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1. Vascular DisordersPeripheral Arterial Disease of the Lower Extremities
Aortoiliac, femoral, popliteal, tibial, or peroneal arteries
Classic symptom: Intermittent Claudication
Ischemic muscle ache precipitated by a consistent level of exercise
Paresthesia numbness / tingling in toes & feet
Trophic changes: reactive hyperemia
dependent rubor
Rest pain nocturnal
2. Peripheral Arterial Disease
3. Peripheral Arterial Disease of the Lower Extremities
Diagnostics:
Non-invasive: Doppler Studies
Invasive: Angiography
4. Peripheral Arterial Disease of the Lower Extremities Treatment:
Risk Factor Modification
HTN Stepped Approach to Control
Smoking - Cessation
Treatment of hyperlipidemia - Nutrition
Exercise slow progressive walking
Medication
Antiplatelet Therapy Plavix / ASA
< blood viscosity / >erythrocyte flexibility Trental
< platelet aggregation & promote vasodilation - Pletal
5. Peripheral Arterial Disease of the Lower Extremities Critical Limb Ischemia
Interventional Radiology
Percutaneous transluminal balloon angioplasty
Atherectomy
Surgical Revascularization
Endarterectomy
Graft angioplasty
Peripheral artery bypass surgery
End-stage surgery - amputation
6. Vascular DisordersPeripheral Arterial Disease of the Lower Extremities Nursing Diagnoses
Ineffective tissue perfusion
Impaired skin integrity
Acute pain
Activity intolerance
Ineffective therapeutic management
7. Peripheral Arterial Disease of the Lower Extremities
Assess: Peripheral pulses, pallor, blanching, hyperemia, warmth, capillary refill, ability to bear weight and walk, pain, risk factors
Nsg Action: Medication administration, prepare for tests, treatment, surgery, prevent injury, skin care, community referrals
Pt/Family Education: Skin care, Medications, risk factor modification, exercise
8. Peripheral Vascular DiseaseThromboangiitis ObliteransBuergers Disease Nonathersclerotic, segmental inflammation of arteries, veins & nerves of upper and lower extremities
More common in men 25-40 years of age
Correlates with cigarette smoking
Rest pain, ischemic ulcerations
Tx: smoking cessation / medications
anti-platelets, vasodilators
Surgical: Amputation
9. Peripheral DiseaseClinical Manifestations
10. Peripheral Vascular DiseaseTreatment
11. Peripheral Vascular DiseaseRaynauds Phenomenon Episodic vasospastic disorder of small cutaneous arteries in fingers & toes
Cause: Exaggerated SNS stimulation
Occurs in women 15 -40 years of age
May occur with collagen diseases: RA, scleroderma, systemic lupus erythematosus
Vasospasm Phase: Blanching of hands & fingers with throbbing, aching pain, numbness, tingling
Hyperemic Phase: swelling
Tx: Smoking Cessation, no meds with vasoconstrictive effect; avoid cold; avoid constrictive clothes; Give Calcium-channel blockers