PVD Flashcards
What is PVD
- refers to diseases of blood vessels outside of the heart and brain
- PAD “ peripheral arterial disease: is a type of PVD
What causes PVD
Result from a narrowing of the blood vessels that carry blood to the legs or arms
Most common cause is atherosclerosis
PVD most commonly affects
- legs and feet ( sluggish blood flow, blood clots)
- more in men
Atherosclerosis
a disease of the arteries characterized by the deposition of plaques of fatty material on their inner walls.
buildup of fats, cholesterol and other substances in and on your artery walls.
specific type of arteriosclerosis.
Atherosclosis build up can cause
- Heart: myocardial infarction
- Brain: stroke
- legs: Gangrene
arteriosclerosis
occurs when the blood vessels that carry oxygen and nutrients from your heart to the rest of your body (arteries) become thick and stiff
sometimes restricting blood flow to your organs and tissues.
Healthy arteries are flexible and elastic, but over time, the walls in your arteries can harden, a condition commonly called hardening of the arteries
Risk factors for PVD
Modifiable and non-modifiable
MODIFIABLE:
- atherosclerosis
- CAD
- smoking
- hyperlipidemia (diet)
- HTN
- diabetes
- stress
- sedentary lifestyle
- overweight
NON- MODIFIABLE
- increasing age
- gender
- family history
Clinical manifestations of PVD
• Intermittent Claudication:
- leg cramp type pain relieved by rest
- blood can’t flow down, pressure on tissues causing pain
• Pain, discomfort in legs
- walking and standing most painful
- Changes of skin of legs/feet, including red to blue color, coldness, thin or skinny skin
- weak pulses in the legs and feet
- dead tissue due to lack of blood flow
- hair loss on legs
- non healing wounds on the legs or ankles
- numbness, weakness, or heaviness in the leg muscles
- thickened discolored toenails
- erectile dysfunction
Assessment PVD
- history of intermittent clarification (rest pain) location of pain
- inspect skin ( cool, pale, pollar, rubor, loss of hair, brittle nails, dry or scaly skin, atrophy, ulceration)
- palpate pulses
- medications and risk factors
- signs and symptoms of arterial insufficiency
PAD assessment
- assess for location of pulses
- assess for presence of ulcers
- assess for the 6 P’s • pain • pollar (pale) • paresthesia (loss of sensation) • pulselessness • paralysis (lack of movement) • poikilothermia (decrease temp of tissues)
Diagnostic test for PVD
- Ankle brachial index (ABI) looking at differences in pressure in brachial and ankle
- Duplex ultrasonography can see blood flow
- Angiography go in vessel
Non Pharmacological Treatment for PVD
- exercise program
- weight reduction program
- smoking cessation program
- diet low saturated fat; low cholesterol
Pharmocolgical Treatment for PVD
- pentoxifylline ( trental)
- cilostazol (pletal)
- # 1 Aspirin
- # 2 clooidogrel (plavix)
- statins
- all antiplatlete
Nursing management for PVD
- encourage moderate amount of walking or extremity exercises if no contradictions
- discourage standing still or sitting for long periods
- smoking cessation teaching
- encourage avoidance of crossing legs
- encourage wear of properly fitting clothes, shoes and stockings
- warm feet or massage feet (not calf!)
- inspect feet daily
- promote good nutrition
Nursing management PVD ARTERIAL
Lower extremities below the level of the heart
Nursing management for PVD VENOUS
Elevate extremities above heart level
PVD post op management
- maintain adequate tissue circulation
- notify surgeon immediately for disappearance of pulse !
- monitor output, metal status, VS
- instruct patient not to cross legs or have extremely independent position for long periods
- encourage patient to perform leg exercises in bed
- Monitor for signs of compartment syndrome
- assess patient’s ability to perform ADLs
- encourage patient to make necessary lifestyle changes ( diet, activity, skin care)
- teach patient to monitor for complications at home( infection, occlusion, decrease blood flow)
Compartment syndrome signs
Severe edema of extremities
Pain
Decrease sensation of toes or fingers
Potential complications of PVD
Stroke Heart attack Non healing ulcers Limb amputation Blood clots
Other peripheral vascular diseases
1) Buerger disease
2) venous thromboembolism (VTE)
- deep vein thrombosis (DVT)
- pulmonary embolism (PE)
3) raynaids phenomenon
4) varicose veins
Antiplatelets
Decrease platelet aggregation
- aspirin
- clopidogre
- garlic
Anticoagulant
Decrease prothrombin -> thrombin
Decrease fibrinogen -> fibrin
- warfarin
- heparin
- abans ( oral)
Thrombolitic (ase)
Break down fibrin
Used in emergency
- can’t have any risk for bleeding
- only given to people who will die with out it
What is Buerger disease
vascular system is constricted all the time, usually have clots
What is venous thromboembolism (VTE)
- deep vein thrombosis (DVT)
- pulmonary embolism (PE)
What is raynaids phenomenon
areas of the body feel numb and cool in certain circumstances. smaller arteries that supply blood to the skin constrict excessively in response to cold, limiting blood supply to the affected area.
What is varicose veins
swollen, twisted and enlarged veins often caused by damaged or faulty valves that allow blood to travel in the wrong direction
PAD
- very bad !
- low o2 to tissue
- decrease pulses and cold skin
- absence of hair
- round ulcer (punched out)
- pale toes or necrosis
- SHARP pain during exercise or elevation “rest pain” pain while sleeping
PVD
VENOUS
- decrease blood flow to heart
- strong pulses and warm skin
- edema (blood pulling)
- DULL pain
- brown ankles!
- irregular ulcer( venous stasis ulcer)
