Ch 38 Peripheral Arterial Disease

8/10/2019 Ch 38 Peripheral Arterial Disease

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Copyright 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.

(Relates to Chapter 38,Nursing Management: Vascular Disorders,

in the textbook)


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Involves progressive narrowing anddegeneration of arteries of neck,

abdomen, and extremities

Atherosclerosis is the leading cause ofmajority of cases


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Typically appears in patients betweentheir 60s and their 80s

Largely undiagnosed

Risk factors Cigarette smoking Hyperlipidemia Hypertension Diabetes mellitus


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Certain segments of arterial systemmore likely to be involved


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Fig. 38-1


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Peripheral arterial disease (PAD) mayaffect Aortoiliac artery Femoral artery Popliteal artery Tibial artery

Peroneal artery


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Classic symptom of PADintermittentclaudication Ischemic muscle ache or pain that is

precipitated by a constant level ofexercise

Resolves within 10 minutes or less with

rest Reproducible


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Pain at rest Occurs in the forefoot or toes and is

aggravated by limb elevation Occurs from insufficient blood flow Occurs more often at night


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Nonhealing arterial ulcers andgangrene are most serious

complications

May result in amputation if blood flowis not adequately restored or if severe

infection occurs


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Angiography Magnetic resonance angiography

(MRA)


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Smoking cessation Aggressive treatment of

hyperlipidemia

Hypertension and diabetes mellitus

BP maintained


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Antiplatelet agents Aspirin Ticlopidine (Ticlid) Clopidogrel (Plavix)


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Drugs prescribed for treatment ofintermittent claudication Pentoxifylline (Trental) Erythrocyte flexibility Blood viscosity

Cilostazol (Pletal)

Vasodilation Walking distance


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Exercise improves oxygen extractionin the legs and skeletal metabolism

Walking is the most effective exercise

for individuals with claudication 30 to 60 minutes daily


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Dietary cholesterol


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Ginkgo biloba Effective in increasing walking distance

for patients with intermittent claudication

Folate, vitamin B6, cobalamin (B12) Lowers homocysteine levels


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Protect from trauma Reduce vasospasm

Prevent/control infection

Maximize arterial perfusion

Other strategies Immune modulation therapy Angiogenic gene therapy


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Indications Intermittent claudication symptoms

become incapacitating

Pain at rest Ulceration or gangrene severe enough to

threaten viability of the limb


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Percutaneous transluminal balloonangioplasty Involves the insertion of a catheter

through the femoral artery Catheter contains a cylindrical balloon Balloon is inflated, dilating the vessel by

cracking the confining atheroscleroticintimal shell


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Most common surgical approach A peripheral arterial bypass operation

with autogenous vein or synthetic graft

material to bypass blood around thelesion


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Fig. 38-7


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Most common surgical approach(contd) Synthetic grafts typically used for long

bypasses Balloon angioplasty with stenting used in

combination with bypass surgery


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Endarterectomy Patch graft angioplasty

Amputation


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Past health history Diabetes mellitus Smoking

Hypertension Hyperlipidemia Obesity


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Exercise intolerance Loss of hair on legs and feet

Decreased or absent peripheral pulses


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Ineffective tissue perfusion(peripheral)

Impaired skin integrity

Activity intolerance

Ineffective therapeutic regimen

management


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Overall goals for patient with PAD Adequate tissue perfusion Relief of pain

Increased exercise tolerance Intact, healthy skin on extremities


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Health Promotion Identification of at-risk patients Community involvement

Diet modification


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Identify activities that promotecirculation

Maintain adequate peripheral tissue

perfusion Experience intact skin, free of

infection, on lower extremities


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62-year-old male complains of painwhen walking his dog that is relieved

with rest

He has a history of hypertension and

hyperlipidemia, and he smokes one

pack of cigarettes per day


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1. What risk factors for peripheral arterialdisease does he display?

2. What can he do to prevent furthercomplications?

3. What patient teaching is essential forhim to help manage his disease?

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Ch 38 Peripheral Arterial Disease

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