Improving Peripheral Arterial Circulation Nursing Management PDF

1/16/24, 10:21 PM Realizeit for Student Improving Peripheral Arterial Circulation Nursing Management Arterial blood supply to a body part can be enhanced by positioning the body part below the level of the heart. For the lower extremities, this is accomplished by elevating the head of the patient’...

1/16/24, 10:21 PM Realizeit for Student Improving Peripheral Arterial Circulation Nursing Management Arterial blood supply to a body part can be enhanced by positioning the body part below the level of the heart. For the lower extremities, this is accomplished by elevating the head of the patient’s bed or by having the patient use a reclining chair or sit with the feet resting on the floor. Concept Mastery Alert For patients with PAD, blood flow to the lower extremities needs to be enhanced; therefore, the nurse encourages keeping the lower extremities in contrast, for patients with venous insufficiency, blood return to the heart needs to be enhanced, so the lower extremities are elevated. Exercise prom circulation (arterial) and activates the musculovenous pump (venous). The nurse can assist the patient with walking or other moderate or graded isometric exercises that promote blood flow and encourage the development of collateral circulation. The amount of exercise a patient can tolerate before the onset of pain is determined to provide a baseline for evaluation. The nurse instructs the patient to walk to the point of pain, rest until the pain subsides, and then resume walking so that endurance can be increased as collateral circulation develops. Pain can serve as a guide in determining the appropriate amount of exercise. The onset of pain indicates that the tissues are not receiving adequate oxygen, signaling the patient to rest. A supervised exercise therapy (SET) program should be prescribed for patients with claudication. SET can result in increased walking distance before the onset of claudication (Gerhard-Herman et al., 2016). Before recommending any exercise program or SET, the patient’s primary provider should be consulted. Conditions that worsen with exercise include leg ulcers, cellulitis, gangrene, or acute thrombotic occlusions. Promoting Vasodilation and Preventing Vascular Compression Arterial dilation increases blood flow to the extremities and is therefore a goal for patients with PAD. However, if the arteries are severely sclerosed, inelastic, or damaged, dilation is not possible. For this reason, measures to promote vasodilation, such as medications, endovascular interventions or surgery, may be only minimally effective. Nursing interventions may involve applications of warmth to promote arterial flow and instructions to the patient to avoid exposure to cold temperatures, which causes vasoconstriction. Adequate clothing and warm temperatures protect the patient from chilling. Quality and Safety Nursing Alert Patients are instructed to test the temperature of bath water and to avoid using hot-water bottles and heating pads on the extremities. It is safer to to the abdomen; this can cause reflex vasodilation in the extremities. In patients with vasospastic disorders (e.g., Raynaud’s disease), heat may be applied directly to ischemic extremities using a warmed or electric blanket; however, the temperature of the heat source must not exceed body temperature. Even at low temperatures, trauma to the tissues can occur in ischemic extremities. Quality and Safety Nursing Alert Excess heat may increase the metabolic rate of the extremities and the need for oxygen beyond that provided by the reduced arterial flow through with great caution! Nicotine from any tobacco product causes vasospasm and can thereby dramatically reduce circulation to the extremities. Tobacco smoke also impairs transport and cellular use of oxygen and increases blood viscosity. Patients with arterial insufficiency who smoke, chew tobacco, or use electronic nicotine delivery systems (ENDS), including e-cigarettes, e-pens, e-pipes, e-hookah, and e-cigars, must be fully informed of the effects of nicotine on circulation and encouraged to stop. https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=lqf9HhURQ5RqpgqAkzH2zbfuwFjUs0mdxkPeVey4KH2F7i%2fH0LC0NH7inQLoUzK%2fM… 1/4 1/16/24, 10:21 PM Realizeit for Student Emotional stress can stimulate the sympathetic nervous system and cause peripheral vasoconstriction. Emotional stress can be minimized to some degree by avoiding stressful situations when possible or by consistently following a stress management program. Counseling services or use of alternative or complementary therapies (e.g., relaxation, yoga, aromatherapy, mindfulness) may be indicated for patients who cannot cope effectively with situational stressors. Constrictive clothing and accessories such as tight socks or shoelaces may impede arterial circulation to the extremities and promote venous stasis and therefore should be avoided. Crossing the legs for more than 15 minutes at a time should be discouraged because it compresses vessels in the legs. Relieving Pain Frequently, the pain associated with peripheral arterial insufficiency is chronic, continuous, and disabling. It limits activities, affects work and life responsibilities, disturbs sleep, and alters the patient’s sense of well-being. Patients may be depressed, irritable, and unable to exert the energy necessary to execute prescribed therapies, making pain relief even more difficult. Analgesic agents such as hydrocodone plus acetaminophen, oxycodone, oxycodone plus acetylsalicylic acid, or oxycodone plus acetaminophen may be helpful in reducing pain so that the patient can participate in therapies that can increase circulation and ultimately relieve pain more effectively. Particularly in older patients, these medications can be dangerous, contributing to delirium and falls. In