Download CHAPTER 38 KEY POINTS FOR BLOCK 2 CONCEPTS

CHAPTER 38 KEY POINTS FOR BLOCK 2 CONCEPTS
 PERIPHERAL ARTERIAL DISEASE & PERIPHERAL VENOUS DISEASE
 Peripheral vascular disease occurs in disorders that alter the natural flow of blood through
the peripheral arteries and veins, especially the lower extremities.
 Most patients are not diagnosed with PAD until they develop leg pain.
 Most patients initially seek medical attention for a characteristic leg pain known as intermittent
claudication, able to walk only a certain distance before a cramping, burning muscle discomfort or
pain forces them to stop.
 Recognize that clinical manifestations of peripheral vascular disease (PVD) depend on
whether it affects the arteries or veins.
 Rest pain, which may begin while the disease is still early, is a numbness or burning
sensation, described like a toothache that is severe enough to awaken patients.
 Arterial function of foot is assessed by the quality of the posterior tibial & the pedal pulses
 Note early signs of the complication of skin ulcer formation.
 Doppler used if pulses not palpable
 Magnetic resonance imaging may also be used to assess blood flow in the peripheral arteries.
 The interventions of exercise to increase collateral circulation, position changes, promotion of
vasodilation, drug therapy, and invasive nonsurgical procedures are used to increase arterial
flow to the affected limb.
 Vasodilating drugs or surgery are used for arterial vascular diseases.
 For chronic disease, prescribed drugs include antiplatelet agents.
 A nonsurgical but invasive method of improving arterial flow is percutaneous transluminal
angioplasty, which opens the vessel lumen and improves arterial blood flow creating a smooth
inner-vessel surface, sometimes with stent placement.
 Laser-assisted angioplasty vaporizes the arteriosclerotic plaque in smaller arteries.
 The technique of mechanical rotational abrasive atherectomy is used to improve blood flow
to ischemic limbs in people with PAD.
o The rotablator device is designed to scrape “hard” surfaces (e.g., plaque) while
minimizing damage to the vessel surface.
 Arterial revascularization is the surgical procedure most commonly used. If graft
occlusion occurs, notify the surgeon immediately!
o Perfusion through the graft must be resolved promptly to avoid ischemic injury
to the limb.
ACUTE PERIPHERAL ARTERIAL OCCLUSION
 Acute arterial occlusions may be sudden and dramatic, usually caused by an embolus from
recent acute myocardial infarction and/or atrial fibrillation.
 Those with acute arterial insufficiency often present with the “six P’s” of ischemia: pain,
pallor, pulselessness, paresthesia, paralysis, and poikilothermia.
 Anticoagulant therapy with unfractionated heparin is usually the first intervention.
 A surgical thrombectomy or embolectomy with local anesthesia may also be performed.

PERIPHERAL VENOUS DISEASE
 Venous disease causes blood to back up into the distal areas and can lead to edema and
thromboses that can become emboli, a life-threatening complication.
 Venous thromboembolism refers to deep vein thrombosis and pulmonary embolism, with
symptoms of tenderness and pain or asymptomatic.
 Deep vein thrombosis is the most common type of peripheral vascular problem. When
symptoms are present (but may not always be present) they include swelling, redness,
localized pain, and warmth.
 The preferred diagnostic test is venous duplex ultrasonography, a noninvasive test.
 It is most often treated medically using a combination of rest, drug therapy such as
anticoagulants, and preventive measures.
 Closely observe the patient receiving anticoagulants or thrombolytics for signs of bleeding
and monitor appropriate laboratory values for desired outcome values.
 Inferior vena caval interruption may be indicated for recurrent thrombosis or emboli not
responding to treatment and for patients who cannot tolerate anticoagulation.
 Venous insufficiency occurs as a result of prolonged venous hypertension which results in
edema, venous stasis ulcers, swelling, and cellulitis.
 Treatment of chronic venous insufficiency is primarily nonsurgical, unless it is complicated
by a venous stasis ulcer that requires surgical débridement.
 Varicose veins are distended, protruding veins that appear darkened and tortuous.
 Postoperatively, after varicose vein surgery- assess the groin and leg for bleeding through the
elastic bandage, keep legs elevated, and perform range-of-motion exercises of the legs at least
hourly.
 Teach patients ways to prevent deep vein thrombosis and subsequent embolism. In the
hospital setting, provide measures, such as wearing graduated compression stockings, to
prevent or manage DVT.
 Teach patients about self-care when they have venous insufficiency
 Closely observe the patient receiving anticoagulants or thrombolytics for signs of bleeding,
and monitor appropriate laboratory values for desired outcome values.