Peripheral Vascular Disease
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| Define PVD | Peripheral Vascular Disease – circulatory problems originating from venous or arterial pathology
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| Why is careful assessment so important for PVD? | The signs, symptoms, and treatment vary widely depending on the source of pathology
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| Name some predisposing factors for PVD. | Aterial – Atherosclerosis (95% of cases), advanced age; Venous – History of DVT, Valvular incompetence
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| Name some disease associated with arterial PVD. | Raynaud disease, Buerger disease, Diabetes, Acute Occlusion (emboli/thrombi)
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| Define Raynaud disease. | A disorder in which vasospasm of small arteries decrease blood flow to extremities like fingers, toes, or nose – usually fingers- in response to cold or stress
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| Define Buerger disease. | a progressive thrombosis and clotting of small arteries and veins decreasing blood flow to hands and feet, associated with smoking
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| Name some venous disorders associated with PVD. | Varicose veins, Thrombophlebitis, Venous stasis ulcers
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| Define thrombophlebitis. | Inflammation of a vein caused by a blood clot
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| What alterations might a nurse find during assessment of the patient’s skin and appendages if PVD is due to arterial insufficiency? | smooth, shiney skin; loss of hair; thickened nails
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| What alterations in skin may be present in the skin if a patient has PVD of venous origin? | Brown pigment around ankles
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| What color changes will be observed with elevation and dependent position when PVD is arterial in origin? | Elevation – pallor; Dependent – Rubor
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| What color would dependent limbs be in PVD if the origin is venous? | Cyanotic/blue
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| What will the nurse note about temperature of extremities when the source PVD is arterial? Venous? | Arterial – cool; Venous – warm
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| What difference will the nurse note when assessing pulses of arterial PVD vs. venous PVD? | arterial – decreased or absent; venous –normal
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| What type of pain is associated with PVD of arterial origin? | Sharp pain that increases with walking and elevation; intermittent claudication; rest pain when extremities are horizontal – may be relieved by dependent position
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| Describe the pain associated with PVD of venous origin. What relieves this pain? | Persistent, aching, full feeling, dull sensation; relieved when horizontal ( elevate and use elastic stockings)
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| Describe ulcers associated with PVD of arterial origin. | very painful on lateral lower legs, toes, and heels; demarcated edges; necrotic; not edematous
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| Describe ulcers associated with PVD of venous origin. | slightly painful, on medial legs and ankles, uneven edges, superficial, marked edema
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| Give several applicable nursing diagnoses for the patient with PVD. | Ineffective tissue perfusion, impaired skin integrity, risk for infection, pain
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| What are some noninvasive treatments for arterial PVD? | stop smoking, topical antibiotic, saline dressing, bed rest/immobilization, finbrinolytic agents if clots – not for Buerger or Raynaud
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| What are some noninvasive treatments for venous PVD? | Systemic antibiotics, compression dressing, limb elevation, fibrinolytic agents and anticoagulants if thrombosis
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| Name 5 surgical interventions for arterial PVD. | Embolectomy, Endarterectomy, Aterial bypass, Percutaneous transluminal angioplasty, Amputation
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| Name 3 surgical interventions for venous PVD. | vein ligation, thrombectomy, debridement
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| A patient with PVD will need assessment of the affected extremities at regular intervals. What will the nurse check? | Color, temperature, sensation, and pulse quality
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| Explain nursing care of the patient with PVD in regards to activity level, positioning, clothing, and promoting warmth of the extremity. | Encourage rest at first sign of pain, schedule activities in patient’s tolerance level, encourage elevation of extremity if venous and frequent position change, avoid restrictive clothing and crossing legs, keep warm with extra clothing not heating pads
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| Why shouldn’t a patient with PVD use external heat sources such as a heating pad? | Sensation in the extremity is diminished so that the patient could burn themselves without realizing it.
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| Why shouldn’t a patient with PVD smoke? | Smoking causes vasoconstriction and spasm of arteries
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| What can we teach the patient with PVD to prevent further injury? | Change position frequently; wear nonrestrictive clothing; avoid crossing legs; avoid keeping legs dependent; wear good shoes; proper foot and nail care
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| How is the affected extremity to be treated preoperatively for the patient with PVD? | Maintain in a level position if venous, 15 degrees dependent if arterial; room temperature; protect from trauma
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| What complication does the nurse assess frequently for after surgical intervention for PVD? | hemorrhage
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| What drug may be given post surgery for PVD? Why? | Anticoagulant to prevent thrombosis
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