Distinctive gangreneous odor is present PAD - Assessment Specific findings for PAD depend on the severity of the disease. Observe for: Arterial: loss of hair on the lower calf, ankle, and foot dry, scaly, dusky, pale, or mottled skin thickened toenails decreased or absent pulses, intermittent claudication, painful & necrotic ulcers PAD - Assessment Venous: brown pigment around ankles, warm, normal pulses, pain relieved with elevation of LE and compression stockings, marked edema. Muscle atrophy can accompany prolonged chronic arterial disease. Gangrene most serious complication. PAD - Assessment with severe areterial disease, extremitiy 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. Diagnostic Tests Imaging: arteriography: Determine amount of vessel narrowing/occlusion; Contrast medium into arterial system Risks: hemorrhage, thrombosis, embolus, death Doppler: inexpensive,noninvasive Ankle Brachial Index (ABI): divide ankle bp by brachial bp: ABI < 0.9 = PAD Exercise tolerance Testing Interventions Exercise/Positioning Promote vasodilation Drug Therapy: Trental, Aspirin, Plavix Angioplasty Surgical Management Acute peripheral arterial occlusion Causes: Embolus / Thrombus Narrowed artery or trauma Six "P's" fo Ischemia Pain Pallor Pulselessness
Paresthesia Paralysis Poikilothermia (coolness) Interventions Must be immediate to save extremity Anticoagulation Therapy (Heparin) Thrombectomy or embolectomy Post-OP Care Compartment Syndrome Loosen dressing, raise extremity to level of heart and notify MD Aneurysm A permanent localized dilation of an artery, which enlarges the artery to at least two times its normal diameter. It may be described as : fusiform or saccular true or false. Fusiform aneurysm a diffuse dilation affecting the entire circumference of the artery Saccular aneurysm an outpouching affecting only a distinct portion of the artery True or False aneurysm In true aneurysms, the arterial wall is weakened by congenital or acquired problems. False aneurysms occur as a result of vessel injury or trauma to all three layers of the arterial wall Patho An aneurysm forms when the middle layer (media) of the artery is weakened, producing a stretching effect in the inner layer (intima) and outer layers of the artery. As the artery widens, tension in the wall increases and further widening occurs, thus enlarging the aneurysm. Hypertension (high blood pressure) produces more tension and enlargement within the artery. As the aneurysm grows, the risk of arterial rupture increases. Dissecting Aneurysms the aneurysm enlarges, blood is lost, and blood flow to organs is diminished. Sudden tear in aortic intima. Not common. Ascending Aorta & Descending thoracic aorta- most common.
You've reached the end of your free preview.
Want to read all 11 pages?
- Spring '12
- Nursing, Atherosclerosis, chronic venous insufficiency