Peripheral Arterial Disease (PAD) Quiz 1

Peripheral Arterial Disease (PAD)

• PAD most frequently affects the superficial femoral, iliac, and popliteal arteries in the lower extremities

Classic Symptoms of PAD

• Intermittent claudication, which involves pain or cramping in the calf during activity that is relieved by rest, is a hallmark sign of PAD

Ankle-Brachial Index (ABI)

• ABI is a diagnostic test that measures the ratio of ankle to arm blood pressure in PAD
• ABI < 0.9 indicates PAD; lower numbers correlate with more severe arterial insufficiency

Complications of Severe PAD

• Severe PAD can lead to ischemia, tissue necrosis, and gangrene

Medications for PAD

• Pentoxifylline is a medication that decreases blood viscosity and enhances tissue oxygenation, improving blood flow

PAD and Leg Appearance

• Reduced arterial perfusion causes the skin to appear pale when legs are elevated

The 6 P's of Acute Limb Ischemia

• The 6 P's include pain, pallor, pulselessness, paresthesia, paralysis, and poikilothermia
• Purpura is not one of the 6 P's

Physical Characteristics of Lower Extremities in PAD

• Hairless, shiny skin with a purplish hue when dependent is a common physical characteristic due to poor perfusion

Non-Modifiable Risk Factors

• Family history is a non-modifiable risk factor for PAD because it is a genetic risk factor

Intermittent Claudication Relief

• Rest relieves pain from intermittent claudication by reducing oxygen demand in ischemic muscles

Smoking and PAD

• Nicotine, a vasoconstrictor, exacerbates PAD by limiting already reduced blood flow

Post-Op PAD Surgery

• Elevating the leg post-op in PAD promotes venous return, helping to reduce swelling and promoting circulation

Leg Crossing

• Patients with PAD should avoid crossing their legs because it compresses arteries, worsening ischemia

Clinical Manifestations of PAD

• Clinical manifestations include decreased pulses, rest pain, and gangrene
• Brown pigmentation and warm skin are signs of chronic venous insufficiency (CVI)

Foot Care and PAD

• Patients should inspect feet daily, wear protection, and report injuries
• Soaking and walking barefoot are contraindicated

Benefits of Exercise for PAD

• Walking and exercise stimulate the development of collateral circulation, improving perfusion

Antiplatelet Medications and PAD

• Antiplatelet medications prevent clots by inhibiting aggregation at plaque sites

Diabetes

• Diabetes increases PAD risk by causing metabolic changes that damage vessels and accelerate atherosclerosis

Rest Pain

• Rest pain implies severe arterial blockage and reflects critical limb ischemia and severe arterial narrowing

Post-Arterial Bypass

• Absence of pulses post-arterial bypass indicates thrombotic occlusion, a limb-threatening emergency, requiring immediate intervention

Leg Pain Relief

• Leg pain at night relieved by dangling the leg is caused by arterial insufficiency because dependent positioning improves blood flow in severe PAD where rest pain is present.

Post-Angioplasty Intervention

• Assessing perfusion is a top priority post-op angioplasty because pulse checks detect occlusion or complications

Effective Nursing Interventions for PAD

• Effective interventions include encouraging walking, providing warm socks, and assessing pedal pulses regularly
• Elevating legs may worsen symptoms, and fluid restriction is not standard

Activity Modification

• Patients should pace themselves and take breaks to reduce claudication symptoms

Non-Healing Ulcers

• Non-healing ulcers on the foot of a patient with PAD suggest worsening perfusion or potential infection and require immediate provider notification

Post-PAD Surgery Assessment

• Pale and cold extremities with diminished perfusion are signs of potential arterial occlusion post-surgery, which is a limb-threatening emergency and require calling the provider immediately

Dietary Changes for PAD and Hyperlipidemia

• Reducing saturated fats helps reduce plaque formation and manage cholesterol

Cilostazol Implications

• Cilostazol takes several weeks (up to 8) to relieve intermittent claudication symptoms

Avoiding Soaking Feet

• Soaking can lead to maceration and infection in ischemic tissues, especially in PAD patients with poor healing

ABI Results

• ABI of 0.41-0.70 indicates moderate PAD
• Results <0.4 suggest severe PAD

Claudication

• Worsening claudication suggests progressive atherosclerosis and arterial narrowing

Post-Angioplasty Complications

• Sudden changes in neuro status and perfusion post-intervention may indicate a clot obstructing arterial flow, indicating acute arterial thrombosis

Chronic Venous Insufficiency (CVI)

• Brown skin pigmentation, edema, and warmth are hallmark signs of CVI, not PAD

Patient Education and PAD

• Soaking feet and elevating legs are contraindicated due to risk of skin breakdown and worsened perfusion

PAD vs. CVI

• PAD findings are classic with cool, pale skin with elevation, rubor when legs are dependent, and decreased or absent pulses
• Warm brown skin and pain relieved by elevation are CVI features

Antiplatelet risks

• Both drugs are antiplatelets, increasing bleeding risk
• Bleeding gums warrant evaluation

Post PTA issues

• Applying pressure helps control bleeding and is the priority intervention

PAD and Smoking

• Since age and genetics can't be changed, smoking is a modifiable risk factor that the nurse must address

Positive Habits

• Walking improves circulation
• Crossing legs and soaking feet are contraindicated
• Medications should not be skipped without guidance