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General info about PAD
- What?
- --Progressive narrowing & degeneration of arteries
- How?
- --Atherosclerosis
- Who?
- --Cigarette smokers
- --Hyperlipidemia
- --Hypertension
- --DM
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SnSs of PAD
- Ischemic muscle ache or pain that is precipitated by a constant level of exercise
- --Resolves within 10 minutes or less with rest (claudication)
- Paresthesia
- Thin, shiny, and taut skin
- Loss of hair on the lower legs
- Diminished/absent pedal, popliteal, or femoral pulses
- Pallor
- Reactive hyperemia
- Rest pain
- --Occurs in the fore
- --foot or toes and is aggravated by limb elevation
- --Occurs from insufficient blood flow
- --Occurs more often at night
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Complications of PAD
- Atrophy of the skin and underlying muscles
- Delayed healing
- Wound infection
- Tissue necrosis
- Arterial ulcers
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Diagnostics for PAD
- Doppler ultrasound
- --Segmental blood pressures
- Ankle-brachial index (ABI)
- --Done using a handheld Doppler
- Duplex imaging
- Angiogram
- Magnetic resonance angiography (MRA)
- H & P
- Include palpation of peripheral pulses
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Rx therapy for PAD
- Antiplatelet agents*
- --aspirin
- --ticlopidine (Ticlid)
- --clopidogrel (Plavix)
- Drugs prescribed for treatment of intermittent claudication:
- pentoxifylline (Trental)
- heparincilostazol (Pletal)
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Exercise therapy for PAD
- Exercise improves oxygen extraction in the legs and skeletal metabolism
- Walking is the most effective exercise for individuals with claudication
- --30 to 40 minutes/day
- --Will only work if PAD has not progressed to the point of occluding pulses.
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Nutritional Therapy for pt w/PAD
- Dietary cholesterol less than 200 mg/day
- Decrease intake of saturated fat
- Soy products can be used in place of animal protein
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Alternative, Collaborative therapies for pt w/PAD
- Gingko biloba
- --Effective in increasing walking distance for patients with intermittent claudication
- Folate, vitamin B6, cobalamin (B12)
- --Lowers homocysteine levels
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Nursing care of an ischemic limb
- Protect from trauma. Pt may not be able to feel feel and are therefore more prone to injury.
- Decrease vasospasm. Use warm water, wear socks and shoes.
- Prevent/control infection
- Maximize arterial perfusion
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Intervensional, collaborative procedures
- Percutaneous transluminal balloon angioplasty (radiological)
- Peripheral-arterial bypass
- Endarterectomy: surgical removal of plaque inside the artery.
- Patch graft angioplasty
- Amputation
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Acute Intervention for pt w/PAD
- Knee-flexed positions should be avoided except for exercise
- Turn and position frequently
- What to call the MD for?
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6 P's of acute and chronic PAD
- *Pain
- *Pallor
- *Pulselessness
- *Parasthesia
- *Paralysis
- *Poikilothermia (taking on temp of surrounding environment in affected extremety)
Without intervension, pt may lose leg. Gangrene within hours.
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Nursing Intervensions for pt w/AAID
- Continuous IV Heparin
- Thrombolytics
- Embolectomy
- Bedrest
- Determine potential cause
- Monitor risks
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Thromboangiitis Obliterans
AKA buerger's disease
- Ischemia secondary to inflammatory thrombus, NOT fat!
- Where?
- Small arteries & veins in UE’s or LE’s
- Who?--Smokers
- Signs/Symptoms?
- --Similar to PAD
- --Cold sensitivities
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What is Raynaud's Syndrome?
- Vasospasm secondary to exaggerated SNS response
- Occupational related trauma?
- Who?
- --Young females
- --Collagen diseases
- S/S?
- --Color changes to fingers, toes, ears & nose
- --Episodic paresthesia/ coldness
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Management of Raynaud's
- Protection from exacerbating factors
- --Cold weather
- --Cold objects
- --Avoid caffeine
- --Avoid tobacco products
- --Avoid drugs with vasoconstrictive effects
- --Stress reduction
- Treatment
- --Drug therapy
- --Test for connective tissue or autoimmune disease
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Aoritic Aneurysms
- What?
- --Dilation of aortic arterial wall
- How?
- --atherosclerosis
- Who?
- --Family Hx
- --Blunt trauma
- --Acute infections
- --Anastomotic disruption
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Aortic Aneurysm: NSG care
- Pre-op & post-op care
- ABG & F/E monitoring
- ECG monitoring
- Aseptic technique
- Meticulous head-toe assessments
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DVT Collaborative Care
- Nonpharmacologic
- --Bedrest
- --Elevation of extremity
- --TED hose
- --SCD’s
- Pharmacologic
- --Heparin
- --Coumadin
- Surgical
- --Thrombectomy
- --Greenfield Filter: filters DVTs if they travel before they enter the heart.
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