Peripheral artery disease (PAD) Flashcards
The leading cause of PAD is
atherosclerosis,
Symptoms of PAD
- Intermittent Claudication
- Atypical Leg Symptoms (burning, heaving, tightness, weakness)
- Neuropathy
- Skin Appearance (thin, shiny, and taut, and hair loss)
- Rest Pain
- Critical Limb Ischemia (can results in gangrene and ampulation0
Complications of Peripheral Artery Disease
- Atrophy of muscles
- Increased damage from minor trauma
- Slowed wound healing
- Increases risk of infection
- Nonhealing arterial ulcers
- Gangrene
- Amputation
how to diagnose PAD
Doppler Ultrasound ( ankle-brachial index (ABI) is a PAD screening tool performed using a Doppler.) • Angiography
The first treatment goal for PAD is to …
reduce CVD risk factors ie. Tobacco Cessation Diabetes Management Lipid Management Hypertension Management
PAD treatments
Antiplatelet agents
Walking
insertion of a specialized catheter into the femoral artery
Bypass surgery
Arterial Ulcer Treatment
Increase blood flow perhaps through reconstructive surgery
Smoking cessation
Control of diabetes, hypertension, hyperlipidemia
Head of bed raised at night may help rest pain
Excellent foot & leg care
Walking is beneficial
Treatment of infections with system antibiotics
Analgesics
Do not debride ulcers
PAD Nursing Interventions
Pain Management
Positioning
Supportive Care (compression stockings, Walking)
Infection Prevention
Diagnose varicose veins
duplex ultrasound,
Difference between primary and secondary varicose veins
Primary Varicose Veins
Primary varicose veins (idiopathic), caused by weakness of the vein walls, are more common in women.
Secondary Varicose Veins
Secondary varicosities typically are the result of direct injury, a previous venous thromboembolism (VTE), or excessive vein distention.
CVI symptoms
- Leathery lower leg skin, with a characteristic brownish or “brawny” appearance
- Persistent and prolonged edema
- Eczema and itching
- Pain, which is worse when the leg is in a dependent position
Varicose veins symptoms
- Achy pain after prolonged standing/or sitting, which is relieved by walking or limb elevation
- A feeling of heaviness
- Pressure or a cramp-like, burning sensation
- Inflammation and/or nocturnal leg cramps
Varicose Veins Treatment
- rest with limb elevation; graduated compression stockings; leg-strengthening exercises,
- Venoactive drugs (e.g., diosmin, hesperidin, and rutosides)
Chronic Venous Insufficiency and Leg Ulcers Treatment
- Compression is essential for venous ulcer healing and prevention of venous ulcer recurrence
- Diet (Consuming foods high in adequate protein, calories, and nutrients is most important for a patient with chronic venous insufficiency (CVI))
- Drugs pentoxifylline and systemic antibiotics
- surgical grafts
Patient Education Varicose Veins
Proper use and care of custom-fitted graduated compression stockings: use the stockings in bed and throughout the day
The importance of periodically positioning the legs above heart level; doing so will help decrease edema and the reoccurrence of varicose veins.
If needed, weight loss can help prevent varicose veins.
Patients with a job that requires long periods of standing or sitting should implement position changes.
Patients should check their lower extremities for skin breakdown or new venous ulcers daily.
Patient education Chronic Venous Insufficiency and Venous Leg Ulcers
Use of Compression Stockings Moisturizer being applied to right foot. Skin Care Two bare hands laying bandage over leg wound. Checking for Infection Lower legs and bare feet–edematous. Changing Positions Lower legs in black pants with blue tennis shoes walking on pavement. Appropriate Exercise
How does Virchow’s Triad work?
When all 3 things are present we have localized platlet development then fibrin traps RBC/WBC then more platlets form which turns into a throbus. If thrombus enlarges then increased number of blood cells that forms behind it as a tail. This blocks the lumen of the vessel. If the thrombus partially occludes the vein, we can have endothelial cells cover the thrombus ahd prevent it from further processing. If it occludes the vein, and the thrombus doesn’t detach it becomes firmly set in 5-7 days. If it detaches it can result in an emboli which can move it unto the heart to become a pulmonary emboli
3 high Risk for thrombis
people over 35, who smoke, and take birth control pills with a family history
Venous Ulcers Care/Teaching
Collaborative Care
Compression only if no arterial disease Moist dressings Diet high in protein, Vit C, A, and zinc Control of diabetes Reduce obesity Observe for infection
Nursing Care – Patient Teaching
Careful foot & skin care
Avoid sitting, standing for long periods
Elevate leg frequently if no arterial disease
Daily walking program
Compression stockings as ordered only if not arterial
Venous stasis symptoms
Symptoms = change in colour, scally skin, thick skin, painful, itchy, sores ooze/crust
Venous stasis treatment
Treatment: compression stockings, feet up, antihistamines (for itching), steroids (for imflammation), moisturizers,
2 types of Venous Thromboembolism (VTE)
DVT – Deep vein thrombosis
PE - Pulmonary Embolism
Superficial Vein Thrombosis
Redness, warmth, tenderness, inflammation, hardening of superficial veins of arms and legs
Cord-like vein
symptoms of DVT
Sometimes no symptoms swelling tenderness Warm skin Redness of the skin
symptoms of PE
Difficulty breathing
Tachycardia or irregular heart beat
Chest pain or discomfort that worsens with a deep breath or coughing
Coughing up blood
Low blood pressure, light-headedness, fainting
Prevention of DVT
Mobilization post-op
Moving limbs
Compression stockings
Intermittent compression devises
Early mobility after surgery. Sitting puts your at risk
Compression stocking help to improve circulation. People can use these for jobs where your on your feet all the time
Intermittent compression devises help to increase circulation for people that may be bedridden
Can’t use compression stocking with someone with PAD
VTE treatment
Prevention and prophylaxis
Drug therapy: Anticoagulant therapy
Surgical therapy
>Inferior Vena Cava Filter (Filter traps blood clots of prevents the clot from moving)
What are things to watch out for with Anticoagulant Treatment
Monitor lab results (e.g., PTT) Observe S & S of bleeding, bruising Do not give IM’s, minimize IV Do not take Vit K, avoid certain herbs Limit alcohol use Report blood in urine or stool
Report prolonged bleeding
Do not take ASA or NSAID’s
Report severe headache, stomach ache
Chronic Venous INsufficiency Symptoms and treatment
Symptoms = swelling, itchy, colour change around ankles, leg cramps/achy/thobiing, thickened skin, prone to leg ulcers, ticghness feeling in calves Treatment = improving blood flow. Elevating legs, compression socks, uncrossing kegs whe sitting, meds are related to getting rid of fluid (diaretics, anticoagulants) or meds to help improve lood flow. Serious = surgery (bypass, removing damaged vein)
