Topic 5: Peripheral Vascular Disease

Question 1

PAD clinical manifestations

Answer 1

1) Intermittent claudication
2) paresthesia;
3) elevation pallor
4) dependent rubor 5)skin that is thin, shiny & taut, hair loss on limb, thickened toe nails
6) diminished/absent pedal/popliteal/femoral pulses,
7) RUBOR = reactive hyperemia (redness) when limb is in dependent position; dependent rubor;
8) arterial ulcerations (usually “dry” ulcers that do not leak)

Question 2

PAD 6 P’s

Answer 2

*Paralysis
*Paresthesia
*Pallor
*Pulse
*Pain
*Poikilothermia

Question 3

Diagnostic Testing/Labs for PAD

Answer 3

*Ankle Brachial Index (ABI)
*Doppler Ultrasound
*Duplex Imaging
*Angiography
*Magnetic resonance angiography

Question 4

arterial ulcer

Answer 4

A wound caused by impaired arterial blood flow to the lower leg and foot. Impairment in blood flow results in tissue ischemia and necrosis.

Question 5

associated skin characteristics for PAD

Answer 5

-Cool skin temperature
-Thin, shiny skin
-Decreased or absent skin hair
-Pain my increase when the leg is elevated
-Pain may decrease or be relieved when the leg is in a dependent position
-Decreased pulse strength in extremity

Question 6

PVD clinical manifestations

Answer 6

*Affected Extremity
*Hyperpigmentation of lower calf and ankle skin from hemosiderin staining.
*Firm/hardened skin
*Dry scaly skin; may be itchy, WARM
*Edema may or may not be present

Question 7

prevention for those at risk of PVD include:

Answer 7

*Patient education
*Leg exercises
*Early ambulation after procedure
*Compression stockings
*Anticoagulation therapy
*Avoid Oral Contraceptives
*Drink adequate fluids to avoid dehydration
*Exercise during long periods of bed rest or sitting

Question 8

*Venous Ulcer

Answer 8

*A wound caused by a decrease of blood flow return from the lower extremities to the heart.

Question 9

when can compression stockings be used

Answer 9

in PVD

Question 10

what kind of dressings are used on venous ulcers

Answer 10

moist dressings

Question 11

what are the nutritional needs for PVD/PVD ulcers

Answer 11

Evaluate nutrition: High protein, vitamin A and C and zinc

Question 12

client teaching for arterial diseases

Answer 12

-Control cardiovascular disease
-Control diabetes
-Smoking cessation
-Medication use
-Exercise tolerance
-Foot care
-Daily foot exams
-Post-Op care (if applicable)

Question 13

client teaching for venous diseases

Answer 13

-Nutrition - adequate protein, Vitamin A, Vitamin C, Zinc
-Medications (Drug Therapy)

Question 14

PVD s/s

Answer 14

· Voluptuous pulses = warm legs
· Edema (blood pooling)
· Irregular shaped sores
· No sharp pain (dull pain)
· Yellow & brown ankles***

Question 15

ABI for PVD

Answer 15

> 0.9

Question 16

cap refil for PVD

Answer 16

<3 sec

Question 17

what does the skin look like in PVD

Answer 17

· Skin color: bronze-brown pigmentation, varicose veins may be present
· Skin temperature: warm
· Skin texture: think, hardened, indurated
· Dermatitis and pruritis often present

Question 18

edema in PVD

Answer 18

lower leg edema

Question 19

pain in PVD

Answer 19

dull ache or heaviness in calf or thigh

Question 20

periperal pulses in PVD

Answer 20

present

Question 21

ulcers in PVD

Answer 21

irregularly shaped; moderate to large amount of drainage; yellow or dark red “ruddy” granulation

Question 22

hair and nails in PVD

Answer 22

Hair: may be present or absent
· Nails: normal or thickened

Question 23

PAD s/s

Answer 23

· Absent pulses, thin, shiny, hairless legs = cool legs
· Round, red sores (hyperemia; redness of the foot dependent rubor)
· Toes & Feet pale or black “eschar”
· Sharp pain in calf (with exercise INTERMITTENT CLAUDICATION or when feet are elevated)

Question 24

ABI in PAD

Answer 24

<0.9

Question 25

Cap refill in PAD

Answer 25

>3 sec

Question 26

edema in PAD

Answer 26

absent in legs unless constantly in dependent position

Question 27

hair and nails in PAD

Answer 27

· Hair: loss of hair on legs, feet, toes · Nails: thickened, brittle

Question 28

pain in PAD

Answer 28

· INTERMITTENT CLAUDICATION or rest pain in foot; ulcer may or may not be painful

Question 29

peripheral pulses in PAD

Answer 29

· decreased or absent

Question 30

skin in PAD

Answer 30

· Skin color: dependent rubor; elevated pallor · Skin temperature: cool · Skin texture: thin, shiny, taut

