the risk of occlusion: – Obesity – Sepsis – Hypotension – Low cardiac output – Aneurysms – Aortic dissection – Bypass grafts • Factors that increase the risk of ischemia: – Emboli – Atrial fibrillation – Proximal atheroma – Tumor – Foreign bodies
Peripheral Artery Disease • Clinical Manifestation – Intermittent claudication : tightening pain, sharp cramp, burning, or pressure in calf or buttocks related to decreased blood flow during walking and disappears at rest – Rest pain – Decreased pulses – Delayed wound healing • Symptoms are: • Caused by inadequate supply of oxygen and other nutrients to the legs • Simple activities like walking or climbing stairs may become painful • Pain is felt in the calf, numbness or heaviness in the legs, changes in LE skin color and loss of hair from the legs
Peripheral Artery Disease • Diagnostic evaluation – Physical assessment of extremities: skin color (pallor), temperature ( ), pulse (weak or absent), nails (poor growth) and hair (loss) – Noninvasive diagnostic tests : • Ankle-Brachial Index (ABI) • Doppler Ultrasound • Transcutaneous oximetry • Treadmill Test • Arteriography
Peripheral Artery Disease • Peripheral signs of PVD are the classic 6 P ’ s Pulselessness Paralysis Paraesthesia (tingling, tickling, prickling, pricking, or burning) Pain Pallor Perishing cold (Polikilothermia)
Peripheral Artery Disease • Ankle-Brachial Index (ABI) – Compare BP measured at ankle with BP measured at arm. • A low ankle-brachial index number can indicate narrowing or blockage of the arteries in the legs. • SBP ankle/ SBP arm – No blockage (1.0 to 1.4) Normal – Borderline (0.9 to 0.99)** – Mild blockage (0.8 to 0.89) – Moderate blockage (0.5 to 0.79) – Severe blockage (less than 0.5)* – Rigid arteries (more than 1.4)
Peripheral Artery Disease • Doppler Ultrasound
Peripheral Artery Disease • Treatment – No cure! Treatment mainly to manage symptoms – Promote arterial flow: Pentoxifylline (Trental) – Lifestyle changes – dietary modification, smoking cessation, and regularly exercising – Manage and control comorbidities: diabetes, hypertension, obesity, hypercholesterolemia and hyperlipidemia – Blood thinners: anticoagulants (heparin or warfarin) or antiplatelets (aspirin, plavix) – Prevention of injury (foot care– details in upcoming slide) – Percutaneous Transluminal Angioplasty (PTA) • Minimally invasive procedure to open up blocked coronary arteries – Reduce risk of PAD
Peripheral Artery Disease • Nursing Care – History • Ask about arterial disease, surgery, and ulcerations • Chest pain, shortness of breath, fatigue, chronic discomforts – Physical Assessment • Peripheral pulses, ABI, arterial flow (doppler), skin color and temp, hair on LE, skin integrity, ulcers, darkening of skin, thickening of nails, capillary refill time, venous filling, edema – Promote arterial flow: LE positioning, smoking cessation, stress, foot care – Pain management – Skin care – Activity intolerance – Education to reduce risk
Physical Examination Examination: What do to: Inspection Expose the skin and look for: • Thick Shiny Skin • Hair Loss • Brittle Nails •
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- Spring '16