Study Guide: Additional Tips for PAD

What is your assessment with PAD:

Nursing health history of patient
Identify risk factors patient has for PAD
o Diabetes, hypertension, chronic kidney, hypercholesterolemia
o Elevated C-reactive protein, family history,
hypertriglyceridemia, age, hyperhomocysteinemia,
hyperuricemia, obesity, sedentary lifestyle, stress
Identify which risk factors can be modified by the patient and those
that cannot
o Obesity, lifestyle, stress
o With medication and/or lifestyle changes: Hypertension,
diabetes, etc.
Physical Assessment
Think pulses, color (reactive hyperemia), sensation, temperature, 6
Ps
Patients with PAD often have intermittent claudication or
pain/cramping with walking that is a result of ischemia to the tissues
(circulation is diminished to the lower extremity). This is a symptom of
PVD (not its own disease). This goes away when the patient rests
How do symptoms of PAD progress from more mild to severe?
o Mild:
Intermittent claudication, Neuropathic pain and
paresthesiaia happen more in diabetic patients
Thin, shiny, and taught skin, hair loss on lower legs,
diminished or absent pedal, popliteal, or femoral pulses
o Severe:
Pallor of foot with leg elevation followed by reactive
hyperemia of foot with dependent position
Pain @ rest progresses in feet or toes; Aggravated by limb
elevation and occurs more often at night
Critical Limb Ischemia Atrial leg ulcers or gangrene
More at risk: Diabetics, history of stroke and heart
failure

For example, what is more serious: Ischemia to the foot at rest or

intermittent claudication (intermittent ischemia).Tip- this is like the
anginas Which angina was worse (the patient experiencing pain at
rest or the patient experiencing pain with activity only what are they
called by the way?)
What are your potential nursing diagnosis?
If it is a c/o pain in the legs?
o Chronic pain related to ischemia, inflammation, and swelling
If it is decreased tissue perfusion evidenced by decreased pulse
o Ineffective tissue perfusion related to deficient knowledge of
contributing factors
 If there is indeed a wound
o Ineffective health management related to lack of knowledge of
disease and self-care measures
What are appropriate nursing interventions? Remember what risk factors do
they have that are modifiable (ones the patient could improve)? If we consider risk
factors that are not modifiable (genetic predisposition), we wont have as many
interventions but we can educate.
Example:
Impaired skin integrity or risk for skin breakdown interventions:
o Inspecting feet daily, comfortable shoes, rounded toe shoes, soft
insoles, lightly laced shoes.

o What should we tell the patient with intermittent claudication

to do?
o They may need medical management (in which case see below)
o They can make lifestyle changes
Dont smoke, continue exercising take breaks when you
have pain, control cholesterol
o Avoid medications and products that cause vasoconstrictions
(smoking again, caffeine)
o Avoid injury, keep legs below heart level

Many patients with PAD require medical management. What are the medical
managements?
Stents Why do they put a stent in? What does that do?

USE ATI Adult Medical Surgical Nursing BOOK PAGE 187: Peripheral
Bypass Grafts: Indications to Post procedure