Peripheral Vascular Disease (PVD) is a progressive circulatory condition that affects blood vessels outside the heart and brain, primarily in the legs. This nursing diagnosis focuses on identifying and managing symptoms, preventing complications, and improving patients’ quality of life through evidence-based interventions.
Causes (Related to)
Peripheral Vascular Disease can develop due to various factors that affect vascular health:
- Atherosclerosis (primary cause)
- Chronic health conditions such as:
- Diabetes mellitus
- Hypertension
- High cholesterol
- Obesity
- Chronic kidney disease
- Lifestyle factors including:
- Smoking
- Sedentary lifestyle
- Poor nutrition
- Risk factors such as:
- Advanced age
- Family history
- Male gender
- Post-menopausal status
Signs and Symptoms (As evidenced by)
PVD presents with distinctive signs and symptoms that nurses must recognize for proper diagnosis and treatment.
Subjective: (Patient reports)
- Intermittent claudication
- Rest pain in legs or feet
- Numbness or tingling
- Cold sensation in extremities
- Decreased exercise tolerance
- Night cramps
- Fatigue in legs
- Non-healing wounds
Objective: (Nurse assesses)
- Decreased or absent peripheral pulses
- Skin changes (thin, shiny, or hairless)
- Temperature differences between extremities
- Delayed capillary refill
- Decreased ankle-brachial index (ABI)
- Pallor on elevation
- Dependent rubor
- Ulcerations or gangrene
- Edema
Expected Outcomes
The following outcomes indicate successful management of PVD:
- The patient will demonstrate improved circulation to affected extremities
- The patient will report reduced pain levels
- The patient will maintain skin integrity
- The patient will demonstrate an understanding of risk factor modification
- The patient will perform prescribed exercises regularly
- The patient will demonstrate proper foot care techniques
- The patient will maintain optimal wound healing
- The patient will verbalize understanding of medication regimen
Nursing Assessment
Vascular Assessment
- Check peripheral pulses
- Assess capillary refill
- Monitor skin color and temperature
- Document ankle-brachial index
- Evaluate for edema
Pain Assessment
- Document pain characteristics
- Monitor pain triggers
- Assess the impact on daily activities
- Evaluate the effectiveness of pain management
Skin Assessment
- Check for ulcerations
- Monitor wound healing
- Assess skin temperature
- Document skin color changes
- Check for signs of infection
Functional Assessment
- Evaluate exercise tolerance
- Assess walking distance
- Monitor activity limitations
- Document claudication onset
- Evaluate independence level
Risk Factor Assessment
- Review smoking history
- Check medication compliance
- Assess dietary habits
- Monitor blood pressure
- Review glucose control
Nursing Care Plans
Nursing Care Plan 1: Decreased Peripheral Tissue Perfusion
Nursing Diagnosis Statement:
Decreased Peripheral Tissue Perfusion related to reduced arterial blood flow as evidenced by diminished peripheral pulses, delayed capillary refill, and complaints of claudication.
Related Factors:
- Atherosclerotic changes
- Vascular insufficiency
- Sedentary lifestyle
- Smoking history
Nursing Interventions and Rationales:
- Assess peripheral pulses q4h
Rationale: Monitors circulation status and disease progression - Position the affected limb in a dependent position
Rationale: Promotes gravitational blood flow - Implement a prescribed exercise program
Rationale: Improves collateral circulation
Desired Outcomes:
- The patient will demonstrate improved peripheral circulation.
- The patient will report decreased claudication pain
- The patient will maintain skin integrity
Nursing Care Plan 2: Acute Pain
Nursing Diagnosis Statement:
Acute Pain related to tissue ischemia as evidenced by verbal reports of pain and altered activity levels.
Related Factors:
- Insufficient blood flow
- Tissue hypoxia
- Metabolic demands
- Inflammation
Nursing Interventions and Rationales:
- Assess pain characteristics regularly
Rationale: Enables appropriate pain management - Implement pain management protocol
Rationale: Reduces discomfort and promotes mobility - Teach pain-relieving positions
Rationale: Empowers patient in pain management
Desired Outcomes:
- The patient will report decreased pain levels
- The patient will demonstrate improved activity tolerance
- The patient will utilize effective pain management strategies
Nursing Care Plan 3: Risk for Impaired Skin Integrity
Nursing Diagnosis Statement:
Risk for Impaired Skin Integrity related to compromised circulation as evidenced by poor tissue perfusion and altered sensation.
Related Factors:
- Decreased circulation
- Impaired sensation
- Poor nutrition
- Decreased mobility
Nursing Interventions and Rationales:
- Perform regular skin assessments
Rationale: Enables early detection of skin breakdown - Implement pressure relief measures
Rationale: Prevents tissue damage - Teach proper skincare
Rationale: Promotes skin integrity
Desired Outcomes:
- The patient will maintain intact skin
- The patient will demonstrate proper skin care techniques
- The patient will identify early signs of skin breakdown
Nursing Care Plan 4: Activity Intolerance
Nursing Diagnosis Statement:
Activity Intolerance related to imbalance between oxygen supply and demand as evidenced by fatigue and claudication during activity.
Related Factors:
- Decreased peripheral blood flow
- Muscular fatigue
- Sedentary lifestyle
- Pain with activity
Nursing Interventions and Rationales:
- Establish a progressive activity plan
Rationale: Builds exercise tolerance gradually - Monitor vital signs during activity
Rationale: Ensures safe activity level - Teach energy conservation techniques
Rationale: Maximizes activity performance
Desired Outcomes:
- The patient will demonstrate improved exercise tolerance.
- The patient will participate ina prescribed exercise program
- The patient will report decreased claudication symptoms
Nursing Care Plan 5: Deficient Knowledge
Nursing Diagnosis Statement:
Deficient Knowledge related to unfamiliarity with disease process and management as evidenced by questions about condition and verbalized misconceptions.
Related Factors:
- Lack of exposure to information
- Misinterpretation of information
- Complexity of treatment regimen
- Language or cultural barriers
Nursing Interventions and Rationales:
- Provide disease-specific education
Rationale: Increases understanding of the condition - Teach risk factor modification
Rationale: Promotes prevention of complications - Demonstrate self-management techniques
Rationale: Enhances patient independence
Desired Outcomes:
- The patient will verbalize understanding of the disease process
- The patient will demonstrate proper self-care techniques
- The patient will identify signs requiring medical attention
References
- Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2023). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.
- Golledge J, Drovandi A. Evidence-Based Recommendations for Medical Management of Peripheral Artery Disease. J Atheroscler Thromb. 2021 Jun 1;28(6):573-583. doi: 10.5551/jat.62778. Epub 2021 Mar 21. PMID: 33746159; PMCID: PMC8219542.
- Harding, M. M., Kwong, J., & Hagler, D. (2022). Lewis’s Medical-Surgical Nursing: Assessment and Management of Clinical Problems, Single Volume. Elsevier.
- Herdman, T. H., Kamitsuru, S., & Lopes, C. (2024). NANDA International Nursing Diagnoses – Definitions and Classification, 2024-2026.
- Ignatavicius, D. D., Rebar, C., & Heimgartner, N. M. (2023). Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care. Elsevier.
- Shamaki GR, Markson F, Soji-Ayoade D, Agwuegbo CC, Bamgbose MO, Tamunoinemi BM. Peripheral Artery Disease: A Comprehensive Updated Review. Curr Probl Cardiol. 2022 Nov;47(11):101082. doi: 10.1016/j.cpcardiol.2021.101082. Epub 2021 Dec 11. PMID: 34906615.
- Silvestri, L. A. (2023). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.
