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Foot - HIGH RISK Feet > Unit 2 - Peripheral Arterial Disease > Flashcards

Unit 2 - Peripheral Arterial Disease Flashcards

1
Q

There are subtle differences between the terms, PAD and PVD.

Peripheral Arterial Disease (PAD)

A

afflicts the arteries alone

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2
Q

There are subtle differences between the terms, PAD and PVD.

Peripheral Vascular Disease (PVD)

A

is a broader term which includes any blood vessel including, veins and lymphatic vessels

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3
Q

Arteriosclerosis

A

refers to normal aging that leads to a gradual loss of elasticity and ‘hardening’ of the vessel walls throughout the body

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4
Q

Atherosclerosis

A

refers to the build up of plaque on the inside of arterial blood vessels that may eventually grow to the point of seriously impeding blood flow and eventually block blood flow altogether

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5
Q

Atherosclerosis risk factors

FM HHAS fat DIKS

A

family history
male gender

hypertension
hyperlipidemia
aging
smoking

obesity

diabetes
inactivity
kidney disease
stress

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6
Q

Clinical Symptoms of PAD:

may be…

A

complete or partial blockage of blood flow to a limb

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7
Q

Clinical Symptoms of PAD:

symptoms depend on…

A

where and how the blockage occurs

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8
Q

Clinical Symptoms of PAD:

Is it acute or chronic?

A

may be acute or chronic

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9
Q

Acute Arterial Occlusion:

usually…

most often caused by…

A

sudden

an embolus of blood clot or plaque coming from the proximal circulation and becoming lodged where the artery narrows or divides

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10
Q

Acute Arterial Occlusion:

S/S occur where?

A

distal to the site of occlusion

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11
Q

Acute Arterial Occlusion:

The 6 Ps distal to the site of occlusion

A

Pain
Rest pain that worsens on passive movement of the limb and is most severe in the distal aspects of the ischemic limb.

Pallor
Skin over the ischemic limb initially appears pale and then becomes mottled and purple-blue.

Pulselessness
Absent peripheral pulses distal to the site of occlusion.

Paralysis
Skin over the ischemic limb initially appears pale and then becomes mottled and purple-blue.

Paresthesia
Initial paresthesia (e.g., decreased fine touch sensation) progresses to anesthesia.
An abnormal sensation of the skin (tingling, pricking, chilling, burning, numbness) with no apparent physical cause.

Poikilothermia
The ischemic limb is typically cold to touch but may be warm in hot environments (i.e., it takes on the ambient temperature).

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12
Q

Acute Arterial Occlusion:

Is this a pressing matter?

A

this is an emergency situation

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13
Q

Acute Arterial Occlusion:

this is an emergency situation!

DO (3)

DO NOT (1)

A

arrange for immediate transport to hospital
keep limb at or below heart level
protect heel from pressure

DO NOT elevate limb

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14
Q

Acute Arterial Occlusion:

Treatment
What is required?
Why?

A

anticoagulant therapy and surgery

to restore circulation

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15
Q

Chronic Arterial Insufficiency:

usually…

A

signs and symptoms appear gradually

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16
Q

Chronic Arterial Insufficiency:

SIGNS

Inspection (3)

Palpation (3)

A

cool, thin shiny skin
thickened toenails
hair loss

diminished or absent pedal pulses
capillary refill time longer than 3 seconds
dependent rubor with pallor on elevation

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17
Q

Chronic Arterial Insufficiency:

SX

1
2
3 a, b, c

A

numbness or tingling

intermittent claudication

rest pain
> often at night
> gets worse with elevation
> may be masked by neuropathy
OR
> may progress to continuous pain
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18
Q

Chronic Arterial Insufficiency:

Wounds
What type?
Describe (5)

A

non-healing ulcers or gangrene

painful
often on bony prominences
“punched out” appearance

little or no drainage
no signs of healing within 2 weeks

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19
Q

Chronic Arterial Insufficiency:

later signs and symptoms may be called?

