Peripheral vascular disease (PVD) goes by many names including atherosclerosis obliterans, arterial insufficiency, and peripheral arterial occlusive. The diseases defining characteristic is the clumping together of plaque where arteries narrow, veer, arch, and branch. The popliteal and superficial femoral arteries are the most common sight of occlusions caused by plaque. When an artery becomes blocked because of an occlusion it causes a decrease in nutrients and oxygenation to the tissue. The occluded artery causes hypoxia in the tissues located distally to the occlusion. Hypoxia first affects the peripheral nerves and muscles then it spreads to the skin and subcutaneous tissues.
If the hypoxia is not corrected it may cause ischemia, which if left untreated may lead to necrosis (Elsevier, 2014). Peripheral vascular disease develops slowly. This slow onset allows compensatory mechanisms to attempt to maintain adequate circulation. Some of the compensatory measures that the body uses are anaerobic metabolism, vasodilation, and development of collateral blood vessels. The newly formed collateral blood vessels are branching, small, and newly formed vessels that supply tissues lacking oxygenation blood. The severity of the symptoms is determined by the extent of the new formation of collateral blood vessels.
Peripheral vascular disease is most common among men over the age of fifty. Atherosclerosis, embolism, thrombosis, trauma, vasospasm, inflammation, and autoimmune responses are factors that contribute to the development of peripheral vascular disease. Some modifiable risk factors for the development of peripheral vascular disease are hyperlipidemia, diabetes mellitus type 2, hypertension, cigarette smoking, and stress (Elsevier, 2014). Peripheral vascular disease is characterized by the slow onset of clinical manifestations.
A classic and usually first sign is intermittent claudation. Aching, tiredness, cramping, and weakness in the legs that occurs while walking and is alleviated with rest characterize intermittent claudation. The absence of peripheral pulses below the occlusion is another classic sign. Pain at rest, rest pain, is generally described as an achy and persistent pain.
The decreased blood flow can cause tingling and/or numbness toes and the affected limb or area is generally noted as being cold, numb, and the skin is pale or cyanotic. Muscle atrophy may also occur because of lack of nutrients and oxygenation. The lack of oxygen also causes the toenails to thicken. Some other classic signs of peripheral vascular disease are shiny and scaly skin, loss of subcutaneous tissue, loss of hair on affect extremity, and ulcers that a pale and brownish in color. The patient may also experience unilateral edema in the affected limb (Elsevier, 2014).
Changes in lifestyle are the first step in the management of peripheral vascular disease. These changes include cessation of smoking, exercise, and weight loss. Cessation of smoking is the highest priority because it can cause vascular constriction for up to one hour. This can lead to all day vasoconstriction because many smokers smoke frequently throughout the day. To aid in the cessation of smoking the patient can use nicotine replacement therapies, such as gums and patches.
The most successful exercise programs have duration of at least six months and meet at least three times a week. Programs with a slow increase in exertion are also highly effective. A treadmill can be used to gradually increase the speed and incline, allowing the patient to ease into a workout regimen. This gradual increase allows the patient to achieve a higher success rate while minimizing adverse effects. These benefits are only sustained if the patient continues with the workout regimen. The patient should also have other diseases treated, such as hypertension, hyperlipidemia, and diabetes.
The management of contributing diseases can lead to better management of their peripheral vascular disease. Patients may complain of problems associated with intermittent claudation, therefore, it should be treated before beginning an exercise regimen. Treatment of intermittent claudation uses cilostazol and clopidogrel; both drugs prevent platelets from clumping and causing an occlusion. The Ace inhibitor ramipril is also used to treat intermittent claudation (Elsevier, 2014). The primary surgical treatment of peripheral vascular disease is to keep the artery open.
This is done through stenting of the artery and endarterectomy. An endarterectomy involves the removal of the diseased portion of the artery and replacing it with graft from another blood vessel or synthetic vessel. The enlargement of the artery may be done prior to grafting. This artery is enlarged through a process called percutaneous transluminal angioplasty (PTA). Some complications of PTA are hematoma, embolism, arterial dissection, and anaphylaxis (Elsevier, 2014). The diet for PVD consists of foods low in saturated fats, sodium, cholesterol and high in fiber.
