Peripheral Vascular Disease Nursing Diagnosis and Nursing Care Plan

Peripheral Vascular Disease Nursing Care Plans Diagnosis and Interventions

Peripheral Vascular Disease NCLEX Review and Nursing Care Plans

Peripheral vascular disease PVD is a blood circulation disorder that causes narrowing, blocking, and spasm of the brain’s blood vessels and the outer part of the heart.

Peripheral vascular disease may cause fatigue and pain, and can also affect the blood supply and oxygen to the arms, stomach, intestines, and kidneys.

When a person has peripheral vascular disease the blood vessels will be narrowed which will cause decreased blood flow.

Narrowing of the blood vessels and decreased blood flow are due to arteriosclerosis. Arteriosclerosis happens because of the buildup of fats, cholesterol, and other substances in the person’s arterial walls that build up plaque.

The circulatory system is made up of blood vessels that are responsible for carrying the blood away from the heart. The circulatory system is responsible for carrying oxygen, nutrients, and hormones to the cells and removing carbon dioxide.

The buildup of plaques in the circulatory system, particularly in the arteries can cause them to be narrowed and will block the blood flow that may lead to a blood clot.

If left untreated, blood clots may block the arteries, leading to organ damage. A clot may be developed when the plaque grows and may lead to a blocked artery.

The arteries are responsible for carrying the blood that is rich in oxygen away from the person’s heart.

Types of Peripheral Vascular Disease

1. Functional Peripheral Vascular Disease. This happens when the flow of blood is decreased. A functional peripheral vascular disease has no physical damage to the structure of the blood vessels. This may cause widening and narrowing of the vessels that bring signals to the brain and cause temperature changes. Functional peripheral vascular disease is caused by:

  • Emotional stress
  • Smoking
  • Cold temperature
  • Operating machinery or tools
  • Drugs

2. Organic Peripheral Vascular Disease. This happens when the structure of the blood vessels is changed and the tissue is damaged. A common example of Organic peripheral vascular disease is arteriosclerosis.

Organic Peripheral Vascular Disease is caused by:

Other potential cause of organic peripheral vascular disease includes inflammation of the blood vessels, infection, extreme injuries, and abnormal structures of the muscles and the ligaments.

Signs and Symptoms of Peripheral Vascular Disease

The first sign of peripheral vascular disease may begin slowly and irregularly. The patient may experience discomfort such as fatigue and cramping of the legs and feet that worsen with physical activity because of insufficient blood flow.

Other symptoms that a person with peripheral vascular disease may experience include:

  • Pulses in the legs and the feet are weak
  • Skin color changes, the skin may be brittle, thin, or shiny skin on the feet and legs
  • Decreased skin temperature
  • Gangrene
  • Impotence
  • Hair loss special on the legs
  • Weakness, numbness, and heaviness of the muscles
  • Wounds that don’t heal over pressure points
  • Paleness of the legs when elevated
  • Burning or aching pain of the toes when resting
  • Restricted mobility
  • Reddish to bluish discoloration of the extremities
  • Thickened toenails
  • Severe pain due to blocked and narrowed arteries

Symptoms of peripheral vascular disease can look like the symptoms of other conditions. The patient should tell the doctor immediately if he or she is experiencing any symptoms of peripheral vascular disease.

Risk Factors to Peripheral Vascular Disease

Several factors can put a person at a higher risk for having peripheral vascular disease and these include:

  • Being overweight
  • History of heart disease
  • over the age of 50
  • Have abnormal cholesterol level
  • With a history of stroke and other cerebrovascular diseases
  • Elevated blood pressure
  • With kidney disease and on hemodialysis

The lifestyle of a person can also increase the risk of developing peripheral vascular disease which includes:

  • Lack of physical exercise
  • Poor eating habits
  • Smoking
  • Drug use

Diagnosis of Peripheral Vascular Diseases

One of the most important steps in diagnosing avascular disease treatment is early detection, which can help to avoid the condition from getting worse or may prevent life-threatening complications.

The doctor may ask about the person’s medical history and may perform a physical exam. Physical exam may include measurement of the pulses of the legs and feet. The presence of a whooshing sound through their stethoscope may indicate narrowed blood vessels.

