PVD Objectives

1) Appropriate parameters for determining status of peripheral circulation

• Ankle-brachial Index, comparison for blood flow between peripheral extremities and extremities closer to the heart

• Capillary refill

• Doppler measurement

• Assess skin color, temperature, and appearance

2) Compare the various diseases of the arteries and their causes, patho changes, manifestations, management, and prevention

• Arteriosclerosis:

  • WHAT: Fibrotic hardening of the arteries; likely d/t smoking, sedentary lifestyles

  • PATHO: Increases peripheral resistance, CNS response to increase RAAS response to compensate for decreased blood flow to arteries. More pressure on target organs such as kidneys, heart, liver, etc.

  • CLINICAL: Patient is usually asymptomatic until key damages occur such as HF, AKI, etc,.

  • MNGMT: Patient lifestyle changes, increase exercise, smoking cessation, dietary considerations. Prescribe blood thinners/anticoagulants   

• Atherosclerosis:

  • WHAT: fatty plaque accumulation in the arteries

  • MGMT: balloon valvuloplasty.

• Peripheral Artery Disease:

  • WHAT: progressive arterial insufficiency; plaque buildup narrows arteries and restricts blood flow to extremities. hallmark: leg pain even at rest

  • PATHO: atherosclerosis is unresolved, patient continues harmful lifestyle choices, blood pressure continues to increase

  • CLINICAL: intermittent claudication

  • MGMT: Lifestyle modifications, increase exercise, smoking cessation, ACEi ARBS ARNIs CCB

• Aneurysm:

  • WHAT: sac located on artery prone to bursting

  • PATHO: atherosclerosis common cause, more pressure on the arteries, formed on weakened part of artery wall.

  • CLINICAL: asymptomatic if unruptured. tachycardia, low BP if ruptured

  • MGMT: separated by Abdominal and Thoracic KEY is to reduce aortic stress and prevent rupture; promote smoking cessation, lipid control, DM, weight management

• Thromboembolism:

  • WHAT: blood clot that has travelled; usually caused by indwelling catheters, invasive procedures

  • PATHO: viscous blood, stagnant blood, leads to clot, clot is dislodged by trauma/invasive procedure/IV drug use = impaired blood flow

  • CLINICAL: cyanosis, high ABI, ischemic pain 6 P’s: Pain, Pallor, Paresthesia, Pulselessness, Paralysis, Poikilothermia

  • MGMT: ensure bed rest to prevent clot from travelling further. no restrictive clothing, clot busters, warfarin and heparin, tPA. Nurse complete Neurovascular check frequently

    • NO HEAT= vasodilation further propels clot or causes vascular damage

• Reynaud’s

  • WHAT: intermittent arterial vasoconstriction triggered by cold. fingers and toes affected bilaterally

  • PATHO: prolonged vasoconstriction = ischemia = stasis = ulcers, necrosis possible

  • CLINICAL: cyanotic or white appearance of skin

  • MNGMT: advise patient to avoid the cold, dress appropriately for winter

• Arterial Leg Ulcers

  • WHAT: pale cool hollow ulcers usally inbetween toes. small circular

  • PATHO: prolonged arterial insufficiency, longer recovery of ulcerations, dry.

  • CLINICAL: “dry, deep, deadly”

  • MGMT: stay in dependent position, improve perfusion through vasodilators