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Teaching topics Explanation of the disorder and treatment plan Medications and possible adverse effects Explanation of all tests and treatments Coughing and deep breathing exercises Slow resumption of daily activities and scheduled rest periods in daily routine

Peripheral artery disease

In peripheral artery disease, the obstruction or narrowing of the lumen of the aorta and its major branches causes an interruption of blood flow, usually to the legs and feet. Peripheral artery disease may affect the carotid, vertebral, innominate, subclavian, mesenteric, and celiac arteries. Occlusions may be acute or chronic and commonly cause severe ischemia, skin ulceration, and gangrene.

Peripheral artery disease is more common in males than in females. The prognosis depends on the location of the occlusion, the development of collateral circulation to counteract reduced blood flow and, in acute disease, the time elapsed between the occlu-sion and its removal.

CAUSES Atherosclerosis Emboli formation Thrombosis Trauma or fracture

CONTRIBUTING FACTORS Age Diabetes Family history of vascular disorders, MI, or stroke Hyperlipidemia Hypertension Smoking

ASSESSMENT FINDINGSAssessment findings depend on the site of the occlusion.

Femoral, popliteal, or innominate arteries Mottling of the extremity Pallor

Paralysis and paresthesia in the affected arm or leg Pulselessness distal to the occlusion Sudden and localized pain in the affected arm or leg (most common symptom) Temperature change that occurs distal to the occlusion

Internal and external carotid arteries Absent or decreased pulsation with an aus-cultatory bruit over affected vessels Stroke Transient ischemic attacks (TIAs), which produce transient monocular blindness, dys-arthria, hemiparesis, possible aphasia, confu-sion, decreased mentation, headache

Subclavian artery Subclavian steel syndrome (character-ized by the backflow of blood from the brain through the vertebral artery on the same side as the occlusion into the subclavian artery distal to the occlusion; clinical effects of ver-tebrobasilar occlusion and exercise-induced arm claudication)

Vertebral and basilar arteries TIAs, which produce binocular vision disturbances, vertigo, dysarthria, and falling down without loss of consciousness

DIAGNOSTIC TEST RESULTS Arteriography demonstrates the type (thrombus or embolus), location, and degree of obstruction and collateral circulation. Doppler ultrasonography shows decreased blood flow distal to the occlusion. EEG and a computed tomography scan may be necessary to rule out brain lesions. Ophthalmodynamometry helps deter-mine the degree of obstruction in the internal carotid artery by comparing ophthalmic artery pressure to brachial artery pressure on the affected side. A more than 20% difference bet-ween pressures suggests insufficiency.

NURSING DIAGNOSES Ineffective tissue perfusion (type depends on the location of the occlusion) Fear Risk for injury

Tickle my toes. Everyone depends on me. If my aorta is obstructed, even

the feet feel it.

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