Peripheral Artery Disease

Question 1

What is peripheral artery disease?

Answer 1

Atherosclerosis of the extremities (virtually always lower) causing ischemia.

Question 2

What is Buerger’s disease?

Answer 2

when fingers and toes turn black in smokers

Question 3

6 P’s of Arterial Insufficiency

Answer 3

Pain
Pulse
Paralysis
Pallor
Paresthesia
Pressure

Question 4

Risk factors for PAD

Answer 4

HTN
Hyperlipidemia
DM
Smoking
Obesity/Sedentary lifestyle
Female/Older adults/Family hx

Question 5

May be asymptomatic or cause intermittent claudication (burning, cramping, and pain in legs during exercise)

Answer 5

Mild PAD

Question 6

May cause rest pain w/ skin atrophy, hair loss, cyanosis, ischemic ulcers, and gangrene

Answer 6

Severe PAD

Question 7

Ankle-brachial index (ABI)

Answer 7

The ankle pressure is compared to the brachial pressure

Question 8

Expected finding for ABI

Answer 8

0.9 to 1.3

Question 9

ABI less than __________ in either leg is diagnostic for PAD.

Answer 9

0.9

Question 10

What type of medication inhibits platelet aggregation and prolong bleeding time?

Answer 10

antiplatelet medications

Ex: Cilostazol and Pentoxifylline

Question 11

General nursing implications for antiplatelet meds

Answer 11

-use caution in pts at risk for bleeding
-concurrent use w/ NSAIDs, heparin, thrombolytics, or warfarin may increase risk of bleeding
-teach bleeding precautions to pt and family
-monitor bleeding times throughout therapy

Question 12

Side effects of Cilostazol

Answer 12

HA, diarrhea, GI bleeding, dizziness, flatus

Question 13

Reminders for Cilostazol

Answer 13

-monitor for relief of intermittent claudication
-grapefruit juice inhibits metabolism
-administer on empty stomach

Question 14

Procedures

Answer 14

• Percutaneous transluminal angioplasty and laser-assisted angioplasty
• Mechanical rotational abrasive atherectomy
• Arterial revascularization surgery

Question 15

Ways to promote vasodilation & prevent vasoconstriction

Answer 15

-warm environment
-wear insulated socks
-never apply direct heat
-avoid exposure to cold
-avoid stress, caffeine, and nicotine

Question 16

Positioning teaching for PAD pts

Answer 16

-avoid crossing legs
-refrain from wearing restrictive garments
-elevate legs to reduce swelling, but do not elevate above the level of the heart

Question 17

Characteristics of ARTERIAL peripheral disease

Answer 17

Peripheral pulses: ABSENT
Cap refill: GREATER THAN 3 SEC
Ankle brachial index: LESS THAN/EQUAL TO 0.90
Edema: ABSENT UNLESS LEG CONSTANTLY IN DEPENDENT POSITION
Hair growth: LOSS OF HAIR ON LEGS, FEET, & TOES
Ulcer location: TIPS OF TOES, FOOT, OR LATERAL MALLEOLUS
Ulcer margin: ROUNDED, SMOOTH, LOOKS PUNCHED OUT
Ulcer drainage: MINIMAL
Ulcer tissue: BLACK ESCHAR OR PALE PINK GRANULATION
Pain: INTERMITTENT CLAUDICATION OR REST PAIN N FOOT; ULCER MAY OR MAY NOT BE PAINFUL
Nails: THICKENED, BRITTLE
Skin color: DEPENDENT RUBOR, ELEVATION PALLOR
Skin texture: THIN, SHINY, TAUT
Skin temp: COOL, TEMP GRADIANT DOWN LEG
Dermatitis & pruritis: RARE