoconstriction. → Ineffective Peripheral Tissue Perfusion ▪ Maintain the legs in a position of slight dependency, so that the gravity enhances tissue perfusion. ▪ If the patient experiences rest pain at night, the head of the bed is elevated 4 to 6 in. → Do not elevate the legs above the level of the heart because it can impede arterial flow. → Avoid the following: ▪ Massage of the extremities – promotes embolus formation. ➢ To identify for the presence of thrombus: warm to touch, redness, pain ▪ Exposure to cold – vasoconstriction ▪ Constrictive or restrictive clothing because it lessens the blood supply in the lower extremities. → Encourage use of elastic stockings because it increases compression and pushes the blood toward the heart. ▪ It should be applied in the morning before the patient gets out of bed. ▪ The stockings should be applies smoothly to avoid wrinkles, but the top should not be rolled down to avoid constriction of circulation. ▪ It should be removed every 8 hours and the patient should elevate the legs for 15 minutes and reapply the stockings. → Properly fitted shoes, soft leather. Shoes should not be pointed or tight because it can decrease the blood supply in the lower extremities. → Toenails are trimmed straight across using nail clippers. ▪ Avoid injuring the toes because wounds may not heal promptly due to reduced blood supply, which could potentially lead to gangrene. NOTE: * Two positions for PAD – (1) If patient can’t walk, elevate the head of the bed because it increases the flow of blood going to the extremities. (2) Put the legs down (dependent position) because by gravity more blood goes to the affected leg. * Never elevate the legs because it further reduces the amount of blood.