week 7- pvd Flashcards
Peripheral Vascular Disease
Disorders that alter the natural flow of blood through the arteries and veins of the peripheral circulation
Epidemiology
• Affects men and women almost equally
• Higher incidence in African Americans than Caucasian
• Risk is highest for the elderly, those who smoke/have smoked, those with diabetes
• Higher incidence in those with chronic kidney disease or transplant
• Lack of awareness of PAD
• 90% of cases secondary to atherosclerosis
• Risk Factors?
Smokers have double the risk of mortality, disease progression and limb amputation vs non-smokers
Duration of diabetes seems to predict greater disease burden of PAD vs glycemic control
Dyslipidemia and HTN are risk factors as well.
Challenges
Lack of disease recognition (may be asymptomatic)
Poor understanding of the impact on a person
Under-use of effective therapies
Lower Extremity Arterial Disease S&S
–Most patients asymptomatic or may have atypical presentation
—Intermittent claudication “angina in the legs”
Pain occurs predictably with exertion
Classic IC = pain, ache, tightening, cramping
Relieved by rest
Pain occurs distal to blockage
Only 10-30% have this
—Minority of patients develop rest pain or ischemic ulcers
LEAD- Diagnostic Tests and History
- CAD? CVD?
- Hematology and biochem blood work (CBC, FBG, HgbA1c, creatinine, fasting lipid profile, urinalysis (glycosuria and proteinuria)
- ECG
- Ankle-Brachial Index (ABI)**diagnostic of PAD if less than 0.9
- Ultrasound
- Duplex scan of carotid arteries (if high risk)
6 P’s
Pain Pallor Pulselessness Pikilothermia (coldness) Paralysis Paresthesia- PINS AND NEEDLES
Physical Assessment
Hair loss and dry, scaly, pale or mottled skin and thickened toenails
Severe arterial disease—extremity is cold and gray-blue or darkened; pallor
Pain that occurs even while at rest; numbness and burning
Physical Assessment (Cont’d) Arterial Ulcers
Complains of claudication (‘limping’) with walking 1-2 blocks
Pain with rest present
Ulcers located between or at end of toes with deep pale ulcer beds, even edges and little granulation tissue
Cool foot with decreased pulses
Hair loss, pallor with elevation, dependent rubor (redness)
Neurological deficits noted
Physical Assessment
Venous Ulcers
No claudication or rest pain
Ulcers located on ankle area with brown pigmentation and ulcer bed pink, superficial uneven and granulation tissue present
Ankle discoloration and edema with pulses present
Full veins when leg slightly dependent
No neurologic deficits
Nonsurgical Management
Exercise- can build up of collateral circulation improving arterial flow to affected limb
Positioning - by elevating feet at rest to decrease swelling but must not elevate legs above heart as this slows arterial flow to legs
Promoting vasodilation- preventing exposure to cold and keeping warmth to extremities (do not apply direct heat), smoking cessation
Drug therapy- includes antiplatelet therapy (ASA)
Invasive Non surgical Treatments include:
Percutaneous transluminal angioplasty - balloon
Laser-assisted angioplasty - laser-tipped catheter is used instead of a balloon catheter
Invasive Non surgical Treatments include:
- Percutaneous transluminal angioplasty – balloon
- Laser-assisted angioplasty - laser-tipped catheter is used instead of a balloon catheter
Health Teaching
Heath Teaching --Foot Care Cleanliness wash between toes - rinse thoroughly mild soap dry well ---Warmth cotton socks - extra socks avoid sunburn --Safety wear soft shoes/slippers trim nails straight across podiatrist no hot water bottles ---Comfort measures leather shoes lanolin lambs wool --Prevent constriction of blood vessels no knee highs, panty hose or garters do not cross legs at knees no smoking ---Exercise encourage - walking careful with acute venous disease --Seeking medical attention skin breakdown, abrasions, blisters, athelete’s foot or pain no meds on feet --Corns ,calluses and athlete's foot do not cut podiatrist -Position elevate leg s avoid standing for long periods - change position
Acute Peripheral Arterial Occlusion
Embolus — the most common cause of occlusions, although local thrombus may be the cause
Assessment -6 P’s
Drug therapy
Surgical therapy
Nursing care
Aneurysms of Central Arteries
- Aneurysm—a permanent localized dilation of an artery, enlarging the artery to twice its normal diameter
- Several types
- Dissecting aneurysm (aortic dissection)
- Abdominal aortic aneurysm
- Thoracic aortic aneurysm
Aneurysm —
a permanent localized dilation of an artery, enlarging the artery to twice its normal diameter
Assessment of Abdominal Aortic Aneurysm (AAA)
Pain related to AAA is usually steady with a gnawing quality, is unaffected by movement, and may last for hours or days.
Pain is in the abdomen, flank, or back.
Abdominal mass is pulsatile.
Rupture is the most frequent complication and is life threatening.
