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.
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
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
- Intermittent Claudication
- Pain at rest – awaken from sleep
- Numbness and tingling in extremities
- Hair loss on lower extremities
- Cool, pale skin on extremities
- Triphasic color changes (Raynaud’s)
- Rubor (red)
- Cyanosis (blue)
- Pallor (white)
- 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
- 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
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
Hey guys, today, we’re going to take a look at the care plan for arterial disorders.
So, in this lesson, we’ll briefly take a look at the pathophysiology, as well as the etiology of arterial disorders. We’ll also look at subjective and objective data that your patient may present with and also the nursing interventions and rationales.
So, arterial disorders are an issue because arteries are the vessels, which are responsible for delivering oxygenated blood to the body. Peripheral arterial disease, also known as PAD, Raynaud’s disease and Buerger’s disease are all examples of arterial disorders. PAD specifically is the occlusion of the arteries in the lower extremities while Raynaud’s disease is identified by vasospasms of small hand arterials, and Buerger’s disease is an inflammatory disease of the medium, small arteries and veins in the arms and the legs. So, the most common cause of PAD is atherosclerosis. Raynaud’s can be secondary to atherosclerosis, but also lupus and RA or rheumatoid arthritis and can be triggered by cold and stress.
The cause of Buerger’s disease is unknown, but there seems to be some link between genetics and tobacco use. So, the desired outcome when dealing with arterial disorders is to allow for proper blood flow to the extremities and to also prevent long-term complications like necrosis or loss of fingers, toes, et cetera.
So, let’s take a look at some of the subjective data and also objective data that your patient with an arterial disorder may present with. Remember subjective data is going to be things that are based on your patient’s opinions or feelings. These things might include intermittent claudication, pain at rest that awakens them at night, or numbness and tingling. Objective, or visualize measurable data in your patient may include hair loss on the extremity, cool/pale skin and with Raynaud’s, the patient may have triphasic color changes being red, blue, and white, or rubber cyanotic skin or paler.
Um, we also may see swelling, diminished pulses, and even ulcerations on the extremities.
Okay, so let’s start to look at some of the nursing interventions necessary with arterial disorders. First, assessing peripheral circulation is necessary as arterial disorders affect the arteries that bring oxygenated blood to the tissues. So, pulses may be diminished. So, it may be necessary to use a Doppler to locate their peripheral pulses. Monitoring pulses is imperative to prevent necrosis of tissue or even the need for amputation. Also guys, educating your patient on smoking cessation is another super important nursing intervention because smoking causes vasoconstriction and is the number one cause of complications in patients with arterial disease.
So, when we talk about activity in the patients with arterial disorders, we must talk about intermittent claudication, which is muscle pain that occurs with a predictable amount of activity and then goes away with rest. Intermittent claudication is indicative of schema to muscle tissue. The patient must be taught to exercise only to the point of intermittent claudication and then rest until the pain goes away. So, it’s also important for patients with Raynaud’s to be taught to avoid triggers, which could be being in the cold weather, drinking caffeine and even stressful situations. Arterial disorders can be very, very painful because of the ischemia associated. So be sure to assess your patient’s pain level and administer pain meds or analgesics as ordered. So in addition to analgesics, the patient may also be ordered vasodilators to open up the vessels to improve blood flow or calcium channel blockers, to act on smooth muscle to prevent vasospasms. In some serious situations, surgical interventions like bypass grafting, angioplasty, endarterectomy, and sympathectomy may be necessary. So, with bypass grafting, a graft is placed to bypass the arterial structure, just like it sounds. With angioplasty, a balloon is inserted in the occlusion and it’s inflated to compress the plaque and open the narrowed area, and endarterectomy is the surgical removal of the arterial lining, and the sympathectomy dissects nerve endings to decrease pain in the affected area.
Okay, here is a look at the completed care plan for arterial disorders.
All right, guys, let’s do a quick review. Arterial disorders affect the arteries, which are vessels that carry oxygenated blood to the body. Arterial disorders include PAD, Raynaud’s and Buerger’s. PAD is usually caused by atherosclerosis while Raynaud’s can be caused by atherosclerosis lupus and rheumatoid arthritis also cold and stress. For Buerger’s disease, the cause is unknown.
Subjective data includes intermittent claudication pain at rest, extremity numbness and tingling.
Objective data includes extremity hair loss, cool/pale skin, swelling and diminished pulses. Assess your patient’s peripheral circulation, you may need a Doppler. Monitor, pulses, assess their pain and administer analgesics and also other medications. When necessary, prepare the patient for a surgical intervention if necessary, and also educate on activity, smoking cessation and avoiding triggers.
Okay guys, that is it on this lesson, on the care plan for arterial disorders. We love you guys. Go out and be your best self today and as always, happy nursing!