Nursing Care for Peripheral Vascular Disease

Peripheral Vascular Disease (PVD)

• Disrupted blood flow in the peripheral blood and lymphatic system affecting oxygen and nutrient delivery
• Includes peripheral arterial disease (PAD) and peripheral venous disease (DVT)

Diagnostic Tests for PAD

• Ankle-Brachial Index (ABI): Compares blood pressure at ankle and brachial artery using a Doppler probe.
• Plethysmography: Assesses arterial blood flow in the lower extremities.
• Treadmill/Exercise Tolerance Test: Evaluates for claudication through walking, noting leg pain due to arterial narrowing.
• Arteriography: X-ray with contrast medium to visualize areas of reduced blood flow.
• MRI: Uses contrast to visualize blood flow through peripheral arteries.

Clinical Tools and Assessments

• Bedside Doppler: Measures difficulty in detecting pulses; identifies differences in bilateral pulses.
• PAD Risk Factors: Includes age (over 65), male gender, family history, African American ethnicity, atherosclerosis, obesity, smoking, diabetes, hypertension, hyperlipidemia, sedentary lifestyle.

Atherosclerosis and Arteriosclerosis

• Atherosclerosis: Slow buildup of lipid particles reducing blood flow; a form of arteriosclerosis.
• Arteriosclerosis: Hardening or thickening of arterial walls; most common arterial disease.

PAD Assessment Findings

• Indicators include decreased/non-palpable pedal pulses, rest pain, hair loss, cold/cyanotic extremities, pallor with elevation, rubor, and intermittent claudication.

Intermittent Claudication

• Pain during exercise due to inadequate oxygen delivery in narrowed arteries.

Management and Goals for PAD

• Aims to reduce symptoms and prevent disease progression through diet, exercise, weight loss, and smoking cessation.

Medications for PAD

• Pentoxifylline (Trental): Reduces platelet aggregation; therapeutic effects seen in 8 weeks.
• Cilostazol (Plavix): Lowers thromboemboli risk.
• Aspirin and Clopidogrel: Antiplatelet agents.
• Additional medications include statins and ACE inhibitors.

Raynaud's Disease

• Functional PAD with intermittent vasoconstriction; more common in women.
• Assessment involves pallor, cyanosis, rubor, and pain.

Buerger's Disease

• Exclusively linked to tobacco use; causes inflammation of smaller vessels.

Critical Limb Ischemia

• Severe, chronic blood flow decrease to lower extremities, potentially leading to infection and limb loss.

Arterial Ulcers

• Characteristics include small, deep, circular wounds with cold skin temperature; often found on feet.

Acute Limb Ischemia (ALI)

• Sudden blood supply interruption usually due to embolism; categorized as an emergency situation with potential for surgery.

ALI Assessment Findings

• Evaluated using Six P's: Pain, Pallor, Pulselessness, Paresthesia, Paralysis, Poikilothermia.

ALI Management

• Anticoagulation (IV heparin), surgical intervention to remove clots.

Surgical Procedures for PAD

• Techniques include Percutaneous Transluminal Angioplasty, Laser-Assisted Angioplasty, Rotational Atherectomy, and Embolectomy to restore blood flow.

Graft Procedures

• Bypass Graft: Reroutes circulation around arterial occlusion.
• Types include Autogenous Graft, Composite Graft, and Synthetic Graft.

Complications and Nursing Care

• Compartment Syndrome: Caused by swelling; expect muscle vessel compression leading to necrosis.
• Leg Revascularization Care: Includes monitoring for graft occlusion and s/s of infection alongside vital signs management.

Venous Thromboembolism (VTE)

• Formation of clots leading to disrupted blood flow; includes DVT and PE.

Virchow's Triad

• Factors contributing to thrombus formation: vessel wall injury, venous stasis, and hypercoagulability.

DVT Assessment and Management

• Signs: swelling, tenderness, warmth, and erythema.
• Management includes anticoagulation therapy, elevation, analgesics, and compression stockings.

Anticoagulation Medications

• Heparin: High alert medication monitored through aPTT levels.
• Warfarin: Prevents blood clotting by inhibiting vitamin K metabolism; requires monitoring of INR.
• Rivaroxaban: Anticoagulant without regular blood monitoring; increased risk of bleeding.

Venous Insufficiency

• Caused by incompetent valves in deep veins, leading to blood pooling and possible venous stasis ulcers.

Varicose Veins

• Dilated, tortuous veins typically affecting the lower extremities due to incompetent valves.
• Management includes lifestyle modifications, compression therapy, sclerotherapy, and potential surgery.

Education and Prevention Strategies

• Promote environment warmth, smoking cessation, regular leg inspections, and maintenance of hydration to prevent DVT and manage venous insufficiency.