UNIT 6 VASCULAR DISEASE/ ISSUES CHAPTER 33 Flashcards
What are the 6 signs of Arterial Insufficiency
Pain
* Pallor
* Pulselessness
* Paresthesia
* Paralysis
* Poikilothermia (coolness)
What is Peripheral Vascular Disease
Peripheral vascular disease (PVD) includes disorders that change the natural flow of blood through the arteries and veins of the peripheral circulation, causing decreased perfusion to body tissues. It affects the legs much more frequently than the arms.
What are the risk factor of Peripheral Vascular Disease
The cost of the disease is very high and is expected to increase as “baby boomers” age and obesity
-Smoking
-Sedentary Lifestyle
What are the two types of Peripheral Vascular Disease? Select all the apply
A. Myocardial infarction
B. Peripheral arterial disease
C. Neuropathy
D. Peripheral venous disease
B. Peripheral arterial disease
D. Peripheral venous disease
What is Peripheral Arterial Disease?
due to atherosclerosis, blood has difficulty traveling to the lower extremities which can cause a plethora of health problems, which may cause lower extremities to become necrosis due to a lack of oxygenated blood flow.
PAD is a result of systemic atherosclerosis. It is a chronic condition in which partial or total arterial occlusion (blockage) decreases perfusion to the extremities. The tissues below the narrowed or obstructed arteries cannot live without an adequate oxygen and nutrient supply. PAD in the legs is sometimes referred to as lower extremity arterial disease (LEAD).
What are the signs and symptoms of Peripheral Arterial Disease
Specific findings for PAD depend on the severity of the disease. Observe for loss of hair on the lower calf, ankle, and foot; dry, scaly, dusky, pale, or mott led skin; and thickened toenails. With severe arterial disease, the extremity is cold and gray-blue (cyanotic) or darkened. Pallor may occur when the extremity is elevated. Dependent rubor (redness) may occur when the extremity is lowered (Fig. 33.4). Muscle atrophy can result from prolonged chronic arterial disease.
Are they stages to Peripheral Arterial Disease? Name one
Stage I: Asymptomatic
* No claudication is present.
* Bruit or aneurysm may be present.
* Pedal pulses are decreased or absent.
Stage II: Claudication
* Muscle pain, cramping, or burning occurs with exercise and is relieved with rest.
* Symptoms are reproducible with exercise.
Stage III: Rest Pain
* Pain while resting commonly awakens the patient at night.
* Pain is described as numbness, burning, toothache-type pain.
* Pain usually occurs in the distal part of the extremity (toes, arch, forefoot, or heel), rarely in the calf or the ankle.
* Pain is relieved by placing the extremity in a dependent position.
*PAIN DOES NOT GO AWAY WITH REST
Stage IV: Necrosis/Gangrene
* Ulcers and blackened tissue occur on the toes, forefoot, and heel. * Distinctive gangrenous odor is present.
do patients with peripheral arrival disease go through intermittent claudication?
A. No
B. Yes
B. Yes
Most patients initially seek medical a ention for a classic leg pain known as intermi ent claudication (a term derived from a word meaning “to limp”). Usually they can walk only a certain distance before discomfort, such as cramping or burning muscular pain, forces them to stop. The pain stops with rest. When patients resume walking, they can walk the same distance before it returns. Thus the pain is considered reproducible. As the disease progresses, they can walk only shorter and shorter distances before pain recurs. Ultimately it may occur even while at rest.
Nursing Intervention and Health Promotion for Peripheral Arterial Disease. What should the patient avoid to reduce symptoms of PAD?
Instruct all patients with the disease to avoid crossing their legs and avoid wearing restrictive clothing (e.g., garters to hold up nylon stockings, particularly common among older women), which interfere with blood flow. Teach them the importance of inspecting their feet daily for color or other changes.
Vasodilation can be achieved by providing warmth to the affected extremity and preventing long periods of exposure to cold.
Encourage the patient to maintain a warm environment at home and to wear socks or insulated shoes at all times.
. Caution the patient to avoid the application of direct heat to the limb with heating pads or extremely hot water. Sensitivity is decreased in the affected limb. Burns may result.
Encourage patients to prevent exposure of the affected limb to the cold because cold temperatures cause vasoconstriction (decreasing of the diameter of the blood vessels) and therefore decrease arterial perfusion.
Emotional stress, caffeine, and nicotine also can cause vasoconstriction. Emphasize that complete abstinence from smoking or chewing tobacco is essential to prevent vasoconstriction. The vasoconstrictive effects of each cigare e may last up to 1 hour after the cigare e is smoked.
The nurse is caring for a client with intermi ent claudication due to peripheral arterial disease. Which client statement indicates understanding of proper self-management?
A. “I need to reduce the number of cigare es that I smoke each day.”
B. “I’ll elevate my legs above the level of my heart.”
C. “I’ll use a heating pad to promote circulation.”
D. “I’ll start to exercise gradually, stopping when I have pain.”
D. “I’ll start to exercise gradually, stopping when I have pain.”
Which of the following drugs as a nurse would you anticipate the HCP to prescribe for a pt who is currently experiencing severe Intermittent claudication?
A. Cyclobenzaprine
B. Morphine
C. Cilostazol
D. Benztropine
C. Cilostazol
Patients who experience disabling intermi ent claudication may also benefit from phosphodiesterase inhibitors such as cilostazol because it can help improve symptoms and increasing walking distance. This drug can also increase HDL-C levels. Teach patients taking the drug that it may cause headaches and GI disturbances, especially flatulence (gas) and diarrhea.
Patient Teaching for Peripheral Vascular Disease?
Foot Care for the Patient With Peripheral Vascular Disease
- Keep your feet clean by washing them with a mild soap in room- temperature water.
- Keep your feet dry, especially the ankles and between the toes.
- Avoid injury to your feet and ankles. Wear comfortable, well-fi ing shoes. Never go without shoes.
- Keep your toenails clean and filed. Have someone cut them if you cannot see them clearly. Cut your toenails straight across.
- To prevent dry, cracked skin, apply a lubricating lotion to your feet.
- Prevent exposure to extreme heat or cold. Never use a heating pad on your feet.
- Avoid constricting garments.
- Avoid extended pressure on your feet or ankles, such as occurs when you lean against something.
- Inspect your feet daily for injuries.
- See your health care provider at the first sign of a sore or injury to your skin.
How would a HCP diagnose PAD?
Ankle Brachial Index
* Measure BP in arm and ankle.
ABI= SBP ankle/SBP arm.
less than<0.9=PAD
Goals and Interventions for PAD AND PVD
Goals and Interventions are the same for
arterial or venous
Peripheral Artery
* Goal – improve circulation
* Interventions –
* Exercise, positioning, no smoking
* Meds- antiplatelets (aspirin, Plavix)
* Control HTN
* Surgery – stents, atherectomy, bypass –
* after surgery must assess circulation to lower extremity, occlusion can happen-pt
will complain of severe pain and will not have pulse, feel cold
- The nurse is evaluating a 3-day diet history with a client who has an elevated lipid panel. What meal selection indicates that the client is managing this condition well with diet?
a. A 4-ounce steak, French fries, iceberg lettuce
b. Baked chicken breast, broccoli, tomatoes
c. Fried catfish, cornbread, peas
d. Spaghetti with meat sauce, garlic bread
b. Baked chicken breast, broccoli, tomatoes