Specific tests to diagnose peripheral vascular disease include:

  • Doppler Ultrasound. A Doppler ultrasound is a non-invasive test that can help to estimate the blood flow through the person’s blood vessels by bouncing high-frequency sound waves off circulating red blood cells. A Doppler ultrasound can diagnose many conditions such as; blood clots, poorly functioning valves in the leg veins, heart valve defects, congenital heart disease, blocked arteries, decreased circulation of the blood in the legs, bulging arteries, and narrowing of the arteries in the neck.
  • Ankle-Brachial Index. An ankle-brachial index test helps to compare the pressure of blood at the patient’s ankle with the blood pressure measured at the person’s arm. A low ankle-brachial index may indicate narrowed or blocked arteries in the person’s legs.
  • Magnetic Resonance Angiography. A magnetic resonance angiography uses a magnetic field, radio waves, and a computer to evaluate the blood vessels and helps to identify abnormalities. Magnetic resonance angiography does not use radiation and may need an injection of contrast material that is less likely to cause an allergic reaction. MRA is performed by insertion of an intravenous catheter into the vein in the arm or hand. The IV line will be used for the injection of the contrast material.
  • Angiography. Angiography is a procedure that uses x-ray imaging to view the blood vessels of the heart. This test is usually done to assess if there’s a restriction in the blood flow going to the heart. The blood vessel cannot be seen clearly on a normal X-ray, so a special dye needs to be injected into the patient’s blood first, which will highlight the blood vessels and help visualize any problems of the blood vessels.
  • Computerized Tomography angiography. CT Angiography is a test that combines a CT scan with an injection of a special dye to produce images of the blood vessels and tissues in the part of the body. CT Angiography helps to diagnose and evaluate diseases of the blood vessels and other related conditions such as aneurysms and blockage. Through computed tomography angiography blood clots that may have formed in the leg veins may be seen and may help evaluate a tumor in the blood vessels.

Complications of Peripheral Vascular Disease       

If left undiagnosed and untreated, PVD can lead to serious and life-threatening complications. When the blood flow is restricted, peripheral vascular disease can be a warning sign of other vascular diseases.

The complications of peripheral vascular disease may include:

  • Limp amputation due to tissue death
  • Impotence
  • Skin paleness
  • Pain at rest and if moving
  • Restricted mobility due to severe pain
  • Inability of the wounds to heal
  • Life-threatening infections that affect the bones and the bloodstream

If the arteries bring blood to the heart and brain this may indicate serious complications When the arteries are clogged, it may lead to heart attack, stroke, and death.

Treatment of Peripheral Vascular Disease

The main goal of peripheral vascular disease treatment is to stop the progress that will help in managing pain and symptoms. The treatments may also reduce the risk of acquiring serious complications.

  1. Medications. Medications may also be used to treat peripheral vascular disease, this medication may help to improve blood flow and help to relax the blood vessels such as anti-platelet agents and anti-clotting medications.
  2. Treatment of related diseases. Aggressive treatment for diseases and existing conditions, such as diabetes, high cholesterol, and high blood pressure might worsen the peripheral vascular disease.
  3. Lifestyle changes. Lifestyle changes are  important in the treatment of PVD. The physician may suggest a regular exercise program that includes walking, a balanced diet, and weight loss. The physician will also advise the patient to quit smoking if the patient is smoking. Smoking causes decreased blood flow in the vessels. Smoking will also make the peripheral vascular disease get worse and may increase the risk of stroke and heart attack.
  4. Surgery. Vascular surgery and angioplasty may also help in treating peripheral vascular disease. Vascular surgery may help in managing the diseases of the vascular system, arteries, veins, and lymphatic circulation through medical therapy through minimally-invasive catheter procedures and surgical reconstruction of the vascular system. On the other hand, angioplasty may also be performed, angioplasty is used to open blocked coronary arteries that create more spaces inside the artery.

Prevention of Peripheral Vascular Disease

Reducing the risk of developing the peripheral vascular disease through a healthy lifestyle includes:

  • Smoking cessation
  • Regulate the blood sugar to normal levels, for persons with diabetes
  • Routine exercise for at least 25 to 30 minutes a day
  • Maintaining cholesterol and blood pressure at a low level
  • Maintaining a healthy diet that is low in saturated fats
  • Weight should be maintained at a healthy level

Peripheral Vascular Disease Nursing Diagnosis

Peripheral Vascular Disease Nursing Care Plan 1

Acute Pain

Nursing Diagnosis: Acute Pain related to medical condition secondary peripheral vascular disease as evidenced by facial grimace, guarding behavior of the body part, and changes in the vital signs.

