Peripheral Vascular Disease (PVD) Nursing Management & Care Plan

Notes

Description

Peripheral artery disease (PAD), also known as peripheral vascular disease (PVD), peripheral artery occlusive disease, andperipheral obliterative arteriopathy, is a form of arteriosclerosis involving occlusion of arteries, most commonly in the lower extremities.

Peripheral_Arterial_Disease

Risk Factors
  • Trauma
  • Thrombosis
  • Inflammation
  • Embolism
  • Atherosclerosis
  • Autoimmune response
  • Smoking
Pathophysiology
  • Narrowing of the arterial lumen nor damage to the endothelial lining can result from such factors as atherosclerotic buildup of lipid deposits or arteriosclerosis obliterans that causes arterial occlusion. This leads to reduced or absent peripheral blood flow, and if unchecked, tissue ischemia and eventual necrosis.
Assessment/Clinical Manifestations/Signs and Symptoms
  • Pain or loss of sensory nerves secondary to ischemia
  • Paresthesias and loss of position sense
  • Polar or coldness
  • Paralysis
  • Pallor due to empty superficial vessels (can progress to mottled, cyanotic, and cadaverous cold leg)
  • Pulselessness
  • Intermittend claudication – calf muscle pain occurring when muscle is forced to contract without adequate blood supply (e.g. after walking). The calf muscle pain is alleviated with rest.
  • Resting pain, which is pain at rest when limited blood flow cannot meet very low tissue requirements.
  • Trophic changes in skin and nails such as dryness, scaling, and thinning of skin; decreased or absent hair growth, brittle and thickened nails and gangrenous changes marking death and decay of tissues.
Laboratory and diagnostic study findings
  • Doppler ultrasound flow studies reveal that extremity blood pressure measurements in the legs are lower than in the arms.
  • Angiography may confirm the diagnosis and shows vascular obstructions or aneurysms and the presence of collateral circulation
  • Digital subtraction angiography visualizes vascular obstructions, aneurysms, narrowing of vessels and atherosclerotic plaque.
Medical Management
Pharmacologic therapy
  • Pentoxifylline (Trental) and cilostazol (Pleta) are the only medications specifically indicated for the treatment of claudication.
  • Antiplatelet agents such as aspirin or clopidogrel (Plavix) help prevent the formation of thromboemboli, which can lead to myocardial infarction and stroke.
Surgical treatment.

The choice of the surgical procedure depends on the degree and location of the stenosis or occlusion.

  • Endarterectomy (incision is made into the artery and the atheromatous obstruction is removed) is the treatment of choice.
  • Bypass grafts are performed to reroute the blood flow around the stenosis or occlusion. Before the bypass grafting, the surgeon determines where the distal anatomosis (site where the vessels are surgically joined) will be placed.
Nursing Diagnosis
  • Ineffective peripheral tissue perfusion related to impaired arterial circulation.
  • Pain related to decreased oxygen supply to tissues.
  • Risk for impaired skin integrity related to compromised tissue perfusion.
  • Fear and anxiety related to actual or potential lifestyle changes.
Nursing Management
Provide proper positioning
  • Place the client’s legs in a dependent position in relation to the heart to improve peripheral blood flow
  • Avoid raising the client’s feet above heart level unless specifically prescribed by the health care providers
  • Keep the client in a neutral, flat, supine position if in doubt about the nature of his peripheral vascular problems.
Promote vasodilation.
  • Provide insulating warmth with gloves, socks and other outerwear as appropriate.
  • Keep room temperatures comfortably warm.
  • Instruct the client to warm himself with warm drinks or baths.
  • Never apply a direct heat source to the extremities. Limited blood flow combined occur with normal circulation.
  • Teach the client about the vasoconstrictive effects of nicotine and caffeine, emotional stress, and chilling, discuss ways to avoid or minimize these risk factors.
  • Teach the client to avoid constricting clothes, such as garters, knee-high stockings and belts.
  • If overreplacement of glucocortiocoid is indicated, inform the client about the purpose of therapy and possible adverse effects such as cushingoid appearance, weight gain, acne, hirsutism, peptic ulcer, diabetes mellitus, osteoporosis, infection, muscular weakness, mood swings, cataracts and hypertension.
Promote activity and mobility.
  • For a client with decreased arterial function but without activity-limiting tissue damage, encourage a program of balanced exercise and rest to promote development of collateral circulation.
Provide care for a client undergoing angiography or percutaneous transluminal angioplasty.
  • Before the procedure, provide information related to the procedure, validate that the informed consent has been obtained, mark peripheralpulses, obtain diagnostic data as ordered and withhold food and fluids as prescribed.
  • After the procedure, maintain bed rest as prescribed, keeping the involved extremity extended, monitor vital signs and assess peripheral pulses and circulation every 15 minutes for 2 hours and then every hour for 4 hours.
  • Assess for bleeding, hematoma, or edema at the catheter insertion site, encourage oral fluid and monitor urine output.
Provide care for a client receiving an autogenous saphenous vein or a synthetic bypass graft.
  • Prepare the client for surgery and mark the site of the peripheral pulses
  • Monitor the client carefully after the procedure (especially for the first 24 hours) for signs of graft occlusion as manifested by decreased arterial perfusion.
  • Anticipate and take steps to prevent complications of any surgical procedure involving general anesthesia, particularly respiratory problems and infection.
Provide care for a client who has received an axillofemoral or axillobifemoral bypass graft or an endarterectomy (i.e. removal of atheromatous plaque).
  • Avoid positioning the client on the side of the graft or incision after the procedure
  • Warn the client not to wear tight clothing which can lead to graft occlusion
  • Instruct the client on signs and symptoms of infection to report to the health care provider.
Provide care for client undergoing an amputation.
Promote and teach skin and foot care

