Vascular Disorders Peripheral Arterial Disease of the Lower

Vascular Disorders Peripheral Arterial Disease of the Lower Extremities n Aortoiliac, femoral, popliteal, tibial, or peroneal arteries n Classic symptom: Intermittent Claudication n n 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

Peripheral Arterial Disease

Peripheral Arterial Disease of the Lower Extremities n Diagnostics: n Non-invasive: Doppler Studies n Invasive: Angiography

Peripheral Arterial Disease of the Lower Extremities n Treatment: n Risk Factor Modification – HTN – Stepped Approach to Control n Smoking - Cessation n Treatment of hyperlipidemia - Nutrition n Exercise – slow progressive walking n n Medication – Antiplatelet Therapy – Plavix / ASA n < blood viscosity / >erythrocyte flexibility – Trental n < platelet aggregation & promote vasodilation - Pletal n

Peripheral Arterial Disease of the Lower Extremities n Critical Limb Ischemia n Interventional Radiology n n n Surgical Revascularization n n Percutaneous transluminal balloon angioplasty Atherectomy Endarterectomy Graft angioplasty Peripheral artery bypass surgery End-stage surgery - amputation

Vascular Disorders Peripheral Arterial Disease of the Lower Extremities n Nursing Diagnoses Ineffective tissue perfusion n Impaired skin integrity n Acute pain n Activity intolerance n Ineffective therapeutic management n

Peripheral Arterial Disease of the Lower Extremities n n n 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

Peripheral Vascular Disease Thromboangiitis Obliterans Buerger’s Disease n Nonathersclerotic, segmental inflammation of arteries, veins & nerves of upper and lower extremities More common in men 25 -40 years of age n Correlates with cigarette smoking n Rest pain, ischemic ulcerations n Tx: smoking cessation / medications – anti-platelets, vasodilators n Surgical: Amputation n

Peripheral Disease Clinical Manifestations

Peripheral Vascular Disease Treatment

Peripheral Vascular Disease Raynaud’s Phenomenon n Episodic vasospastic disorder of small cutaneous arteries in fingers & toes n n n 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 n Tx: Smoking Cessation, no meds with vasoconstrictive effect; avoid cold; avoid constrictive clothes; Give Calcium-channel blockers