Peripheral arterial disease (PAD) is a condition impairing the normal circulation of the blood due to arterial occlusion (atherosclerosis) or the narrowing of arteries in the extremities.
The decreased blood flow typically causes claudication or pain during exertion or ambulation; therefore, it is necessary to diagnose PAD to modify risk factors and improve survival.
Signs And Symptoms Of Peripheral Arterial Disease
- Painful cramping in the legs, hips, or thighs
- Numbness in the lower extremities
- Absent or weak peripheral pulses
- Erectile dysfunction
- Fatigue
- Leg weakness or numbness
- Chest pain for severe PAD
- Muscle atrophy
- Clamminess or cyanosis
- Bruit
- Loss of hair
Causes of Peripheral Arterial Disease
- Atherosclerosis. Caused by the buildup or deposition of fatty deposits, also known as plaques, in the artery walls, thus impeding blood flow. In PAD, fatty deposits tend to restrict the flow of oxygenated blood through the arterial lumen. Similarly, it is expected that patients with coronary artery disease will have systemic arterial disease distribution, resulting in PAD.
- Connective tissue disorders. Abnormalities in the structural properties of the extracellular matrix and its regulatory control can result in significant dysfunction of vascular integrity, resulting in fragility, aneurysm, rupture, and stenotic lesion.
- Abnormal anatomy of limbs
- Hypertension. Increases arterial wall tension and facilitates tissue and plasma mediator release, resulting in increased endothelial permeability, hyperplasia, hypertrophy, and fibromuscular thickening.
- Hypercoagulability. Reinforces the arterial occlusion process in patients with peripheral vascular disease (PVD).
- Inflammation Buerger disease involves the chronic inflammation of the arteries, resulting in frequent blood clots and decreased blood flow in the upper and lower extremity.
Risk Factors to Peripheral Arterial Disease
- Diabetes
- Hypercholesterolemia
- Age (50 years old and above)
- Obesity or body mass index of >30
- Family history of cardiovascular diseases
Diagnosis of Peripheral Arterial Disease
- Medical history and physical examination. Patients are frequently evaluated to determine the location of their symptoms (e.g., pain) and their vital signs, including their respiratory rate, blood pressure, and heart rate. Common complaints include claudication (pain when walking), and sometimes general fatigue or weakness is also present. The nurse should include questions that establish the nature and location of pain in the extremities and its precipitating and relieving factors. Several questionnaires were developed for PAD, such as the Rose, Walking Impairment, and Edinburgh Claudication Questionnaire.
In evaluating the patient’s medical history, the nurse must take note of the risk factors that may be responsible for the manifestation of PAD, specifically systemic atherosclerosis. The examination of the upper extremities includes an inspection for diminished perfusion in the fingers. Changes in the color of the skin (e.g., cyanosis or pallor) are also obvious symptoms. On the other hand, microemboli disease is indicated by atrophic ulcerations and lesions.
The nurse should also evaluate for tendon xanthomas, which may indicate atherosclerotic disease. Examining the limbs or lower extremities for arterial insufficiency involves evaluating skin color changes (such as cyanosis and pallor), taut skin, thickened nails, and muscle atrophy. Ulcerations in the toes and feet are frequently observed to aid in the differential diagnosis of venous ulcers, which are frequently observed in the lower calf and hyperpigmented bases.
- Radiographic imaging. The use of imaging is indicated for patients who are being evaluated for endovascular surgery.
- Vascular ultrasound. This test uses sound waves to produce images of the arteries and narrow down any obstructions that may be present.
- Doppler ultrasound. This is a specialized form of ultrasound that is used to search for plaques in the arteries.
- Magnetic resonance angiography (MRA). MRA should be used in patients who are unlikely to benefit from ultrasound or whose procedure will take longer to complete (e.g., obese patients).
- Catheter angiography. Imaging exam that involves the use of contrast dyes to demonstrate blood flow in the arteries. The process of administering the contrast dye involves the use of a catheter or tube that is inserted in the groin and passed through the blood vessel.
- Ankle-brachial index (ABI). Used to confirm the presence of arterial occlusive disease or cardiovascular ischemic events. In cases where the ABI at rest is normal, exercise testing can be used to determine if symptoms are caused by PAD. It can also be measured in the clinical setting by performing 20 heels or toe raises, and a decrease in ABI after exercise/exertion indicates PAD.
- Buerger test. Measures arterial sufficiency by raising the legs to 45 degrees (Buerger angle) while sitting or lying down. If the affected limb has venous guttering, it is considered positive. Additionally, hanging one leg over the bed’s edge after elevation and observing for reactive hyperemia is also considered a positive test.
- Blood tests. Reviewed to examine for risk factors including hyperglycemia and hyperlipidemia.
