Hey everyone, nurse Mike here from simple nursing.com. Today we're breaking down the differences between PA AD versus PVD. We're talking about the must know signs and symptoms, interventions, and the nursing care that shows up on every nursing exam and ultimately the enclelex. So for all our simple nursing members, be sure to download your study guide in the membership area to help this information stick where it counts. All right, let's get into it. Norma is a 63-year-old female presenting to her primary provider with complaints of pain to her calves when walking up the stairs in her house. She says the pain is getting worse and she must frequently take rest breaks even when walking short distances. Norma has a history of diabetes, hyper lipidmia, and hypertension. OMG, what could it be? And what is the first thing you would prioritize in her plan of care? Today we're wrapping up peripheral vascular disease, which is just scarring and narrowing of the peripheral blood vessels like those found in the arms and legs, making them really small and stiff and more difficult for blood to get through to the extremities. Now, peripheral vascular disease, also called peripheral vascular insufficiency, technically an umbrella term, used to describe diseases affecting both the veins and the artery. Now, so many students get confused with this, so please listen close. Again, PBD stands for peripheral vascular disease, which affects both the blood vessels, veins, and arteries. Now, PBD is also short for a very specific disease called peripheral venus disease, also called peripheral venus insufficiency. It's a disease specific to the veins itself where blood can't get back up to the heart. And on the other end, P A refers to the narrowed arteries where oxygen can't get down to the distal extremities like the fingers and the toes. Okay, so what's really going on in the body? Well, as you know, we have arteries and veins. Arteries pump oxygen away from the heart and out to the body. And veins act like vacuums, vacuuming blood back up to the heart into the venneava. So remember by thinking oxygen away to the body and veins vacuum deoxxygenated blood back to the heart. So veins naturally have lower pressure as they are vacuuming blood and arteries naturally have higher pressure as they pump to the body. So narrow veins in peripheral venus disease means we have a problem vacuuming back to the heart. So we get blood pools in the leg like a big old veiny pool party. Now please write this down. This is not an oxygen problem since the arteries are working correctly. On the other side of things P A that's the worst problem here guys because it is an oxygen problem. The narrowed arteries makes the pumping of oxygen a for away a in the arteries extremely hard. So there's no or low oxygen which means eskeemia and then necrosis tissue death. This is a way more severe condition than the oxygenated pool party of PVD. So P A think B AD it's very bad. Low blood flow means low oxygen and low to no pulses, meaning we have cold legs that lack warmth and also sharp calf pain when walking caused by the lack of oxygen. Guys, P A is the worst. Now, as far as the signs and symptoms, PVD is the veins. So, use the acronym veiny like a veiny arm. V for voluumptuous pulses, meaning the blood is being pumped. Guys, the arteries are fine, the veins are the problem here, and that's why the legs are warm. So, that's a huge test tip right here. Yes, we have pulses. This means oxygen is getting to the extremity. E stands for edema where blood starts pooling. So guys, think of an oxygen pool party in PVD. I is for irregularly shaped sores. So think of this pool party as an exotic pool that has a weird shape, which is very different than the boring P A that's just round and smooth. Now N is for no sharp pain. Instead, we have dull pain. So no sharp pain during exercise because guys, we don't have an oxygen problem. We have oxygen because we have pulses. Unlike P A where we have a very sharp vein from the lack of oxygen. And lastly, Y is for yellow and brown ankles. Big test tip right there is the ankles. Now P A is even worse and everyone knows that. So P A think B A because it's bad. Bad because we have low oxygen in the arteries. So use the acronym arts for artery. A is for absence of pulse and absence of hair. So we have shiny cold legs. And imagine that, never having to shave those legs ever again. R is for round red smooth soores. Unlike those exotic pools in PBD with those weird shapes, in P A we have red soores, also called ruber. So remember R for red. T is for toes and feet that are pale from the low oxygen. Or even in advanced stages, we get black toes called eschar. Big anklex tip right there. These black crispy feet are dead tissue. The toes have suffocated to death and usually have to be amputated, aka cut off. Now, S is for sharp pain in the calves when stressed, like during exercise or even elevation, like when sitting in a lazy boy chair recliner at night. This pain is the warning signs of low oxygen. And big test tip right here, guys, write this down. It's called intermittent claudication. This key word right here, intermittent claudication, comes up a lot on exams and the enclelex specifically for P A. Want more tips and tricks to pass your exams? Join our simple nursing membership for exit prep lectures and access to over 8,000 questions built to take your studying to the next level. So guys, remember intermittent claudication is intermittent cavocation because it causes pain in the cab. And the emphasis is on the A for intermittent claication because we remember P A D. So claication for calification. Now why does this happen? Well again guys, exercise like walking up the stairs or even across a parking lot, the muscles are using more oxygen than while at rest. So the lack