Peripheral Artery Disease
What is the main contributor of PAD?
Atherosclerosis
Where is stenosis most significant in this disorder?
The Carotid Bifurcation
What are the three locations of Aortic Aneurysm development? Which is the most common?
Ascending - in the Aortic arch itself
Descending/Thoracic - above the diaphragm
Abdominal - below the diaphragm (most common)
What places a client at higher risk of developing DVT?
Anything that allows venous stasis
prolonged bedrest/reduced activity, surgery (vascular injury), pregnancy, postpartum, oral contraceptive use, hormone therapy, trauma, cancer with chemotherapy, increased age, varicose veins, prior VTE
What risk factors lead to Chronic Venous Insufficiency?
Obesity, female gender, smoking, sedentary lifestyle, increased age, prolonged standing, previous lower extremity trauma or thrombosis, hypertension
List a major clinical manifestation of PAD.
Intermittent Claudication - muscle pain that occurs during exercise and is relieved by rest.
Atypical leg pain - exercise induced, relieved by rest
Activity intolerance
Decreased quality of life
What are the clinical manifestations of Carotid Artery Disease?
Clinical signs of a stroke or Transient Ischemic Attack (TIA)
sudden weakness, dizziness, loss of coordination, difficulty speaking, sudden vision problems, facial droop, sudden and severe headache
List 3 risk factors for Aneurysm development
Family history, advanced age, genetic abnormalities, history of Coronary Artery Disease, smoking, high cholesterol, hypertension
What is Virchow's Triad?
The factors implicated in the formation of a VTE
decreased blood flow rate/stasis of blood flow
damage to the vessel wall or endothelial injury
increased tendency for blood to clot - hypercoagulability
What are the clinical manifestations of Chronic Venous Insufficiency?
Lower extremity pain and edema, varicose veins, brown skin pigmentation, skin thickening and weakening, ulcer formation
List 2 teaching points that are important for clients with PAD.
Medication adherence, extremity positioning to promote blood flow, inspect feet daily and report skin changes immediately, report chest discomfort or neurological changes, lifestyle changes
How is Carotid Artery Disease diagnosed?
Combination of physical assessment, non-invasive procedures, invasive procedures
Carotid Angiography is gold standard
Carotid duplex U/S, MRI/MRA, CTA
What are 2 major complications of an aneurysm? How would you describe each? What are symptoms of each?
Aortic Dissection - tear in the intima, creates a false lumen on the vessel so blood can flow into the aortic wall - sudden/severe pain in the anterior chest or back, pain described as ripping, can cause nausea or vomiting, BP different in LUE v RUE
Aneurysm Rupture - rupture of the aorta itself - life-threatening - sudden and extreme blood loss, chest pain, loss of consciousness, hypotension - 80% death rate
What are the clinical manifestations of DVT?
Most often in the calf - Homans' Sign (calf pain elicited by dorsiflexion of the foot - elicit this with caution
pain, swelling, tenderness, discoloration/redness, warmth of the affected site
impaired mobility or use of the extremity
How is Chronic Venous Insufficiency treated?
Compression stockings, avoiding prolonged standing, basic skin care, feet assessments, wound care if ulcers are present, leg elevation, adequate nutrition (protein and calorie intake), antibiotics for cellulitis, aspirin and steroids to promote fibrinolysis and healing
How many stages of PAD are there? What is the clinical presentation for each? (ie. what differentiates them)
4 stages
1: asymptomatic, may have decreased pedal pulses
2: Claudication present; pain is reproducible by repeating the exercise
3: Rest pain; pain at rest and during activity; pain decreases with placing the extremity in a dependent position
4: Necrosis or gangrene; evidence of necrosis in the periphery
List necessary focused assessment points and key patient teaching.
Neurologic assessment, auscultation of carotid arteries, BP monitoring
Medication adherence, maintaining normal glucose levels, BP management, clinical manifestations of a stroke, lifestyle changes
What treatment options are available for Aneurysms?
Medical management - imaging and monitoring, ECG, cardiac MRI; medications (antihypertensives, antibiotics, and statins)
Surgical management - based on size, location, and presence of symptoms; Aneurysmectomy or EVAR
How are DVT's prevented/managed?
First step is prevention - ambulation and VTE prophylaxis (LMWH, compression stockings)
Medications for treatment - antigoagulant (heparin, warfarin, eliquis, apixiban)
Less commonly surgery - thrombectomy
Leg discoloration, varicose veins, edema, leg pain, activity intolerance, ulcer formation, cellulitis, sepsis, limb amputation, DVT/PE
What are 2 of the 4 goals for effective treatment of PAD? What are 2 treatment options for PAD?
Goals: 1. Provide relief of symptoms to improve quality of life
2. Prevent progression of Arterial disease
3. Prevent cardiovascular complications
4. Provide further education about the disease process
Treatments: nonpharmacologic therapy (weight loss, smoking cessation, exercise, low-fat diet), medications (antihypertensives, antiplatelets, statins), non-surgical interventions (Angio or arthrectomy), Surgery for revascularization
What are the treatment options for Carotid Artery Disease?
Based on severity of the occlusion
lifestyle changes and medications (antiplatelets, antihypertensives, statins)
Surgical management for revascularization (Carotid Endarterectomy, Carotid Artery Stenting)
What patient teaching is key for nursing management?
strict treatment regimen adherence
med compliance, smoking cessation, weight loss/maintain healthy weight, regular exercise, do not cross legs or elevate legs, reduce stress, continue with U/S or CT monitoring
What are the complications of DVT? What are the symptoms of each?
PE - most serious, life-threatening; shortness of breath, tachycardia, dec SpO2, hypotension, sharp chest pain, hemoptysis
Post-thrombotic syndrome - chronic disorder of the affected extremity; limb swelling, severe pain, intractable edema, irreversible skin changes, ulceration
What nursing interventions are critical for patient care? (include teaching points)
skin care and dressing application, would care, medication administration, compression therapy, encourage ambulation, educate on leg positioning, lifestyle changes to avoid prolonged standing, therapy adherence for wound care