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Peripheral Arterial Disease (Medical Management (Endovascular management…
Peripheral Arterial Disease
Assessment
Signs/Symptoms
intermittent claudication
aching :check:
cramping :check:
fatigue :check:
weakness :check:
Pain with ambulation :check:
Buttock
Hip :check:
not promtly relieved by rest :check:
Thigh
Calf :check:
relieved by rest :check:
decreased ability to walk :check:
slow healing of injuries
Elevating extremity increases pain
Cold/numb and pale extremities
muscle atrophy may be evident
gangrene
Bruits may be auscultated
diminished or absent peripheral pulses
nail changes
thickened
opaque
sparse hair growth and shiny skin on legs
History
69 year-old :check:
Smokes 2-3 packs of cigarrettes per day :check:
Comorbidities :check:
Coronary artery disease (CAD) :check:
HTN :check:
Peripheral vascular disease (PVD) :check:
Osteoarhritis
Surgical history :check:
Quadruple coronary bypass graft (CABG x 4) 3 years ago :check:
Open-reduction internal fixation (ORIF) of right femoral fracture 20 years ago
Obesity :check:
Height: 5 ft 10 in :check:
Weight: 295 lb :check:
Vital Signs
Temp: 98.4 F
Pulse: 82 bpm
RR: 16 breaths/min
BP: 163/91 :check:
Diagnotics
CW Doppler
ABIs :check:
Right Leg: 0.43 :check:
Left Leg: 0.59 :check:
treadmill testing for claudication
duplex ultrasonography
other imaging studies
CBC :check:
Cholesterol: 239 mg/dl :check:
HDL: 28 mg/dl :check:
LDL: 181 mg/dl :check:
Triglycerides: 150 mg/dl :check:
Incidence
8.5 million people in the U.S. have PAD
Etiology
Modifiable risk factors :check:
Nicotine use :check:
Diet (hyperlipidemia) :check:
Hypertension :check:
Diabetes
Stress
Sedentary lifestyle
Obesity :check:
Nonmodifiable risk factors :check:
Increasing age (>60yo) :check:
Familial predisposition/genetics
Ethinicity
African descent
Hispanic
Pathophysiology
Risk factors
Reaction-to-injury theory
Prolonged hemodynamic forces
Turbulent flow :check:
Chronic hyperlipidemia :check:
chemical exposure
Irridation
Vascular endothelial cell injury
Aggregation of platelets
Matrix of collagen and elastic fibers form
Narrowing of the lumen
5 more items...
Monocytes at site of injury
Smooth muscle cells migrate and proliferate
Shearing stresses
HTN :check:
Advanced age :check:
Hypelipidemia :check:
Smoker :check:
Medical Management
Participation in exercise program :check:
arm-ergometer exercises
walking program
Physical therapy :check:
weight reduction :check:
smoking cessasion :check:
Pharmacologic Management :check:
Antiplatelet agents :check:
Aspirin
:check:
325 mg daily :check:
clopidogrel (Plavix) :check:
75 mg daily :check:
For symptomatic claudication
Pentoxifylline (Trental)
cilostazol (Pletal)
Statins :check:
simvastatin :check:
20 mg :check:
Endovascular management
ballon angioplasty
stent
stent graft
atherectomy
drug-eluting ballons or stents
Surgical Management
Endarterectomy
Bypass grafts
diet changes :check:
low-fat diet
low-cholesterol diet
Nursing Diagnosis 2: Chronic Pain r/t chronic ischemic state of peripheral tissues AEB patient reports symptoms consistent with intermittent claudication
Goal: Patient will report a pain level of 0-3 (mild at most) 1 hour after antiplatelet medications have been administered
Interventions
Assess the patient's pain level, location, exacerbating factors
alleviating factors, and any associated symptoms
to set a baseline
Promote increase in circulation through exercise
as the increase in oxygenation of the tissues will reduce ischemic pain
Administer analgesic agents as prescribed
as the reduction in pain will allow patient to perform exercises that promote circulation
Recommend patient keep a pain diary
to aid in identifying behaviors that aid in pain relief and to aid in evaluating effectiveness of exercises and physical therapy
Evaluation
Patient has reported a decreased in pain level from a 5 to a 2, one hour after interventions were carried out.
Nursing Diagnosis 1: Ineffective peripheral tissue perfusion r/t compromised circulation AEB diminished lower peripheral pulses
Goal: Patient will have an increase in strength of lower peripheral pulses from a +1 to a +2/+3 1 hour after interventions to improve arterial blood supply have been completed
Interventions
Lower the extremities below the level of the heart
to will enhance arterial blood supply
Encourage moderate amount of walking or extremity exercises if no contraindications present.
To promote blood flow and circulation.
Maintain warm temperature on the extremities and avoid chilling
as warmth will promote arterial flow by preventing vasoconstriction effects of chilling.
Discourage use of smoking
because nicotine in tobacco will cause vasoconstriction and further impede peripheral circulation.
Discourage crossing of the legs
as this would cause compression of the vessels and further impede circulation.
Administer vasodialtors and antiplatelets
as prescribed as these will relax the smooth muscle and facilitate arterial blood flow.
Evaluation
Patient's peripheral arterial blood supply has improved as evidenced by lower peripheral pulses have increased to a +3 and extremities feel warm to touch.
Nursing Diagnosis 3: Risk for impaired skin integrity r/t compromised circulation AEB cold lower extremities, sparse hair growth on legs and diminished pulses.
Goal: Patient's skin will remain free of wounds for duration of hospitalization
Interventions
Instruct on ways to avoid trauma to the lower extremities
because poorly nourished tissues are more susceptible to trauma and infection
Encourage wearing protective shoes and padding for common pressure areas
to prevent injuries like blisters
Encourage meticulous hygiene such as trimming long nails and maintaining skin clean and moisturized
as this will help prevent cracking of the skin or accidental cutting of skin
Promote a balanced diet with adequate protein and supplemental vitamins A and C
as good nutrition promotes better healing
Teach patient to avoid scratching skin or any rubbing of rough materials on skin
as this can cause a break in the skin and possible infection
Evaluation
Patient's skin appears intact and free of any wounds.
occuring with activity :check: