Venous
This type of vascular disease is primarily a problem with blood returning to the heart.
What is peripheral venous disease?
What is the most common cause of peripheral artery disease?
What is atherosclerosis?
This test compares ankle systolic pressure with brachial systolic pressure.
What is the ankle-brachial index (ABI)?
Name the six Ps of acute limb ischemia.
Brown pigmentation + edema + medial malleolus ulcer + palpable pulses. Venous or arterial?
Venous
Name two common findings associated with chronic venous disease.
What are edema, varicose veins, brown pigmentation, heaviness, pruritus, or restless legs?
What is the term for cramping leg pain that occurs with walking and improves with rest?
What is intermittent claudication?
What diagnostic test measures changes in blood volume in the lower extremities?
What is plethysmography?
What does poikilothermia mean?
The affected limb cannot regulate its temperature and becomes cool/takes on room temperature.
Cool foot + diminished pulse + toe ulcer + pain relieved by dependency. Venous or arterial?
Arterial.
Where is a venous ulcer most commonly located?
What is the medial malleolus?
Name three classic physical findings associated with PAD
Pale/shiny skin, decreased hair growth, slow toenail growth, cool extremity, or diminished/absent pulses.
What test uses sound waves to evaluate vessel size, blood-flow direction, and reflux?
What is duplex ultrasound?
Which finding is more concerning: chronic brown pigmentation or new pulselessness?
New pulselessness.
A patient with chronic venous insufficiency has significant edema. What position should the nurse encourage?
Elevate the legs above the heart.
A patient has edema, brown ankle pigmentation, varicose veins, and a moist, irregular ulcer. Is this venous or arterial disease?
What is venous disease?
A patient says their foot pain improves when they hang their leg over the side of the bed. Why?
The dependent position allows gravity to assist arterial blood flow to the ischemic foot.
A patient's ankle systolic pressure is 80 mmHg and brachial pressure is 120 mmHg. Calculate the ABI.
80 รท 120 = 0.67
This is consistent with PAD.
A client develops sudden pain, pallor, paresthesia, and pulselessness in the leg. What condition should the nurse suspect?
Acute limb ischemia
A nurse is about to apply compression stockings to a client with venous disease. What must be assessed first?
Arterial circulation/pulses or ABI.
Explain why elevation and compression are both helpful for chronic venous insufficiency.
Elevation uses gravity to help venous blood return to the heart, while compression supports the veins/valves and decreases pooling and edema.
Why should a client with significant PAD NOT be taught to elevate the legs above the heart?
Elevation can decrease arterial blood flow to the ischemic extremity and worsen pain.
Before a contrast study, name three important things the nurse should assess.
Renal function/creatinine, history of previous contrast reactions, and metformin use.
A client with PAD suddenly develops paralysis and paresthesia of the affected extremity. What should the nurse do?
Recognize this as an emergency and notify the provider immediately.
A 72-year-old client has diabetes and a history of smoking. The client reports burning foot pain at night that improves when the foot is placed in a dependent position. Assessment shows a cool, pale foot, decreased hair growth, slow toenail growth, diminished pedal pulses, and a painful, round ulcer on the toe.
Question:
Identify the condition, explain the underlying problem, identify the ulcer, and state the appropriate positioning.
Peripheral artery disease.
It is a supply problem in which oxygen-rich blood cannot adequately reach the tissues, commonly due to atherosclerosis.
The wound is an arterial ulcer.
The leg should not be elevated above the heart; a dependent position can help gravity improve arterial blood flow and relieve ischemic pain.