PAD by Audrey Stegemann https://padlet.com/astegema/40xsvukgo2rfygcj en-us 2025-02-03 14:40:44 UTC 2025-02-03 16:35:08 UTC hello@padlet.com Nursing Interventions https://padlet.com/astegema/40xsvukgo2rfygcj/wish/3313783477

  • Bilateral Blood Pressure: Patients with PAD are at an increased risk for subclavian artery stenosis (narrowing of the artery), when the blood pressure difference is 15-20 mm Hg higher it could suggest this.

  • Palpate all pulses in both legs: Weak and/or absent pulses are a sign of poor blood flow to that extremity.

  • Visual assessment of feet and limbs: You are looking for signs of ulcers forming, loss of hair on the lower limbs, and poor blood flow to the feet.

  • Temperature: Cool or cold temperature in the extremities signify poor blood flow.

  • Assess bilateral muscle tone: Muscle atrophy can accompany prolonged chronic arterial disease.

  • Assess Pain: Pain in the affected extremities with activity that is relieved with the is indicative of PAD.

    • ]]>     2025-02-03 15:02:04 UTC https://padlet.com/astegema/40xsvukgo2rfygcj/wish/3313783477     Labs and Diagnostics astegema https://padlet.com/astegema/40xsvukgo2rfygcj/wish/3313793372 Assessment:

    • Pulse palpation will be low/absent in the pedal/popliteal

    • Auscultate for bruits

    • Inspect legs/feet for necrosis/gangrene

      • Confirm findings with Dx testing

    Ankle Brachial Index:

    • Complete with a Doppler probe.

    • Used to compare the BP of the ankle with the BP of the brachial artery.

      • ABI = Ankle BP/Brachial BP

    • Normally, the ankle BP should be more than the brachial artery, so a ratio below 1.29 indicates PAD.

      • 0.99-0.99 = Boarderline PAD

      • 0.41-0.9 - Mild-Moderate PAD

      • 0-0.4 = Severe PAD

    • The BP is lower because blood flow is being restricted.

    Plethysmography

    • Pulse volume is used to detect changes in the volume flowing through a limb

      • Waveforms decrease with PAD

    Treadmill test

    • Confirms diagnosis of intermittent claudication and PAD

    Duplex Ultrasound

    • velocity of blood flow

    Computed Tomography Angiography (CTA)

    • CT Scan to visualize the vessels

    Angiography

    • Quantifies the narrowing of occluded vessels.


    LABs:

    • Lipid profile

      • evaluate risks for vascular disease

    • Coagulation tests

      • INR to test clotting time (possible warfarin use)

    ]]>     2025-02-03 15:08:07 UTC https://padlet.com/astegema/40xsvukgo2rfygcj/wish/3313793372     Patient Education https://padlet.com/astegema/40xsvukgo2rfygcj/wish/3313794985

  • Positioning: Avoid crossing the legs as this can obstruct blood flow.

  • Inspect feet daily: This should be monitored daily as patients with PAD are at a higher risk for developing ulcers on the bottom of the feet and between the toes.

  • Report chest discomfort or neurological changes immediately: These patients have an increased risk for developing chronic Angina, MI, or Stroke.

  • Lifestyles changes consistent with the management of atherosclerosis: DASH diet (1,600 mg Sodium restriction), limit alcohol intake, smoking cessation, moderate exercise

    • ]]>     2025-02-03 15:09:14 UTC https://padlet.com/astegema/40xsvukgo2rfygcj/wish/3313794985     Risk Factors: ehoward3_11 https://padlet.com/astegema/40xsvukgo2rfygcj/wish/3313800116 Modifiable Risk:

    -Aging

    -Diabetes

    -Smoking

    -Hypertenstion

    -Dyslipidemia

    -Sedentary Lifestyle

    -Obesity

    -Ineffective Stress Management


    Nonmodifiable risk factors:

    -age

    -gender

    -ethnicity

    -Family History


    ]]>     2025-02-03 15:12:09 UTC https://padlet.com/astegema/40xsvukgo2rfygcj/wish/3313800116     Patho astegema https://padlet.com/astegema/40xsvukgo2rfygcj/wish/3313805240

  • Progressive & Chronic Condition in which blood flow is obstructed through LARGE peripheral arteries.