of oxygen causes this calf muscle pain. And when the legs are elevated, well, it's harder and harder to pump blood uphill, right? So again, low oxygen equals mo pain. And now that you know the main testable differences between PVD and P A. So what about the six Ps? You guys remember those six Ps the instructor always talks about? Well guys, the six Ps just assess the oxygenation of the limb. Usually always the lower limb since it's harder for oxygen to get from the heart all the way down to the legs, right? Especially with the narrowing of the blood vessels from atheroscerosis that plaque build up like seen here. The lower the oxygen in the extremity, the worse the sixpiece get. It's like your limb is being strangled to death because this is exactly what happens when the body has no oxygen. It dies, also called necrosis. So, write this down. The two most important P's that will be on your test and usually always comes up in prioritization questions. Number one is pain. But guys, not any kind of pain, unreieved pain at rest. Big key word right there. When claudication is unreieved at rest, this means P A has moved into the most severe stages. And number two is paristhesia. Fancy words for tingling and numbness. It's like when your leg falls asleep, but guys, this is way more severe version. It's like the leg is holding its breath for a long, long time or just being choked out. All right, guys. A little side note for your future exams. These two Ps are always the priority and will always show up on CAS care and even P A. Guys, in both cases, we have an oxygenation problem leading to a loss of limb problem. So guys, we always think of the worst case scenarios here which always revolve around oxygen problems. Really any oxygen problem is an emergency problem and is always a priority guys. That's why the ABCs are always to prevent the loss of life, airway, breathing, circulation. They always should be assessed first, then loss of limb, then it goes into like risk factors and other stuff. Now the other four Ps we sort of expect to be there. So we don't really focus on in terms of priority for tests. So we already know pulses are going to be diminished or weak especially in P a and palar is just the palenness from that low blood flow. We use the word polar which the leg gets cold like a polar bear since the leg lacks that warm blood flow. And lastly paralysis the inability to move the limb like a paralyzed patient. Just think the limb is passed out from that lack of oxygen. All right, guys. As far as treatments and nursing interventions, I'm sorry for jumping ahead right now, but guys, the biggest enclelex and test tip I can give you in this lecture is right here. So, guys, grab a pen, write this stuff down. Always, what makes the pain better? So, guys, veins, we elevate the veins. So, PVD and even DVT, you're going to elevate. And arteries, you always hang. So, P A D put the arteries down. Now, I can almost guarantee you this next part is going to be on your exam. So PVD guys, we elevate the legs. V is for elevate all vein problems. Remember elevating helps to vacuum all that fluid back up to the heart. So elevate, PVD, and even DVT. Now P A D remember put arteries down. A for hang the leg over the bed. Now the pain should stop and the color should return because oxygen is flowing now down and away. So arteries pump oxygen away, right? And it's always harder to pump oxygen uphill. That's why we hang that leg. Now, a little memory trick for your legs. This one's really fun. All right. So, you have two legs, right? Like you have two fingers. Now, am I making a V or an A? Cool. I'm making a V. So, are my legs up or down? They are up. So, PVD and DVT, you guys put the legs up. Now, if I turn it over for P A D, where are the legs? Well, they're down, right? So you always put the legs down to help the arteries push oxygen away for a. So guys, just do this finger trick during your test if you're having trouble on those confusing questions. PVD, you elevate and P A D, you hang the legs. Now, your teacher is probably going to be looking at you funny and your classmates are going to think you're weird, but trust me, you're going to get the questions right. Okay. Now the causes of vascular disease are anything that damages vessels like smoking which scars the lining of the blood vessels, uncontrolled diabetes where the blood is turned into mud with all that sugar, tearing and stretching those blood vessels apart and even high cholesterol over 200. These little cholesterols stick to the vessel walls making them stiff and hard and lastly even years of chronic high blood pressure called hypertension over 140 over 90. This adds so much stress and so much pressure eventually stretching those blood vessels out causing small tears in the vessels themselves. So to officially diagnose this vascular disorder or even just to see how bad the disease has progressed, we can use a Doppler ultrasound that gives us an uplose and personal look on how narrow those vessels really are. Or a less accurate way of checking is an ABI, artery brachial index, which works only for P A, that arterial problem. All we're trying to do is compare the blood pressure in the arm versus the leg. If the pressure in the leg is lower, well then something may be blocking that blood flow to the leg, meaning it's possibly P A. And usually ABI blood pressures are done first, like in the ER or urgent care before we do an ultrasound. Usually only done if a clot is expected. All right. Now, for the famous treatments, we always ask, what's the main patient outcome goal? Well, guys, in this case, we have those very narrow blood vessels, right? So, we want to open up those blood vessels like we're opening up a vein in TKO to keep open. So, in PVD, we want to keep those veins open, helping the veins vacuum