Before taking the NCLEX, a nursing student must master the topic about Peripheral Vascular Disease (PVD). A nurse must be familiar with the difference between peripheral arterial disease, peripheral venous disease, nursing interventions, pathophysiology, and treatment. Let this post be your review guide in memorizing and understanding the topic easily.
Peripheral Vascular Disease is a common problem of the body’s blood flow. This is usually caused by damage in veins or arteries, resulting in reduced blood flow in the limbs or extremities. Peripheral Vascular Disease is classified into two types: Peripheral Arterial Disease and Peripheral Venous Disease.
Peripheral Arterial Disease Pathophysiology
- The blood carried from the heart to the arteries and flowing to the extremities is oxygenated blood.
- When an artery is damaged, this will compromise the arterial circulation. This will then lead to poor oxygen supply to the extremities, resulting in ischemia.
- With Peripheral Arterial Disease, there is an absent or diminished pulse.
- The lack of oxygen supply in the extremities will result in a pale, cool, and painful sensation. If not addressed immediately, this will lead to necrosis (or death of tissues).
Peripheral Venous Disease Pathophysiology
- Unoxygenated blood from the extremities and other parts of the body are carried by the veins to the heart for oxygenation.
- The unoxygenated blood is squeezed back to the heart with the assistance of the blood and veins.
- If a vein is damaged, blood cannot return to the heart because of the vein congestion in the lower extremities.
- This will result in poor clearance of cellular waste, altered tissue formation, development of blood clots, skin infections, and venous ulcer formation.
Peripheral Arterial Disease Risk Factors
- Obesity or sedentary lifestyle
- High Cholesterol Levels
- Uncontrolled high blood pressure
Peripheral Venous Disease Risk Factors
- Females with a history of using birth control pills are at higher risk.
- Obesity or sedentary lifestyle
- Standing or sitting for prolonged periods.
- Advanced stage
Peripheral Artery Disease Causes
- Atherosclerosis is the main cause of Peripheral Artery Disease. It’s the buildup of plaques or fats on the artery.
- The plaques may cause clot formation, break off, become emboli, and cause a stroke.
- The plaque or fat on the artery narrows the blood flow or damages the artery, and worse may rupture.
- The other types or causes of PAD are Raynaud’s Disease and Buerger’s Disease.
- Raynaud’s Disease: This occurs when peripheral arteries in the fingers or toes narrow down. The vasospasm occurs in stressful events or prolonged exposure to cold temperatures. The symptoms include numbing, tingling, white, or bluish discoloration of the affected peripheral extremity.
- Buerger’s Disease: This is a product of the inflammation of vessels (it can affect both arteries and veins of the hands and feet). Buerger’s Disease is caused by heavy smoking.
Peripheral Venous Disease Causes
- Damaged veins are insufficient to push blood back to the heart.
- Overstretched veins
- Varicose veins – damaged vein valves
- Superficial venous thrombophlebitis: The clotting or inflammation of the superficial vein of the legs or arms.
- Deep Vein Thrombosis (DVT): This is a medical condition where blood clots are formed in the deep vein. DVT usually develops in the thigh, lower leg, pelvis, or arm.
- Chronic venous insufficiency: Valves are damaged, or veins are overstretched.
- When the patient is placed in various positions, does the pain alleviate or aggravate?
- What are the characteristics of the pain? (When it happens, location, pain scale)
- Assess the skin and nails for any discoloration and temperature.
- Assess the strength of the pulse.
- Check for the presence of edema.
- Are there lesions or ulcers? Note the appearance and location.
Peripheral Artery Disease
- Goals: Promote circulation, improve skin integrity, and alleviate pain
- Avoid very cold temperatures and make sure to wear loose clothing.
- Avoid tight or constrictive clothes or footwear.
- Avoid smoking.
- Avoid crossing the legs or knee-flex position (may impede the blood flow)
- Take prescribed medications: antiplatelet, anticoagulants, or cholesterol meds.
- Adhere to a low-fat diet and exercise.
- Recommended medical procedures: Percutaneous Transluminal Angioplasty (for wider blood vessel), Atherectomy (removal of the blockage in the artery), amputation (for necrosis cases)
Peripheral Venous Disease
- Goals: Wound care, prevent blood stasis, prevent infection, treat, and monitor clots.
- Monitor the signs and symptoms of a dislodged clot: swollen, red, painful, and warm area. If the clot traveled to the lungs, the patient might manifest chest pain, dyspnea, breathing difficulty, decreased oxygen saturation, and increased respirations.
- Medication may be prescribed for blood clots: Blood thinners like Heparin and Warfarin.
- Promote blood return by elevating the lower extremities above the heart (after work or at the end of the day before going to sleep).
- Avoid long periods of standing and sitting.
- Wear compression stockings on the affected extremity.
- If there is an ulcer present, provide wound care as prescribed.