Complications of Peripheral Arterial Disease
- Amputation
- Impaired mobility
- Critical limb ischemia. This condition is characterized by the presence of open sores in the feet or legs, which do not heal.
- Stroke
- Myocardial Infarction
- Gangrene
- Ulceration
Treatment for Peripheral Arterial Disease
Treatment strategies for PAD are usually centered on reducing cardiovascular risk, stopping atherosclerosis, and enhancing walking ability.
- Exercise therapy. This involves walking to attain pain tolerance, resting, and repeated ambulation once the pain subsides. These sessions are performed three to four times per week for 30 to 45 minutes.
- Pharmacotherapy. This nvolves medications that promote vasodilation, improve oxygen delivery, and alleviate claudication.
- Surgery
- Bypass grafts. Restores normal blood flow by rerouting the blood around the obstruction.
- Endarterectomy. Relieves constricted arteries and restores blood flow by removing atheromatous plaque from the occluded blood vessel.
- Balloon angioplasty. Indicated for patients with PAD symptoms who are unresponsive to exercise and pharmacotherapy. This procedure involves opening narrowed or obstructed arteries through insertion of a catheter followed by inflation of the balloon at the site of occlusion.
- Catheter-directed thrombolysis. Provides a minimally invasive treatment option using a catheter to infuse the clot-dissolving drug into the site of obstruction. This typically requires an overnight infusion. Typically, an overnight infusion is required.
Prevention of Peripheral Arterial Disease
- Smoking cessation
- Lowering cholesterol
- Controlling blood pressure
- Controlling blood sugar levels and hypertension
- Regular exercise
Nursing Diagnosis for Peripheral Arterial Disease
Nursing Care Plan for Peripheral Arterial Disease 1
Nursing Diagnosis: Fatigue related to a decreased oxygen supply, secondary to peripheral arterial disease, as evidenced by exhaustion, expressions of exhaustion or lack of energy, lethargy, weakness, and increased need for sleep.
Desired Outcomes:
- The patient will demonstrate effective energy conservation methods to minimize fatigue.
- The patient will verbalize which tasks are more important during fatigue.
| Nursing Interventions for Peripheral Arterial Disease | Rationale |
| Assess the patient’s pattern of fatigue using an appropriate quantitative scale ranging from 1 to 10. | With the aid of a scoring scale, the patient is better able to articulate the intensity and extent of their fatigue, thereby assisting the nurse in formulating a care plan, specifying energy conservation techniques, and adjusting medication dosages. |
| Assess the patient’s ability to perform activities of daily living (ADLs), and demonstrate the use of assistive aids if indicated. | Fatigue can limit a patient’s ability to engage in self-care and fulfill familial and societal responsibilities, such as continuing to work. |
| Evaluate the patient’s nutritional intake. | This intervention allows the nurse to determine if the patient is receiving sufficient energy sources, vitamins, iron, and protein-calorie nutrition to prevent or treat fatigue and weakness. It will also assist in increasing tolerance to subjected activity. |
| Evaluate the patient’s quality and pattern of sleep. | Inadequate sleep can amplify the fatigue experienced. |
| Assist the patient in planning out their daily activity and rest. Emphasize the significance of frequent rest. | With planning, patients should be able to maximize their capacity to engage in routine and leisure activities. |
| As applicable, suggest an exercise conditioning program and teach energy conservation methods. | Patients and caregivers can set priorities, delegate tasks, and engage in self-care more effectively when they acquire the skills necessary for clustering energy resources to complete desired activities. |
| Provide information on the signs and symptoms of overexertion. | Changes in the patient’s heart rate, oxygen saturation, and respiratory rate will reflect their activity tolerance. |
| Ensure that the patient’s environment promotes rest and sleep and that environmental stimuli are absent. | Environmental disturbances include having numerous visitors, bright lighting, loud noises, and other interruptions. These factors can hinder relaxation, disrupt rest and sleep, and contribute to fatigue. |
Nursing Care Plan for Peripheral Arterial Disease 2
Nursing Diagnosis: Activity Intolerance related to a mismatch between oxygen supply and demand occurring with atherosclerosis, secondary to peripheral arterial disease, as evidenced by verbalized weakness, dyspnea, fatigue, abnormal blood pressure, dizziness, and inability to perform routine or basic tasks.
Desired Outcomes:
- The patient will demonstrate effective energy conservation techniques.