more blood back to the heart so we can stop the pulling of blood, right? And in P A, we want to push all that oxygen rich blood away from the heart down to the toes and extremities. So, how do we do this? Well, we prevent the clogging of these vessels with some nifty drugs and surgeries. So, think AC for anti-logging of the arteries. A is for anti-platelets like aspirin and chilopitigil brand name Plavix. This guy prevents platelets from clumping together and forming clot. And C for cholesterol lowering drugs. Guys, these end in statin like lova statin. So remember, stay clean because it cleans out the arteries keeping them free from cholesterol. Now since statins prevent the production of cholesterol in the liver, it is very liver toxic. So guys, don't give this to patients with liver problems like hepatitis or cerosis. Oh, and also avoid grapefruit juice since it blocks statin drugs. Lastly, if our AC anti-clogging drugs aren't working to do the full job, we can always do the ABCs of surgery to prevent the really big issue, a big clot in the blood vessel. So, just like in the coronary arteries, we can do an A for angoplasty where we put a balloon or stent to push aside that plaque and get more oxygen to the muscle. Or B, we can do a bypass to go around the plaque filt arteries. and see, we can just cut out the fatty blockage called an endard ectomy. All right, guys. I said it once, but I'm going to say it again. The very biggest test topic is always positioning. Again, if you missed this on the test, it's not my fault because I tried to warn you. So, guys, always PVD, we're elevating the legs to get that deoxxygenated blood down to the heart. And P A D, you hang the legs to help oxygen move away from the body. All right. Now, as far as safety, remember our little acronym SHT, like oh shitake mushrooms. But I'm going to keep our little veiny and artery acronym in the corner there because it's super important. So, our first S is for safety, which includes the eight C's. What not to do, guys. Avoid these, please. Our first C is to be careful with hot temperatures. guys, they have impaired feeling or impaired sensation, which means they're huge risk for burning their skin and a huge risk for infection of that burned skin. Now, C is for caution with foot trauma, guys. Again, impaired feeling means injured feet can go unnoticed leading to big wounds and again infections and then if the infection gets bad enough, amputation. So, a good rule of thumb here is that diabetic patients and peripheral vascular patients were to treat their feet nearly the same. And this brings us to our main C to avoid constriction, guys. Constriction of all kinds. We already have vessels with a narrowing problem. We don't need more constriction. So guys, big no on these guys. No crossing the legs, no constrictive clothing. That means no skinny jeans, no cigarettes, no caffeine, guys. And we're not only talking coffee. We're talking teas, sodas, chocolates, and even Red Bull energy drinks. And lastly, no cold temperatures, guys. that constricts the blood vessels. So guys, teach your patients to dress warm and bundle up before going out. Now, our second S is for skin. We want to teach our patients to assess their skin daily. And the third S is for shoes that are well fitted. Huge enclelex tip right there. For some reason, the feet are always well protected with diabetic patients and peripheral vascular patients. So, a big rule of thumb is no sandals. Again, guys, we have impaired feeling. So, we want to protect the feet from injury. If those feet are injured, that low circulation means low and slow repair and really long-term wound care. H is for hydration. That makes the blood less thick and less likely to get stuck pooling in the extremity. So basically, it's easy for those veins to vacuum it back and easier for the arteries to pump away. Okay. Lastly, this final one, our tea, always seems to be coming up on nursing exams. For some reason, the toenails toenails being trimmed only by the provider, only by the doctor, the health care provider, the PA, the NP, whoever is taking care of the patient mainly. And this goes for diabetics, too. Huge Enclelex tip, guys. Those toenails, I tell you. Woohoo. All right, guys. Now, to wrap this up, the very last tidbit, not really an Enclelex tip or a exam tip, but patients can always limit their standing and even wear compression socks to limit their varicose vein. All right, guys. is now a very quick overview of rayods and burgers disease. We're only going to go over the things you need to know for the enlex and your nursing exams. All right guys, so for reodes disease, it's a condition of cold fingers which is more common in females. So guys, think R for reodes is R for ring fingers. Cold ring fingers. These come from just vasospasms and vasoc constrictions of the tiny blood vessels in the fingers that decrease blood flow usually triggered by cold or stress. So guys, when exposing to cold or stress, those fingers go from white to blue to red. Big and clelex tip right there. So guys, teach your patient to wear warm gloves or they may lose their fingers. Now, similarly, B for burgers disease, we have cold feet and hands, but usually in the feet. So guys, remember B for bare feet and hands. Now, this disease is more common in men and it's worsened by smoking and usually ends with amputation or cutting off of the hands or the feet called auto amputation. So guys, remember to teach your patient to quit smoking, which destroys the small blood vessels, and also avoid trauma to the feet by wearing well-fitted shoes. Guys, nothing too tight. Thanks for watching. Did you know you can unlock beautifully handcrafted study guides packed with key points and memory tricks from all our videos? 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