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Peripheral Vascular Disease Lecture

Jul 7, 2024

Peripheral Vascular Disease (PVD)

Overview

  • Peripheral Vascular Disease (PVD): Impediment of blood flow within the peripheral vascular system due to vessel damage.
  • Peripheral Vascular System: Provides circulation to arms, hands, feet, and legs (outside the heart and brain).
  • Types of PVD:
    • Peripheral Arterial Disease (PAD): Affects the arterial system.
    • Peripheral Venous Disease: Affects the venous system.

Arterial System vs Venous System

  • Arterial System: Carries oxygenated blood from the heart to extremities and organs (represented in red in diagrams).
  • Venous System: Carries deoxygenated blood from extremities and organs back to the heart (represented in blue in diagrams).

Peripheral Arterial Disease (PAD)

  • Mechanism: Narrowing of arteries limits oxygenated blood to extremities.
  • Symptoms: Ischemia, pain, arterial ulcers, potential necrosis, and amputation.
  • Causes: Often due to atherosclerosis (fatty plaque build-up).
  • Risk Factors: Smoking, uncontrolled hypertension, high cholesterol, obesity, diabetes.
  • Specific Types:
    • Renaud's Disease: Vasospasm in peripheral arteries triggered by cold/stress.
    • Burgers Disease: Inflammation of arteries and veins leading to clots, commonly in smokers.

Peripheral Venous Disease

  • Mechanism: Inability of veins/valves to return blood to the heart; leads to pooling of blood.
  • Symptoms: Pain, heavy throbbing, venous congestion, brown pigmentation, venous stasis ulcers, cellulitis.
  • Risk Factors: Female, birth control use, pregnancy, obesity, prolonged sitting/standing, advanced age.
  • Specific Conditions:
    • Varicose Veins: Overstretched veins, may require compression or procedures.
    • Deep Vein Thrombosis (DVT): Development of clots in deep veins, risk of pulmonary embolism.
    • Chronic Venous Insufficiency: Overstretched veins impairing blood return to the heart.

Signs & Symptoms

Arterial Disease

  • Pain: Sharp, worsens at night (rest pain), intermittent claudication.
  • Skin: Cool, thin/dry/scaly, no hair growth, thick toenails, rubor when legs are dangling, pale when elevated.
  • Pulse: Difficult to find, poor to absent in severe cases.
  • Edema: Not common.
  • Ulcers: Located on toes, dorsum of feet, lateral ankle; deep, 'punched out,' round, necrotic.

Venous Disease

  • Pain: Heavy, dull, throbbing, worse with standing/sitting, alleviated by elevating legs.
  • Skin: Warm, thick/tough, brown coloration.
  • Pulse: Present and normal.
  • Edema: Very common.
  • Ulcers: Located on medial lower legs, medial ankle; swollen with drainage, granulation tissue, irregular edges, shallow.

Nursing Interventions

Peripheral Arterial Disease (PAD)

  • Assessment: Check pulses, color, sensation, temperature of extremities.
  • Patient Education: Avoid tight clothing, extreme cold, smoking. Proper positioning, taking medications, low-fat diet, walking programs.
  • Pain Management: Assess and manage pain levels.
  • Preventive Procedures: ABI, angioplasty, arterial bypass, arthrectomy. In severe cases, amputation.

Peripheral Venous Disease

  • Monitoring: Watch for clots (DVTs), administer anticoagulants, monitor clotting levels.
  • Blood Return: Elevate legs above heart, apply compression stockings.
  • Wound Care: Clean and dry compression stockings, wound care for venous stasis ulcers (e.g., Unaboo with zinc oxide).

Note: Additional resources, including free quiz and further lectures, are available at RegisteredNurseRN.com for deeper insights into conditions like DVT.

Full transcript