the risk of occlusion Obesity Sepsis Hypotension Low cardiac output Aneurysms

The risk of occlusion obesity sepsis hypotension low

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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
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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
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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
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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)
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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)
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Peripheral Artery Disease Doppler Ultrasound
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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
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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
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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
  • LorraineHaertel
  • Nursing

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