Peripheral Artery Disease Study Notes

Peripheral Artery Disease Overview

  • Definition: Inadequate blood flow to lower extremities due to atherosclerosis.
  • Pathophysiology:
    • Characterized by thickening of arterial walls due to plaque build-up.
    • Plaque build-up occurs within the:
    • Intima: Innermost layer of the blood vessel.
    • Media: Middle layer of the blood vessel.
    • Progression of plaque accumulation causes arterial narrowing and impaired distal blood flow.

Etiology and Risk Factors

  • Primary Cause: Atherosclerosis.
  • Associated Causes and Risk Factors:
    • Tobacco use
    • Diabetes
    • Hyperlipidemia
    • Uncontrolled Hypertension (HTN)
    • Sedentary lifestyle
    • Obesity
    • Stress

Nursing Diagnoses

  • Clinical nursing diagnoses corresponding to Peripheral Artery Disease address compromised peripheral tissue perfusion, acute/chronic pain, impaired skin integrity, and physical mobility deficits.

Signs and Symptoms

  • Intermittent Claudication:
    • Pain in legs during exercise.
    • Relieved by rest or by placing legs in a dependent (dangling) position.
  • Paresthesia: Tingling sensation in lower extremities.
  • Pallor: Unnatural paleness of the skin.
  • Integumentary Alterations: Thin, shiny skin with hair loss on legs.
  • Rest Pain: Severe arterial ischemia manifesting as pain even while resting.

Complications

  • Nonhealing Ulcers: Nonhealing lesions located over bony prominences.
  • Gangrene / Necrosis: Severe tissue ischemia leading to cell death.
  • Acute Arterial Ischemic Disorder:
    • Defined as a sudden blockage in an artery.
    • Caused by an embolus or thrombi.

Diagnostic Tests and Interventions

  • Diagnostic Assessment:
    • Pulse Palpation: Manual evaluation of peripheral arterial pulses.
    • Angiography: Radiographic visualization of arterial patency and vascular blockages.
    • Ankle-Brachial Index (ABI): Non-invasive pressure ratio comparing lower and upper extremity blood pressures.
    • Doppler Ultrasound: Assessment of arterial blood velocity and perfusion.
  • Revascularization and Surgical Interventions:
    • Interventional Radiology:
    • Catheterization with balloon angioplasty.
    • Stent placement (STENT).
    • Bypass Graft: Surgical re-routing of blood flow past an obstructed arterial segment.
    • Amputation: Removal of non-viable extremity tissue in advanced gangrene or irreversible ischemic necrosis.

Nursing Interventions and Clinical Assessment

  • Pharmacologic Interventions:
    • Antiplatelet agents: To inhibit thrombus formation.
    • ACE Inhibitors (ending in "-pril"): For cardiovascular risk reduction and hypertension control.
    • Pentoxifylline: To improve microvascular circulation and reduce blood viscosity.
  • Clinical Assessment Parameters:
    • Baseline Normal Pulse Grade: Normal pulse baseline is rated as 2+2+ (strong).
    • Continuous evaluation for Intermittent Claudication.
    • The 6 P's of Arterial Ischemia:
    1. Pallor
    2. Pain
    3. Paresthesia
    4. Paralysis
    5. Poikilothermia (inability to regulate core temperature; affected leg feels cold)
    6. Pulselessness
    • Peripheral Pulse and Perfusion Assessment:
    • Decreased or absent peripheral pulses.
    • Feet cold to touch.
    • Capillary refill time is less than 3 seconds\text{less than } 3\text{ seconds}.
    • Auscultate for possible arterial bruits.
  • Post-Procedure Protocol (After Revascularization Surgery):
    • Strict bed rest initially, followed by slow, gradual movement.

Patient Education

  • Lifestyle Changes: Comprehensive modification of cardiovascular risk factors.
  • Exercise: Structured exercise/walking programs to promote collateral arterial circulation.
  • Nutrition: Dietary adjustments aimed at managing lipid levels, blood pressure, and weight.