Peripheral Vascular Disease Flashcards
What are PVDs?
A condition affecting peripheral arteries and veins interfering with normal blood flow.
What does peripheral arterial disease (PAD) usually result from?
Arteriosclerosis or atherosclerosis
What does Chronic venous insufficiency (CVI) usually result from?
Incompetent valves in the deeper veins of the legs.
What is PAD?
Peripheral Arterial Disease
What is CVI?
Chronic Venous Insufficiency
Why do varicose veins develop?
To develop a collateral circulation
Who are more likely to develop PAD?
men over the age of 50
What is occurring in the vessel when a patient has PAD?
Atherosclerotic lesions obstruct vessel lumen
Why would collateral circulation develop?
Due to inadequate blood flow to meet tissue needs
When does PAD manifest?
When the vessel is occluded by 60% or more.
When a patient has PAD what position do they like their legs to be in?
Dependent; hanging down in front of them
What is intermittent claudication?
Cramp like pains at rest in the lower legs due to poor circulation associated with atherosclerosis.
What are the risk factors for PAD?
- Hypertension
- Diabetes
- Hypercholesterolemia
- Cigarette smoking
- Obesity
- Physical inactivity
- Age, genetics : African Americans
In a patient with PAD what is diminished?
- Peripheral pulses
- Capillary refil of toes
When you elevate a patients legs who has PAD what typically happens?
Pallor occurs
When a patient with PAD has their legs in a dependent position what color does their affected legs turn?
Rubor: a dusty red/purple
What types of ulcerations occur in a patient with PAD?
-Little drainage with regular borders
A patient who has PAD tends to have legs and toenails that look….
Shiny, dry, and hairless with thickened toenails
What is paresthesia?
A numb/tingling feeling
What is an ankle-brachial index?
When the blood pressure is taken at the ankle then compared to the blood pressure taken at the brachial artery
What diagnostic studies are done for PAD?
- Ankle-brachial index
- Treadmill exercise arterial studies
- Duplex ultrasound
- Angiography
- CT or MRI
When a patient is undergoing treadmill exercise arterial studies how fast do they walk and for how long?
1.5 mph for 30 minutes
If a patient has intermittent claudication what is lower: The blood pressure in the brachial artery or in the ankle?
Ankle
What conditions does a patient need to control if they have PAD?
Diabetes
Cholesterol Levels
Hypertension
Weight
What type of medications does a patient with PAD take?
Antiplatelet drugs like Aspirin and antilipemic drugs
What type of angioplasty is done in patients with PAD?
Angioplasty with or without stenting
Patients with PAD need to do what about smoking and exercise?
They need to eliminate smoking and do progressive strenuous exercise
True or False:
A patient with PAD should not have a surgical revascularization with bypass?
False:
These patients benefit from revascularization with bypass
If a patient is diabetic with PAD what is their dosage of aspirin?
375 mg- they need a higher dose than patients without diabetes
How does chronic venous insufficiency or CVI normally occur?
From vein pathology, such as vascular incompetence, causing venous stasis and increased venous pressure in the lower extremities
What are the three things that diagnose CVI?
History, physical and duplex ultrasound
Patients with CVI tend to be at higher risk for what?
DVTs
A patient who has CVI is more comfortable with their legs doing what?
Elevated
If you do what you are at a higher risk for CVI?
Standing for a long time each day
What gender is at a higher risk for developing CVI?
females
What are the other 7 risk factors for CVI?
Varicose veins Smoking Inactivity Aging Obesity Pregnancy Thrombophlebitits
When a patient has CVI: What type of edema do they experience?
Lower extremity edema that increases with standing
What type of leg discomfit do patients with CVI experience?
Itching, dull leg discomfort that increases with standing
What type of ulcerations do patients with CVI experience?
Stasis ulcerations: with irregular boarders
What type of pigmentation do patient with CVI experience?
Hyperpigmentation: brownish discoloration of lower leg/foot
How would you describe a CVI patients skin appearance?
Thick, fibrous SQ tissue
Leathery appearance
Hyperpigmentation
True or False:
A patient with CVI tends to have dry appearance to their skin.
False:
They can have weeping dermatitis
What should patients with CVI avoid doing?
- Long periods of standing or sitting
- Crossing legs
- Tight fitting garments
What should patients with CVI DO?
- Exercise regularly
- Elevate legs above the level of the heart when sitting or laying down
- Wear compression stockings
- Good skin hygiene
- Good nutrition
In patients with potential PVDs what should you check on during physical examinations?
- Vital Signs
- Peripheral pulses
- Capillary refill
- Skin color, temperature, lesions/ulcers
- Hair distribution
What are the 4 diagnoses for PVD?
- Ineffective Tissue Perfusion: Peripheral
- Pain
- Impaired Skin Integrity
- Activity Intolerance
What are the 6 diagnoses for CVI?
- Disturbed Body Image
- Ineffective Health Maintenance
- Risk for Infection
- Impaired Physical Mobility
- Impaired Skin Integrity
- Ineffective Tissue Perfusion: Peripheral
What four things do you use for planning in PVD and CVI patients?
- Promote wound healing
- Manage pain
- Promote tissue perfusion
- Optimize activity tolerance
What are the four implementation you should do to encourage activity in a PVD patient?
- Assist with care as needed
- Encourage gradual increases in activity, exercise
- Provide diversional activities
- Encourage frequent position changes
What are the two evaluations a patient would be able to demonstrate if they have PVD?
- Demonstrates positioning to promote perfusion to extremities
- Demonstrates abstinence from tobacco products
What are the two evaluations a patient would be able to verbalize if they have PVD?
- Verbalizes appropriate wound care
- Verbalizes symptoms to report to the provider
