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PAD (Nurse management: (Medical Management: (Nitrates: With PAD we use…
PAD
Nurse management:
Keep them warm: no constrictive clothing if the circulation is weak. If frostbitten Do not put under running water to warm up. Use body heat or cover them. Do not massage extremity
Example: Pt comes in and TED stockings are ordered do you put it on patient if feet are fucked up? NO not for PAD
Arterial ulcer looks sloughy. Borders are white, need to cut out white border and use wound vac to pull in nutrients and help healing.
If doctor says to put on stocking, you recommend ABI to make sure. If he insist tell him to fuck off and do it yourself.
Diet: low fat, home cooked, remove skin from chicken breast.
Promote smoking cessation: Need to tell them to stop smoking, not cut back. Cold turkey, cuz the patches still have nicotine. women who take birth control should not smoke at all.
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Excercise: Tell them to walk. If patient cant walk more than 2 mins, tell them to walk 1 min and rest. Increase everyday steadily.
Medical Management:
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Nitrates: With PAD we use nitro pills, not sublingual because thats only for CAD
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Drug holiday for Nitropaste at night atleast 12 hours. May have headaches, and Orthostatic Hypotension,
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anticoagulants
True class is : heparin, coumadin, and thrombolytics
No such thing as antiplatelets, they are called platelet aggregate inhibitors: Aspirin and PLavix(aka clapidogrel)
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Assessment:
ABI: highest of ankle and highest of brachial and divide. you want 1.0 or above. anything .9-1 is optimal. .7-.89 it is mild. .5-.69 is moderate. less than .5 is gross. NEVER USE TED STOCKINGS FOR ANYTHING LESS THAN 0.9
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PAD: there is pain with the ulcer, wound is usually pale white around it, gross inside it.