- The patient will be able to perform basic tasks without excessive fatigue or energy loss.
| Nursing Interventions for Peripheral Arterial Disease | Rationale |
| Examine the characteristics of the pulse, blood pressure, and respiration rate during physical activity and movement. If the patient responds with chest pain, vertigo, or dizziness, cease the activity. | Provides a starting point for formulating nursing goals |
| Evaluate the patient’s ability to walk and assess the need for ambulation aids such as a walker or cane for ADLs | Chronic stage of PAD can lead to impaired ability to ambulate, loss of functional capacity, pain upon walking, and amputation due to reduced blood flow, arterial stiffness, nerve impairment, and arteriogenesis. The provision of assistive devices will increase the patient’s mobility by allowing him to overcome constraints. |
| Evaluate the patient’s nutritional intake. | Vitamin and iron supplements and the consumption of iron-rich foods, such as liver and other red meats, green vegetables, and oatmeal, will likely provide the energy needed during physical activity and reverse the effects of anemia associated with fatigue and diminished oxygen-carrying capacity. |
| Examine the patient’s sleep pattern, including the quantity and duration of sleep, over a few days. | Sleep deprivation can affect the patient’s activity level since it doesn’t ease muscle tension. Adequate and uninterrupted sleep or rest promotes stress relief and a sense of well-being. Moreover, it aids in successful activity progression. |
| Provide information on energy conservation techniques such as sitting to accomplish tasks, routine position changes, effectively putting frequently used items within easy access, using wheeled carts to transport items, and resting for at least one hour after meals prior to beginning a new activity. | These methods reduce oxygen consumption, allowing for a longer duration of activity. |
| Encourage the patient to perform range of motion (ROM) exercises and establish goals with the patient that gradually increase their endurance. | Prolonged bed rest causes rapid physical deconditioning, which may take several weeks to modify. Understanding the importance of ROM exercise will aid in the preservation of muscle strength, joint ROM, and exercise tolerance. |
Nursing Care Plan for Peripheral Arterial Disease 3
Ineffective Tissue Perfusion (Peripheral)
Nursing Diagnosis: Ineffective Tissue Perfusion (Peripheral) related to reduced arterial flow due to atherosclerosis, secondary to peripheral arterial disease, as evidenced by numbness, pain, dyspnea, and fatigue.
Desired Outcomes:
- The patient will ensure adequate or maximum peripheral perfusion, as indicated by the presence of strong peripheral pulses and the absence of ulcers.
- The patient will demonstrate behaviors or actions aimed at improving peripheral perfusion.
| Nursing Interventions for Peripheral Arterial Disease | Rationale |
| Examine for markers of ineffective tissue perfusion, such as weakness, claudication, aching, and pain on palpitation. | The evaluation of decreased tissue perfusion serves as a benchmark for future comparisons. Making a diagnosis includes an assessment of the patient’s walking ability. |
| Instruct the patient to refrain from massaging the calf and instead promote early ambulation. | This intervention prevents embolization and helps maximize tissue perfusion. |
| Evaluate contributing factors associated with changes in the peripheral circulation. | Possible contributors to poor tissue perfusion include compartment syndrome, embolism, positioning, presence of indwelling arterial catheters, and vascular occlusive conditions (e.g., PAD). Diabetes may also be a risk factor for PAD and can lead to nerve problems that impair lower limb sensation. In addition, it may increase the risk of complications that may result in leg or foot amputation. Rapid recognition of the source enables rapid and efficient management of the condition. |
| Assess the patient’s oxygen saturation and pulse rate using a pulse oximeter. | An effective and non-invasive method for monitoring changes in oxygen saturation |
| Review hemoglobin levels. | Decreased hemoglobin concentrations are associated with an increased risk of diabetes and cardiovascular disorders. |
| Evaluate the patient’s skin for clamminess, coldness, cyanosis, pallor, and mottling. Check the quality of the pulse and report immediately if the amplitude of distal pulses is diminished or absent. | These are signs of decreased peripheral perfusion, which may indicate embolism or hemorrhagic shock. |
| Assist in repositioning the patient from a supine to a standing or upright tilt position. | Repositioning reduces orthostatic blood pressure changes. This intervention will also provide gradual adjustment to the potential effects of venous pooling due to prolonged supine or Fowler’s position. |
| Encourage both active and passive range of motion exercises, and elevate the head of the bed. | Prevents venous stasis and further circulatory compromise. Meanwhile, raising the head of the bed will facilitate blood pooling and increase gravitational blood flow to the extremities. |
| Instruct the patient to avoid raising the legs above the heart level. | Patients with PAD suffer from arterial insufficiency and perfusion as a result of poor blood circulation, arterial narrowing, or fatty buildup. With leg elevation, the arterial blood supply to the extremities can be further reduced, potentially leading to the inability to walk, ulceration, and necrosis of the tissue. |
| Administer medications as prescribed by the physician and take note of the patient’s response. | Certain medications can enhance arterial dilation, optimize perfusion, enhance periarterial blood flow, and decrease vascular resistance. |
Nursing Care Plan for Peripheral Arterial Disease 4
Nursing Diagnosis: Acute Pain related to tissue ischemia, secondary to peripheral arterial disease, as evidenced by restlessness, verbalized aching or cramping sensation, guarding behavior, profuse sweating, and changes in vital signs.
