Hi, I'm Cathy with Level Up RN. In this video, I'm
going to talk about peripheral arterial disease, or PAD, as well as a peripheral bypass graft. At
the end of the video, I'm going to give you guys a little quiz to test your understanding of some of
the key concepts I'll be covering in this video. So definitely stay tuned for that, and be sure to
pull out your Level Up RN medical surgical nursing flashcards so you can follow along with me.
With peripheral arterial disease, or PAD, we have inadequate blood flow to the extremities.
So blood is having a hard time getting down into the legs. This is different than peripheral
venous disease, where blood is having no problem getting into the extremities,
but it's having issues getting back up to the heart. So with peripheral arterial disease,
or PAD, this is caused by atherosclerosis, which either partially or totally
occludes the blood vessels, which impairs blood flow down into the extremities. And
this deprives the extremities of the oxygen and the nutrients that they need. Risk
factors include hypertension, diabetes, smoking, obesity and hyperlipidemia. Signs and
symptoms include intermittent claudication. So this means that the patient is going to have
leg pain that is worse with exertion, like when they're walking, and it will feel better when
they dangle their legs in a dependent position. So I once had a patient with severe PAD who
definitely had this intermittent claudication, and the only position that he was comfortable in
was laying in his hospital bed with his legs kind of draped over the side of the bed, so dangling.
So in order to do wound care on his wounds on his legs, I had to sit on the floor to take care
of those wounds, which was kind of a bummer. Other signs and symptoms of PAD include delayed
capillary refill, as well as decreased pedal pulses. In addition, the patient will likely have
lack of hair on their calves, and the skin over that area will be cool and shiny. In addition,
when they elevate their legs, they will become pale so they'll have pallor. And that makes sense,
right? Because if we already have decreased blood flow into the extremities, if you lift those up,
elevate the legs, that's going to decrease blood flow even more, which is why they turn pale. And
then when they dangle their legs in a dependent position, they will turn red. The blood flow will
go down there, so we'll have dependent rubor. In addition, patients who have PAD often have
wounds on their feet. They usually occur on the toes, and these wounds will be dry and
necrotic, typically filled with eschar. And they will also have delayed wound healing
because in order for a wound to heal, it needs oxygen and it needs nutrients. And we're not
getting those because of that impaired blood flow. So patients with PAD will have delayed
wound healing, if those wounds heal at all. In terms of diagnosis, we can do what's
called an ankle brachial index, or ABI. That's where we compare the patient's ankle
blood pressure to their arm blood pressure. And if their ankle blood
pressure is greatly decreased, then that's indicative of PAD. We can also do
a Doppler ultrasound to assess for blood flow into the extremities. Treatment of PAD includes
medications such as statins and antiplatelets. Surgical procedures that can
be used include an angioplasty. So that attempts to open up those arteries to
restore blood flow to the lower extremities. We can also do a peripheral bypass graft, which
we're going to talk more about here in a minute. In terms of patient teaching, because
intermittent claudication is an issue with PAD, when your patient experiences pain while walking,
they should stop and rest a little bit until that pain subsides and then walk a little more. We also
want to advise our patient to avoid restrictive clothing and crossing their legs because that
can impair blood flow to the lower extremities, and we definitely don't want to do that. We also
want them to maintain a warm environment and wear socks, so we don't want those legs getting
cold because if they get cold, that's going to cause a vasoconstriction, which is definitely not
what we want. We also want to advise our patient to avoid nicotine and caffeine because those
substances can also cause vasoconstriction. So if your patient requires a peripheral bypass
graft - this is where we reroute blood flow around the occluded artery - after the surgery,
you're going to want to closely monitor your patients' pedal pulses as well as their capillary
refill, skin color, and temperature. And then in all likelihood, they will need to keep their
legs straight for 24 hours after the procedure. As the nurse, you're going to want to
monitor for complications, which include a graft occlusion. So the signs and symptoms
of this include pallor, decreased pedal pulses, decreased temperature. So if your patient's
skin suddenly feels cold, that's a warning sign. And then if your patient has a sudden increase
in pain, that is also a sign of graft occlusion. You also want to monitor for compartment
syndrome. So compartment syndrome is where we have increased pressure inside a
muscle compartment due to swelling that can impair blood flow. And it's very serious,
so it can block blood flow altogether. So signs and symptoms of this complication include
numbness, severe pain with even passive movement, as well as edema and taut skin. So if you notice
any of these things with your patient's extremity, you definitely want to alert the provider right
away, as this is a very serious complication. Okay, time for quiz. I have three questions
for you. First question. A patient with PAD will have decreased pain when their
extremity is elevated. True or false? The answer is false. It will feel better-- they
will have decreased pain when their extremity is in a dependent position, so dangling.
Question number two. Pallor with elevation and dependent rubor
are indicative of PAD. True or false? The answer is true.
Third question. Edema, taut skin, numbness, and severe pain are indicative of what
complication following a peripheral bypass graft? The answer is compartment syndrome. Okay. Hopefully, you did well there on the quiz.
If not, be sure to review the flashcards because it takes repetition to remember all of these
different facts. I appreciate you watching. Be sure to like this video and leave me a
comment. Take care and good luck studying. To closely monitor their legs for-- hold up the
[inaudible]. [laughter] Okay, let's try again. I invite you to subscribe to our channel
and share a link with your classmates and friends in nursing school. If you found value
in this video, be sure and hit the like button, and leave a comment and let us know
what you found particularly helpful.