Peripheral Vascular Disease

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Peripheral Vascular Disease

• (Acute Chronic)
• Arterial

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Peripheral Vascular Disease

• PVD - a group of diseases that involve
  pathology in arteries or veins.
• - result in blood flow disturbances.

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Acute Arterial PVD

• Those at risk
• - arterial invasive procedures, i.e. cardiac
  cath
• - Hx of atrial fib
• - post-op vascular patient, i.e. graft
  occulsion
• - trauma patient

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Chronic PVD

• Those _at_ Risk
• - aged - stress
• - male - obesity
• - heredity - smoking
• - ? BP - ?chol

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Acute PVD Assessment

• excruciating pain
• loss of sensation
• loss of movement
• skin cold to touch
• pale or cyanotic
• may be pulseless

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Management - medical

• Restore circulation
• Bedrest stat
• Immobilize extremity protect from injury
• Anticoagulant therapy
• Embolectomy

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Management - Nursing

• Know those _at_ risk
• Assess skin color, temp, pulses
• Alert for pain
• Enforce immobility
• Monitor anticoagulant therapy - bleeding
• Prep for surgery

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Chronic PVD

• ? blood supply O2 starvation
• leg pain most common
• precipitated by walking
• pain relieved by rest or standing
• intermittent claudication - muscles of thigh
  calf
• Pallor on elevation/dependent rubor
• Weak pulses
• Skin changes /Ulcerations

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Assessment

• 1. Inspect lower extremities
• - unilateral vs bilateral
• - skin color changes (pallor, redness,
  cyanosis)
• - presence of clubbing
• - muscle atrophy

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Assessment

• 1. Inspect lower extremities cont
• - skin changes, dry, shining
• - edema dependent, pitting
• - skin lesions, ulcerations
• 2. Palpate skin temperature
• - unilateral vs bilateral

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Assessment

• 3. Check Calf Tenderness
• - Dorsiflex foot - Homans Sign
• 4. Auscultate pulses bilaterally
• 0 - absent
• 1 - weak
• 2 - normal
• 3 - full bounding

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Assessment

• 5. Auscultate for bruits
• - low pitch blowing sound indicates turbulent
  blood flow.
• 6. Assess ROM of hip, knee, ankle joints
• 7. Assess sensory function
• - tingling
• - numbness

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History

• How far can person walk
• What muscle groups hurt?
• What relieves pain?
• When were changes noted?
• When were ulcers noted?
• How are they being cared for?
• Does person have prosthesis? Any pressure areas?

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Diagnostic Tests

• Doppler ultrasound
• Ankle Brachial Pressure Index
• Exercise testing
• Duplex Ultrasound
• CT Scan
• Angiogram
• MRI angiogram

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Management med/surg

• Increase blood supply elevate head of
  bed exercise as tolerated Beurgen Allen
  exercises 4-6 times dialy
• Promote vasodilation and prevent vascular
  compression avoid cold warm compresses
  with caution
• Risk factor management
• - diet
• - exercise
• - smoking

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Management med/surg

• 5. Antihyperlipidemia Meds i.e. Lopid
• 6. Anticoagulants - Warfarin
• 7. Antiplatelet drugs - ECASA, Persantine
• 8. Trental for ? blood viscosity
• 9. Pain Management

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Management med/surg

• 10. No leg crossing
• 11. Avoid restrictive clothes
• 12. Food care
• 13. Emotional Support

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Surgery

• Endartectomy
• Bypass grafts
• Amputation

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OTHERS

• Carotid Blockages
• - cerebral insufficiency
• - bruit over carotid
• - SS TIA/stroke

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OTHERS

• Raynauds Disease
• - nonatherosclerotic
• - spasms of arteries
• - burning, throbbing pain
• - response to cold/stress

• - women gt men
• - Ca channel blockers
• - stop smoking, avoid chills, stress reduction
• - education