hey everyone its air threats Turner sorry and calm and in this video we're going to compare peripheral arterial disease to peripheral venous disease and as always whenever you get done watching this youtube video you can access the free quiz that will test you on these conditions so let's get started when you're studying these two diseases for exams you want to make sure that you know the big differences between how your patient is going to present with either arterial disease or venous disease so to help you remember those differences you want to remember these six things to assess and ask the patient to help you determine if it's arterial or venous and to help us do that we're going to remember the word vessel venous for various positions that alleviate the pain and you want to ask the patient about what type of position helps them alleviate the pain that they're having because this is really going to help you differentiate between arterial and venous with arterial the patient is going to prefer dangling their legs down in the dependent position and the reason for this is because with arterial you're having issues with blood actually going to the extremity so it's causing ischemia so whenever they dangle their legs that helps that blood flow get there however when they elevate the legs that makes the pain a lot worse and again because that is impeding the blood flow with venous disease patients are going to be alleviated with their pain by elevating the legs because what this is going to do this is going to help decrease the swelling because with venous we have a problem with blood returning back to the heart so when they elevate the legs that will help assist with that so dangling the legs or sitting or standing for long periods will actually make the pain in their legs worse along with the swelling is for explanation of the pain have your patient explained to you the characteristics that they're experiencing with the pain with arterial the pain is going to be sharp and it tends to be worse at night and they have something called rest pain this is where whenever they're sleeping their legs will be horizontal in the bed and this is going to affect the blood flow so they'll actually wake up from their sleep with leg pain and they'll throw their leg off the bed and let it dangle and this will actually alleviate the pain they will also have a hallmark sign and symptom called intermittent claudication and this is where when they do any type of activity like running walking they get this severe cramping tingling pain in their legs thighs or buttocks and it'll actually be relieved once they quit doing that activity now why is this happening well arterial we're having an issue with blood going forward to that extremity so whenever they're actually doing that activity that's using up the oxygen and it's depriving that muscle of that blood flow so it starts to hurt but when they rest it the blood starts to go back to the muscle so the pain goes away however with venous disease patients are going to describe the pain as being heavy dull throbbing and aching and the pain will be worse when they're standing or sitting with the legs dangled for long periods of time and that's because the blood flow is not traveling back to the heart and being in that type of position does not allow that to happen so when they elevate the legs that eases the pain and the swelling then as foreskin of the lower extremity as a nurse you want to look at the color of the extremities compare them and feel the temperature is it cold is it warm for arterial disease they have an issue with profusion so that extremities I'm gonna be perfused it's going to be cool to the touch and because that skin is not getting the nutrients it needs the skin is going to appear thin dry and scaly it's probably going to be hairless and half thick toenails now one thing you want to remember for exams is what will happen to the color of that lower extremity if you dangle it or elevate it so remember dr. F for dangling the legs or putting them in the dependent position they will be ruber which means they will become red and warm from the inflammation of those arteries it's getting blood flow that when you elevate those legs that's going to impede blood flow so the legs will be compel with Venus disease there's not an issue with perfusion that blood can get just fine to those lower extremities the problem is it can't leave those lower extremities and drain back to the heart so the extremities will be warm to the touch they will actually because you have so much pulling of the blood you don't have the clearance of that cellular waste the skin is going to be thick and tough it's also going to be swollen from edema and it can have a brownish color to it as you can see here in this picture the next s is for strength of the pulse in the lower extremity for arterial because circulation is compromised to that extremity it's going to be very poor and in severe cases it can be absent whenever you're checking pulses in a patient with PA d you can palpate but you want to use a Doppler device as well so you can actually hear it and grade it accordingly with venous disease we don't have a problem with blood getting there to the extremity so the pulse will be present and it's typically normal efore edema is it present with arterial no it's not common they will not have swelling with venous it's very common and the swelling tends to be worse at the end of the day and that's because we don't have that blood being able to return back to the heart and lastly l4 lesion specifically ulcers and ask the nurse you want to know about where these are going to be located and how they look because they're different so for our Terrier ulcers they're going to be located on the ends of the toes the dorsum of the feet which is the top of the feet or the lateral malleolus which is the lateral ankle region that's where you're going to find these ulcers their appearance is that they're gonna have little drainage remember blood flow is compromised to these ulcers so they're not gonna drain a lot and they're not going to have tissue granulation meaning new whoo healing so they're gonna be Pell and very lot pink or they can even be necrotic and black another thing is that they're unique and how they look because they're deep and they look like literally someone has punched out the skin and that's a term that is used law a punched out appearance with noticeable margins and edges and they'll have this deep round area and here in this picture here you can see an example of an arterial ulcer it is found on the lateral malleolus notice it has that punched out look it's nice and round it's deep it's Pell on the inside and that skin is even scaly and dry around it however with venous ulcers also called venous stasis ulcers they tend to be located on the medial parts of the lower legs and the medial malleolus area so that medial part of the ankle the ulcers tend to appear swollen the skin will be tied around them there'll be a Dima and there will be drainage along with granulation present because remember we don't have a blood flow issue blood flows getting there just fine we have a problem with it returning back so the base of the wound will be pink to a deep red and the edges will be irregular they're not gonna be nice and round and the depth of the wound tends to be shallow and here you can see an example of a venous stasis ulcer it's found on that medial part of the lower leg and the medial malleolus area and notice the skin is very tight around it swollen in the base of the wound is that deep red and it's very irregular in shallow okay so that wraps up this review over arterial versus venous disease