Hey everyone, it's Sarah with RegisteredNurseArianne.com 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. V is 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 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 venus 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 e is for explanation of the pain have your patient explain 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 S for skin 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 perfusion. So that extremity is not going to 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 have 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 get become red and warm from that inflammation of those arteries it's getting blood flow but when you elevate those legs that's That's going to impede blood flow. So the legs will become pale. With venous 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 PAD, 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. E for 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, L for lesions, specifically ulcers. And as the nurse, you want to know about where these are going to be located and how they look because they're present. different.
So for arterial 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 going to have little drainage. Remember, blood flow is compromised to these ulcers, so they're not going to drain a lot and they're not going to have tissue granulation, meaning new wound healing.
So they're going to be... pale and very light pink or they can even be necrotic and black. Another thing is that they're unique in 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 a lot, 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 pale 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 edema and there will be drainage along with granulation present because remember we don't have a blood flow issue blood flow is 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 going to 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. And the base of the wound is that deep red and it's very irregular and shallow. Okay, so that wraps up this review over arterial versus venous disease.