22.13: Peripheral Artery Disease IV: Nursing Management

The nursing management of a patient with peripheral artery disease (PAD) begins with a thorough assessment of the patient’s health history and clinical manifestations.

Assessment

1. Health History: Evaluate the patient’s history of hypertension, hyperlipidemia, family history of cardiovascular issues, and lifestyle factors such as dietary patterns, smoking, and physical activity.
2. Physical Examination:
   • Assess the affected extremity for decreased or absent peripheral pulses, temperature changes, capillary refill time over 3 seconds, hair loss on legs and feet, pallor upon elevation, and dependent rubor.
   • Look for thin, cool, shiny skin and muscle atrophy.
   • Document symptoms like chest pain, breathlessness, and leg pain.
   • Measure blood pressure, check peripheral pulses, and observe skin color and temperature.
   • Doppler ultrasound calculates the Ankle-Brachial Index (ABI) to assess blood flow.

Next, Based on the assessment findings, formulate the following nursing diagnoses:

1. Impaired peripheral tissue perfusion related to compromised circulation, as evidenced by a cool limb and chronic pain.
2. Chronic pain related to impaired oxygen supply to tissues, as evidenced by intermittent claudication.
3. Risk for impaired skin integrity related to diminished blood circulation, as evidenced by thin, shiny, hairless skin on the affected limb.
4. Knowledge deficit regarding self-care related to lack of information, as evidenced by the patient verbalizing uncertainty about managing PAD symptoms.

Goals:

Then, the nurse collaborates with the patient to set goals, such as increasing arterial blood supply to extremities and improving mobility and implements the following interventions to achieve the goals.

Nursing Interventions:

1. Optimize Blood Flow:
   • Elevate the head of the bed to aid gravity-assisted blood flow to the lower extremities.
   • Position the affected limb below heart level to enhance arterial blood flow.
   • Assist with walking or graded isometric exercises to promote and develop collateral circulation. Encourage walking until pain occurs, then resting and resuming to build endurance.
2. Pain Management:
   • Keep the affected limb warm with blankets or warm packs to prevent vasoconstriction.
   • Educate to avoid direct heat sources to prevent burns.
   • Administer prescribed analgesics and regularly assess pain levels to adjust management strategies.
3. Foot Care:
   • Educate on meticulous foot hygiene, using neutral soaps and applying lotion (avoiding areas between toes).
   • Protective footwear and careful nail trimming are recommended to prevent injury and infection.
4. Lifestyle Modifications:
   • Educate on the harmful effects of nicotine and provide resources for smoking cessation.
   • Advise a balanced diet rich in vitamins A and C, protein, and zinc for tissue repair and overall health.
   • Suggest weight reduction strategies if overweight or obese to reduce lower extremity pressure and improve circulation.

Monitoring and Evaluation

• Regularly assess the affected limb for temperature, color, and capillary refill time changes.
• Monitor peripheral pulses with Doppler ultrasound if necessary to evaluate intervention effectiveness.

Conclusion: Effective nursing management of PAD involves a comprehensive approach encompassing thorough assessment, accurate diagnosis, goal setting, and tailored interventions to optimize patient outcomes and improve quality of life.