Polish up on client care

Teaching topics
Explanation of the disorder and treatment
plan
Medications and possible adverse effects
Explanation of all tests and treatments
Coughing and deep breathing exercises
Slow resumption of daily activities and
scheduled rest periods in daily routine

57

Paralysis and paresthesia in the affected

arm or leg
Pulselessness distal to the occlusion
Sudden and localized pain in the affected
arm or leg (most common symptom)
Temperature change that occurs distal to
the occlusion

Internal and external carotid arteries

Peripheral artery disease

In peripheral artery disease, the obstruction
or narrowing of the lumen of the aorta and
its major branches causes an interruption
of blood flow, usually to the legs and feet.
Peripheral artery disease may affect the
carotid, vertebral, innominate, subclavian,
mesenteric, and celiac arteries. Occlusions
may be acute or chronic and commonly
cause severe ischemia, skin ulceration, and
gangrene.
Peripheral artery disease is more common
in males than in females. The prognosis
depends on the location of the occlusion,
the development of collateral circulation to
counteract reduced blood flow and, in acute
disease, the time elapsed between the occlusion and its removal.

Absent or decreased pulsation with an auscultatory bruit over affected vessels

Stroke
Transient ischemic attacks (TIAs), which
produce transient monocular blindness, dysarthria, hemiparesis, possible aphasia, confusion, decreased mentation, headache

Subclavian artery
Subclavian steel syndrome (characterized by the backflow of blood from the brain
through the vertebral artery on the same side
as the occlusion into the subclavian artery
distal to the occlusion; clinical effects of vertebrobasilar occlusion and exercise-induced
arm claudication)

Vertebral and basilar arteries

TIAs, which produce binocular vision
disturbances, vertigo, dysarthria, and falling
down without loss of consciousness

CAUSES

Atherosclerosis
Emboli formation
Thrombosis
Trauma or fracture

CONTRIBUTING FACTORS
Age
Diabetes
Family history of vascular disorders, MI,
or stroke
Hyperlipidemia
Hypertension
Smoking

DIAGNOSTIC TEST RESULTS

Arteriography demonstrates the type
(thrombus or embolus), location, and degree
of obstruction and collateral circulation.
Doppler ultrasonography shows decreased
blood flow distal to the occlusion.
EEG and a computed tomography scan
may be necessary to rule out brain lesions.
Ophthalmodynamometry helps determine the degree of obstruction in the internal
carotid artery by comparing ophthalmic artery
pressure to brachial artery pressure on the
affected side. A more than 20% difference between pressures suggests insufficiency.

Tickle my toes.
Everyone depends
on me. If my aorta
is obstructed, even
the feet feel it.

ASSESSMENT FINDINGS
Assessment findings depend on the site of the
occlusion.

Femoral, popliteal, or innominate arteries

Mottling of the extremity
Pallor

313419NCLEX-RN_Chap03.indd 57

NURSING DIAGNOSES
Ineffective tissue perfusion (type depends
on the location of the occlusion)
Fear
Risk for injury

4/8/2010 7:01:50 PM