all patients, issues of dependence need to be considered. Maintaining Tissue Integrity Poorly perfused tissues are susceptible to damage and infection. Patients with peripheral vascular disease and diabetes are at increased risk. When lesions develop, healing may be delayed or inhibited because of the poor blood supply to the area. Infected, nonhealing ulcerations of the extremities can be debilitating and may require prolonged and often expensive treatments. Amputation of an ischemic toe, forefoot or limb may eventually be necessary. Measures to prevent these complications must be a high priority and vigorously implemented. Centers of excellence for the prevention of amputation which involve a multidisciplinary, specialty team approach to management have become increasingly important for early intervention and surveillance. Trauma to the extremities must be avoided. Advising the patient to wear sturdy, well-fitting shoes or slippers to prevent injury to the skin may be helpful, and recommending neutral soaps and body lotions may prevent drying and cracking of skin. However, the nurse should instruct the patient not to apply lotion between the toes, because the increased moisture can lead to maceration of the interdigital skin. Scratching and vigorous rubbing can abrade skin and create sites for microbial invasion; therefore, feet should be patted dry. Stockings should be clean and dry. Fingernails and toenails should be carefully trimmed straight across and sharp corners filed to follow the contour of the nail. If the nails cannot be trimmed safely, it is necessary to consult a podiatrist, who can also remove corns and calluses. Special shoe inserts may be needed to prevent calluses from recurring. Blisters, ingrown toenails, infection, or other problems should be reported to health care professionals for treatment and follow-up. Patients with diminished vision and those with disability that limits mobility of the arms or legs may require assistance in periodically examining the lower extremities for trauma or evidence of inflammation or infection. Good nutrition promotes healing and prevents tissue breakdown and is therefore included in the plan for patients with peripheral vascular disease. Eating a diet that contains adequate protein and vitamins is necessary for patients with arterial insufficiency. Key nutrients, such as vitamin C and zinc, play specific roles in wound healing. However, a meta-analysis of randomized controlled trials found no evidence to support that supplementation with vitamins and antioxidants prevents vascular diseases (Sultan, Murarka, Jahangir, et al., 2017). Obesity strains the heart, increases venous congestion, and reduces circulation; therefore, a weight reduction plan may be necessary for patients who are overweight or have obesity. A diet low in fats and lipids is indicated for patients with atherosclerosis. Gerontologic Considerations In older adults, the symptoms of PAD may be more pronounced than in younger people. In older patients who are inactive, limb ischemia or gangrene may be the first sign of disease (Schorr, Treat-Jacobson, Lindquist, et al., 2017). These patients may have adjusted their lifestyle to accommodate the limitations imposed by the disease and may not walk far enough to develop symptoms of claudication due to other comorbid conditions such as chronic obstructive pulmonary disease (COPD) or heart failure. Circulation is decreased, although this is not apparent to the patient until trauma occurs. At this point, gangrene develops when minimal arterial flow is impaired further by edema formation resulting from the traumatic event. Intermittent claudication may occur after walking only one half to one block or after walking up a slight incline. Any prolonged pressure on the foot can cause pressure injuries that may become ulcerated, infected, or gangrenous. The outcomes of arterial insufficiency can include reduced mobility and activity as well as a loss of independence. Older adults with reduced mobility are less likely to remain in the community setting, have higher rates of hospitalizations, and experience a poorer quality of life. Those with cognitive impairment may also be unable to verbalize symptoms such as pain. https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=lqf9HhURQ5RqpgqAkzH2zbfuwFjUs0mdxkPeVey4KH2F7i%2fH0LC0NH7inQLoUzK%2fM… 2/4 1/16/24, 10:21 PM Realizeit for Student Summary Adequate perfusion ensures oxygenation and nourishment of body tissues, and it depends in part on a properly functioning cardiovascular system. Adequate blood flow depends on the efficiency of the heart as a pump, the patency and responsiveness of the blood vessels, and the adequacy of circulating blood volume. Nervous system activity, blood viscosity, and the metabolic needs of tissues influence the rate and adequacy of blood flow. Arteriosclerosis is the thickening, hardening, and loss of elasticity of the walls of arteries. This process gradually restricts the blood flow to one's organs and tissues and can lead to severe health risks brought on by atherosclerosis, which is a specific form of arteriosclerosis caused by the buildup of fatty plaques, cholesterol, and some other substances in and on the artery walls. Atherosclerosis is a narrowing of the arteries caused by a buildup of plaque. Arteries are the blood vessels that carry oxygen and nutrients from the heart to the rest of the body. As a patient gets older, fats, cholesterol, and calcium can collect in the arteries and form plaque. Improved treatments have reduced the number of deaths from atherosclerosis-related diseases. These treatments also have improved the quality of life for people who have these diseases. However, atherosclerosis remains a common health problem. Review Arteriosclerosis occurs when the blood vessels that carry oxygen and nutrients from the heart to the