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What is peripheral arterial disease? and what is the most common cause?
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Disorders that interrupt or impede arterial peripheral blood flow due to vessel compression, vasospasm, and/or structural defects in the vessel wall.
atherosclerosis (fatty material collects along the wall of arteries) is the most common cause |
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What are risk factors of PAD?
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Cigarette smoking (causes vasoconstriction)hyperlipidemiahypertensiondiabetes mellitus
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What is the most classic symptom of PAD?
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INTERMITTENT CLAUDICATION-ischemic muscle ache or pain that is precipitated by a constant level of exercise -resolves with 10 minutes or less with rest
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What are other clinical manifestations?
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-thin, shiny, and taut skin-loss of hair on the lower legs-diminished or absent peripheral pulses -nails may be thickened and opaque (trophic change)-cool, pale extremeties-arterial supply ulcers-poor arterial supply makes ulcer development
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What are the 4 diagnostic studies of PAD?
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-Doppler ultrasound-Duplex imaging (one vs. other)-Angiography (shoot dye into arterial circulation to see where it's going and where it's narrowing-Magnetic resonance angiography (MRA)
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What do antiplatelet drugs do and give examples
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Prevent platelet adhesionex: AspirinDipyridamole (Persantine)Clopidogrel (Plavix) and Ticlopidine (Ticlid) -(ADP inhibitors)Tirofiban (aggrastat), Eptifibatide (Integrilin) -new class, GP IIb/IIIa anhibitors, strong drugs used in cath lab and not in acute care -IV use
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What are indications for use of antiplatelets?
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-Reduce risk of fatal or nonfatal strokes in patients who cannot tolerate ASA-Maintain patency in AV shunts-Prevent occlusions post CABG (coronary artery bypass graft)-Decrease severity of sickle cell crisis
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What are the 4 collaborative cares for PAD?
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Exercise therapyNutritional therapyPercutaneous transluminal balloon angioplastyPeripheral arterial bypass balloon
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Why exercise?
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-improves oxygen extraction in the legs and skeletal metabolism-walking is the most effective exercise for individuals with claudication
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Nutritional therapy
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-dietary cholesteral <200 mg/day-decreased intake of saturated fat-soy products can be used in place of animal protein
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What is percutaneous transluminal balloon angioplasty?
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-insertion of a catheter through the femoral artery-balloon is inflated idlating hte vessel by cracking the confining atheroscleroti. c intimal shell
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What is a peripheral arterial bypass operation?
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Autogenous vein or synthetic graft material to bypass blood around the lesion
ex. use of femoral vein to bypass vein |
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What should nurses monitor frequently after surgery?
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Skin color and temperaturecapillary refillpresence of peripheral pulses distal to the operative sitesensation and movement of extremity
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What should we teach?
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-management of risk factors -importance of meticulous foot care-importance of gradual physical activity after surgery
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What is venous insufficiency?
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Inadequate venous return over a long period of time-causes pathologic changes as a result of ischemia in the vasculature, skin and supporting tissues
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