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DISORDERS OF THE PERIPHERAL ARTERIES

may be acute (arterial thrombosis) or chronic (peripheral arteriosclerosis)

THE CLIENT WITH PERIPHERAL VASCULAR DISEASE

arteriosclerosis - thickening, loss of elasticity an calcification of arterial walls.


atherosclerosis is a form of arteriosclerosis - deposits of fat and fibrin obstruct and harden the arteries.

INCIDENCE AND RISK FACTORS

men in 60’s & 70’s, higher among black women


risks are dm, hypercholesterolemia, htn, smoking and high homocystine levels
increases risk for neuropathy, paresthesias, ulcers that don’t heal, necrosis, gangrene and amputation

PATHOPHYSIOLOGY

artherosclerotic lesions involve the intima and media.


lesions typically develop in large and midsized arteries
arteriosclerosis in the abdominal aorta leads to aneurysm
plaque tends to form at bifurcations
manifestations develop when vessel is occluded by 60%+

MANIFESTATIONS AND COMPLICATIONS

intermittent claudication, rest pain, paresthesias, diminished or absent peripheral pulses, pallor with extremity,
elevation, dependent rubor when dependent, thin, shiny, hairless skin, thickened toenails, areas of discolorization or
skin breakdown

INTERDISCIPLINARY CARE

focus on slowing artherosclerotic process and maintaining tissue perfusion

DIAGNOSIS

segmental pressure measurements, stress testing, doppler ultrasound, transcutaneous oximetry, angiography or
magnetic resonance angiography

MEDICATION

aspirin or plavix, pletal (platelet inhibitor with vasodilation), pentoxifylline (lowers blood viscosity, increases rbc
flexibility)

TREATMENTS

smoking cessation, meticulous foot care, diabetes and htn control, lowering cholesterol, weight loss

REVASCULARIZATION

percutaneous transluminal angioplasty, stent placement, artherectomy, surgery: endarterectomy, grafts

COMPLEMENTARY THERAPIES

aromatherapy, biofeedback, therapeutic touch, herbal supplements, exercise

NURSING CARE

HEALTH PROMOTION

discuss healthy lifestyle habits


ASSESSMENT

health history, physical examination

NURSING DIAGNOSIS AND INTERVENTIONS

INEFFECTIVE TISSUE PERFUSION: PERIPHERAL

assess peripheral pulses, pain color temp and cap refill, position with extremities dependent, discuss benefits of regular
exercise, use foot cradle, lightweight blankets, socks, slippers, keep extremities warm; encourage frequent position
changes, don’t cross legs or use pillow under knee

PAIN

tissue ischemia, lactic acid build up, assess pain, keep extremities warm, teach pain relief

IMPAIRED SKIN INTEGRITY

chronic tissue ischemia leads to dry scaly and atrophied skin; meticulous skin care; bed cradle; egg-crate mattress,
flotation pad, sheepskin or heel protectors

ACTIVITY INTOLERANCE

assist with self care as needed, encourage gradual increases in duration and intensity of exercise; rest with extremities
dependent; provide diversional activities; encourage frequent position changes and rom exercises

USING NANDA, NIC, AND NOC

COMMUNITY BASED CARE

smoking cessation, medications, signs of excess bleeding, skin surveillance and foot care, diet and exercise.
Revascularization: incision care, complications, limitations.