Overview
This lecture explains the key differences between Peripheral Arterial Disease (PAD) and Peripheral Venous Disease (PVD), including signs, symptoms, nursing interventions, and high-yield test tips for nursing exams.
PAD vs PVD: Core Differences
- PAD affects arteries, causing reduced oxygen to extremities; PVD affects veins, leading to blood pooling.
- PAD is more severe due to oxygen deprivation, leading to tissue death (necrosis).
- PVD involves impaired blood return but oxygen delivery is intact.
Signs & Symptoms
PVD (Peripheral Venous Disease)
- Use "VEINY" mnemonic:
- Voluptuous pulses (present, legs are warm)
- Edema (blood pooling)
- Irregularly shaped sores
- No sharp pain (dull pain, especially at rest)
- Yellow and brown ankles
PAD (Peripheral Arterial Disease)
- Use "ARTS" mnemonic:
- Absence of pulse & hair (shiny, cold legs)
- Round, red, smooth sores (rubor)
- Toes/feet: pale or black (eschar) in severe cases
- Sharp calf pain (intermittent claudication), worsened by exercise or elevation
Six Ps of Limb Assessment
- Pain (especially unrelieved at rest—priority)
- Paresthesia (tingling, numbness—priority)
- Pulselessness
- Pallor (paleness)
- Polar (coldness)
- Paralysis (inability to move limb)
- Oxygen problems always take priority in emergencies.
Diagnosis and Causes
- Major risk factors: smoking, uncontrolled diabetes, high cholesterol, hypertension.
- Diagnosed with Doppler ultrasound or Ankle-Brachial Index (ABI for PAD).
- ABI compares arm and leg blood pressures; lower leg indicates PAD.
Nursing Interventions & Treatments
- Positioning:
- PVD: Elevate legs to help blood return.
- PAD: Hang legs down to facilitate arterial flow.
- Medications:
- Antiplatelets (aspirin, clopidogrel)
- Statins (cholesterol-lowering; avoid in liver disease and with grapefruit juice)
- Surgeries: Angioplasty, bypass, endarterectomy (for severe cases).
- Safety: Avoid heat, trauma, constriction (tight clothing, leg crossing, smoking, caffeine), and cold exposure.
- Skin & Foot Care: Daily inspection, well-fitted shoes, hydration, toenail care by provider only.
Raynaud's & Buerger's Disease
- Raynaud's: Vasospasm of fingers (cold, color change: white-blue-red); teach to keep hands warm.
- Buerger's: Affects hands/feet (usually in men, worsened by smoking); avoid trauma, wear proper shoes, stop smoking.
Key Terms & Definitions
- Ischemia — Lack of oxygen to tissues due to reduced blood flow.
- Necrosis — Tissue death from prolonged lack of oxygen.
- Intermittent Claudication — Muscle pain on exercise, relieved by rest; hallmark of PAD.
- ABI (Ankle-Brachial Index) — Diagnostic test comparing blood pressure in arm vs. leg.
- Edema — Swelling due to fluid accumulation.
- Eschar — Black, dead tissue often seen in severe PAD.
Action Items / Next Steps
- Memorize "VEINY" and "ARTS" mnemonics for exam use.
- Practice identifying and prioritizing the six Ps, especially pain and paresthesia.
- Review positioning and safety interventions for PAD and PVD.
- Read further on Raynaud's and Buerger's for additional test preparation.