NR462 Vascular Issues (Lecture 7/2/19)

Complications from PAD/PVD

Atrophy of the skin and underlying muscles Delayed healing Wound infection Tissue necrosis Arterial ulcers Nonhealing arterial ulcers and gangrene are most serious complications. May result in amputation if blood flow is not adequately restored, or if severe infection occurs

Venous Thrombosis

Formation of a thrombus in association with inflammation of the vein.

Virchow's Triad

1. Venous stasis 2. Damage to the inner lining of the vein (endothelium) 3. Hypercoagulability

Causes of Arterial Damage

Emboli Formation, Infection, Thrombosis, Trauma fracture, vasculitis

Drug Therapy for PAD

Antiplatelet agents Aspirin Clopidogrel (Plavix) ACE inhibitors Ramipril (Altace) ↓ Cardiovascular morbidity ↓ Mortality ↑ Peripheral blood flow ↑ ABI ↑ Walking distance

Dependent Rubor

Affected leg may look pale when elevated but turns red in comparison to unaffected leg in dependent position b/c arteries do not constrict

Nutrition for PAD

BMI <25 kg/m2 Waist circumference <40 inches for men and <35 inches for women Recommend reduced calories and salt for obese or overweight persons

Hemosiderin

Brownish color of legs with venous insufficiency due to breakdown of red blood cells

A client with a history of angina and intermittent claudication reports pain in both legs with a need to stop and rest after ambulating down the hall. Which statement by the nurse best addresses this concern? A. "You are experiencing leg pain because of venous congestion." B. "You are experiencing pain due to inadequate removal of carbon dioxide from the tissues in the legs." C. "The pain is probably related to inadequately oxygenated blood getting through the arteries into the muscles of your legs." D. "The pain is related to atherosclerosis that is the same problem causing your angina."

C. "The pain is probably related to inadequately oxygenated blood getting through the arteries into the muscles of your legs."

Critical Limb Ischemia (CLI)

Chronic ischemic rest pain lasting more than 2 weeks; Arterial leg ulcers or gangrene

Venous Disorders

Chronis venous insufficiency Venous thrombosis Venous thromboembolism Varicose veins Pulmonary Embolism

Exercise for PAD

Exercise improves oxygen extraction in legs and skeletal metabolism Walking is most effective exercise for individuals with claudication 30 to 45 minutes daily, 3 times/week STOP walking if Intermittent Claudication to prevent tissue ischemia

dependent position

Dangling of Legs

Nursing Goals for PAD

Goal- Health Promotion Goal-Promote circulation- ambulate/ increased exercise tolerance Goal: adequate tissue perfusion Goal: relief of pain Goal: intact, healthy skin on extremities Goal: increased knowledge of disease and treatment plan

Risk factors for Arterial Damage

Hypertension, Chronic Kidney Disease, Diabetes, Smoking, Family Hx, Hypercholesterolemia

Priority Nursing Dx for PAD

Ineffective tissue perfusion Impaired skin integrity r/t impaired circulation Pain

Intermittent claudication

Ischemic muscle ache or pain that is precipitated by a constant level of exercise Resolves within 10 minutes or less with rest

Paresthesia

Numbness or tingling in the toes or feet Produces loss of pressure and deep pain sensations Injuries often go unnoticed by patient

malleolar

Wounds that happen around the malleolus bones of the ankle

Clinical Manifestations of Advancing PVD

Pain at rest Occurs in the forefoot or toes Aggravated by limb elevation Occurs from insufficient blood flow Occurs more often at night

Interventional Radiology Procedures for PAD

Percutaneous transluminal angioplasty (PTA) Atherectomy Cryoplasty

PVD

Peripheral Vascular Disease (Refers to ARTERIAL)

Surgical Therapy for PAD

Peripheral artery bypass surgery with autogenous vein or synthetic graft to bypass blood around the lesion PTA with stenting may also be used in combination with bypass surgery Endarterectomy Patch graft angioplasty Amputation

Conservative care for leg with critical limb ischemia

Protect from trauma Decrease ischemic pain Prevent/control infection Improve arterial perfusion

Care for leg with critical limb ischemia

Revascularization via bypass surgery Percutaneous transluminal angioplasty (PTA) IV prostanoids (iloprost [Ventavis]) Spinal cord stimulation Angiogenesis

S/S of Peripheral Vascular Disease

Thin, shiny, taut skin; Dec hair growth, Dec pulses, Delayed cap refill, pain, pallor, paresthesia, ulcers or gangrene

Risk Factor Modification for PAD

Tobacco cessation Glycosylated hemoglobin <7.0% for diabetics Aggressive treatment of hyperlipidemia BP maintained <140/90

Etiology for Venous Insufficiency

Valves in veins are damaged Retrograde blood flow Pooling of blood in legs and swelling Exact cause unknown Probable risk factors Standing in the same position Obesity Pregnancy Thrombophlebitis

VI

Venous Insufficiency refers to VEINS

PTA

percutaneous transluminal angioplasty