Peripheral artery disease (PAD)

Question 1

The leading cause of PAD is

Answer 1

atherosclerosis,

Question 2

Symptoms of PAD

Answer 2

• 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

Question 3

Complications of Peripheral Artery Disease

Answer 3

• Atrophy of muscles
• Increased damage from minor trauma
• Slowed wound healing
• Increases risk of infection
• Nonhealing arterial ulcers
• Gangrene
• Amputation

Question 4

how to diagnose PAD

Answer 4

Doppler Ultrasound ( ankle-brachial index (ABI) is a PAD screening tool performed using a Doppler.)
• Angiography

Question 5

The first treatment goal for PAD is to …

Answer 5

reduce CVD risk factors 
ie.
Tobacco Cessation
Diabetes Management
Lipid Management
Hypertension Management

Question 6

PAD treatments

Answer 6

Antiplatelet agents
Walking
insertion of a specialized catheter into the femoral artery
Bypass surgery

Question 7

Arterial Ulcer Treatment

Answer 7

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

Question 8

PAD Nursing Interventions

Answer 8

Pain Management
Positioning
Supportive Care (compression stockings, Walking)
Infection Prevention

Question 9

Diagnose varicose veins

Answer 9

duplex ultrasound,

Question 10

Difference between primary and secondary varicose veins

Answer 10

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.

Question 11

CVI symptoms

Answer 11

• 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

Question 12

Varicose veins symptoms

Answer 12

• 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

Question 13

Varicose Veins Treatment

Answer 13

• rest with limb elevation; graduated compression stockings; leg-strengthening exercises,
• Venoactive drugs (e.g., diosmin, hesperidin, and rutosides)

Question 14

Chronic Venous Insufficiency and Leg Ulcers Treatment

Answer 14

• 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

Question 15

Patient Education Varicose Veins

Answer 15

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.

Question 16

Patient education Chronic Venous Insufficiency and Venous Leg Ulcers

Answer 16

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

Question 17

How does Virchow’s Triad work?

Answer 17

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

Question 18

3 high Risk for thrombis

Answer 18

people over 35, who smoke, and take birth control pills with a family history

Question 19

Venous Ulcers Care/Teaching

Answer 19

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

Question 20

Venous stasis symptoms

Answer 20

Symptoms = change in colour, scally skin, thick skin, painful, itchy, sores ooze/crust

Question 21

Venous stasis treatment

Answer 21

Treatment: compression stockings, feet up, antihistamines (for itching), steroids (for imflammation), moisturizers,

Question 22

2 types of Venous Thromboembolism (VTE)

Answer 22

DVT – Deep vein thrombosis

PE - Pulmonary Embolism

Question 23

Superficial Vein Thrombosis

Answer 23

Redness, warmth, tenderness, inflammation, hardening of superficial veins of arms and legs
Cord-like vein

Question 24

symptoms of DVT

Answer 24

Sometimes no symptoms
swelling
tenderness
Warm skin
Redness of  the skin

Question 25

symptoms of PE

Answer 25

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

Question 26

Prevention of DVT

Answer 26

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

Question 27

VTE treatment

Answer 27

Prevention and prophylaxis
Drug therapy: Anticoagulant therapy
Surgical therapy
>Inferior Vena Cava Filter (Filter traps blood clots of prevents the clot from moving)

Question 28

What are things to watch out for with Anticoagulant Treatment

Answer 28

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

Question 29

Chronic Venous INsufficiency Symptoms and treatment

Answer 29

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)