A

critical limb ischemia (CLI)

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20
Q

Chronic Arterial Insufficiency:

critical limb ischemia

A

Critical limb ischemia (CLI) is a severe blockage in the arteries of the lower extremities, which markedly reduces blood-flow. It is a serious form of peripheral arterial disease, or PAD, but less common than claudication. … Left untreated, the complications of CLI will result in amputation of the affected limb.

Ischemia can occur in any muscle group, organ, or tissue in the body. For example, in the lower extremities, ischemia can cause claudication in peripheral artery disease (PAD) or may cause critical limb ischemia (CLI) in severe cases.

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21
Q

What is used to diagnose peripheral arterial insufficiency? (2)

A

Doppler ultrasound probe

and

Ankle Brachial Pressure Index (ABPI)

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22
Q

Doppler ultrasound probe – how does this work?

A

Emits and then receives a sound wave that bounces off red blood cells.

This converts blood flow in a vessel into sound that can be heard and displayed in a wave form.

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23
Q

Ankle Brachial Pressure Index (ABPI)

How is this measured?

A

The systolic blood pressure is measured in both arms (brachial pressure) and the highest pressure in either arm will be used to calculate the ABPI in each foot.

The systolic pressure for each ankle is measured at the post tibial and dorsalis pedis pulses and the highest of the two readings is used.

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24
Q

Ankle Brachial Pressure Index (ABPI)

How is this calculated?

A

In the following formula:

Highest systolic ankle pressure
DIVIDED BY
Highest systolic brachial pressure

= Ankle Brachial Pressure Index

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25
Q

Interpretation of ABPI

normal

A

> 0.90 - 1.2

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26
Q

Interpretation of ABPI

claudication

A

0.50-0.90

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27
Q

Interpretation of ABPI

ischemia

A

< 0.50

28
Q

Measuring to calculate ABPI

In what situation might ABPI be falsely elevated?
When is this commonly seen?

A

If the ankle vessels cannot be compressed due to calcification of the leg arteries

common in diabetics

29
Q

Measuring to calculate ABPI

If ABPI is falsely elevated because the ankle vessels cannot be compressed d/t calcification of the leg arteries, what is measured instead?

A

toe pressures

30
Q

Measuring to calculate ABPI

Systolic toe pressure

potential for healing

A

> 45 mmHg

31
Q

Measuring to calculate ABPI

Systolic toe pressure

possible but slowed healing indicated

A

30 to 45 mmHg

32
Q

Measuring to calculate ABPI

Systolic toe pressure

unlikely to heal, palliative measures

A

< 30 mmHg

33
Q

Goals and Treatments for PAD:

P2 M3

A

prevent complications of ulceration, infx or amputation

pain mgmt PRN

maintain mobility and quality of life

medical treatment of chronic arterial insufficiency

medical management of hypertension, diabetes, hyperlipidemia, kidney disease

34
Q

Goals and Treatments for PAD:

WALS MM

A

walking exercise

antiplatelet therapy

lifestyle changes to manage weight and stress

smoking cessation

Medical management of hypertension, diabetes, hyperlipidemia, kidney disease

35
Q

Goals and Treatments for PAD:

if worsening of condition?

A

family physician refers to vascular surgeon

36
Q

Goals and Treatments for PAD:

if worsening of condition family physician refers to vascular surgeon who may? (2)

A

order an angiogram

evaluate for possible revascularization

37
Q

Goals and Treatments for PAD:

if worsening of condition family physician refers to vascular surgeon who may order an angiogram and/or evaluate for possible revascularization.

How is the latter accomplished?

