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Peripheral Vascular Disease Nursing Guide

This course is intended as a Quick Reference for peripheral vascular disease and will cover an overview as well as nursing considerations utilizing the nursing process.

Etiology and Epidemiology

Peripheral Vascular Disease Definition

Peripheral vascular disease (PVD) is a broad term that describes multiple conditions and diseases that cause a reduction and/or restriction of blood flow to the areas of the body outside the brain and heart, including arteries, veins, and the lymphatic vessels, which can lead to lymphedema. While these conditions can occur in any peripheral vessels, they most commonly occur in the lower extremities. PVD can be chronic or acute with mild to severe symptoms and complications. PVD encompasses several conditions which include (Columbia University, 2021): 

  • Atherosclerosis 
  • Buerger disease 
  • Venous thromboembolism (VTE) 
    • Deep vein thrombosis (DVT) 
    • Pulmonary embolism (PE) 
  • Raynaud phenomenon 
  • Thrombophlebitis 
  • Chronic venous insufficiency (CVI) 

Some familiar disorders and diseases that are classified as PVD include peripheral arterial disease (PAD), CVI, DVT, and lymphedema. 

PVD is often times used interchangeably with PAD, as it is a very common form of PVD. There are over 6.5 million people living with PAD over the age of 40 in the U.S. (Centers for Disease Control and Prevention [CDC], 2021). Peripheral artery disease (PAD) is a condition that causes a decrease in blood flow to the body’s tissues due to narrowing and hardening of the arteries, usually in the lower extremities. 

Unlike PVD that may affect any blood vessel, PAD only effects the arteries of the body. PAD results from a thickening of the muscle and wall lining of small arteries and arterioles (arteriosclerosis) and the gradual accumulation of plaques in the arteries (atherosclerosis). Researchers theorize that PAD starts from an injury to the lining of the artery wall. This injury is likely due to smoking, diabetes, hypertension, hypercholesterolemia, and/or being over 60 years old, which are all risk factors for PAD (CDC, 2021). 

The severity of symptoms is a direct result of the degree of blood flow to the affected extremity. Symptoms of PAD include: 

  • Pain: Intermittent claudication and rest pain 
  • Skin changes: Cool and pale, rubor, loss of hair, brittle nails, and dry scaly skin 
  • Pulses: Weakening or absence of peripheral pulses 
  • Skin ulcers/injury 

 

Other signs and symptoms of PAD may include (Mayo Clinic, 2021): 

  • Pallor or ashen skin tone with a shiny appearance 
  • Delayed capillary refill 
  • Erectile dysfunction in men 
  • Poor or absent hair growth on the legs and feet 
  • Leg numbness and/or weakness 

Chronic venous insufficiency (CVI) is a condition in which venous blood flow of the lower extremities is impaired, causing blood to pool in the veins (stasis). Venous insufficiency causes progressive damage to the vein, ranging from mild cosmetic issues to very severe issues. This progressive damage can result in chronic venous insufficiency. Impairment of venous blood flow may occur because of (Youn & Lee, 2019): 

  • An obstruction, such as a thrombus. Once the obstruction is removed, blood flow will usually resume as normal. 
  • The failure of the valves to close completely, resulting in the backward flow of blood and the pooling of blood in the lower extremities. This is called venous stasis. Valve closure failure can occur due to: 
    • Damaged valves, usually because of phlebitis or deep vein thrombosis (DVT). 
    • Stretched veins. A lack of muscle contraction when a person stands or sits for long periods engorges the vein with blood. Over time, the increased pressure stretches the vein wall, causing incomplete closure of the valve. 

CVI may cause problems which include (Youn & Lee, 2019): 

  • Edema 
  • Pigmentation and/or eczema 
  • Atrophie blanche 
  • Lipodermatosclerosis 
  • Varicose veins 
  • Telangiectases 
  • Reticular veins 
  • Venous ulceration 

DVT can range across the entire clinical spectrum from being unsuspected to causing death. Researchers believe that three factors, known as Virchow’s triad, are involved in the development of DVTs in the lower extremities. The risk for the development of a DVT increases in the presence of any one of these factors. Individuals who have multiple factors are at an even greater risk. 

The three factors are (Kushner et al., 2020): 

  • Venus stasis 
  • Vessel wall injury 
  • Hypercoagulability 

 

Peripheral Vascular Disease ICD-10 Code (unspecified): I73.9

 

Peripheral Vascular Disease Diagnosis 

Diagnosis of PVD diseases and disorders range from visual inspection to specialized imaging including: 

  • Ankle-brachial index (ABI) 
  • Magnetic resonance imaging (MRI) 
  • Computed tomography (CT) scan 
  • Angiography 
  • Doppler ultrasound 
  • Duplex ultrasonography is the standard imaging test to diagnose a DVT 
  • D-dimer 
  • Contrast venography 
  • Lymphoscintigraphy, which is radionuclide imaging of the lymphatic system 

 

Management 

Management of PVD diseases and disorders are dependent on the acuity, severity, and type of PVD. With the aim to relieve symptoms, preserve function, and minimize risk factors that contribute to disease progression, interventions include attention to: 

  • Diet 
  • Activity/exercise 
  • Education 
  • Foot and skin care 
  • Pharmacological therapy 
    • Anti-inflammatories 
    • Vasodilators 
    • Antiplatelet therapy 
    • Anticoagulants 
    • Thrombolytics 
  • Compression therapy 
    • Compression garments 
    • Multi-layer compression bandaging 
    • Compression devices 
  • Surgical treatments: 
    • Revascularization 
    • Sclerotherapy 
    • Endovenous thermal ablation 
    • Stripping and ligation 
    • Microincision/ambulatory phlebectomy 
    • Vein bypass 
    • Thrombectomy/embolectomy 
    • Inferior vena cava (IVC) filters 

 

Nursing Considerations 

Use the nursing process to develop a plan of care for individuals. The nursing assessment (with common findings listed), diagnoses, interventions, expected outcomes, and education for peripheral vascular disease are listed below. 

