Term
PAD incidence and prevalence
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Definition
§A common condition affecting 8-10 million Americans
§Most common cause is atherosclerosis
§Prevalence increases with age
§10%-30% of persons over 65 y.o. suffer from PAD
§30% of persons with PAD also have CAD
§Persons with PAD have a mortality rate 3 times higher than the healthy population
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Term
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Definition
nAge: increased incidence with aging
nAtheroscleosis: hx. CAD, hx. CVD, Carotid Stenosis)
nTobacco Smoking
nDiabetes
nHypertension
nHyperlipidemia
nElevated Homocysteine (unknown reason why)
nLack of Use / Inactivity
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Term
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Definition
nIntermittent claudication with use:
nDull, cramping pain in buttock, thighs & calf muscles occurring with walkingà relieved with rest
nIschemic Rest Pain:
nPain at rest while supineàrelieved with dangling of leg or dependent position of leg
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Term
| complete vascular assessment |
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Definition
nSkin color & temperature
nLook for edema & ulcers
nSigns of Chronic Ischemia:
nPallor, cyanosis, gangrene, atrophy, delayed capillary refill
nLoss of hair, shiny pale skin, thickened/tropic toenails
nPalpation & Auscultation of Arteries:
nCarotid, aorta, femoral, popliteal, pedal
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Term
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Definition
nABI: Ankle-brachial Index
nSequential Limb Toe pressures
nDoppler Ultrasound (U/S)
nComputed Tomography Angiogram (CTA)
nMagnetic Resonance Angiography (MRI)
nContrast Angiogram
nInvasive
nMost accurate
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Term
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Definition
The Meaning of ABI
Simple, non-invasive test
Measures ratio of ankle to arm BP
•Normal ABI= >0.90
•A value <0.90 indicates presence of PAD
•Pt usually symptomatic with ABI 0.70-0.90
•Lower ABI indicates more severe PAD
•ABI 0.40-0.60 = indicates ischemic disease
rest pain is usually seen
•ABI <0.40 indicate impending tissue loss** necrosis
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Term
| medical management of PAD |
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Definition
risk modification cornerstone of managment
•Smoking cessation
•Treat to Goal:
•BP Control (Anti-hypertensives)
•Blood Glucose Control (oral agents &/or insulin)
•Cholesterol reduction (statins, bile sequestering agents, niacin)
•Additional Medications
•Vasodilators (Dypramidole 400mg 3x day with food)
•Antiplatelet agents( Plavix 75 mg daily, ASA)
•Exercise as tolerated/Rest to relieve claudication
tailored to patient's needs (diabetic, htn, etc)
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Term
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Definition
When medical management fails àrefer to Vascular Surgeon
Invasive treatment is considered when:
1. patient experiences recurrent rest pain
2. evidence of tissue loss
3. disabling claudication interferes with QOL
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Term
| types of surgical options for PAD |
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Definition
nPercutaneous Transluminal Angioplasty (PTA)
nNot appropriate for longer lesions
nNot cardiac-another artery of the body
nInflate with balloon
nRisk of re-stenosis (only fair to poor long-term patency)
nPTA with Stent
nHigher success rates than with PTA alone
nBypass Graft Surgery
nMost invasive
nImproved long term patency
nHigher rate of mortality
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Term
| complications from PTCA/stent placement |
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Definition
nBleeding
nHematoma Formation
nRetroperitoneal Bleeding
nEmboli
nContrast Media Reaction
nContrast Induced Renal Failure (kidneys already stressed)
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Term
| long term self managment of PAD |
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Definition
nAddress individual’s modifiable risk factors
nEncourage exercise to build collateral circulation
nWalk to the point of painàSTOP & RESTà then walk further
nAvoid leg crossing
nAvoid constricting clothing
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Term
| nursing interventions post PAD |
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Definition
üMark site for assessment of pulse (if not done pre-op)
üMaintain Bedrest
üsupine/flat
üNon-flexion of affected extremity
üVS assessment
üHYPOTENSION, TACHYCARDIA,TACHYPNEA
üAssessment of Groin Area
MONITOR FOR BLEEDING, HEMATOMA FORMATION AT PUNCTURE SITE
üNeuro vascular assessment (according to policy)
üQ15 minutes x 1 hr
üQ30 min x1 hr
üAssessment of Distal pulses
üPopliteal , posterior tibial, & pedal pulses
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Term
| promoting vasodilation and preventing vasoconstriction in PAD |
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Definition
•Keep warm, wear insulated socks
•Avoid Direct application of heat
•Avoid direct exposure to cold temperatures
•Avoid: stress, caffeine & nicotine
•Complete abstinence from smoking or tobacco chew
(effect of vasoconstriction of one cigarette lasts up to 1 hour)
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Term
| medications for PAD avoid constriction/promoting dilation |
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Definition
Administer Medications as prescribed
•Trental-treats claudication, affects blood viscosity
•Dypramidol-vasodilator
•Clopidogrel (Plavix)
•ASA
•Antihypertensives
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Term
| 5 p's of acute limb ischemia |
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Definition
üPallor
üPain
üParesthesia
üParalysis
üPulseless
üSkin may become edematous & blisters may form within 24 hours after acute ischemia occurs
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Term
| nursing interventions for PAOD |
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Definition
nAssess & treat Pain
nAssess hydration status
nMonitor Urinary Output
nAssist with initial ambulation when allowed
Patient teaching regarding post-procedure follow-up
Patient teaching regarding management of modifiable risk factors for PAD
Patient teaching regarding resuming activity & exercise
nMonitor lab results
nElectrolytes
nHbg/Hct
nPT/PTT
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