 Welcome to the video Peripheral Vascular Disease Assessment. In this video, we'll use peripheral vascular assessment data, pain, peripheral pulses, changes in the skin, edema, ulcer characteristics, risks of complications to examine the characteristics of four conditions. These conditions are peripheral arterial disease, deep vein thrombosis, chronic venous insufficiency, and arterial occlusion. Please feel free to pause the video to reflect on or process the information given. In this activity, you will examine characteristics that specify assessment data with signs and symptoms. Peripheral vascular disease, or PVD, includes conditions that alter the natural flow of blood through the arteries and veins of the peripheral circulation. PVD is common in people who are older or diabetic. It is important for the nurse to know if the origin of the vascular problem is arterial or venous to provide appropriate care and to prevent serious complications from occurring. Atherosclerosis is the leading cause of PVD. Plaque forms in the lumen of the vessel. Atherosclerosis occurs over a long period of time. No symptoms of PVD occur until a major artery is affected in a lower extremity, and organs and surrounding tissues are deprived of oxygen and nutrients. Assessment Clinical signs of PVD reflect the blood's inability to circulate freely to the extremity. By the time symptoms occur, the artery is approximately 85 to 95 percent occluded. Risks for PVD include modifiable risks, like a diet high in saturated fats or cholesterol, smoking, obesity, decreased activity, and stress. Non-modifiable risks include familial tendencies, age, and gender. Peripheral arterial disease. PAD is most common in men ages 50 to 75 years old. The risk for PAD increases with age. PAD develops in the major bifurcations and areas of acute angulation. Clients do not experience symptoms in early stages of the disease. There are four stages of PAD progression. Stage one is asymptomatic. Stage two is claudication. Stage three is rest pain, and stage four is necrosis and gangrene, pain. The classic symptom of PAD pain is caused by intermittent claudication. The pain increases with activity, such as walking one or two blocks, and the pain decreases with rest or positioning the limb in a dependent position. Rest pain is another symptom. This is a sensation of burning or numbness in toes or peristhesia. It is relieved by keeping the limb in a dependent position. Ulcer site pain is also a common symptom. Pulses. PAD pulses are absent or diminished. The nurse should check for a posterior tibial pulse. A Doppler may be needed to accurately find the pulse. Skin changes. These include dry, shiny, hairless skin, thickened nails, dependent ruber, paler on elevation, dusky, pale or mottled skin, and cool or cold foot. Edema. A mild peripheral edema is possible. Ulcer characteristics. These include deep, small round ulcers with a punched out appearance. The ulcer bed is pale with even edges and little granulation. The ulcer is often located on the toes and there is often pain at the ulcer site. Complications. These include gain green and an increased risk of chronic angina, MI or stroke. Acute arterial occlusion or AAO. An acute arterial occlusion occurs when a thrombus or blood clot adheres to the vessel wall. If the thrombus breaks off and travels, it becomes an embolism. An embolism can lodge in a narrowed vessel and obstruct blood flow to vital organs or tissues. Six classic signs of acute arterial occlusion include pain, paler, pulselessness, peristhesia, paralysis, and poculothermia or cold temperature. Pain. The classic symptoms of acute arterial occlusion is acute and sudden onset pain as well as peristhesia. Pulse. There is an absent pulse that is distilled to the occlusion and a doppler may need to be used to confirm the findings. Skin changes include skin that has a pale paler or a cyanotic and dusky or the extremity feels cold. Edema. There is no edema with AAO. Complications include the AAO needs immediate treatment. There is a risk of ischemia and tissue necrosis and gain green can develop within hours. Other complications include paralysis and amputation of the affected extremity. Venous insufficiency. The cause of venous insufficiency is incompetent valves. Valves become overstretched because of persistent excessive pressure. Symptoms reflect the inability of blood to drain from the extremity and return to the heart. Causes of chronic venous insufficiency or CVI. Stasis is caused by working on feet all day, airplane travel, obesity, pregnancy and heart disease. Pain includes a dull aching pain in the affected leg, cramping but no claudication. The pain may be relieved by elevation and no neuro deficit. Pulse. The pulse is present but the pulse is difficult to find because of the edema. Skin changes include thick, tough, brawny pigmented skin, skin that has a normal temperature with no neurologic deficit, they may have scars from previous ulcers and there may be full veins when the leg is slightly dependent. Edema. Uphill or leg edema increases throughout the day and the edema decreases when lying down or elevating the legs. Ulcer. With CVI there may be a chronic, non-healing ulcer. It could be superficial with a pink bed and uneven edges. The ulcer is usually over the inner or outer ankle, there might be moderate ulcer discomfort and there is granulation tissue present. Complications include chronic, non-healing ulcers. Now let's compare arterial versus venous ulcers. With arterial ulcers the wound margins are even, sharply demarcated and punched out and they are often located on the ends of toes. With venous ulcers the wound is often superficial with a pink bed and uneven edges and they occur between the knee and ankle usually over the inner or outer ankle. Deep vein thrombosis or DVT. Thrombosis formation is associated with stasis of blood flow, endothelial injury and or hypercoagulability. This is also known as Virgo's triad. Deep vein thrombosis pain may be a symptomatic. There may be pain in the calf with dorsiflexion of the foot. Homan sign occurs in only 10% of patients. The pain is localized or occurs when standing and there is also tenderness in the groin. The deep vein thrombosis pulse is present. The skin may have inflammation, redness or soreness or an increased temperature over the affected area. An edema may be present over the tibia. There may be sudden onset, unilateral edema of the leg, induration along the blood vessel. There is also warmth when an edema is present. Patients include a high risk of developing a pulmonary emboli. You have completed the video peripheral vascular disease assessment.