Desired Outcomes:

  • The patient will use proper diversional activities and skills for relaxation.
  • The patient will satisfactorily express that the pain is controlled.
  • The patient will display normal vital signs at acceptable levels.
Peripheral Vascular Disease Nursing InterventionsRationale
1. Do a comprehensive assessment of the patient’s vital signs and pain scale including the severity, characteristics, duration, location, and intensity of the present pain.The assessment of vital signs and interviewing the patient about his or her pain will help in planning pain management and prioritizations when doing a plan of care. The nurse may use charts or drawings or ask the patient to pinpoint the location of pain, this may help in determining the specific location of pain properly.
2. Ask the patient about the previous pain medications that the patient used, ask about their effectiveness and the duration of previous pain medication, and ask for any side effects and allergies that the patient experienced after taking the medication.Asking about the previous medication may help in determining whether additional pain medication or dosage should be administered to the patient. Assessing previous allergies and side effects from the pain medications is important to avoid administration or giving pain medications that are not appropriate for the patient.
3. Provide physical stimulation and intervention that will help to alleviate pain such as massage, heat and cold application, acupressure, contralateral stimulation, immobilization, and therapeutic exercise that may help to decrease pain.Stimulation activities will provide relief and alleviate pain temporarily by distracting the patient away from the sensation of pain and will reduce the need for pharmacological interventions.
4. Give the patient pharmacological treatment if necessary and as prescribed by the physician.Pharmacological pain management such as non-steroidal inflammatory medications will help in managing mild to moderate pain. Advise the patient to take the medication with a full stomach.
5. Check the patient’s response to the interventions and management.Evaluating the interventions is important to know if additional interventions are still needed for the patient, this may also evaluate the effectiveness of care.

Peripheral Vascular Disease Nursing Care Plan 2

Ineffective Tissue Perfusion

Nursing Diagnosis: Ineffective Tissue Perfusion related to insufficient blood flow secondary to peripheral vascular disease as evidenced by weak pulse, cool skin temperature, prolonged capillary refill, and loss of hair on legs.

Desired Outcomes:

  • The patient will sustain adequate peripheral perfusion as evidenced by strong peripheral pulses and the patient’s skin temperature is warm.
  • The patient will be able to identify ways to improve proper circulation.
  • The patient will participate in activities that will help improve tissue perfusion.
Peripheral Vascular Disease Nursing InterventionsRationale
1. Check for the signs of impaired tissue perfusion such as changes in distal pulses and the changes in the color, temperature, and sensation of the extremities.Checking for the possible signs and symptoms of impaired tissue perfusion will help to provide baseline data for future comparison. This will also facilitate quick and effective management to avoid the risk of further complications. Changes in the color, temperature, and sensation of the extremities may indicate venous insufficiency.
2. Check for the capillary refill time and note for any abnormalities.Press the nailbeds of the patient not longer than 3 seconds to assess their pinkish color. Pale nail beds may indicate poor perfusion.
3. Check for signs of deep vein thrombosis. Check for the presence of pain, tenderness, swelling, and redness of the extremities.Clot formation is usually seen as well as swelling of the leg and then as pain.
4. Sustain optimal cardiac output. The nurse should check for changes in blood pressure and heart rate.Cardiac output is the blood amount that the person’s heart pumps. Adequate cardiac output ensures perfusion to vital organs.
5. Check for the possible contributing factors that cause impaired arterial blood flow that may cause tissue perfusion.Contributing factors such as medications, positioning, pathology, and medical equipment may cause compromised tissue perfusion and may cause tissue damage.

Peripheral Vascular Disease Nursing Care Plan 3

Risk for Impaired Skin Integrity

Nursing Diagnosis: Risk for Impaired Skin Integrity related to immobility secondary to peripheral vascular disease.

Desired Outcomes:

  • The patient will report changes in the sensation and pain at the site of tissue impairment.
  • The patient will show understanding of the healing plan for the tissue and injury prevention.
  • The wound of the patient will decrease in size and the granulated tissues are increased.
Peripheral Vascular Disease Nursing InterventionsRationale
1. Assess for the etiology of the impaired skin integrity.Assessment of the wound etiology will help to properly identify the nursing interventions and the treatment strategies for better outcomes.
2. Check for the site of impaired tissue integrity and the condition of the wound. Check for possible redness, swelling, and pallor.Indications of inflammation such as redness, swelling, pain, burning, and itching must be checked to properly assess impaired tissue integrity. Changes in color and the presence of pallor may indicate impaired blood circulation.
3. Check the body temperature of the patient if there are changes.Increased body temperature or fever is a manifestation and may indicate infection.
4. Ask the patient about skin care practices and the frequency of cleansing the wound.Any impairments around the wound should be monitored regularly to confirm if the infection is localized and not spreading.
5. Administer antibiotics to the wound if necessary and as prescribed by the physician.Wounds may be treated with antibiotics that can be given orally or topically. Completion of the medication is necessary.
6. Encourage the patient about hygiene and encourage him/her to avoid scratching the wound.Scratching may worsen the wound and may aggravate wound healing. The nurse should be particular about hygiene and avoidance of scratching the wound.
7. Advise the patient to move and change the position from time to time and as needed.Movement and position change will promote blood circulation and will reduce the risk of impaired tissue integrity.

