PAD

Question 1

What are the clinical manifestations?

Answer 1

• aching
• cramping (intermittent claudication in calf muscles, thighs, buttocks, etc when doing activity)
  
  • intermittent claudication is when there is burning or cramping pain in the legs during exercise. Relieved by rest.
• inducing fatigue or weakness that occurs with some degree of exercise or activity, which is relieved with rest
• increased pain with ambulation
• rest pain (if severe), sharp pain worse at night

Assessment Findings:

• coldness or numbness in the extremities
• pale or cyanotic extremities
• Skin and nail changes, ulcerations, gangrene, and muscle atrophy may be evident.
• Bruits may be auscultated with a stethoscope.
• Peripheral pulses may be diminished or absent.
• loss of hair
• dry scaly mottled skin
• thick toe nails
• dependent rubor (redness) of the extremity

-Unequal pulses between extremities or the absence of a normally palpable pulse is a sign of PAD.

Question 2

How is the diagnosis of PAD made?

Answer 2

• CW Doppler and ABIs (ankle-brachial index)
  
  • The ankle pressure is compared to the brachial pressure. The expected finding for ABI is 0.9 to 1.3. ABI less than 0.9 in either leg is diagnostic for PAD.
• treadmill testing for claudication
• duplex ultrasonography
• other imaging studies

Question 3

What are the nursing interventions?

Answer 3

• to help alleviate pain, have pt dangle legs down (dependent position) Elevation the feet at rest is okay but do not elevate above the level of the heart, it makes it worse!
• Encourage the client to exercise to build up collateral circulation.
  -Initiate exercise gradually and increase slowly.
  -Instruct the client to walk until the point of pain, stop and rest, and then walk a little farther.
• Promote vasodilation and avoid vasoconstriction.
• Provide a warm environment for the client.
  -Have the client wear insulated socks.
  -Tell the client to never apply direct heat, such as
  a heating pad, to the affected extremity because
  sensitivity is decreased, and this can cause a burn.
• Instruct the client to avoid exposure to cold (causes vasoconstriction and decreased arterial flow).
• Instruct the client to avoid stress, caffeine, and nicotine, which also cause vasoconstriction.
  -Vasoconstriction is avoided when the client completely abstains from smoking or chewing tobacco.
  
  • Vasoconstriction of vessels lasts up to 1 hr after smoking or chewing tobacco.
• Instruct the client to avoid crossing the legs.
• Tell the client to refrain from wearing restrictive garments.

Question 4

What are examples of PAD?

Answer 4

• Buerger’s disease
• subclavian steal syndrome
• thoracic outlet syndrome
• Raynaud’s disease
• popliteal entrapment

Question 5

What are the risk factors of PAD?

Answer 5

• Hypertension
• Hyperlipidemia
• Diabetes mellitus
• Cigarette smoking
• Obesity
• Sedentary lifestyle
• Familial predisposition
• Female sex
• Age older than 65
• Elevated C-reactive protein
• Hyperhomocysteinemia

Question 6

What is Raynaud’s Disease?