Peripheral Vascular Disease PVD & Peripheral Arterial Disease PAD NCLEX Review Care Plans
Nursing Study Guide for Peripheral Artery Disease (PAD)
Peripheral arterial disease (PAD) is a medical condition that involves the narrowing of arteries, leading to a reduction in the blood flow to the limbs, usually the lower extremities.
PAD is one of the many circulatory diseases under the umbrella of Peripheral Vascular Disease (PVD).
Because of the decreased blood supply in the legs, PAD may manifest as a leg pain while walking, also known as claudication.
This symptom, along with leg weakness and numbness may have a significant effect on the patient’s quality of life. PAD is a common circulatory problem, and is managed using medications in combination with lifestyle changes, such as smoking cessation, diet modification, and exercise.
Signs and Symptoms of Peripheral Arterial Disease
- Claudication – cramping pain after physical activity such as walking; usually located in calf, thigh, or hips
- Weak pulse or absent pulse in the affected leg / limb
- Leg weakness or numbness
- Coldness in the affected limb, as compared to the unaffected side
- Sores on the affected leg that has slow healing
- Hair loss or slower hair growth on the affected limb
- Erectile dysfunction in men
Causes and Risk Factors of Peripheral Arterial Disease
The build up of fatty deposits or plaques on the arterial wall, known as atherosclerosis, is the most common cause of PAD.
Some cases of PAD may result from inflammation of blood vessels, radiation exposure, or trauma and injury to the limb.
People age 50 and above as we as family history of heart disease, stroke, or PVD also increase the risk for developing PAD.
Complications of Peripheral Arterial Disease
- Ischemic rest pain. Worsening PAD may result to limb pain not only after a physical activity, but even at rest or while lying down. This can severely affect the patient’s activities of daily living, particularly sleep and rest.
- Gangrene. Open sores that do not heal due to lack of blood supply to the affected area are susceptible to both infection and tissue death or gangrene. This condition, known as critical limb ischemia, may require amputation of the infected or gangrenous limb.
- Atherosclerosis. Patients diagnosed with PAD are likely to suffer from atherosclerosis, or accumulated fatty deposits in the arteries that may result to decrease blood flow to vital organs such as the heart (e.g. myocardial infarction or heart attack) and brain (e.g. stroke).
Diagnosis of Peripheral Arterial Disease
- Physical exam and history taking – to check for signs of claudication, weakness, and absence of pulse of the affected limb; to check for any risk factors related to PAD
- Ankle-brachial index (ABI) – to compare the blood pressure and blood flow on the ankle versus that in the arm, by using a blood pressure machine and ultrasound
- Blood test – to check for cholesterol levels
- Doppler Ultrasound – to check for the blood flow and any narrowing in the blood vessels
- Angiography – to visualize the blood flow through the arteries by means of injecting a contrast dye in one of them.
Treatment of Peripheral Arterial Disease
- Medications. Statins are used in PAD to lower the low-density lipoprotein (LDL) cholesterol or bad cholesterol, to a level less than 100 mg/dL. Antihypertensives, anticoagulants, and blood glucose-lowering medications are also used in the management of PAD. To increase the blood flow to the limbs by opening up the narrowed blood vessels, cilostazol o pentoxifylline may be prescribed. These may help relieve leg pain and numbness.
- Angioplasty. The surgeon threads a catheter to the affected artery, and then inflates the balloon to stretch and re-open the blocked artery. This allows the blood flow to increase. A stent may be placed at the same time to keep the affected artery open.
- Graft bypass. The surgeon may use a healthy blood vessel from another part of the body or a synthetic blood vessel to create a graft bypass and allow the blood to flow around the affected artery.
- Lifestyle changes. Smoking cessation, low sugar and low cholesterol diet, and a supervised exercise program are all helpful in managing PAD.
Nursing Care Plans for Peripheral Arterial Disease
1. Nursing Diagnosis: Acute Pain related to decreased peripheral arterial blood flow as evidenced by pain score of 10 out of 10 after walking or exercise, verbalization of cramping leg pain (claudication), guarding sign on the affected limb, leg weakness, blood pressure level of 180/90, respiratory rate of 29 bpm, and restlessness
Desired Outcome: The patient will demonstrate relief of pain as evidenced by a pain score of 0 out of 10, stable vital signs, and absence of restlessness.
|Administer prescribed medications that alleviate the symptoms of cramping leg pain.||Aspirin may be given to reduce the ability of the blood to clot, so that the blood flows easier through the narrowed arteries. To increase the blood flow to the leg by opening up the narrowed blood vessels, cilostazol or pentoxifylline may be prescribed. These helps relieve leg pain and numbness.|
|Assess the patient’s vital signs and characteristics of pain at least 30 minutes after administration of medication.||To monitor effectiveness of medical treatment for the relief of claudication. The time of monitoring of vital signs may depend on the peak time of the drug administered.|
|Elevate the head of the bed if the patient is short of breath. Administer supplemental oxygen, as prescribed. Discontinue if SpO2 level is above the target range, or as ordered by the physician.||To increase the oxygen level and achieve an SpO2 value within the target range.|
|Place the patient in complete bed rest during pain attacks. Educate patient on stress management, deep breathing exercises, and relaxation techniques.||Stress causes a persistent increase in cortisol levels, which has been linked to people with circulatory issues.|
2. Nursing Diagnosis: Ineffective Tissue Perfusion (Peripheral) related to decreased arterial blood flow secondary to PAD, as evidenced by calf pain upon palpation, absent or weak pulse on the affected leg, leg numbness and weakness
Desired Outcome: The patient will maintain optimal tissue perfusion in the affected leg as evidenced by having strong and palpable pulses, regained leg strength, and reduced calf pain.
|Assess the patient’s vital signs at least every 4 hours, or more frequently if there is a change in them.||To assist in creating an accurate diagnosis and monitor effectiveness of medical treatment for PAD.|
|Administer the prescribed anticoagulants. Administer cilostazol or pentoxifylline.||To prevent blood clot formation using anticoagulants such as heparin or warfarin. To increase the blood flow to the leg by opening up the narrowed blood vessels, cilostazol o pentoxifylline may be prescribed. These may help relieve leg pain and numbness.|
|Administer analgesics as prescribed.||To provide pain relief especially in the calf area.|
|Ensure adequate hydration.||Increased blood viscosity is a contributory factor to clotting. Adequate hydration helps reduce blood viscosity.|
|Avoid elevating the legs above the level of the heart.||Leg elevation may contribute to the reduction of arterial blood supply to the legs.|
Other nursing diagnoses:
- Activity Intolerance
- Deficient Knowledge
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. (2017). 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. (2018). 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
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