  • This causes partial or total arterial occlusion.

  • PAD deprives the lower extremities of O2 & nutrients.

    • This results in inadequate tissue perfusion (ischemia and necrosis or cell death)

    • Causes:

    • Combination of atherosclerosis, inflammation, stenosis, embolus, & thrombus


    ]]>     2025-02-03 15:15:18 UTC https://padlet.com/astegema/40xsvukgo2rfygcj/wish/3313805240     Treatments: apeter34 https://padlet.com/astegema/40xsvukgo2rfygcj/wish/3313806943

  • Provide relief for symptoms

  • Prevent progression of cardiovascular disease

  • Improve quality of life

  • Provide patient education

  • Weight reduction'

  • Smoke cessation

  • Exercise

  • Low-fat diet

  • Surgical treatment

  • Medications

    • Medications:

    • Hypertensive meds or beta blockers to achieve blood pressure control

    • Antiplatelet (Asprin or clopidogrel) Improves blood flow and intermittent claudication symptoms

    • Lipid lowering statins to reduce total cholesterol

    • Vasodilators (ACE inhibitors) dilate blood vessels by blocking the formation of angiotensin II which is a vasoconstrictor

    • Hemorheological agents (Trental) lowers blood viscosity by inhibiting platelet aggregation which increases blood flow to affected extremity

    • NOTE: These medications can cause symptoms of headache, dizziness, diarrhea or palpitations that could potentially cause the patient to discontinue medications. - Patient education is very important!

    ]]>     2025-02-03 15:16:19 UTC https://padlet.com/astegema/40xsvukgo2rfygcj/wish/3313806943     Complications https://padlet.com/astegema/40xsvukgo2rfygcj/wish/3313808571

    • Risk for impaired skin integrity due to altered circulation or sensation.

    • CRITICAL LIMB ISCHEMIA: a sustained, severe decline of arterial blood flow to the affected extremity leading to chronic ischemia, pain at rest, ulceration gangrene, and ultimately limb loss if left untreated.

    • ACUTE LIMB ISCHEMIA: a sudden decrease in blood flow to an extremity that threatens tissue viability. May be FIRST manifestation of PAD in a previously asymptomatic patient, or it may be caused by an acute event that leads to symptomatic deterioration in a patient with lower extremity PAD and intermittent claudication.

    ]]>     2025-02-03 15:17:22 UTC https://padlet.com/astegema/40xsvukgo2rfygcj/wish/3313808571     apeter34 https://padlet.com/astegema/40xsvukgo2rfygcj/wish/3313809850 2025-02-03 15:18:08 UTC https://padlet.com/astegema/40xsvukgo2rfygcj/wish/3313809850 Peripheral ARTERY Disease astegema https://padlet.com/astegema/40xsvukgo2rfygcj/wish/3313840113 Artery = AWAY from the heart, when blocked, blood can't flow to the tissue -> Ischemia (pain) caused by the lack of O2.

    ]]>     2025-02-03 15:37:21 UTC https://padlet.com/astegema/40xsvukgo2rfygcj/wish/3313840113     *Remember the 6 P's of ischemia! ncrain4 https://padlet.com/astegema/40xsvukgo2rfygcj/wish/3313912251 -Pain

    -Pallor (pale)

    -Pulselessness (weak or absent pulses to affected area)

    -Paresthesia (tingling,numbness, & burning)

    -Paralysis

    -Poikilothermia (cool or cold)

    ]]>     2025-02-03 16:23:13 UTC https://padlet.com/astegema/40xsvukgo2rfygcj/wish/3313912251