Vascular DisordersVascular DisordersPeripheral Arterial Disease Peripheral Arterial Disease of the Lower Extremitiesof the Lower Extremities

Aortoiliac, femoral, popliteal, tibial, or peroneal arteriesAortoiliac, femoral, popliteal, tibial, or peroneal arteries

Classic symptom: Intermittent ClaudicationClassic symptom: Intermittent Claudication

Ischemic muscle ache precipitated by a consistent Ischemic muscle ache precipitated by a consistent level of exerciselevel of exercise

Paresthesia – numbness / tingling in toes & feetParesthesia – numbness / tingling in toes & feet Trophic changes: reactive hyperemiaTrophic changes: reactive hyperemia

dependent rubor dependent rubor Rest pain – nocturnalRest pain – nocturnal

Peripheral Arterial DiseasePeripheral Arterial Disease

Peripheral Arterial Disease Peripheral Arterial Disease of the Lower Extremitiesof the Lower Extremities

Diagnostics: Diagnostics:

Non-invasive: Doppler Non-invasive: Doppler StudiesStudies

Invasive: AngiographyInvasive: Angiography

Peripheral Arterial Disease Peripheral Arterial Disease of the Lower Extremitiesof the Lower Extremities

Treatment: Treatment:

Risk Factor Modification – Risk Factor Modification – HTN – Stepped Approach to ControlHTN – Stepped Approach to Control Smoking - CessationSmoking - Cessation Treatment of hyperlipidemia - NutritionTreatment of hyperlipidemia - Nutrition Exercise – slow progressive walkingExercise – slow progressive walking

Medication – Medication – Antiplatelet Therapy – Plavix / ASAAntiplatelet Therapy – Plavix / ASA < blood viscosity / >erythrocyte flexibility – Trental< blood viscosity / >erythrocyte flexibility – Trental < platelet aggregation & promote vasodilation - Pletal< platelet aggregation & promote vasodilation - Pletal

PPeripheral Arterial Disease eripheral Arterial Disease of the Lower Extremitiesof the Lower Extremities

Critical Limb IschemiaCritical Limb Ischemia

Interventional RadiologyInterventional Radiology Percutaneous transluminal balloon angioplastyPercutaneous transluminal balloon angioplasty AtherectomyAtherectomy

Surgical RevascularizationSurgical Revascularization EndarterectomyEndarterectomy Graft angioplastyGraft angioplasty Peripheral artery bypass surgeryPeripheral artery bypass surgery

End-stage surgery - amputationEnd-stage surgery - amputation

Vascular DisordersVascular DisordersPeripheral Arterial Disease Peripheral Arterial Disease of the Lower Extremitiesof the Lower Extremities

Nursing DiagnosesNursing Diagnoses

Ineffective tissue perfusionIneffective tissue perfusion Impaired skin integrityImpaired skin integrity Acute painAcute pain Activity intoleranceActivity intolerance Ineffective therapeutic managementIneffective therapeutic management

Peripheral Arterial Disease Peripheral Arterial Disease of the Lower Extremitiesof the Lower Extremities

AssessAssess: Peripheral pulses, pallor, blanching, : Peripheral pulses, pallor, blanching, hyperemia, warmth, capillary refill, ability to hyperemia, warmth, capillary refill, ability to bear weight and walk, pain, risk factorsbear weight and walk, pain, risk factors

Nsg ActionNsg Action: Medication administration, : Medication administration, prepare for tests, treatment, surgery, prevent prepare for tests, treatment, surgery, prevent injury, skin care, community referralsinjury, skin care, community referrals

Pt/Family EducationPt/Family Education: Skin care, : Skin care, Medications, risk factor modification, exerciseMedications, risk factor modification, exercise

Peripheral Vascular DiseasePeripheral Vascular DiseaseThromboangiitis ObliteransThromboangiitis Obliterans

Buerger’s DiseaseBuerger’s Disease

Nonathersclerotic, segmental Nonathersclerotic, segmental inflammation of arteries, veins & inflammation of arteries, veins & nerves of upper and lower extremitiesnerves of upper and lower extremities More common in men 25-40 years of ageMore common in men 25-40 years of age Correlates with cigarette smokingCorrelates with cigarette smoking Rest pain, ischemic ulcerations Rest pain, ischemic ulcerations Tx: smoking cessation / medications – Tx: smoking cessation / medications – anti-platelets, anti-platelets,

vasodilatorsvasodilators Surgical: AmputationSurgical: Amputation

Peripheral DiseasePeripheral DiseaseClinical ManifestationsClinical Manifestations

Peripheral Vascular DiseasePeripheral Vascular DiseaseTreatmentTreatment

Peripheral Vascular DiseasePeripheral Vascular DiseaseRaynaud’s PhenomenonRaynaud’s Phenomenon

Episodic vasospastic disorder of small Episodic vasospastic disorder of small cutaneous arteries in fingers & toescutaneous arteries in fingers & toes Cause: Exaggerated SNS stimulationCause: Exaggerated SNS stimulation Occurs in women 15 -40 years of ageOccurs in women 15 -40 years of age May occur with collagen diseases: RA, scleroderma, May occur with collagen diseases: RA, scleroderma,

systemic lupus erythematosussystemic lupus erythematosus Vasospasm Phase: Blanching of hands & fingers Vasospasm Phase: Blanching of hands & fingers

with throbbing, aching pain, numbness, tingling with throbbing, aching pain, numbness, tingling Hyperemic Phase: swellingHyperemic Phase: swelling

Tx: Smoking Cessation, no meds with Tx: Smoking Cessation, no meds with vasoconstrictive effect; avoid cold; avoid vasoconstrictive effect; avoid cold; avoid

constrictive clothes; constrictive clothes; Give Give Calcium-channel blockersCalcium-channel blockers