 

Assessment 

A thorough history should be taken on past/present health condition, current symptoms, medication regimen, diet, and activity habits. You may discover a wide range of symptoms as you explore the individual’s: 

  • Past and present health conditions 
  • Current symptomology 

 Medication history 

  • Surgical history 
  • Smoking history 
  • Dietary history 
  • Activity history 

During the head to toe assessment there may be few to no symptoms. However, some symptoms that you may encounter include: 

  • Diminished/weakened pulses of the lower extremities 
  • Weakness 
  • Open wounds 
  • Purulent drainage 
  • Weeping 
  • Redness 
  • Swelling 
  • Edema 
  • Eczema 
  • Flaking/crusted skin 
  • Hardened skin 
  • Cool skin 
  • Shiny skin 
  • Pallor 
  • Poor skin turgor 
  • Necrotic skin 
  • Low grade fever 
  • Limited range of motion (ROM) 
  • Delayed capillary refill in toes 
  • Decreased sensations of lower extremities 
  • Stroke signs and symptoms 
  • Pulmonary embolism (PE) signs and symptoms 

The individual may report (Beckerman, 2020): 

  • Pain 
  • Cold feet and legs 
  • Loss of leg hair 
  • Impotence 
  • Falls 
  • Numbness 
  • Tingling 
  • Decrease in activities 
  • Weakness/heaviness in lower extremities 

During assessment, it is also important to assess the individual’s emotional and mental state 

 due to possible changes in quality of life and mobility. 

 

Nursing Diagnosis/Risk For 

  • Pain 
  • Fatigue 
  • Deficient knowledge of disease and disease processes 
  • Imbalanced fluid volume 
  • Imbalanced nutrition 
  • Falls 
  • Injury 
  • Fracture 
  • Impaired skin 
  • Infection 
  • Disturbed body image 
  • Depression 
  • Failure to thrive 

 

Interventions 

Interventions should reflect the individualized needs of the person. Interventions should ensure safety, comfort, and symptom management and include: 

  • Monitoring: 
    • Vital signs 
    • Levels of consciousness 
    • Efficacy of treatment 
    • Input and output 
    • Fall precautions 
  • Restricting water intake if warranted 
  • Assessing the skin 
  • Providing: 
    • Comfort measures 
    • Prescribed wound care 
  • Encouraging: 
    • Activity/exercise 
    • Dietary changes to reduce diet-related symptoms 

 

Expected Outcomes 

The individual will demonstrate: 

  • Reduction of symptoms 
  • Maintenance of normal pulses in extremities 
  • Improved circulation to lower extremities 
  • Compliance with medication regimen 
  • Compliance with dietary requirements and fluid restrictions 
  • No report of new falls and/or injuries 
  • Improved wound healing 
  • Improved mobility and functioning 

 

Individual/Caregiver Education 

  • Disease process: How to prevent or lessen vasoconstriction, which further impedes blood flow, by avoiding (Mayo Clinic, 2021): 
    • Smoking 
    • Exposure to cold temperatures 
    • Crossing the legs when sitting 
    • Wearing constrictive clothing 
    • Over-the-counter cold medications containing pseudoephedrine 
  • Work with provider to successfully manage comorbidities that contribute to symptoms such as: 
    • Hypertension 
    • Hypercholesterolemia 
    • Diabetes 
  • Self-care measures: 
    • Quiet space 
    • Relaxation techniques 
    • Deep breathing 
  • Medication compliance: Importance of taking medication as prescribed to manage symptoms and prevent permanent damage to multiple body systems 
  • Importance of dietary changes and management (USA Vascular Centers, 2020): 
    • Avoid a diet high in saturated fats, sugar, and sodium such as fatty meats, bacon, high sodium processed lunch meat, fried food, and fast food. 
    • Incorporate the use of healthy oils such as avocado and olive oil; replace sugar with honey; add nuts, berries, legumes, and sliced turkey instead of processed lunch meats, and whole grain bread instead of white bread. 
  • A healthy diet should also include a healthy water intake and avoidance of sugary drinks and alcohol. 
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Additional Information

Content Release Date 

4/1/2022

Content Expiration

12/31/2027

 

Course Contributor 

The content for this course was created by Tameka N. Warren, MSN, RN, CLC. 

Tameka N. Warren, MSN, RN, CLC, earned her Bachelor and Master of Science in Nursing degrees from Indiana University School of Nursing at IUPUI, and her Associate of Science in Nursing from Ivy Tech College. She has over 16 years of nursing experience in public health, regulation, home health, education, maternal child community health, and long-term care environments. Tameka served as a Public Health Nurse Surveyor (Home Health & Hospice) certified by the Centers for Medicare & Medicaid Services, or CMS, a maternal and infant mortality advocate, an ALPP Certified Lactation Counselor, and an Adjunct Clinical Professor. Tameka’s passion is to serve the most vulnerable populations affected by health disparities and to inspire a new generation of nurses to do the same successfully. 

 

References