rest of the body (arteries) become thick and stiff, sometimes restricting blood flow to the organs and tissues. Healthy arteries are flexible and elastic, but over time, the walls in the arteries can harden, a condition commonly called hardening of the arteries. Atherosclerosis is a specific type of arteriosclerosis, but the terms are sometimes used interchangeably. Atherosclerosis refers to the buildup of fats, cholesterol, and other substances in and on the artery walls (plaque), which can restrict blood flow. The plaque can burst, triggering a blood clot. Although atherosclerosis is often considered a heart problem, it can affect arteries anywhere in the body. Atherosclerosis may be preventable and is treatable. Symptoms Atherosclerosis develops gradually. Mild atherosclerosis usually does not have any symptoms. Atherosclerosis symptoms do not usually appear until an artery is so narrowed or clogged that it cannot supply adequate blood to organs and tissues. Sometimes a blood clot completely blocks blood flow or even breaks apart and triggers a heart attack or stroke. Symptoms of moderate to severe atherosclerosis depend on which arteries are affected. The following are some symptoms: Chest pain or pressure (angina). Sudden numbness or weakness in the arms or legs, difficulty speaking or slurred speech, temporary loss of vision in one eye, or drooping muscles in the face. These signal a transient ischemic attack (TIA), which, if left untreated, may progress to a stroke. High blood pressure or kidney failure. Atherosclerosis is a slow, progressive disease that may begin as early as childhood. Although the exact cause is unknown, atherosclerosis may start with damage or injury to the inner layer of an artery. The damage may be caused by the following: High blood pressure High cholesterol High triglycerides, a type of fat (lipid) in the blood Smoking and other sources of tobacco Insulin resistance, obesity, or diabetes Inflammation from diseases, such as arthritis, lupus or infections, or inflammation of unknown cause Over time, plaque (fatty deposits) build-up at the injury site and harden, narrowing the arteries. The organs and tissues connected to the blocked arteries then do not receive enough blood to function properly. Eventually, pieces of the fatty deposits may break off and enter the bloodstream, which may cause a blood clot, which can block the blood flow to a specific part of the body, such as occurs when blocked blood flow to the heart causes a heart attack. Risk factors Hardening of the arteries occurs over time. Besides aging, factors that increase the risk of atherosclerosis include the following: High blood pressure High cholesterol Diabetes Obesity Smoking and other tobacco use A family history of early heart disease https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=lqf9HhURQ5RqpgqAkzH2zbfuwFjUs0mdxkPeVey4KH2F7i%2fH0LC0NH7inQLoUzK%2fM… 3/4 1/16/24, 10:21 PM Realizeit for Student Lack of exercise An unhealthy diet Complications The complications of atherosclerosis depend on which arteries are blocked: Coronary artery disease: When atherosclerosis narrows the arteries close to the heart, the patient may develop coronary artery disease, which can cause chest pain (angina), a heart attack, or heart failure. Carotid artery disease: When atherosclerosis narrows the arteries close to the brain, the patient may develop carotid artery disease, which can cause a transient ischemic attack (TIA) or stroke. Peripheral artery disease: When atherosclerosis narrows the arteries in the arms or legs, the patient may develop circulation problems in the arms and legs called peripheral artery disease. This can make the patient less sensitive to heat and cold, increasing the risk of burns or frostbite. In rare cases, poor circulation in the arms or legs can cause tissue death (gangrene). Aneurysms: Atherosclerosis can also cause aneurysms, a serious complication that can occur anywhere in the body. An aneurysm is a bulge in the wall of the artery. Most people with aneurysms have no symptoms. Chronic kidney disease: Atherosclerosis can cause the arteries leading to the kidneys to narrow, preventing oxygenated blood from reaching them. Over time, this can affect kidney function, keeping waste from exiting the body. Diagnosis Finding of enlarged or hardened arteries, including the following: A weak or absent pulse below the narrowed area of the artery Decreased blood pressure in an affected limb Whooshing sounds (bruits) over the arteries, heard using a stethoscope Doppler ultrasound, Electrocardiogram (ECG), and stress test are used to assist in diagnosis. A stress test, also called an exercise stress test, is used to gather information about how well the heart works during physical activity. Interventions include lifestyle changes, medications which can include Cholesterol medications, Anti-platelet medications, Beta blockers, Angiotensin-converting enzyme (ACE) inhibitors, Calcium channel blockers, and diuretics. Surgical procedures Angioplasty and stent placement: insertions of a long, thin tube (catheter) into the blocked or narrowed part of the artery. A second catheter with a deflated balloon on its tip is then passed through the catheter to the narrowed area. The balloon is then inflated, compressing the deposits against the artery walls. A mesh tube (stent) is usually left in the artery to help keep the artery open. Endarterectomy: fatty deposits are surgically removed from the walls of a narrowed artery. Fibrinolytic therapy: clot-dissolving drug to break blockage apart. Bypass surgery: a graft bypass using a vessel from another part of the body or a tube made of synthetic fabric. This allows blood to flow around the blocked or narrowed artery. https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=lqf9HhURQ5RqpgqAkzH2zbfuwFjUs0mdxkPeVey4KH2F7i%2fH0LC0NH7inQLoUzK%2fM… 4/4