Peripheral vascular disease: scaring or narrowing of the blood vessels (found in arms and legs).
Makes it difficult for blood to get through to the extremities
- Affects both arteries and veins
Peripheral venous insufficiency (PVI): specific to narrowing of the VEIN. Blood can’t get back
UP TO the heart.
Peripheral arterial disease: Oxygen can not make it to distal extremities (fingers and toes)
Veins: Vacuum, blood back to the vena cava, low pressure
Artery: Away from the heart and out to the body, high pressure
PVD: not an oxygen problem
PAD: oxygen problem (ischemia, then necrosis)
- BAD
- Cold legs that lack warmth!
PVD think VEINY:
V: Voluptuous pulses… warm legs. Veins are the problem, arteries are fine
E: Edema (blood pooling)
I: Irregularly shaped sores (exotic pools)
N: No sharp pain (dull pain)
Y: Yellow and brown ankles
PAD think ARTS (for artery:
A: Absent pulses
R: Round, red, smooth sores (rubor)
T: Toes and feet are pale (advanced stages, eschar)
S: Sharp pain in calves, during exercise or elevation (AKA intermittent claudication)
- Signs of low oxygen
- Exercise uses more oxygen than while at rest
- Elevation (harder to pump blood uphill)
6 Ps: assess oxygenations of the limb
- Pain: unrelieved pain at rest
- Paresthesia: Tingling and numbness
- Pulselessness: diminished or weak
- Pallor: Pale
- Pokiolothermia (Polar): Cold leg, lack of warmth
- Paralysis: limb is not working
Pain and Paresthesia: LIFE THREATENING
TREATMENTS AND NURSING INTERVENTIONS
What makes the pain better?
PVD and DVT: veins = elevate
- All vein problems you elevate (V)
PAD: arteries = hang
PUT the ARTERIES DOWN
RISK FACTORS (Causes of PVD)
- Smoking: scars lining of blood vessels
- Diabetes
- High cholesterol
- High BP (Hypertension) 140/90
Diagnostic tests and Labs
- Doppler ultrasound
- ABI (Artery Brachial Index): done first before ultrasounds
- Only works for PAD (arterial problems)
GOALS
PVD: want to keep veins open (helping veins vacuum more blood back to the heart)
PAD: push all the oxygen-rich blood to the lower extremities (keeping arteries open)
Meds/Pharm: AC: Anti-Clogging of Arteries
Anti-platelets and Cholesterol-lowering drugs
- Avoid grapefruit juice
Test TOPIC: POSITIONING
Treatments and Education: SSHT
S: Safety
Avoid the 8 Cs
- Careful with HOT temp (impaired sensation)
- Caution with foot trauma (wounds and infection)
- Constriction must be avoided
- Crossing Legs
- Constrictive clothing
Cigarettes
- Caffeine (coffee, tea, chocolate)
- Cold temperatures
S: Skin assessed daily
S: Shoes well fitted, no sandals (avoid injury)
H: Hydration (easy for blood to move)
T: Toenails being trimmed ONLY BY THE PROVIDER (goes for diabetics as well)
Raynaud’s: Cold fingers, common in females.
- R for Ring fingers
- Decreased blood flow triggered by cold or stressed
- White, blue, to red
- Wear warm gloves
Buergers: Cold feet and hands (typically in the feet)
- B for Bare feet and hands
- Common in men, worsen by smoking (can lead to amputation)
- Education: avoid trauma to the feet and avoid smoking.