This type of diet is ordered to slow the progression of atherosclerosis, improve blood fats, achieve/maintain a healthy body weight and reduce the risk of PVD, heart disease, and stroke. This diet, if followed correctly, should show a decrease in LDL and an increase in HDL. LDL also called low density lipoproteins are bad for us because they leave behind cholesterol that sticks to the walls of our arteries and causes them to narrow. HDL also called high-density lipoprotein is good for us.
It removes cholesterol from our arteries and takes it to the liver where it is removed from the body. The cholesterol in our diet is important because it can raise our cholesterol levels, however, its impact is not as big as trans and saturated fats. Foods, such as organ meats, untrimmed poultry, high fat milk products, and eggs are high in cholesterol and should be eaten sparingly (Elsevier, 2014). The two types of fats the pt should avoid are trans and saturated fats.
Trans fats are found in fast food, fried foods, shortening, and commercially baked goods. Saturated fats are found in fatty meats, pork, high fat milk products, lunchmeats, and coconut/palm oil. The pt should increase her intake of unsaturated fats and fiber. Unsaturated fats are mono/polyunsaturated and omega-3 fat.
These types of fat do not raise the cholesterol levels in the blood and can help to lower LDL when they are used in place of saturated fats. Foods high in saturated fat include: olive, canola, soybean, peanut, and vegetable oils; non-hydrogenated margarines; nuts and seeds; avocados; and fatty fish. The pt should also increase their intake of fiber. Fiber comes in two forms: soluble and insoluble. Both types are good for health and help to decrease LDL levels, which help to lower the risks associated with PVD.
Foods high in fiber include: dried or canned beans, peas and lentils; whole grains; products that contain psyllium fiber; fresh fruits and vegetables. The pt should also increase water intake when increasing fiber to prevent constipation. The pt should also restrict sodium in the diet. Sodium increases the amount of water that our body retains. In increase in body water causes edema that exacerbates the symptoms of PVD. The pt should avoid the use of salt and processed foods because they are extremely high in sodium.
The pt should use the following methods of cooking when preparing foods: bake, broil, grill, steam, barbeque, poach, and microwave (Elsevier, 2014). Teaching should include: cessation of smoking, dietary modifications, exercise, and medication compliance. Cessation of smoking is the most important lifestyle change that the pt can have. Smoking causes vasodilation, which increases the pain and symptoms, associated with PVD.
The pt can also use cessation aids, such as nicotine gum and patches. The pt should also be encouraged to attend support groups. The cessation of smoking can reduce the risk of stroke, heart attack, and amputation. An exercise regimen should also be put in place.
The pt should be instructed to exercise for at least 30-60min three times a week. At first this should be done as part of training exercises with a healthcare provider. This reduces the risk for injury to the pt and increases the successfulness of the regimen (Elsevier, 2014). The pt should also be instructed on dietary modifications. These modifications include: eating whole grains, fruits, and vegetables; limiting salt and foods high in fat. Dietary modifications can help reduce symptoms and give the pt a better quality of life.
If the pt has other health conditions then they should be managed as well. Proper management of high cholesterol and high blood pressure decreases the risk factors of PVD and can help relief symptoms. The pt should also be instructed in the administration of their medications. Proper medication administration allows the medicine to reach and stay at therapeutic levels.
If the patient is on antiplatelet medicine they should be instructed to avoid garlic because it intensifies the effect of these medications. The patient should also take other medications as ordered and report any new medications to their primary health doctor. The pt should contact their doctor if they have pain in the legs with ambulation; dry, red, or scaly skin; sores or wounds that will not heal. These are signs of serious complications associated with PVD and the primary health doctor should be contacted immediately (Elsevier, 2014).
References
- Elsevier. (2014). medical surgical nursing assessment and management of clinical problems. st louis.
