Lecture on Peripheral Vascular Disease (PVD)

Overview

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

Signs and Symptoms of PVD

• Primarily affect lower extremities.
• Different symptoms for arterial vs. venous disease.

Arterial System

• Function: Carries oxygenated blood from the heart to extremities and organs.
• PAD: Fatty plaques (atherosclerosis) impede blood flow, causing pain, arterial ulcers, and possible necrosis.

Venous System

• Function: Carries deoxygenated blood from extremities and organs back to the heart.
• Peripheral Venous Disease: Issues such as varicose veins and DVT prevent blood return, causing pain, venous congestion, and ulcers.

Risk Factors

Risk Factors for PAD

• Smoking, uncontrolled hypertension, high cholesterol, diabetes.

Risk Factors for Peripheral Venous Disease

• Being female, birth control pills, pregnancy, obesity, prolonged sitting/standing, advanced age.

Detailed Look at PAD and Peripheral Venous Disease

Peripheral Arterial Disease (PAD)

• Main Cause: Atherosclerosis (accelerated by smoking, hypertension, high cholesterol).
• Renaud's Disease: Vasospasm triggered by cold/stress, affecting fingers, toes, nose, ears.
  • Symptoms: Extremities turn white/blue, followed by a red, tingling sensation when warming up.
• Buerger's Disease: Inflames arteries and veins, causes clots (mainly in feet/hands, associated with smoking).

Peripheral Venous Disease

• Issues: Veins unable to return blood to the heart, causing swelling, edema, ulcers, and cellulitis.
• Conditions: Varicose veins, deep vein thrombosis (DVT), superficial venous thrombosis, chronic venous insufficiency.

Arterial vs. Venous Diseases Characteristics

Positions to Alleviate Pain

• Arterial: Pain alleviated by dangling legs; worsened by elevation.
• Venous: Pain alleviated by elevation; worsened by dangling.

Pain Description

• Arterial: Sharp, worse at night (rest pain), intermittent claudication (pain during activity, relieved by rest).
• Venous: Heavy, dull, throbbing, achy; worse when standing/sitting.

Skin Condition

• Arterial: Cool, thin, dry, scaly skin; no hair growth; thick toenails; becomes red (rubor) when legs are dangled; pale when elevated.
• Venous: Warm skin; thick and tough; brown pigmentation.

Pulse Strength

• Arterial: Weak or absent pulses.
• Venous: Normal pulses.

Edema

• Arterial: Rare.
• Venous: Common, worse at end of the day.

Ulcers

• Arterial: End of toes, top of feet, lateral ankle; deep, round, little drainage.
• Venous: Medial lower leg, medial ankle; swollen, lots of drainage, irregular edges, shallow.

Nursing Interventions for PAD

• Circulation: Check pulses, color, sensation, and temperature of extremities.
• Patient Education:
  • Avoid tight clothing and extreme cold.
  • Avoid smoking.
  • Proper positioning (no tight knee flex or leg crossing).
  • Medications: Cholesterol-lowering, anticoagulants, antiplatelets.
  • Low-fat diet and walking program.
  • Skin inspection to prevent injury and infection.
• Pain Management
• Diagnostic Procedures: Ankle brachial index (ABI), angioplasty, arterial bypass, atherectomy.

Nursing Interventions for Peripheral Venous Disease

• Increasing Blood Return: Elevate legs, apply compression.
• Skin Care and Infection Prevention:
  • Keep compression stockings clean and dry.
  • Manage venous stasis ulcers and use Unna boots.
• Clot Management: Monitor for DVT, administer anticoagulants, use filters (if needed).