You will perform a history of a peripheral vascular problem that your instructor has provided you or one that you have experienced and perform a peripheral vascular assessment. You will document your subjective and objective findings, identify actual or potential risks, Write from a nursing perspective No consideration for plagiarism DUE 03/ 03/2022
Introduction
Peripheral vascular problems refer to conditions that affect the blood vessels outside of the heart and brain. These conditions can have various causes, including atherosclerosis, thrombosis, embolism, vasculitis, and aneurysms. In this assignment, we will explore the history of a peripheral vascular problem and perform a peripheral vascular assessment. The chosen case for this assignment is a patient with peripheral arterial disease (PAD). PAD is a common peripheral vascular disorder characterized by narrowing of the arteries that supply blood to the lower extremities.
History of Peripheral Arterial Disease (PAD)
Peripheral arterial disease is a chronic condition caused by atherosclerosis, a buildup of fatty deposits (plaque) in the arteries. The narrowing of the arteries restricts blood flow to the legs and feet, resulting in various symptoms. It is estimated that PAD affects approximately 8 to 12 million people in the United States (Gardner et al., 2019).
The patient in this case is a 65-year-old male who presents with a history of intermittent claudication. Intermittent claudication is a classic symptom of PAD characterized by leg pain or fatigue that occurs during exercise and is relieved by rest. The patient reports experiencing cramping, heaviness, and fatigue in his calves when walking for more than a few minutes. He states that the pain subsides when he stops walking and rests.
The patient also reports having a history of smoking for more than 30 years. Smoking is a major risk factor for PAD as it damages the lining of blood vessels and increases the risk of atherosclerosis. Additionally, the patient has a sedentary lifestyle and admits to rarely engaging in physical activity. Lack of exercise contributes to the development and progression of PAD by promoting atherosclerosis.
Peripheral Vascular Assessment
Performing a thorough peripheral vascular assessment is essential in evaluating a patient with suspected or diagnosed peripheral vascular problems. The assessment aims to identify any abnormalities in arterial or venous circulation, assess tissue perfusion, and determine the overall vascular status of the patient.
Subjective Findings
During the subjective assessment, the patient’s complaints and symptoms related to peripheral vascular problems are discussed. The patient reports intermittent claudication, which is indicative of compromised arterial blood supply to the lower extremities. The severity and frequency of the symptoms should be documented, as well as any factors that exacerbate or alleviate the pain or discomfort.
The patient also reports a history of smoking, which is a significant risk factor for atherosclerosis and PAD. It is important to assess the patient’s smoking status, years of smoking, and any efforts made to quit or reduce smoking.
Objective Findings
The objective assessment involves the physical examination and the use of specialized assessment techniques to assess vascular status. The physical examination includes inspecting and palpating the extremities, assessing the peripheral pulses, and checking the temperature and color of the skin.
During the examination of the lower extremities, the nurse should observe for signs of peripheral arterial insufficiency, such as pale or cool skin, hair loss, nail abnormalities, and dry or scaly skin. The presence of ulcers or wounds that are slow to heal may also indicate poor arterial circulation.
The nurse should also assess the peripheral pulses, including the radial, brachial, popliteal, dorsalis pedis, and posterior tibial pulses. Diminished or absent pulses may indicate arterial occlusion or stenosis.
Furthermore, the nurse should evaluate the capillary refill time, which is the time taken for color to return after pressure is released from the skin. Prolonged capillary refill time may indicate impaired tissue perfusion. Additionally, measuring the ankle-brachial index (ABI) can provide an objective measure of arterial blood flow to the lower extremities.
Risks of Peripheral Arterial Disease
Identifying actual or potential risks associated with peripheral arterial disease is crucial in managing the patient’s condition effectively. Risk factors can be categorized as modifiable or non-modifiable. The modifiable risk factors for PAD include smoking, sedentary lifestyle, hypertension, diabetes mellitus, dyslipidemia, obesity, and metabolic syndrome. Non-modifiable risk factors include age, gender (males are at a higher risk), and a family history of cardiovascular disease.
Conclusion
Performing a comprehensive history and peripheral vascular assessment is essential in evaluating and managing peripheral arterial disease. Understanding the patient’s subjective and objective findings, as well as identifying actual or potential risks, provides a basis for developing an appropriate care plan and implementing effective interventions. By addressing modifiable risk factors and promoting lifestyle modifications, such as smoking cessation and regular exercise, healthcare providers can improve patient outcomes and prevent further complications associated with peripheral arterial disease.