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Vascular Disorders Peripheral Arterial Disease of the Lower Extremities

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Vascular Disorders Peripheral Arterial Disease of the Lower Extremities

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    1. Vascular Disorders Peripheral Arterial Disease of the Lower Extremities Aortoiliac, femoral, popliteal, tibial, or peroneal arteries Classic symptom: Intermittent Claudication Ischemic muscle ache precipitated by a consistent level of exercise Paresthesia – numbness / tingling in toes & feet Trophic changes: reactive hyperemia dependent rubor Rest pain – nocturnal

    2. Peripheral Arterial Disease

    3. Peripheral Arterial Disease of the Lower Extremities Diagnostics: Non-invasive: Doppler Studies Invasive: Angiography

    4. Peripheral Arterial Disease of the Lower Extremities Treatment: Risk Factor Modification – HTN – Stepped Approach to Control Smoking - Cessation Treatment of hyperlipidemia - Nutrition Exercise – slow progressive walking Medication – Antiplatelet Therapy – Plavix / ASA < blood viscosity / >erythrocyte flexibility – Trental < platelet aggregation & promote vasodilation - Pletal

    5. Peripheral Arterial Disease of the Lower Extremities Critical Limb Ischemia Interventional Radiology Percutaneous transluminal balloon angioplasty Atherectomy Surgical Revascularization Endarterectomy Graft angioplasty Peripheral artery bypass surgery End-stage surgery - amputation

    6. Vascular Disorders Peripheral Arterial Disease of the Lower Extremities Nursing Diagnoses Ineffective tissue perfusion Impaired skin integrity Acute pain Activity intolerance Ineffective therapeutic management

    7. Peripheral Arterial Disease of the Lower Extremities Assess: Peripheral pulses, pallor, blanching, hyperemia, warmth, capillary refill, ability to bear weight and walk, pain, risk factors Nsg Action: Medication administration, prepare for tests, treatment, surgery, prevent injury, skin care, community referrals Pt/Family Education: Skin care, Medications, risk factor modification, exercise

    8. Peripheral Vascular Disease Thromboangiitis Obliterans Buerger’s Disease Nonathersclerotic, segmental inflammation of arteries, veins & nerves of upper and lower extremities More common in men 25-40 years of age Correlates with cigarette smoking Rest pain, ischemic ulcerations Tx: smoking cessation / medications – anti-platelets, vasodilators Surgical: Amputation

    9. Peripheral Disease Clinical Manifestations

    10. Peripheral Vascular Disease Treatment

    11. Peripheral Vascular Disease Raynaud’s Phenomenon Episodic vasospastic disorder of small cutaneous arteries in fingers & toes Cause: Exaggerated SNS stimulation Occurs in women 15 -40 years of age May occur with collagen diseases: RA, scleroderma, systemic lupus erythematosus Vasospasm Phase: Blanching of hands & fingers with throbbing, aching pain, numbness, tingling Hyperemic Phase: swelling Tx: Smoking Cessation, no meds with vasoconstrictive effect; avoid cold; avoid constrictive clothes; Give Calcium-channel blockers

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