A

by–pass surgery

angioplasty

38
Q

Goals and Treatments for PAD:

Re. lesions secondary to? (3)

A

advice on potential to heal of any lesions

wound care needs to be based on good assessment of potential to heal with an appropriate choice between dry or moist wound healing

pain management as needed

39
Q

Goals and Treatments for PAD:

Risk factor modifications (7)

Lifestyle
Labs (3)
VS
Rx

A
  • Smoking cessation
  • LDL cholesterol < 100 mg/dL
  • LDL < 70mg/dL if high risk
  • HbA1c < 7.0%
  • BP < 140/90 mmHg
  • BP< 130/80 mmHg if diabetic or renal disease

-Anti-platelet therapy

40
Q

If risk factors modified and limitations that affect quality of life still present, then what?

A

Suspected proximal lesion

41
Q

Limitations that affects quality of life are Ax’ed how?

A 
- History of significant exercise limitation
or
- Reduced treadmill performance
or
- Reduced function by questionnaire
42
Q

If proximal lesion suspected, how is the lesion localized?

A

Localize the lesion:

  • Conventional angio
  • MRI or CTA
  • Ultrasound
  • Hemodynamic localization

Computed tomography angiography (CTA) uses an injection of contrast material into your blood vessels and CT scanning to help diagnose and evaluate blood vessel disease or related conditions, such as aneurysms or blockages.

43
Q

Treatment for localized lesion

A

Revascularization
> Endovascular
> Surgical

44
Q

Approximate magnitude of the effect of risk factors on the development of critical limb schema in patients with peripheral arterial disease:

A

Increased lipids x2
Age > 65 x2

ABPI < 0.7 x2
ABPI < 0.5 x2.5

Smoker x3
Diabetes x4

45
Q

Natural Outcomes of Patients > 50 years of age with PAD

A

97 to 99% present with claudication or no symptoms

1 to 3% will present with critical limb ischemia

of this 1 to 3%, after 1 year, 30% will have had an amputation and 25% will have died

46
Q

Natural Outcomes of Patients > 50 years of age with PAD

AFTER FIVE YEARS

A

70 to 80% have stable claudication

10 to 20% have worsening of claudication

10% have critical limb ischemia

47
Q

Effects of PAD on the Lower Limb: (3)

A

thin skin is more fragile and easily injured

thickened nails exert more pressure on nail beds and sulci leading to greater potential
for tissue damage

minor injury can become major limb threatening disease!

48
Q

Effects of PAD on the Lower Limb:

thin skin is more fragile and easily injured – HOW? (2)

A

from minor trauma

poorly fitted shoes

49
Q

Effects of PAD on the Lower Limb:

minor injury can become major limb threatening disease – HOW? (cascade 4)

A

poor blood flow limits normal immune response

infection can spread more easily

infection can spread to bone

antibiotics cannot easily reach infected tissue

50
Q

Effects of PAD on General Health and Mobility:

cascade 4

A

pain from claudication or injury will decrease walking

decreased walking leads to muscle atrophy and stiffness

decreased activity tolerance may seriously impair ability to manage ADL independently

prolonged impaired mobility eventually negatively effects all body systems

51
Q

Effects of PAD on Common Foot Pathologies of Nails and Skin:

3

A

fragile skin is more prone to injury over bony prominences

increases the production of hyperkeratotic tissue in skin and nails

thicker corns, calluses and nails put even more pressure on underlying tissue

52
Q

Nursing Foot Care for Clients with PAD:

Assessment (5)

A Q IOU

A

1st AX — is PAD in present (S/S)

question client about and leg/foot pain;
onset, duration, what makes it better or worse?

identify any history of PAD or testing done (e.g., ABPI)

other health care providers involved e.g. family doctor, vascular surgeon, wound specialist

understanding of condition and any current treatments

53
Q

Nursing Foot Care for Clients with PAD:

Planning (3)

A

plan realistic goals for treatment in consultation with client and based on their preferences for treatment

plan interventions including education and referrals with client

plan frequency of treatment based on rate of nail growth and client preference

54
Q

Nursing Foot Care for Clients with PAD:

Intervention

Nursing teaching (3)

A

strongly advise smoking cessation for all smokers

advise clients of their increased risk for foot complications and how to prevent and manage minor injury

teach client to monitor all accidental or minor breaches of skin very carefully and seek medical attention for any pain, redness, swelling or discharge.

