NUR 642 Exam 2
Define PAD - ANS decreased blood flow to extremities due to atherosclerotic narrowing or obstruction
of vessels
When is PAD a medical emergency or vascular surgeon referral needed - ANS if suspect arterial occlusion
or dissecting aneurysm
PAD Type 1, 2, 3 - ANS TYPE 1: Arteriosclerosis obliterans (ASO)
TYPE 2: Sudden/acute arterial obstruction: occluding arterial supply, from thrombus or embolus
TYPE 3: Varicose veins-abnormally distended and tortuous superficial veins, primarily in distal
extremities
Occlusive arterial disease most affects? This can lead to ? - ANS the abdominal aorta and the small- and
medium-sized arteries of the lower extremities
leads to absent dorsalis pedis, posterior tibial, and/or popliteal artery pulses.
Risk factors for PAD - ANS Age>50
Male sex
Tobacco abuse
Diabetes mellitus
,HTN
Hyperlipidemia
Hyperhomocysteinemia
Associated CVD in most
Associated cerebrovascular disease (stroke)
Causes of PAD - ANS Degenerative or collagen abnormalities ( Marfan's Syndrome)
Dysplastic disorders (fibromuscular)
Vascular inflammatory processes (arteritis)
Autoimmune conditions
Arteriosclerosis
Obstruction/ Thrombosis
Symptoms of PAD - ANS Can be asymptomatic
,Intermittent CLAUDICATION: pain/cramping in calf with exercise (due to lactic acid build up) that is
relieved with rest
Purple coloring of BLE
Calf vs Hip claudication occlusion sites - ANS Calf claudication: occlusion at or proximal to popliteal
artery
Hip claudication: occlusion is aortoiliac
Diabetics and onset of PAD. Where are their occlusions? - ANS they have earlier onset of PAD.
Occlusions in tibial and popliteal arteries
Claudication severity is assessed by - ANS how far a patient can walk before pain ensues
What can decrease distance when someone has claudication - ANS Weather, meals, and incline may
reduce distance
Does claudication occur at rest - ANS no!
What is first muscle that can affected in claudication - ANS Thigh/butt (Leriches Syndrome)
Pain at rest results in? - ANS severe obstruction in circulation of feet ( recliner sleeping, hanging feet
over edge of bed to help improve circulation to relieve pain)
History of PAD - ANS Exertional leg symptoms ( fatigue, aching, numbness, or pain; record location of
symptom: buttock, thigh, calf, or foot)
, Poor wound healing in legs or feet
Pain at rest in lower leg or feet; note whether occurs when patient is recumbent or upright
Abdominal pain that occurs after eating and is associated with weight loss
Family history thats important for PAD - ANS a first degree relative with AAA or with a brain aneurysm
Physical exam of PAD - auscultation - ANS Auscultate carotid arteries bilaterally for bruits
Auscultate femoral arteries for bruit
Physical exam of PAD - palpation - ANS Palpate carotid pulses ( upstroke/pulse amplitude)
Palpate abdomen ( measure width of aortic pulsation)
Palpate pulses/intensity( 0=absent, 1= diminished, 2= normal, 3=bounding)
Physical exam of PAD - inspection - ANS Assess lower extremities for PAD distal hair loss, trophic skin
changes, hypertrophic nails
Assess feet color, temperature, skin integrity, ulcerations/lesions
How to measure BP in PAD - ANS in both arms!
Define PAD - ANS decreased blood flow to extremities due to atherosclerotic narrowing or obstruction
of vessels
When is PAD a medical emergency or vascular surgeon referral needed - ANS if suspect arterial occlusion
or dissecting aneurysm
PAD Type 1, 2, 3 - ANS TYPE 1: Arteriosclerosis obliterans (ASO)
TYPE 2: Sudden/acute arterial obstruction: occluding arterial supply, from thrombus or embolus
TYPE 3: Varicose veins-abnormally distended and tortuous superficial veins, primarily in distal
extremities
Occlusive arterial disease most affects? This can lead to ? - ANS the abdominal aorta and the small- and
medium-sized arteries of the lower extremities
leads to absent dorsalis pedis, posterior tibial, and/or popliteal artery pulses.
Risk factors for PAD - ANS Age>50
Male sex
Tobacco abuse
Diabetes mellitus
,HTN
Hyperlipidemia
Hyperhomocysteinemia
Associated CVD in most
Associated cerebrovascular disease (stroke)
Causes of PAD - ANS Degenerative or collagen abnormalities ( Marfan's Syndrome)
Dysplastic disorders (fibromuscular)
Vascular inflammatory processes (arteritis)
Autoimmune conditions
Arteriosclerosis
Obstruction/ Thrombosis
Symptoms of PAD - ANS Can be asymptomatic
,Intermittent CLAUDICATION: pain/cramping in calf with exercise (due to lactic acid build up) that is
relieved with rest
Purple coloring of BLE
Calf vs Hip claudication occlusion sites - ANS Calf claudication: occlusion at or proximal to popliteal
artery
Hip claudication: occlusion is aortoiliac
Diabetics and onset of PAD. Where are their occlusions? - ANS they have earlier onset of PAD.
Occlusions in tibial and popliteal arteries
Claudication severity is assessed by - ANS how far a patient can walk before pain ensues
What can decrease distance when someone has claudication - ANS Weather, meals, and incline may
reduce distance
Does claudication occur at rest - ANS no!
What is first muscle that can affected in claudication - ANS Thigh/butt (Leriches Syndrome)
Pain at rest results in? - ANS severe obstruction in circulation of feet ( recliner sleeping, hanging feet
over edge of bed to help improve circulation to relieve pain)
History of PAD - ANS Exertional leg symptoms ( fatigue, aching, numbness, or pain; record location of
symptom: buttock, thigh, calf, or foot)
, Poor wound healing in legs or feet
Pain at rest in lower leg or feet; note whether occurs when patient is recumbent or upright
Abdominal pain that occurs after eating and is associated with weight loss
Family history thats important for PAD - ANS a first degree relative with AAA or with a brain aneurysm
Physical exam of PAD - auscultation - ANS Auscultate carotid arteries bilaterally for bruits
Auscultate femoral arteries for bruit
Physical exam of PAD - palpation - ANS Palpate carotid pulses ( upstroke/pulse amplitude)
Palpate abdomen ( measure width of aortic pulsation)
Palpate pulses/intensity( 0=absent, 1= diminished, 2= normal, 3=bounding)
Physical exam of PAD - inspection - ANS Assess lower extremities for PAD distal hair loss, trophic skin
changes, hypertrophic nails
Assess feet color, temperature, skin integrity, ulcerations/lesions
How to measure BP in PAD - ANS in both arms!
