Peripheral Vascular Disease (Week 6 Perfusion)

What is Peripheral Arterial Disease (PAD)?

Progressive thickening and narrowing of arterial walls due to atherosclerosis, leading to poor distal perfusion in extremities.

What is Chronic Venous Insufficiency (CVI)?

Blood trapping and stasis in the extremities due to faulty valves and endothelial injury from inflammation.

What is an arteriography used for in PAD?

It visualizes areas of decreased arterial flow in the lower extremities using contrast on X-ray; may include stent placement

What should be monitored after an arteriography?

Bleeding at catheter insertion site and distal perfusion

What does a Doppler ultrasound with duplex imaging do?

Maps blood flow through an entire arterial region

What does an exercise stress test assess in PAD?

Claudication (calf cramping) during exercise, which may indicate PAD

What is the Ankle-Brachial Index (ABI) and what is it used for?

A test that compares ankle systolic BP to brachial systolic BP using a Doppler; used to diagnose PAD

What ABI value is diagnostic for PAD?

Less than 0.9 in either leg.

What is the normal ABI range?

0.9–1.3.

PAD color, pain, and ulcers?

• pallor of extremity when elevated

• rubor (redness) of extremity when dangled

• pain when elevated, relief when dangled

• ulcers look ‘hole punched’, round, smooth

PAD s/s

• intermittent claudication: pain and cramping of the calf

• delayed capillary refill

• weakened or non-palpable pulses

• loss of hair on calf

• dry, scaly, taut, shiny skin

• muscle atrophy

What key assessments are important in PAD?

Skin integrity, tissue perfusion, activity intolerance, musculoskeletal problems, and pain.

How should peripheral pulses be assessed in PAD?

Palpate or use Doppler ultrasound and mark the location once found.

What medications are commonly used in PAD management?

• Aspirin (antiplatelet)

• Statins (lipid-lowering, slows atherosclerosis)

Patient education for PAD

1. diet

2. gradual walking exercise, rest when claudication occurs

3. encourage heat

4. avoid cold, stress, caffeine, nicotine, crossing legs, compression stockings

5. dont elevate legs, dangle to increase blood flow

6. monitor extremities for injuries and poor wound healing

CVI color, pain, & ulcers

• brown, leathery skin

• edema

• ulcers (medial malleolus) irregular in shape

• pain when dangling

Nursing care for CVI

1. mon. for edema

2. wound care

3. elastic stocking

4. avoid standing or sitting for prolonged periods of time

5. elevate legs (20 minutes, 4 -5 times a day)

Manifestations of DVT

• tenderness to palpation

• warmth

• edema

• swelling

Nursing care for DVT

1. provide thigh-high compression stockings

2. no SCDs

3. avoid massaging

4. dont place anything behind the knees

5. elevate legs for edema

6. frequent ambulation

7. mon. anticoagulation medications

8. mon. s/s of PE (sudden onset of sharp chest pain and dyspnea, distress)

How does Heparin work?

Inhibits thrombin and multiple clotting factors.

Medication: Heparin (PVD)

1. route: subcutaneous or continuous IV infusion

2. mon. aPTT: normal is 30-40 secs, therapeutic while on heparin is 60-80 secs

3. mon. platelet

4. antidote: protamine sulfate

Medication: Low Molecular Weight Heparin (Enoxaparin) (PVD)

1. route: subcutaneous

2. doesnt require routine coagulation monitoring, can be used at home

How does warfarin work?

interferes with vitamin K’s effects on clotting

Medication: Warfarin (PVD)

1. route: only PO

2. therapeutic effect may take up to 5 days

3. mon. PT (normal 11-12, therapeutic 1.5-2x) and INR (normal, 1.0-2.0, therapeutic 2.0-3.0)

Nursing care/education of patients on anticoagulants

1. use straight razor only

2. use soft toothbrushes

3. avoid aspirin, gingko, garlic, NSAIDs

4. avoid forcefully blowing nose

5. stool softeners to avoid straining

6. avoid vitamin K foods if taking warfarin (green leafy veggies)

7. avoid IM injections

8. assess for mental status changes, can indicate cerebral bleeding