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