PERIPHERAL ARTERIAL DISEASE (PAD) Flashcards
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.
PERIPHERAL ARTERIAL DISEASE (PAD)
Having PAD puts a person 2 to 6 times greater risk of dying of a
Heart Attack of Brain Attack due to blockage of lipids in the arteries.
is a common underlying cause of PAD
Atherosclerosis
EXPLAIN
→ Diabetes Mellitus
Glucose is not absorbed due to lack of insulin making the blood viscous and can affect the circulation.
It involves the buildup of plaque in the arteries, leading to narrowing and reduced blood flow to the extremities.
Atherosclerosis
RISK FACTORS
Hypertension
Diabetes Mellitus
Smoking
High Homocystine Levels
EXPLAIN
→ Cigarette Smoking
The nicotine causes vasoconstriction which narrows the artery resulting to increase blood pressure and reduce blood flow to the extremities.
EXPLAIN
→ High Homocystine Levels (meat)
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
lack of adequate blood supply can
damage or destroy nerve endings
PVD interferes with Arterial Blood Flow to the lower extremities, risk for (3):
→ Neuropathy and Paresthesia
→ Ulcers that do not heal, Necrosis, Gangrene
→ Amputation
It is a sudden pain, tingling sensation,
usually only one leg is involved
one of the clinical manifestation of PAD
Intermittent Claudication
Example of Intermittent Claudication
The patient is walking, and
after 30 minutes, he feels pain, which is
relieved when resting
blood vessel affected in PAD
Artery
most common symptoms of PAD
Intermittent Claudication
how can resting relieved pain after walking
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.
Rubor, Cyanosis, Pallor is Visible particularly when the extremity is in
one of the clinical manifestation of PAD
Dependent Position
how can elevating the legs causes pallor
because
it further reduces the amount
of blood
ASSESSMENT
When the blood supply to the distal areas are
diminished or absent, the cells in those areas die, leading to
ulcer formation and gangrene in the digits.
other clinical manifestation of PAD
Thin, Shiny, Hairless-Skin and Thick, Brittle, Slow
Growing-Nails
An ________ is uncommon in a client
diagnosed with arterial occlusive disease.
absent pulse
→ Five Ps of PAD
Pain, Pallor, Pulselessness, Paresthesia , & Paralysis
ASSESSMENT
Shoes should be purchased in the afternoon
when the feet are the
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.
ASSESSMENT
The nurse must ensure that the feet can be moved and are warm, which indicates
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
ASSESSMENT
Poikilothermia
Ischemic tissue is pale in appearance and cool to touch compared to other areas of the body
❖ NEUROVASCULAR ASSESSMENT
→ 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
ASSESSMENT
is a test used to examine the blood
flow
CW Doppler
ASSESSMENT
Return of color after more than 3 seconds indicates a slow arterial inflow.
Capillary Refill
EXPLAIN FUNCTION
→ Cilostazol (Pletal)
▪ Platelet inhibitor with vasodilator properties and improves claudication.
PAD MEDICATIONS
→ Aspirin or Clopidogrel
→ Cilostazol (Pletal)
→ Pentoxifylline (Trental)
EXPLAIN FUNCTION
→ Aspirin or Clopidogrel
▪ To inhibit platelet aggregation.
▪ To reduce the risk of arterial thrombosis.
EXPLAIN FUNCTION
→ Pentoxifylline (Trental)
▪ 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.
examine drug flow of major artery and veins
to visualize blood flow in upper and lower
DUPLEX ULTRASONOGRAPHY
EXPLAIN
→ AVOID Gingko (herb)
▪ 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.
❖ NURSING INTERVENTIONS FOR PAD
→ 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.