Desired Outcomes:
- The patient will report a decrease in pain with a pain score of less than four.
- The patient’s well-being will improve as a result of normalizing baseline levels and improving mood or coping.
| Nursing Interventions for Peripheral Arterial Disease | Rationale |
| Evaluate the nature of the pain (such as duration, frequency, and intensity) and take note of any claudication. | Since patients with PAD have reduced blood flow, causing pain in their thighs or calf during ambulation or exertion (claudication), possible ischemia can be identified. Similarly, claudication or leg cramping are typical indicators that could signal potential amputation. |
| Assess the location of the pain and conduct a review of the patient’s medical history. | This intervention helps clarify the precipitating factors of pain since other conditions can mimic its presentation. Claudication may also be concealed in patients who do not exercise or whose exertion/ambulation is restricted by other symptoms, such as fatigue. |
| Evaluate the pain intensity using a Wong-Baker FACES scale. | This intervention is aimed specifically at pediatric, geriatric, and language-impaired patients, as they may be unable to communicate or relate to numerical pain scales. |
| Assists the patient in providing the most subjective and factual information regarding their pain and the efficacy of pain management strategies. | Strategies that were effective in the past may be effective for the current pain. However, some patients may be unwilling to try pharmacologic treatment options and may be open to nonpharmacologic alternatives. |
| Encourage nonpharmacologic strategies for pain relief, such as cognitive-behavioral therapy (CBT). | These techniques are used to alleviate pain by altering psychological responses. |
| Administer analgesics or painkillers as prescribed and record the efficacy of the medication or other pain control methods. | The administration of analgesics alleviates pain and anxiety and provides the patient with reporting guidelines for symptoms. Moreover, this explains the degree of pain relief achieved, the interventions utilized, the efficacy of the interventions, and the need for ongoing follow-up. |
Nursing Care Plan for Peripheral Arterial Disease 5
Risk for Sexual Dysfunction
Nursing Diagnosis: Risk for Sexual Dysfunction related to erectile dysfunction (ED), secondary to peripheral arterial disease.
Desired Outcomes:
- The patient will express the desire to resume sexual activity.
- The patient will interact and express personal feelings and contentment with sexual relationships or gender assignments.
| Nursing Interventions for Peripheral Arterial Disease | Rationale |
| Analyze the patient’s sexual history by using the International Index of Erectile Function (IIEF). | PAD may cause progressive sexual dysfunction. Obtaining information about the patient’s sexual history using IIEF provides an objective measure indication of improvement or worsening of the condition. This measure addresses the aspects of sexual function from its symptoms, quality of erections, satisfaction, arousal, sexual desire, and problematic orgasms, and also determines the man’s current emotional status. |
| Examine the patient for anatomical abnormalities and identify cardiovascular risk factors. | Patients should be asked about their risk factors for coronary heart disease, ED, and smoking since these can lead to PAD. |
| Encourage the patient to share concerns with a close friend or family member. | Due to shame and embarrassment, men frequently isolate themselves and refuse to discuss their concerns. |
| Review laboratory tests (e.g., testosterone, prolactin, serum follicle-stimulating hormone). | Low testosterone levels may be an atherosclerosis risk factor. Serum hormone measurements are useful for identifying potential causes of erectile dysfunction. In case testosterone level is below reference level, follicle-stimulating hormone (FSH) and prolactin can disclose endocrine disease as the possible cause for ED instead of PAD. |
| Discuss the normal sexual response and the alterations caused by PAD. | Patients with PAD may have impaired sexual function due to vascular stressors. This tends to result in ED, which men may experience as an inability to maintain an erection and a decreased likelihood of ejaculating. In addition, their sperm quality and delivery system may decline as a result of plaque accumulation. |
| Ensure that the patient’s environment is supportive and devoid of judgment. Encourage him to express his sexual concerns freely and solicit any questions or concerns he may have. | This is a typical reaction to anxiety regarding the sexual response and progression of the disease. |
| Aid the patient in making the necessary lifestyle adjustments | Changes in lifestyle, such as quitting smoking and managing weight, are necessary modifiable risk factors for ED patients. It may also prevent vascular diseases (such as PAD) and improve cardiovascular health, both of which are risk factors for sexual dysfunction. |
| Provide support and instruct the patient to avoid twisting or turning the penis shaft. Suggest that he place two fingers beneath the penis and the thumb on top. | Help patients develop psychomotor technique |
| Describe drug interactions that affect ED | Medications used to treat systemic diseases such as antihypertensive drugs, antipsychotics, and antidepressants can cause sexual dysfunction. Changes to prescription drugs that may be contributing to the issue should be considered. |
Nursing References
Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier. Buy on Amazon
Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon
Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2020). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier. Buy on Amazon
Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier. Buy on Amazon
