Pathophysiology of PAD

The leading cause of PAD is atherosclerosis-which is a gradual thickening of the inner most layer & middle layer's of the arterial wall.

Risk Factors include: tobacco use, hyperlipidemia, elevated high-sensitivity C-reactive protein, diabetes, & uncontrolled hypertension.

• They will experience and increase in fatigue & weakness in their legs.
• They will experience leg pain with exercise due to ischemia.
• They can experience a sensory impairment.
• You will notice the changes in skin color of the feet and legs.

• Reduction of serum cholesterol levels.
• Utilizing an exercise program.
• Maintaining a dependent position for the legs can help to improve arterial perfusion.

Cholesterol lowering drugs-ending in statin

Antiplatelet-aspirin,plavix

Anticoagulant-heparin/warfarin

Beta blockers-ending in lol

Cilostazol/Pletal-increase activity

Pentoxifylline/Trantal-improves blood flow

When developing a teaching plan for a patient newly diagnosed with PAD which information should the nurse include?

a-"Try to keep your legs elevated whenever you are sitting."

b-"It is important to try to stop smoking."

c-"Exercise only if you do not experience pain.

d-"Put on support hose early in the day before swelling occurs."

B-is correct

Smoking cessation is essential for slowing the progression of PAD to critical limb ischemia and reducing the risk of myocardial infarction and death. Circulation to the legs will decrease if the legs are elevated. Patient's with PAD are taught to exercise to feeling pain, rest and then resume walking. Support hose are not used for patient's with PAD.

The nurse identifies the nursing diagnosis of ineffective peripheral perfusion related to decrease arterial blood flow for a patient with chronic PAD. In evaluating the patient outcomes following patient teaching the nurse determines a need for further instructions when the patient says:

a-"I will use a heating pad on my feet at night to increase the circulation and warmth in my feet."

b-"I will change my position every hour and avoid long periods of sitting with my legs down."

c-"I will have to buy some loose clothing that does not bind across my legs or waist."

d-"I will walk to the point of pain, rest and walk again until I develop pain for a half hour daily."

Pathophysiology of PAD

By: Carole Phalin

NCLEX Review

The nurse is performing an assessment with a patient who has chronic PAD of the legs would expect to find:

a-swollen, dry, scaly ankles

b-a positive Homan's sign

c-prolonged capillary refill

d-draining ulcer on the heel

Answer & Rationale

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Etiology

Treatment

C-is correct

Capillary refill is prolonged in PAD because of the slower and decreased blood flow to the periphery. The other listed clinical manifestations are consistent with chronic venous disease.

• Slowing the progression of atherosclerosis.
• Maintaining circulation in the legs.
• Cessation of smoking in turn will cause an increase in platelet adhesion.
• Angioplasty or surgery

NCLEX Review

Cellular Level

Pharmacotherapy

CAMs (cellular adhesion molecules) play a crucial role in atherosclerosis by recruiting circulating leukocytes to the blood vessel wall & their subsequent migration into the subendothelial space.

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http://www.sirweb.org

Answer & Rationale

Interventions

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Signs & Symptoms

References

NCLEX Review

http://www.coloradofootinstitute.com

http://www.metabolicinstitute.com

Arterial and Vascular Disease (2014). Retrieved from http://www.quizlet.com

Brevetti, G., Schiano, V., Chiariello, M., (2006). Cellular Adhesion Molucles &

Peripheral Artery Disease. (2006). Retrieved from http://www.ncbi.nlm.gov

Brevetti, G, Schiano, V., Chiariello, M., (2006). Vascular Medicine. Retrieved from

http://vmj.sagepub.com

Dirksen, S. R., Lewis, S. L., Heitkemper, M. M., & Bucher, L. (2011). Medical-

surgical nursing assessment & management of clinical problems. (8th ed.). St.

Louis, MO: Elsevier Mosby

Health for Boomers & Beyond (1997). Retrieved from http://www.thirdage.com

Peripheral Artery Disease (2010). Retrieved from http://www.blueassurance.com

Peripheral Artery Disease (2014). Retrieved from http://www.mayoclinic.org

Answer & Rationale

A is correct

Because the patient has impaired circulation and sensation to the feet, the use of a heating pad could lead to burns. The other patient statements are correct and indicate that teaching had been successful.

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References

Stoppler, Melissa, (2014). Peripheral

Artery Disease. Retrieved from http://

www.medicinenet.com

VanMeter, K. C., & Hubert, R. J., (2014).

Gould's pathophysiology for health

professionals. (5th ed.). St. Louis, MO:

Elsevier Saunders