55
Q

Nursing Foot Care for Clients with PAD:

Intervention

In terms of actual foot care (4)

A

question the client about any changes

monitor and record pedal pulses at each visit

identify any areas of pressure from footwear and work with client to prevent skin breakdown

exercise particular caution to protect fragile skin during foot and nail care

56
Q

Nursing Foot Care for Clients with PAD:

Evaluation (3)

A

evaluate effectiveness of interventions including teaching and referrals

if maintenance is the goal, share achievement of same periodically with client and document

document changes to care plan along with any new goals or interventions

57
Q

Information re. wound care repeats (word-for-word) @ end of this unit.

Questions about same appear in
Deck 1
Questions 93-100

A

Yah so!

58
Q

Role of the Foot Care Nurse as a Member of the Health Care Team Managing PAD

SRAFC

Sarah Runs A Fight Club!

A 
Supportive
Referrals
Advocating
Follow-up
Communication
59
Q

Role of the Foot Care Nurse as a Member of the Health Care Team Managing PAD

Supportive: (4)

A

demonstrate support for whatever treatment and caregivers are currently in place

encourage clients to ask questions and be active participants in their own care

encourage all clients to manage risk factors for PAD and refer for help if needed.

60
Q

Role of the Foot Care Nurse as a Member of the Health Care Team Managing PAD

Referrals: (3)

A

refer client back to doctor if claudication gets worse or progresses to rest/night pain

refer client back to doctor if develops a non healing lesion that is present for more that 2 weeks

refer clients back to the home care or wound care nurse for questions about therapy

61
Q

Role of the Foot Care Nurse as a Member of the Health Care Team Managing PAD

Advocating: (3)

A

advocate for clients to have access to a family physician

can suggest calling Health Links or Manitoba Medical Association for a list of physicians taking new clients

advocate for home care assessment through family physician if needed.

62
Q

Role of the Foot Care Nurse as a Member of the Health Care Team Managing PAD

Follow-up: (1)

A

document referrals and ask the client about outcomes at subsequent visits

63
Q

Role of the Foot Care Nurse as a Member of the Health Care Team Managing PAD

Communication (2)

A

if concerns are urgent or more detail is required consider a phone call, letter or FAX to clarify communication

keep a record of communications

64
Q

angiogram

A

an X-ray test that uses a special dye and camera (fluoroscopy) to take pictures of the blood flow in an artery (such as the aorta) or a vein (such as the vena cava). An angiogram can be used to look at the arteries or veins in the head, arms, legs, chest, back, or belly

65
Q

angioplasty

A

If you have coronary artery disease, the arteries in your heart are narrowed or blocked by a sticky material called plaque. Angioplasty is a procedure to restore blood flow through the artery.

You have angioplasty in a hospital. The doctor threads a thin tube through a blood vessel in the arm or groin up to the involved site in the artery. The tube has a tiny balloon on the end. When the tube is in place, the doctor inflates the balloon to push the plaque outward against the wall of the artery. This widens the artery and restores blood flow.

66
Q

by-pass surgery

A

Peripheral artery bypass is surgery to reroute the blood supply around a blocked artery in one of your legs. Fatty deposits can build up inside the arteries and block them.

A graft is used to replace or bypass the blocked part of the artery. The graft may be a plastic tube, or it may be a blood vessel (vein) taken from your body (most often the opposite leg) during the same surgery.

67
Q

intermittent claudication

A

Intermittent claudication is a symptom of peripheral arterial disease. Intermittent claudication is a tight, aching, or squeezing pain in the calf, foot, thigh, or buttock that occurs during exercise, such as walking up a steep hill or a flight of stairs. This pain usually occurs after the same amount of exercise and is relieved by rest.

Foot - HIGH RISK Feet (6 decks)

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