Exam

Welcome to your MSN Exam for Peripheral Vascular Diseases! This exam is carefully curated to help you consolidate your knowledge and gain deeper understanding on the topic.

 

Exam Details

  • Number of Questions: 20 items
  • Mode: Practice Mode

Exam Instructions

  1. Practice Mode: This mode aims to facilitate effective learning and review.
  2. Instant Feedback: After each question, the correct answer along with an explanation will be revealed. This is to help you understand the reasoning behind the correct answer, helping to reinforce your learning.
  3. Time Limit: There is no time limit for this exam. Take your time to understand each question and the corresponding choices.

Tips For Success

  • Read each question carefully. Take your time and don't rush.
  • Understand the rationale behind each answer. This will not only help you during this exam, but also assist in reinforcing your learning.
  • Don't be discouraged by incorrect answers. Use them as an opportunity to learn and improve.
  • Take breaks if you need them. It's not a race, and your understanding is what's most important.
  • Keep a positive attitude and believe in your ability to succeed.

Remember, this exam is not just a test of your knowledge, but also an opportunity to enhance your understanding and skills. Enjoy the learning journey!

 

Click 'Start Exam' when you're ready to begin. Best of luck!

💡 Hint

Consider which of these findings is not typically associated with the vascular nature of an abdominal aortic aneurysm.

1 / 20

1. Nurse Ian is conducting an assessment on Mr. Robinson, a 70-year-old man diagnosed with an abdominal aortic aneurysm. While examining various signs and symptoms, Nurse Ian identifies one finding that is likely not related to the abdominal aortic aneurysm. Which of these findings is probably unrelated?

💡 Hint

Think about which system in the body primarily regulates "fight or flight" responses and can rapidly alter the diameter of blood vessels.

2 / 20

2. Nurse Amelia is educating Mr. Thompson, a 52-year-old patient with hypertension, about factors affecting blood flow and resistance. She wants to explain the most critical factor in controlling the diameter of blood vessels, which in turn influences resistance to flow. What should she point out as the primary determinant?

💡 Hint

Think about how cancer affects the blood's tendency to form clots, and relate this to the components of Virchow's triad.

3 / 20

3. Nurse Caroline is caring for Ms. Lewis, a 63-year-old patient recently diagnosed with cancer. In educating her patient about the increased risk of thrombosis, Nurse Caroline discusses Virchow's triad. Which component of Virchow’s triad is most likely to be affected by cancer?

💡 Hint

Think about the immediate risks associated with the surgical procedure and the patient's prior use of an anticoagulant medication.

4 / 20

4. Nurse Emily is taking care of Mr. Thompson, a 56-year-old patient who recently underwent percutaneous insertion of an inferior vena cava filter and was on heparin therapy prior to the procedure. What should Nurse Emily be most vigilant about when inspecting the surgical site?

💡 Hint

Consider the triad of factors that traditionally contribute to thrombosis, also known as Virchow's triad.

5 / 20

5. Nurse Emily is caring for Mr. Wilson, a 70-year-old patient who is at risk for venous thrombosis following hip replacement surgery. She is explaining the major factors that contribute to the formation of a venous clot. Which of the following should she identify as a significant cause?

💡 Hint

Think about how gravity can assist in increasing arterial blood flow to the affected limb.

6 / 20

6. Nurse Julia is caring for Mrs. Johnson, a 65-year-old patient with peripheral arterial insufficiency. Mrs. Johnson complains of leg pain even when she is resting. What position should Nurse Julia recommend to alleviate her leg pain during rest?

💡 Hint

Focus on the symptom of leg pain that occurs with walking and stops with rest, and think about what vascular condition this is most commonly associated with.

7 / 20

7. Nurse Amelia is seeing Mr. Garcia, a 55-year-old man who has come to the outpatient clinic complaining of leg pain that starts when he walks and stops when he ceases walking. Based on this symptom, what condition should Nurse Amelia primarily assess for?

💡 Hint

Buerger's disease primarily involves inflammation and thrombosis, but think about whether it is associated with atherosclerotic factors like lipid deposits.

8 / 20

8. Nurse Oliver is preparing educational materials about Buerger's disease for a community health talk. He wants to clarify what characterizes this disease and what does not. Which of the following should he state is NOT a characteristic of Buerger’s disease?

💡 Hint

Consider the primary issue that varicose veins present with and how it fits into the components of Virchow's triad.