Question 31

ulcer in PAD

Answer 31

rounded, smooth, looks "punched out," minimal drainage; tissue-black eschar or pink granulation

Question 32

PAD is an OXYGEN PROBLEM: 6 P's

Answer 32

· Pain* · Paresthesia* · Pulses · Polar · Pallor (blanching of the foot) Paralysis

Question 33

diagnostic assemnt for vascular disorders

Answer 33

· Health Hx and physical examination, including palpation of peripheral pulses · Doppler ultrasound studies · Segmental BPs · ABI · Duplex imaging · Angiography

Question 34

IN PVD how should the legs be set for treatment

Answer 34

· ELEVATE LEGS; to help get blood back to the heart

Question 35

IN PAD how should the legs be set for treatment

Answer 35

· HANG LEGS; to help blood get to periphery

Question 36

PVD interventions

Answer 36

· Early and aggressive mobilization is easiest and most cost-effective method to decrease VTE risk · change position every 2 hours · TEACH patients to flex and extend their feet, knees and hips at least every 2-4 hours · Patients who can get out of bed need to be in a chair at all meals and walk at least 4-6 tomes a day · Compression stockings · Intermittent pneumatic compression devices (IPCs) · anticoagulant therapy to prevent clot formation

Question 37

PAD intervention: CVD risk factor modification

Answer 37

o Tobacco cessation o Regular physical exercise o Achieve or maintain ideal body weight o DASH diet o Tight glucose control o Thigh BP control o Treatment of hyperlipidemia o Antiplatelet agent o ACE inhibitors

Question 38

treatment of claudication symptoms

Answer 38

o Structured walking or exercise program

Question 39

other interventions for PAD

Answer 39

· Nutritional therapy · PT/OT · Proper foot care

Question 40

in acute car setting how often should the PAD pateint be assess and what are the assessed for

Answer 40

· Check operative extremity every 15 minutes initially and then hourly for color, temperature, cap refill, presence of peripheral pulses, sensation and movement

Question 41

when should the HCP b enotified immediately in a PAD patient

Answer 41

if loss of palpable pulses or change in doppler sound over pulse

Question 42

PAD teaching: anticoagulant therapy

Answer 42

· Take drug at same time each day (preferably afternoon or evening) · Watch for signs of unusual bleeding · Avoid any trauma or injury that may cause bleeding · Avoid all aspirin-containing drugs and NSAIDS · Limit alcohol intake · Wear medic alert bracelet that says anticoagulant is being taken · Give stool softeners to avoid straining and hard stools · Use soft toothbrushes or foam swabs for oral care · Use electric razors

Question 43

when taking warfarin what should be avoided?

Answer 43

foods high in vitamin K (broccoli, spinach, kale, greens)

Question 44

Thromboangiitis obliterans (Buerger disease)

Answer 44

A non-atherosclerotic, segmental, recurrent inflammatory disorder of the small and medium arteries and veins of the arms and legs.

Question 45

who does Thromboangiitis obliterans (Buerger disease) mostly occur in

Answer 45

Mostly occurs in men younger than 45 years of age with long Hx of tobacco and/or marijuana use without other CVD risk factors

Question 46

s/s of Thromboangiitis obliterans (Buerger disease)

Answer 46

BLACK FEET AND HANDS ·Color and temperature changes of the limbs, paresthesia, superficial vein thrombosis and COLD sensitivity

Question 47

main treatment for Thromboangiitis obliterans (Buerger disease)

Answer 47

· Cessation of tobacco and marijuana use in any form · Use of nicotine replacement products are CONTRAINDICATED

Question 48

management for Thromboangiitis obliterans (Buerger disease)

Answer 48

· Avoid limb exposure to cold temperatures · Supervised walking program · Antibiotics to treat any infected ulcers Analgesics for pain

Question 49

Raynaud's phenomenon

Answer 49

Episodic vasospastic disorder of small cutaneous arteries, most often involving the fingers and toes, mostly occuring in women

Question 50

what often brings of symptoms of raynauds phenomenon

Answer 50

Exposure to cold, emotional upset, tobacco use, and caffeine

Question 51

S/S of Raynaud's Disease

Answer 51

· Vasospasm induced color changes of fingers, toes, ears, and nose (white, blue and red) · Client describes coldness and numbness in vasoconstrictive phase · Throbbing, aching pain , tingling Swelling in hyperemic phase (when blood flow is restored)

Question 52

management for raynauds disease

Answer 52

· Focus on teaching about how to prevent episodes o Avoid temperature extremes o Wear looks warm clothing as protection from the cold (including gloves) o Stop using tobacco products o Avoid caffeine · Stress management techniques · Immersing hand in warm water often decreases vasospasm · Sustained-release CCB are he first-line drug therapy