Peripheral Arterial Disease Of The Lower Extremities

Peripheral Arterial Disease of the Lower Extremities

Description 

PAD may affect  Aortoiliac artery  Femoral artery  Popliteal artery  Tibial artery  Peroneal artery

Clinical Manifestations 

Classic symptom of PAD  Intermittent claudication 

Ischemic muscle ache or pain that is precipitated by a constant level of exercise

Clinical Manifestations 

Classic symptom of PAD  Intermittent claudication Resolves within 10 minutes or less with rest  Reproducible 

Clinical Manifestations    

Paresthesia Thin, shiny, and taut skin Loss of hair on the lower legs Diminished/absent pedal, popliteal, or femoral pulses

Clinical Manifestations  

Pallor Reactive hyperemia

Clinical Manifestations 

Rest pain  Occurs in the forefoot or toes and is aggravated by limb elevation  Occurs from insufficient blood flow  Occurs more often at night

Complications 

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Atrophy of the skin and underlying muscles Delayed healing Wound infection Tissue necrosis Arterial ulcers

Diagnostic Studies 

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Doppler ultrasound  Segmental blood pressures Ankle-brachial index (ABI)  Done using a handheld Doppler Duplex imaging

Diagnostic Studies  

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Angiogram Magnetic resonance angiography (MRA) Health and physical examination  Include palpation of peripheral pulses

Collaborative Care Risk Factor Modification  

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Smoking cessation Aggressive treatment of hyperlipidemia Hypertension and diabetes mellitus BP maintained < 130/85 Glycosylated hemoglobin < 7.0% for diabetics

Collaborative Care Drug Therapy 

Antiplatelet agents  aspirin  ticlopidine (Ticlid)  clopidogrel (Plavix)

Collaborative Care Drug Therapy 

Drugs prescribed for treatment of intermittent claudication  pentoxifylline (Trental)  heparin  cilostazol (Pletal)

Collaborative Care Exercise Therapy 

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Exercise improves oxygen extraction in the legs and skeletal metabolism Walking is the most effective exercise for individuals with claudication  30 to 40 minutes/day

Collaborative Care Nutritional Therapy 

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Dietary cholesterol less than 200 mg/day Decrease intake of saturated fat Soy products can be used in place of animal protein

Collaborative Care Complementary/Alternative Therapies 

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Ginkgo biloba  Effective in increasing walking distance for patients with intermittent claudication Folate, vitamin B6, cobalamin (B12) 

Lowers homocysteine levels

Collaborative Care Care of the Leg with Critical Limb Ischemia    

Protect from trauma Decrease vasospasm Prevent/control infection Maximize arterial perfusion

Collaborative Care Interventional Radiologic Procedures 

Indications  Intermittent claudication symptoms become incapacitating  Pain at rest  Ulceration or gangrene severe enough to threaten viability of the limb

Collaborative Care Interventional Radiologic Procedures 

Percutaneous transluminal balloon angioplasty  Involves the insertion of a catheter through the femoral artery  Catheter contains a cylindric balloon

Collaborative Care Interventional Radiologic Procedures 

Percutaneous transluminal balloon angioplasty  Balloon is inflated dilating the vessel by cracking the confining atherosclerotic intimal shell

Collaborative Care Surgical Therapy 

Most common surgical approach  A peripheral arterial bypass operation with autogenous vein or synthetic graft material to bypass blood around the lesion

Collaborative Care Surgical Therapy

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Endarterectomy Patch graft angioplasty Amputation

Nursing Management Nursing Assessment 

Past Health History  Diabetes mellitus  Smoking  Hypertension  Hyperlipidemia  Obesity

Nursing Management Nursing Assessment

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Exercise intolerance Loss of hair on legs and feet Decreased or absent peripheral pulses

Nursing Management Nursing Diagnoses 

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Ineffective tissue perfusion (peripheral) Impaired skin integrity Acute pain Activity intolerance Ineffective therapeutic regimen management