9 / 20

9. Nurse Lauren is assessing Mr. Davis, a 40-year-old patient who comes to the clinic with concerns about varicose veins in his lower legs. While explaining the associated risks, Nurse Lauren talks about Virchow’s triad. Which component of Virchow's triad is most likely to be impacted by varicose veins?

💡 Hint

Think about the specific antidote that would be necessary to counteract the effects of heparin if needed.

10 / 20

10. Nurse Olivia is preparing to administer intravenous heparin therapy to Sarah, a 58-year-old patient with a history of blood clots. To ensure patient safety, Nurse Olivia checks that which medication is readily available on the unit as a reversal agent for heparin?

💡 Hint

This diagnostic method uses sound waves to examine the flow of blood in the veins. It’s non-invasive and widely accepted for diagnosing DVT.

11 / 20

11. Nurse Hannah is coordinating the diagnostic tests for Sarah, a 35-year-old woman suspected of having deep vein thrombosis (DVT). Nurse Hannah knows that there is a particular diagnostic technique considered the gold standard for confirming DVT. What is this diagnostic method?

💡 Hint

Focus on the key symptom of calf pain during minimal activity that improves with rest, and consider how this is most likely affecting tissue perfusion in the extremities.

12 / 20

12. Nurse Samantha is assessing Brad, a 43-year-old construction worker with a history of hypertension and a two-pack-a-day smoking habit. Brad is anxious about his job security and is having trouble managing stress. Lately, he's been experiencing calf pain during minimal physical activity, which alleviates upon resting. Nurse Samantha suspects these symptoms are related to peripheral arterial occlusive disease. What is the most likely nursing diagnosis for Brad?

💡 Hint

Consider the implications of a palpable and consistent pedal pulse along with the surgical procedure conducted to understand the current neurovascular status.

13 / 20

13. Nurse Megan is conducting a neurovascular assessment on Mr. Thompson, a 57-year-old patient who returned to the surgical nursing unit four hours ago after receiving an aortoiliac bypass graft. The affected leg is warm, exhibits redness, and shows signs of edema. The pedal pulse is palpable and consistent with the pre-operative status. How should Nurse Megan interpret these findings regarding Mr. Thompson's neurovascular status?

💡 Hint

Consider the nature of deep vein thrombosis and what kind of discomfort or pain is typically reported in these cases.

14 / 20

14. Nurse Jacob is assessing Mrs. Patel, a 48-year-old woman admitted to the hospital with suspected deep vein thrombosis (DVT). Nurse Jacob is focused on evaluating the pain characteristics associated with DVT. What type of pain is generally expected in a patient with DVT?

💡 Hint

Consider the triggers of Raynaud's disease and how maintaining a specific environmental condition could help in symptom management.

15 / 20

15. Nurse Olivia is preparing discharge instructions for Mr. Anderson, a 50-year-old patient with arterial insufficiency and Raynaud's disease. As she outlines the care plan, what key instruction should she include to help manage his condition effectively at home?

💡 Hint

Consider lifestyle factors that are known to be major risk factors for vascular issues, especially in a young adult.

16 / 20

16. Nurse Emily is assessing Mark, a 24-year-old male who came in complaining of claudication in the arch of his foot. She also observes signs of superficial thrombophlebitis in his lower leg. What should Nurse Emily assess next to better understand the underlying cause of Mark's symptoms?

💡 Hint

Think about the typical skin changes associated with venous stasis ulcers, particularly with regard to the pigmentation around the affected area.

17 / 20

17. Nurse Ethan is caring for Mrs. Williams, a 65-year-old patient admitted with a venous stasis leg ulcer. During the assessment, Nurse Ethan inspects the ulcer closely. What characteristic should he expect to find when evaluating this type of ulcer?

💡 Hint

Warfarin (Coumadin) does not have an immediate effect on coagulation. Think about how long it generally takes for this anticoagulant to achieve its therapeutic action.

18 / 20

18. Nurse Chloe is educating Mrs. Davis, a 55-year-old patient who has recently been prescribed warfarin (Coumadin) for a newly diagnosed deep vein thrombosis. Chloe emphasizes the need for monitoring and wants to inform Mrs. Davis about the timeframe in which therapeutic benefits of the medication can be expected. What should Nurse Chloe tell her?

💡 Hint

Consider which substance is essential for the synthesis of clotting factors and could counteract the effects of warfarin sodium.

19 / 20

19. Nurse Emily is about to administer warfarin sodium (Coumadin) to John, a 68-year-old patient with atrial fibrillation. Before starting the medication, Nurse Emily ensures that a particular antidote is readily accessible on the nursing unit in case of a bleeding emergency. Which medication should be available?

💡 Hint

Focus on the underlying pharmacology of warfarin sodium, specifically how it impacts clotting factors synthesized in the liver and the time needed for it to take effect.

20 / 20

20. Nurse Lisa is caring for Mark, a 52-year-old patient with a history of deep vein thrombosis (DVT). Mark is currently on heparin therapy and has recently been prescribed warfarin sodium (Coumadin) as well. Confused, Mark questions Nurse Lisa about the need for both anticoagulants. As Nurse Lisa prepares her explanation, she takes into account that warfarin sodium:

Nursing Care Plan