Peripheral Arterial Disease
-Abnormal narrowing of arteries (outside of the arteries that supply the heart &
brain).
-Usually affects the legs.
-Elevating the extremity or placing it in a horizontal position increases the
pain, whereas placing the extremity in a dependent position reduces the
pain.
Raynaud's Syndrome
Causes
-Smoking
-Diabetes Mellitus
-Dyslipidemia
-Hypertension
-Obesity
-Increasing age
-Artery spasm
-Thrombosis
-Vasculitis
Clinical Manifestations
-Intermittent claudication
oAching
oCramping
oInducing fatigue or
weakness that occurs with
some degree of activity or
exercise, which is relieved
with rest.
-Ulcers
-Bluish color
-Poor nail & hair growth
-If severe, rest pain
oIschemic rest pain is worse
at night & often wakes the
patient.
Diagnosis
-Physical exam
oSensation of coldness or
numbness in the
extremities; cool & pale
when elevated or ruddy
& cyanotic when placed
in a dependent position.
oSkin & nail changes
oUlceration
oGangrene
oMuscle atrophy
-Ankle brachial index
-Ultrasound
-Angiography
-Blood tests
Medical Management
-Manage symptoms
oFeet care
-Stop progression of atherosclerosis
-Lifestyle modifications
oExercise
oQuit smoking
oEat healthy
Medications
-Pentoxifylline (Trental)
oAnti-inflammatory and
Vasodilator
oPt teaching: no caffeine, teach
to assess feet, 8 weeks for
effectiveness.
-Cilostazol (Pletal)
oVasodilator
-Aspirin
-Clopidogrel (Plavix)
oAntiplatelet
-Statins
Nursing Management
-Positioning the body part below the level of the heart.
-Assist with walking or other moderate or graded isometric exercises that promote blood flow
and encourage the development of collateral circulation.
-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.
oPain can serve as a guide in determining the appropriate amount of exercise.
oThe 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.
oSET can result in increased walking distance before the onset of claudication.
-Applications of warmth to promote arterial flow and instructions to the patient to avoid
exposure to cold temperatures, which causes vasoconstriction.
oAdequate clothing and warm temperatures protect the patient from chilling.
-Do not cross legs for more than 15 minutes at a time (compression of vessels).
Promoting Care
-Activities that promote arterial and
venous circulation, relieve pain, and
promote tissue integrity are acceptable.
-The patient and family are helped to
understand the reasons for each aspect
of the plan, the possible consequences
of nonadherence, and the importance
of keeping follow-up appointments.
-Long-term care of the feet and legs is
of prime importance in the prevention
of trauma, ulceration, and gangrene.
