 What comes to nursing school explain in this video on peripheral artery disease or that sometimes also referred to as PAD for abbreviation and the underlying cause is Artherosclerosis just like anywhere in the body the arteries can get clogged causing that narrowing of the Vascular tear and then the blood flow is impeded So if we look at this here pathophysiology of PAD is Artherosclerosis affecting the vessels of the lower extremities Just like with Artherosclerosis anywhere in the body risk factors include smoking which is a very big risk factor here as well as hypertension hyperlipidemia chronic kidney disease Diabetes and often we see PAD peripheral artery disease also in patients with coronary artery disease and carotid artery disease because The plaque build-up doesn't just affect certain body parts It affects the arteries of the entire body and then we can see that progressing to the lower extremities as things progress So with PAD there is a term called intermittent Claudication and think about this as intermittent being off and on and then Claudication think about as a cloud kind of surrounds the patient's lower extremities So as the patient exerts themselves or walks as the blood flow is Concentrated to the lower extremities There is some ischemia that happens because of the narrowing of the arteries that blood flow is impeded and so this Is considered a reproducible muscle pain due to that ischemia that lack of blood flow to the lower extremities and Reproducible means that the patient walks for example For one mile and then after one mile he starts he or she starts having symptoms So that is reproducible with the same amount of exercise or time that the patient experiences these signs and symptoms And they typically resolve within less than 10 minutes of rest So as soon as the patient stops walking the blood flow is restored the body doesn't have to work so hard the blood flow Is a little bit less demanding to the lower extremities as the muscles don't need that oxygen and therefore the symptoms resolve And that is that term intermittent Claudication and these signs and symptoms that patients often report is a burning heaviness soreness or tightness in the lower extremities particularly in the calves They might also complain of peristusias. So numbness and tingling think about if the blood flow is Not correct or not happening the way that it should it can also affect the nerves Therefore leading to this numbness and tingling Their skin might look thin shiny and taut and there might be some hair loss again This is mostly happening over time. This is not a sign and symptom that'll happen You know overnight, but it'll happen very slowly as that blood flow is impeded the hair growth Doesn't take priority For for the blood flow the blood flow to the skin also doesn't take priority therefore the skin becomes thin shiny and there loses hair and then with arthrosclerosis think about it if there is not a Considerable amount of blood flow or normal blood flow to the lower extremities We're not going to be able to palpate their pulses. So there might be weak or absent completely And then there are two other terms, which is elevation pallor and dependent Rubber so now when the patient typically when the patient has lower extremity pain We will tell them to elevate the lower extremities to kind of help with swelling But in this case if the blood flow is already impeded and we elevate that lower extremity now The heart has to work extra hard pumping through those lower extremities that are clogged and the patient will have Lack of blood flow, which is that elevation pallor So if the legs are elevated that will be pallor or paleness to the lower extremity because it increases the obstruction And then the dependent rubber means that if the patient sits down like on a chair and the Lower extremities are in a dependent position They will cannot turn this ruddy reddish blue kind of a color and that is because there is some reactive Hyperemia occurring so increased amount of blood flow Specifically after the exercise the body is trying to feed the lower extremities with some extra blood And therefore they kind of become engorged with that extra blood and they therefore look a little bit kind of like red in color Rubber think ruby ruby red and then over here for Diagnostic tests so when we want to know how severe is the obstruction of the atherosclerosis in the lower extremities We usually check that with a Doppler ultrasound where we can check the blood flow But also we can measure the blood pressure in the lower extremities and typically that's done at three Different places so in the thigh Right below the knee and right above the ankle and if the blood pressure drops from one location to the other By more than 30 millimeters of mercury that is diagnostic of PAD Also, we can do a CT angiogram inject contrast to see exactly how bad the obstruction is Where is it located and maybe if the patient has already developed collateral circulation and then another test here that is very indicative of PAD is called the ankle brachial index or ABI so we take the systolic blood pressure in the affected extremities the ankle and Then in the brachial arteries of the upper arm and the brachial arteries either left or right, whichever one is higher So we take that ankle systolic blood pressure and divided by the brachial systolic blood pressure and then there is usually a graph or a sheet depending on the Ratio that this comes out to be it is either diagnostic or not diagnostic or it also tells us more about the severity of Dpad Complications so as the lower extremity loses blood flow to the skin to the hair to the blood vessels that Skin and muscles they atrophy so not enough blood flow means less exercise capability meaning atrophy and then there can also be delayed Delayed wound healing because we need that oxygen to be transported to the tissues in case there is a small abrasion or blister A cut but if we can deliver the oxygen because of this narrowing of the arteries The wound healing will be delayed and if it is significant then it can lead to necrosis Think about that also many times patients have underlying Hypercholesterolemia or diabetes so now they have a blister they already have delayed wound healing from their PAD now They have diabetes on top Maybe they have decreased sensation so that pretty quickly can lead to significant wound problems and also necrosis and then it also depends on the Amount of collateral circulation that they've might developed and if you want to know more about this term I have a separate video going into that Treatment for PED is decreasing the risk factors if we know patients have Hypertension their smokers they have high cholesterol. They have kidney issues their diabetics and also have these other Artherosclerotic arteries that we certainly need to counsel them on nutrition weight management decreased smoking decrease your lipid intake and also Exercise regularly in managed their weight here Many times patients are placed on anti platelet agents such as aspirin or plavix to as with anybody with with Artherosclerosis to make the blood a little bit more viscous going through the obstructed or narrowed arteries We also want to focus on foot care and make sure they have properly fitting shoes So that they don't have any kind of wounds that they develop on their lower extremities that then might have trouble healing If all these this fails and the patient has significant PAD as evidenced by any of these diagnostic tests or they are so symptomatic that they now are not able to ambulate at all There are surgical options So just like in the coronary arteries stents can be placed to open up the Clogged arteries that can be peripheral artery bypasses that are placed So we're bypassing the artery that's clogged or in severe cases if necrosis occurs amputations might occur as For nursing care our job is always making sure we educate our patients about the disease how it occurs and to decrease their risk Factors in the post-op period when any of these occur We always want to focus on the five piece just like with any lower extremity injury So we want to focus on the circulation the nerve the movement of the lower extremities We also manage their pain and check for complications because Arteries have been involved that can be a chance for bleeding. So hemorrhage that can be a hematoma formation They can also develop a thrombosis as with anybody post-op They might develop comp-martin syndrome or signs and symptoms of infection. So we need to be aware on how to check for those Possible post-op complications And then as with most patients we encourage early ambulation to get them moving Hopefully prevent thrombosis formation frequent position changes to help with the skin and also the prevent any kind of pulmonary issues and Then we don't want them then their need to be flexed because now if we have let's say a stent place to a peripheral artery Bypass we don't want to kink that new bypass in the knee passage So because that could obstruct it and then impede the blood flow to the lower extremities And that depends on the surgeon on how long that needs to occur And then certainly compression stockings to help the blood flow and the venous return from the lower extremities And make sure the patient doesn't develop a blood clot So thank you for watching this video on the peripheral artery disease also check out my video on venous thromboembolism or DVT as it is sometimes called plus all the Complications that I've talked about during the video. 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