Peripheral Vascular Disease Nursing Care Plan 4

Fatigue

Nursing Diagnosis: Fatigue related to lack of sleep, anxiety, and stress about the condition secondary to peripheral vascular disease as evidenced by lethargy, weakness, lack of interest in surroundings, and lack of participation in activities.

Desired Outcomes:

  • The patient will express increased daily activities and energy.
  • The patient knowledge about the cause of fatigue will be increased.
  • The patient will verbalize learning about conserving techniques for energy.
  • The patient will participate in interventions and activities that will help him or her to overcome fatigue.
PVD Nursing InterventionsRationale
1. Ask the patient about his/her description of fatigue, its severity, and the factors that alleviate fatigue.To assess fatigue, the nurse may ask the patient his/her level of fatigue through a quantitative scoring scale of 1 to 10 and or by developing pictures or descriptive language. Assessment of the patient’s level of fatigue will help the nurse to compare if the patient’s fatigue changes over time.
2. Check for the possible cause of the patient’s fatigue such as pain, physical illness, emotional stress, depression, side effects of medication, sleeping pattern problems, and imbalanced nutrition.Assessment of the cause of fatigue can help to recognize and build a plan of care to reduce fatigue.
3. Evaluate the ability of the patient to do activities of daily living and check for the demand of daily living.Fatigue may cause restriction of the patient to participate in self-care and the patient’s ability to do his/her roles in the family and society. Encourage the patient to do the activities as tolerated.
4. Evaluate the patient’s nutritional status. Check for adequate energy sources and metabolic demands of the patient.Protein calorie malnutrition, vitamin deficiencies, and iron deficiency may be seen in patients experiencing fatigue. It is important to advise the patient to maintain a proper diet by eating nutritious foods that will help the patient to increase energy.
5. Evaluate the patient’s emotional reaction to fatigue. Check for the presence of anxiety and depression.Anxiety is a common emotional response associated with fatigue. Anxiety and depression can increase a person’s level of fatigue.
6. Educate the patient about the habits to promote rest.Having enough rest will keep the patient feeling relaxed. Providing several hours of interrupted sleep may help to restore energy.

Peripheral Vascular Disease Nursing Care Plan 5

Activity Intolerance

Nursing Diagnosis: Activity Intolerance related to prolonged bed rest, pain, muscle weakness, and insufficient sleep secondary to peripheral vascular disease as evidenced by facial grimace, difficulty engaging in activities, and elevated vital signs.

Desired Outcomes:

  • The patient will be able to participate in the nursing interventions.
  • The patient will express an increased physical state.
  • The patient will be to tolerate activities without affecting the vital signs.
PVD Nursing InterventionsRationale
1. Evaluate the patient’s physical activity level and check for the patient vital signs and note any abnormal changes after an activity.This will help the nurse to formulate goals and interventions to help the patient to tolerate activities. Advise the patient to discontinue the activity if the patient experienced chest pain and vertigo and if the activity affects the vital signs.
2. Check for the patient’s nutritional status that may affect the patient’s tolerance to activities.A nutritional status assessment is important to assess if the energy source of the patient is adequate to perform an activity. Proper nutrition means that the body gets all the nutrients that a person needs and may help in supporting the muscles.
3. Monitor the patient’s sleeping pattern and amount of sleep that may affect the patient’s tolerance to activities.The sleeping pattern should be assessed because a person’s sleeping pattern may affect the patient’s ability to tolerate activities. When a person doesn’t have enough rest and sleep the patient may not tolerate activities and interventions.
4. Provide ambulation aids that will help the patient such as canes and walkers if needed for activities of daily living.Devices that may assist the patient will help to enhance the patient’s mobility. Assistive devices should be properly used to ensure the safety of the patient.
5. Observe and evaluate the patient’s response to the interventions and activities.Monitoring the patient closely and evaluating the effectiveness of the interventions will serve as a  guide for optimal progression of activity.

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

Disclaimer:

Please follow your facilities guidelines, policies, and procedures.

The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes.

This information is intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.

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Anna C. RN, BSN, PHN

Anna C. RN, BSN, PHN
Clinical Nurse Instructor

Emergency Room Registered Nurse
Critical Care Transport Nurse
Clinical Nurse Instructor for LVN and BSN students

Anna began writing extra materials to help her BSN and LVN students with their studies. She takes the topics that the students are learning and expands on them to try to help with their understanding of the nursing process.

Her experience spans almost 30 years in nursing, starting as an LVN in 1993. She received her RN license in 1997. She has worked in Medical-Surgical, Telemetry, ICU and the ER. She found a passion in the ER and has stayed in this department for 30 years.

She is a clinical instructor for LVN and BSN students along with a critical care transport nurse.

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