Topic 5: Peripheral Vascular Disease Flashcards
covers PVD & PAD; not VTE
PAD clinical manifestations
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)
PAD 6 P’s
*Paralysis
*Paresthesia
*Pallor
*Pulse
*Pain
*Poikilothermia
Diagnostic Testing/Labs for PAD
*Ankle Brachial Index (ABI)
*Doppler Ultrasound
*Duplex Imaging
*Angiography
*Magnetic resonance angiography
arterial ulcer
A wound caused by impaired arterial blood flow to the lower leg and foot. Impairment in blood flow results in tissue ischemia and necrosis.
associated skin characteristics for PAD
-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
PVD clinical manifestations
*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
prevention for those at risk of PVD include:
*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
*Venous Ulcer
*A wound caused by a decrease of blood flow return from the lower extremities to the heart.
when can compression stockings be used
in PVD
what kind of dressings are used on venous ulcers
moist dressings
what are the nutritional needs for PVD/PVD ulcers
Evaluate nutrition: High protein, vitamin A and C and zinc
client teaching for arterial diseases
-Control cardiovascular disease
-Control diabetes
-Smoking cessation
-Medication use
-Exercise tolerance
-Foot care
-Daily foot exams
-Post-Op care (if applicable)
client teaching for venous diseases
-Nutrition - adequate protein, Vitamin A, Vitamin C, Zinc
-Medications (Drug Therapy)
PVD s/s
· Voluptuous pulses = warm legs
· Edema (blood pooling)
· Irregular shaped sores
· No sharp pain (dull pain)
· Yellow & brown ankles***
ABI for PVD
> 0.9
cap refil for PVD
<3 sec
what does the skin look like in PVD
· Skin color: bronze-brown pigmentation, varicose veins may be present
· Skin temperature: warm
· Skin texture: think, hardened, indurated
· Dermatitis and pruritis often present
edema in PVD
lower leg edema
pain in PVD
dull ache or heaviness in calf or thigh
periperal pulses in PVD
present
ulcers in PVD
irregularly shaped; moderate to large amount of drainage; yellow or dark red “ruddy” granulation
hair and nails in PVD
Hair: may be present or absent
· Nails: normal or thickened
PAD s/s
· 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)
ABI in PAD
<0.9
Cap refill in PAD
> 3 sec
edema in PAD
absent in legs unless constantly in dependent position
hair and nails in PAD
· Hair: loss of hair on legs, feet, toes
· Nails: thickened, brittle
pain in PAD
· INTERMITTENT CLAUDICATION or rest pain in foot; ulcer may or may not be painful
peripheral pulses in PAD
· decreased or absent
skin in PAD
· Skin color: dependent rubor; elevated pallor
· Skin temperature: cool
· Skin texture: thin, shiny, taut
ulcer in PAD
rounded, smooth, looks “punched out,” minimal drainage; tissue-black eschar or pink granulation
PAD is an OXYGEN PROBLEM: 6 P’s
· Pain*
· Paresthesia*
· Pulses
· Polar
· Pallor (blanching of the foot)
Paralysis
diagnostic assemnt for vascular disorders
· Health Hx and physical examination, including palpation of peripheral pulses
· Doppler ultrasound studies
· Segmental BPs
· ABI
· Duplex imaging
· Angiography
IN PVD how should the legs be set for treatment
· ELEVATE LEGS; to help get blood back to the heart
IN PAD how should the legs be set for treatment
· HANG LEGS; to help blood get to periphery
PVD interventions
· 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
PAD intervention: CVD risk factor modification
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
treatment of claudication symptoms
o Structured walking or exercise program
other interventions for PAD
· Nutritional therapy
· PT/OT
· Proper foot care
in acute car setting how often should the PAD pateint be assess and what are the assessed for
· Check operative extremity every 15 minutes initially and then hourly for color, temperature, cap refill, presence of peripheral pulses, sensation and movement
when should the HCP b enotified immediately in a PAD patient
if loss of palpable pulses or change in doppler sound over pulse
PAD teaching: anticoagulant therapy
· 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
when taking warfarin what should be avoided?
foods high in vitamin K (broccoli, spinach, kale, greens)
Thromboangiitis obliterans (Buerger disease)
A non-atherosclerotic, segmental, recurrent inflammatory disorder of the small and medium arteries and veins of the arms and legs.
who does Thromboangiitis obliterans (Buerger disease) mostly occur in
Mostly occurs in men younger than 45 years of age with long Hx of tobacco and/or marijuana use without other CVD risk factors
s/s of Thromboangiitis obliterans (Buerger disease)
BLACK FEET AND HANDS
·Color and temperature changes of the limbs, paresthesia, superficial vein thrombosis and COLD sensitivity
main treatment for Thromboangiitis obliterans (Buerger disease)
· Cessation of tobacco and marijuana use in any form
· Use of nicotine replacement products are CONTRAINDICATED
management for Thromboangiitis obliterans (Buerger disease)
· Avoid limb exposure to cold temperatures
· Supervised walking program
· Antibiotics to treat any infected ulcers
Analgesics for pain
Raynaud’s phenomenon
Episodic vasospastic disorder of small cutaneous arteries, most often involving the fingers and toes, mostly occuring in women
what often brings of symptoms of raynauds phenomenon
Exposure to cold, emotional upset, tobacco use, and caffeine
S/S of Raynaud’s Disease
· 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)
management for raynauds disease
· 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
