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Peripheral Arterial Disease (PAD) - Coggle Diagram
Peripheral Arterial Disease (PAD)
Risk Factors
Tobaccos Use
Kidney Disease
Diabetes
HTN
Hypercholesterolemia
Family Hx
Increasing age
Obesity
Sedentary life style
Stress
Clinical Manifestations
Thin, shinny taught skin
Loose of hair on lower limbs
Diminished or absent pedal, popliteal, or femoral pulses
pallor of the foot w/ elevation
reactive hyperemia
Raise foot turns pale, lower it turns red
pain at rest
starts in the toes and feet
aggravated by limb elevation
often at night
patient will drop legs of the side of the bed to elevate pain
Classic Symptoms
Intermittent claudication
classically in the calf mulse
exacerbation w/ exercise
rest/relief w/ elevation
Complications
non healing arterial ulcers and gangrene are the most serious complications
May result in amputation
if inadequate flow is not restored
if severe infection occurs
6 P's
Pain
Pallor
Pulselesness
Parethesia
Paralysis
Poikilothermia
Diagnostic Studies
Doppler Ultrasound
Ankle-brachial Index
Take Ptt's BP in both arms and ankles
Highest ankle/highest arm
Want it to be close to one
Normal: 0.91-1.30
Mild PAD: 0.71-0.90
Moderate PAD: 0.41-0.70
Severe PAD: <0.40
Inter-professional care
Risk Factor Mod
Tobacco Cessation
A1C <7
Tx of hyperlipdemia
BP controlled: <140/90
Drug therapy
ACE inhib
Ex. Ramipril
Helps to...
Decrease cardio morbidity
^ peripheral blood flow
^ ptt's ABI
^ distance they are able to walk
Anti-platelets
Ex
Aspirin
Clopidogrel
helps too..
prevents platelets from aggregating and aggravating the existing blockages
Statins
ex
Simvastatin
Helps to...
Decrease plaque formation
Exercise Therapy
Exercise improves oxygenation
Goal: 30-45 min/day, 3x per week
increases rate of survival
Nutritional Therapy
BMI <25
BMI = kg/m2
Waist circumference <40in for men, <35 in for women
DASH Diet
Even moderate weight lose of 3-5%, causes significant reduction of triglycerides, glucose, A1C, and risk of developing type 2 diabetes
Radiology
PTA
"Roto Router"
Use balloons and stents to open arteries
Artherectomy
Cryoplasty
Takes place in the cath lab
Only where there is a blockage
Surgical
Indicated for ptt w/ long areas of stenosis or severely calcified area
Peripheral bypass surgery
Use autogenous vein or graft
Do not bend leg
PTA with stenting may be used with bypass surgery
Nursing Management
Assessment
Past Health hx
Diabetes
smoking
HTN
hyperlipidemia
Obesity
Exercise
Exercise intolerance
Loss of hair on legs and feet
Assess for any wounds or openings
Intermittent claudication
Nursing problems
Ineffective tissue perfusion related to PAD activity
activity intolerance related to pain
Chronic pain related to poor tissue perfusion
ineffective health management
Smoking cessation
Control of hyperlipdemia
Diabetes management
Planning/goals
Adequate tissue perfusion
Relief of pain
Increased exercise intolerance
Intact, healthy skin on extremities
Increased knowledge of disease / tx
Nursing implementation
Health promotion
Id at risk ptts
Diet modification
Proper care of feet
Avoid injury
Acute care/ monitor post op
Skin color and temp
Cap refill
Sensation and ROM of extremity
Circulatory assessment
Monitor for potential complications
Compare to preop assessment --> should see improvement
Mark pules once found
Continuous circulatory assessment
Knee flexed position showed be avoided
Turn and position frequently
Other post op nursing care
Cough and deep breathe
Assess bowel sounds
Assess for bleeding and infection
Discourage prolonged sitting
Doc orders
Ambulatory care/ management
Patient ed before discharge
Long-term anti platelet therapy
Importance of supervised exercise
daily inspection of feet
Comfortable shoes w/ rounded toes and soft insoles
Shoes lightly laced
Evaluation
Adequate peripheral tissue perfusion
Increased activity intolerance
Effective pain management
Knowledge of disease and tx plan
Plans for walking program
Have ptt verbalize key elements