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8/10/2019 Ch 38 Peripheral Arterial Disease
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Copyright 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.
(Relates to Chapter 38,Nursing Management: Vascular Disorders,
in the textbook)
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Copyright 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.
Involves progressive narrowing anddegeneration of arteries of neck,
abdomen, and extremities
Atherosclerosis is the leading cause ofmajority of cases
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Typically appears in patients betweentheir 60s and their 80s
Largely undiagnosed
Risk factors Cigarette smoking Hyperlipidemia Hypertension Diabetes mellitus
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Certain segments of arterial systemmore likely to be involved
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Fig. 38-1
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Peripheral arterial disease (PAD) mayaffect Aortoiliac artery Femoral artery Popliteal artery Tibial artery
Peroneal artery
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Classic symptom of PADintermittentclaudication Ischemic muscle ache or pain that is
precipitated by a constant level ofexercise
Resolves within 10 minutes or less with
rest Reproducible
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Pain at rest Occurs in the forefoot or toes and is
aggravated by limb elevation Occurs from insufficient blood flow Occurs more often at night
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Nonhealing arterial ulcers andgangrene are most serious
complications
May result in amputation if blood flowis not adequately restored or if severe
infection occurs
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Angiography Magnetic resonance angiography
(MRA)
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Smoking cessation Aggressive treatment of
hyperlipidemia
Hypertension and diabetes mellitus
BP maintained
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Antiplatelet agents Aspirin Ticlopidine (Ticlid) Clopidogrel (Plavix)
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Drugs prescribed for treatment ofintermittent claudication Pentoxifylline (Trental) Erythrocyte flexibility Blood viscosity
Cilostazol (Pletal)
Vasodilation Walking distance
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Exercise improves oxygen extractionin the legs and skeletal metabolism
Walking is the most effective exercise
for individuals with claudication 30 to 60 minutes daily
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Dietary cholesterol
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Ginkgo biloba Effective in increasing walking distance
for patients with intermittent claudication
Folate, vitamin B6, cobalamin (B12) Lowers homocysteine levels
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Protect from trauma Reduce vasospasm
Prevent/control infection
Maximize arterial perfusion
Other strategies Immune modulation therapy Angiogenic gene therapy
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Indications Intermittent claudication symptoms
become incapacitating
Pain at rest Ulceration or gangrene severe enough to
threaten viability of the limb
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Percutaneous transluminal balloonangioplasty Involves the insertion of a catheter
through the femoral artery Catheter contains a cylindrical balloon Balloon is inflated, dilating the vessel by
cracking the confining atheroscleroticintimal shell
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Most common surgical approach A peripheral arterial bypass operation
with autogenous vein or synthetic graft
material to bypass blood around thelesion
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Fig. 38-7
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Most common surgical approach(contd) Synthetic grafts typically used for long
bypasses Balloon angioplasty with stenting used in
combination with bypass surgery
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Endarterectomy Patch graft angioplasty
Amputation
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Past health history Diabetes mellitus Smoking
Hypertension Hyperlipidemia Obesity
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Exercise intolerance Loss of hair on legs and feet
Decreased or absent peripheral pulses
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Ineffective tissue perfusion(peripheral)
Impaired skin integrity
Activity intolerance
Ineffective therapeutic regimen
management
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Overall goals for patient with PAD Adequate tissue perfusion Relief of pain
Increased exercise tolerance Intact, healthy skin on extremities
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Health Promotion Identification of at-risk patients Community involvement
Diet modification
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Identify activities that promotecirculation
Maintain adequate peripheral tissue
perfusion Experience intact skin, free of
infection, on lower extremities
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62-year-old male complains of painwhen walking his dog that is relieved
with rest
He has a history of hypertension and
hyperlipidemia, and he smokes one
pack of cigarettes per day
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1. What risk factors for peripheral arterialdisease does he display?
2. What can he do to prevent furthercomplications?
3. What patient teaching is essential forhim to help manage his disease?