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Christine Felipe

on 20 September 2014

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Transcript of PVD

Desiree Delgado
Karla Estrada
Christine Felipe
Ivon Gonzalez
Lourdie Joseph
Nadege Laurent

What is Peripheral Vascular Disease?
Nursing Assessment
Nursing Diagnosis
Planning self care activities, Medications, & Collaborative Care
1. Activity Intolerance related to poor blood flow to lower ex- tremities

2. Ineffective Health Maintenance related to smoking and lack of information about disease management

3. Risk for Impaired Skin Integrity related to ischemic tissues of legs and feet

4. Risk for Peripheral Neurovascular Dysfunction related to impaired peripheral blood flow to lower extremities
Teach about peripheral atherosclerosis and its relationship to the patient symptoms.
Instruct client to warm up slowly, and to stop exercise when pain accur and rest for 3 minutes (or until pain is relieved) when claudication develops, then resume exercising.
Discuss the effects of smoking on blood vessels and help client identify smoking cessation strategies such as support groups, clinics, and nicotiReinforce and supplement previous foot care teaching and the importance of foot care.ne patches.
Assess for any noticeable change in color (blueness or paleness) or temperature (coolness) when compared to the other limb (termed unilateral dependent rubor
Discuss effects of impaired circulation on sensation in feet and legs and measures to prevent injury.
Peripheral Vascular Disease
Nursing Implementation
Patient education guidelines
Scheduling an appointment with a dietitian to develop a low calorie, low-fat, and low-cholesterol diet that includes :
- eating a diet that contains adequate protein and vitamins that are necessary for patients with PVD
- Vitamin C is essential for collagen synthesis and capillary development
- Vitamin A enhances epitheliazation (wound-healing)
Classic "5P's" of PVD:
Pulselessness, Pallor, Pain,
Paresthesias, and Paralysis.

The last two suggest limb-threatening ischemia and prompt mandatory evaluation and consultation.
A useful tool in assessing the peripheral vasculature is the ankle-brachial index (ABI).

The ABI can be done in the office or at the bedside and involves the use of a blood
pressure cuff and Doppler ultrasound. In the supine position, the cuff is inflated on the
calf and slowly deflated while the Doppler signal is monitored.

The pressure at which the Doppler signal reappears is the systolic pressure within the
artery. By dividing this pressure by the systolic blood pressure in the arm, the ABI is
Normally the ratio is greater than 1 and an ABI between 0.9 and 1.1 is considered
normal. The lower the ABI, the worse the disease. A patient with
an ABI less than 0.9 has (by definition) some degree of PVD, and claudication
typically occurs at an ABI of about 0.8. Rest pain and tissue loss occur at an ABI
Smeltzer, S. C., Bare, B. G., Hinkle, J. L., & Cheever, K. H. (2010). Brunner and suddarth's textbook of medical-surgical nursing. (12 ed., Vol. 1). Philadelphia: Wolters Kluwer / Lippincott Williams & Wilkins.
Planning self care activities
“Management of the patient with peripheral arteries/venous insufficiency”

A) Increase Arterial Blood Supply to extremities
1. Position the part below the level of the heart.
2. Exercise

B) Decrease in Venous congestion
1. Elevate extremities above the heart
2. Discourage standing still or sitting for prolonged periods
3. Exercise

C) Promoting Vasodilation and Preventing Vascular Compression
1. Maintain warm temperature and avoid chilling.
2. Discourage use of tobacco products.
3. Management of emotional upsets.
4. Avoidance of contractive clothing and accessories.
5. Avoid of crossing the legs.

D) Maintain tissue integrity
1. Avoid trauma to extremities.
2. Encourage meticulous hygiene.
3. Promote good nutrition.
- Avoiding constricting clothing and accessories
- Avoiding crossing legs
- Inspecting skin daily for evidence of injury or ulceration
- Avoiding trauma and irritation to the skin
- Adhering to meticulous hygiene regimen
- Eating a healthy diet
- Avoiding all tobacco products
- Protecting extremities from exposure to cold
- Gradually increasing walking times
- Avoiding prolonged standing still or sitting
- Elevating lower extremities as prescribed
Collaborative Care
Enrolling in a rehabilitation program supervised by a physical therapist and prescribed by a doctor
- exercising three times a week 30-45 minutes
Exercise usually involves walking on a monitored treadmill until claudication develops; walking time is then gradually increased with each session. Patients are also monitored for the development of chest pain or heart rhythm irregularities during exercise
The self-care program is planned with the patient so that the activities that promote arterial and venous circulation, relieve pain, and promote tissue integrity are acceptable
Medications indicated or prescribed for patients with PVD are:

Antiplatelet medications (such as Aspirin, Ticlopidine (Ticlid) and clopidogrel [Plavix])
- Low dose aspirin (81 to 325 mg/day) is usually prescribed indefinitely
- Clopidogrel (Plavix) is an alternative to aspirin for those who are allergic or cannot tolerate aspirin.
Anticoagulant medications act to prevent blood clotting.
- Heparin,
- low molecular weight Heparin,
- warfarin (Coumadin)
- enoxaparin (Lovenox)

- i.e. - simvastatin (Zocor)

ACE inhibitors
- Anti-hypertensive drugs recommended for intermittent claudication
- Rifampril (Altace) is recommended for patients with symptomatic PVD to reduce the risk of cardiovascular events
(i.e. - strokes and heart attacks)
Phosphodiesterase Inhibitors
- help improve blood flow in patients.
- Cilostazol (Pletal) is a mediation that can help increase physical activity (enabling one to walk a greater distance without the pain of claudication).
- Pentoxifylline (Pentoxyl, Trental) improves blood flow to the extremities by decreasing the viscosity ("stickiness") of blood, enabling more efficient blood flow.
Peripheral Vascular Disease, or PVD, is a general term that covers all diseases of the blood vessels outside the heart. PVD can affect both the arteries (that carry blood from the heart to the body) and veins (that carry blood from the body back to the heart).
Peripheral artery disease (also called peripheral arterial disease) is a common circulatory problem in which narrowed arteries reduce blood flow to your limbs.

When you develop peripheral artery disease (PAD), your extremities — usually your legs — don't receive enough blood flow to keep up with demand. This causes symptoms, most notably leg pain when walking (intermittent claudication).

Peripheral artery disease is also likely to be a sign of a more widespread accumulation of fatty deposits in your arteries (atherosclerosis). This condition may be reducing blood flow to your heart and brain, as well as your legs.
Peripheral Vein Disease
In addition to artery disease, the vessels that take blood back to your heart also can develop problems, known as Vein Disease.

Blood clots can form in the large veins of the legs, causing pain and potentially fatal complications if the clot breaks off and travels to the lungs. The veins can also be gradually damaged over time and become unable to pump enough blood back to the heart.
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