PERIPHERAL ARTERIAL OCCLUSIVE DISEASE

INTRODUCTION
Arterial insufficiency of the extremities occurs most often in men and is a common cause of disability.
The legs are most frequently affected; however, the upper extremities may be involved. The age of onset
and the severity are influenced by the type and number of atherosclerotic risk factors. In PAD, obstructive
lesions are predominantly confined to segments of the arterial system extending from the aorta below the
renal arteries to the popliteal artery. Distal occlusive disease is frequently seen in patients with diabetes
and in older patients.
Peripheral Arterial Occlusive Diseases (PAOD) is blockage or narrowing of an artery in the legs (or
rarely the arms), usually due to atherosclerosis and resulting in decreased blood flow. Thrombus or blood
clotting also cause narrowing of the artery. Most cases of arterial thrombosis are caused when a process
called atherosclerosis damages an artery. Fatty deposits build up on the walls of the arteries and cause
them to harden and narrow.
PT’S DATA
Name: Mr. E. D.
Age: 42 y/o
Sex: Male
Address: Roxas City
Birthday: March 15, 1980
Religion: Roman Catholic
Civil Status: Married
Nationality: Filipino
Ward: Male Surgical Ward
Chief Complaint: Infected wound left foot
Attending Physician: Dr. C. Entona
Admitting Diagnosis: Peripheral arterial occlusive disease
PAST MED HX
PRESENT MED HX
FAMILY HX
HTN
SOCIAL HX
Military
CLINICAL HX
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MANAGEMENT/ TREATMENT
 Medical
1. Medication therapy.
a. Antiplatelet agents.
b. Anti-platelet agents.
c. Antihypertensive agents.
d. Antihyperlipidemic medications.
2. Stop smoking.
3. Dietary management.
a. Decrease cholesterol and triglyceride intake.
b. Reduce weight if needed.
c. Control sodium intake.
4. Exercise program as tolerated.
5. Control diabetes and hypertension.

 Surgical
1. Peripheral atherectomy removal of plaque within the artery.
2. Bypass graft: bypass of an obstruction by suturing a graft proximally and distally to the
obstruction.
3. Patch graft angioplasty: artery is opened, plaque is removed, and a patch is sutured in the opening
to widen the lumen.
4. Amputation: use as a last resort when other therapies have failed and gangrene or infection is
extensive.

 Non-surgical
1. Percutaneous transluminal angioplasty: use of a balloon catheter to compress the plaque against
the arterial wall.
2. Laser-assisted angioplasty: a probe is advanced through a cannula to the area of occlusion a laser
is used to vaporize atherosclerotic plaque.
3. Intravascular stent: placement of a stent within a narrow vessel to maintain patency.
Surgical Interventions:
o Surgical procedures for PAD
 Percutaneous transluminal angioplasty
- Invasive intra-arterial procedure uses a balloon and stent to open and help
maintain patency of the vessel.
- It is used for candidates who are not suitable for surgery or in cases where
amputation is inevitable.
 Laser-assisted angioplasty
- Invasive procedure where a laser probe is advanced through a cannula to the site
of stenosis.
- The laser is used to vaporize atherosclerotic plaque and open the artery.
 Nursing Actions
- The priority for postoperative care is observing for bleeding at the puncture site.
- Closely monitor the client’s vital signs, peripheral pulses, and capillary refill.
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- If prescribed, keep the client on bed rest with his limb straight for six to eight
hour before ambulation.
- Anticoagulant therapy is used during the operative procedure, followed by
antiplatelet therapy for one to three months.
 Arterial revascularization surgery is used with clients who have severe claudication
and/or limb pain at rest, or with clients are at risk for losing a limb due before arterial
circulation.
- Bypass grafts are used to re-route the circulation around the arterial occlusion.
- Grafts can be harvested from the client (autologous) or made from synthetic
materials.
 Nursing Actions
- The priority for postoperative care is to maintain adequate circulation in the
repaired artery. The location of the pedal or dorsalis pulse should be marked and
its pulsatile strength compared with the contralateral leg on a scheduled basis
using a Doppler.
- Color, temperature, and capillary refill should be compared with the contralateral
extremity on a scheduled basis.
- Warmth, redness, and possible edema of the affected limb should be present as a
result of increase blood flow.
- Monitor the client for pain. Pain may be severe due to the reestablishment of
blood flow to the extremity.
- Monitor the client’s blood pressure for hypotension or hypertension. Hypotension
may result in an increased risk of clotting or graft collapse, while hypertension
increases risk for bleeding from sutures.
- Instruct the client to limit bending of the hip and knee to decrease the risk of clot
formation.
 Client Education
- Instruct the client to avoid crossing his legs or raising his legs above the level of
the heart.
- Instruct the client to wear loose clothing.
- Instruct the client on wound care if revascularizations surgery was done.
- Discourage smoking and cold temperatures with the client.
- Instruct the client about foot care (keep feet clean and dry, wear good-fitting
shoes, never go barefoot, cut toenails straight across or have the theories
podiatrist cut nails).
 PERIPHERAL ARTERIAL OCCLUSIVE DISEASE

NCP - Risk for Infection

Intervention
1. Note risk factors for occurrence of infection such as skin or tissue wounds and surgeries or
invasive procedures underwent.
R: Causative factors for infection are the following: broken skin, suppressed inflammatory
response, immunosuppression, tissue destruction, chronic disease, and malnutrition.
2. Observe for localized signs of infection at the sutures or surgical incisions such as redness,
drainage and swelling.
R: Incisions that have been closed with sutures or staples should be free of redness, swelling, and
drainage. These incisions are usually kept covered by a dressing for 24-48 hours; beyond 48
hours there is no need for a dressing if the incision is not draining.
3. Note for signs and symptoms of sepsis such as fever, chills, diaphoresis, and altered level of
consciousness.
R: For the first 48-72 hours to postoperatively, temperatures of up to are expected as normal
stress response after major surgery. Beyond 72 hours, temperatures spikes, usually occurring in
the later afternoon or night, are often indications of infection.
4. Assess all peripheral and central IV sites for redness, swelling, warmth, purulent drainage, and
pain.
R: Continual monitoring for signs of inflammation or infection is essential.
5. Monitor white blood cell count.
R: Elevated WBC count is typically an indication of infection; however, in older patients,
infection may be present without an increase in WBC count because of normal changes in the
immune system.
6. Educate the patient and family on the signs and symptoms of infection: elevated temperature,
redness, swelling of the incisional site, and purulent or foul-smelling wound drainage.
R: Educating the patient and family assists in early recognition of adverse signs and symptoms. It
promotes their sense of control and minimizes anxiety and fear.
Evaluation
Goal met AEB:

 Clean and dry wound dressing /op site;

 Surrounding area of the incision site is free of redness, swelling, and purulent discharge.
 Normal V/S.