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Outline
Pathophysiology
Disorders of the arteries, which are the vessels that are responsible for delivering oxygenated blood to the body. This includes Peripheral Arterial Disease, which is chronic occlusion of the arteries in the lower extremities leading to decreased oxygen supply. Another form is Raynaud’s disease, which occurs when small arterioles in the hands vasospasm and prevent blood flow. The third is Buerger’s disease which is an inflammatory disease of the medium to small arteries and veins of the arms and legs. In this condition, microthrombi form which can lead to vasospasm and occlusions.
Etiology
The most common cause of peripheral arterial disease is atherosclerosis. Raynaud’s can be secondary to atherosclerosis, lupus, or rheumatoid arthritis and can be triggered by cold or stress. The cause Buerger’s disease isn’t exactly known, but there is a link to genetics as well as tobacco use
Desired Outcome
To allow for proper blood flow to the extremities and prevent long-term complications like necrosis or the loss of fingers, toes, etc.
Arterial Disorders Nursing Care Plan
Subjective Data:
- Intermittent Claudication
- Pain at rest – awaken from sleep
- Numbness and tingling in extremities
Objective Data:
- Hair loss on lower extremities
- Cool, pale skin on extremities
- Triphasic color changes (Raynaud’s)
- Rubor (red)
- Cyanosis (blue)
- Pallor (white)
- Swelling
- Diminished pulses
- Ulceration in extremities
Nursing Interventions and Rationales
- Assess peripheral circulation
- May need to use a doppler to locate peripheral pulses
Arterial disorders affect the arteries that bring oxygenated blood to the tissues. This most often affects the extremities where the vessels are smaller. You may see cool, pale skin, or feel diminished pulses – it’s imperative to monitor peripheral perfusion to prevent necrosis of tissue or the need for amputation.
- Educate patient on smoking cessation
Smoking causes vasoconstriction and is the #1 cause of complications in a patient with arterial disease. Quitting smoking can improve the risk of complications dramatically.
- Educate patient on appropriate levels of activity
- Exercise to the point of claudication, then rest
Intermittent claudication is muscle pain that occurs with a predictable amount of activity and goes away with rest. It is indicative of ischemia to the muscle tissue. The patient should be taught not to exercise past the claudication. They should stop when it occurs and rest until it dissipates.
- Educate patient on avoiding triggers for Raynaud’s
Raynaud’s can be triggered by cold, stress,caffeine, etc. Patients should be taught how to identify those triggers and avoid them whenever possible.
- Assess pain and administer analgesics
Arterial disorders can be very painful because of the ischemia to the tissues. Pain control is important
- Administer medications as ordered
- Vasodilators
- Calcium Channel Blockers
Vasodilators are given to open up the vessels in the periphery to improve the flow of oxygenated blood.
Calcium channel blockers are given because they act on vascular smooth muscle to prevent vasospasm.
- Prepare patient for surgical intervention
- Bypass grafting
- Angioplasty
- Endarterectomy
- Sympathectomy
Bypass grafting – a graft is placed to bypass the occluded arterial structure
Angioplasty – a balloon is inserted into the occlusion and inflated to compress plaque and open the narrowed area.
Endarterectomy – the plaque is surgically removed from the inside of the artery
Sympathectomy – nerve endings are dissected to decrease pain sensation in the affected area
References
- https://www.mayoclinic.org/diseases-conditions/peripheral-artery-disease/symptoms-causes/syc-20350557
- http://www.heart.org/HEARTORG/Conditions/VascularHealth/PeripheralArteryDisease/About-Peripheral-Artery-Disease-PAD_UCM_301301_Article.jsp#.WrOzTujwY2w
- https://www.mayoclinic.org/diseases-conditions/raynauds-disease/symptoms-causes/syc-20363571
- https://www.mayoclinic.org/diseases-conditions/buergers-disease/symptoms-causes/syc-20350658
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