1. Peripheral Vascular Disease By: Tabitha Piegza, Samantha Panek, Carlos Rubio, and Jared Grossman

2. Peripheral Vascular Disease Peripheral artery disease (also called peripheral arterial disease) is a common circulatory problem in which narrowed arteries reduce blood flow to your limbs. When you develop peripheral artery disease (PAD), your extremities — usually your legs — don't receive enough blood flow to keep up with demand. This causes symptoms, most notably leg pain when walking (claudication). Peripheral artery disease is also likely to be a sign of a more widespread accumulation of fatty deposits in your arteries (atherosclerosis). This condition may be reducing blood flow to your heart and brain, as well as your legs. You often can successfully treat peripheral artery disease by quitting tobacco, exercising and eating a healthy diet. (Mayo Clinic.org)

3. Concepts Involved Gas Exchange Sensory Perception Mobility Safety Comfort

4. Mr. Peterson Mr. Peterson is a 68-year-old retired painter who is experiencing right leg calf pain. The pain began approximately 2 years ago but has become significantly worse in the past 4 months. The pain is precipitated by exercise and is relieved with rest. Two years ago he could walk 2 city blocks before having to stop due to leg pain. He presents to the doctor’s office today with his wife and 2 of his adult children because he has severe pain in his legs when he walks even short distances and also because he has lost sensation in several areas on both feet. He has several injuries on his feet that he was not aware of.

5. Mr. Peterson (cont.) Mr. Peterson has smoked 2 to 3 packs of cigarettes per day (PPD) for the past 45 years. He has a history of coronary artery disease (CAD), hypertension (HTN), peripheral vascular disease (PVD), and osteoarthritis. Surgical history includes quadruple coronary artery bypass graft (CABG \4) 3 years ago. He continues to eat anything he wants, and continues to smoke 2 to 3 PPD. Mrs., Peterson has become very irate with her husband because he continues to smoke. He states his wife has locked him out of the house on several occasions when he goes out on the porch to smoke. Mrs. Peterson agrees that the relationship with her husband has become very strained because of his smoking and because he won’t follow the doctor’s recommendations.. “and besides he stinks and smells like smoke”.

6. What is Peripheral Vascular Disease (PVD)? What are the signs and symptoms and how the diagnosis is established (venous vs arterial)? A circulatory condition in which narrowed blood vessels reduce blood flow to the limbs. What are the types of PVD? Arterial occurs in the peripheral arteries. Venous occurs in the vein such as deep vein thrombosis caused by claudication What are the risk factors? Aging, diabetes, and smoking What is the collaborative care for this patient? Cardiologist: Specializes in heart disorders. Vascular surgeon: Specializes in surgery for vascular system diseases. Primary care provider (PCP): Prevents, diagnoses, and treats diseases. Vascular medicine doctor: Specializes in circulatory and lymphatic diseases.

7. What is the treatment? Stop smoking because it reduces blood flow cilostazol or pentoxifylline—to increase blood flow to the legs, ease leg pain, and relieve symptoms of claudication clopidrogel or daily aspirin—to reduce risk of blood clots. Clots could cut off the blood supply to a limb. This puts you at risk of amputation. atorvastatin, simvastatin, or other statins—to lower high cholesterol angiotensin-converting enzyme (ACE) inhibitors—to lower high blood pressure Diabetes medication to control blood sugar if you have diabetes Blood thinners: Clopidogrel (Plavix), Pentoxifylline (Trental) Statin: Simvastatin (Zocor), Atorvastatin (Lipitor), Rosuvastatin (Crestor) Other treatments: Cilostazol (Pletal) Self-treatment Anti-inflammatory: Aspirin (Ecotrin) Also common Lifestyle: Physical exercise, Smoking cessation Procedures: Angioplasty Other treatments: Heart healthy diet

8. What is the prognosis? If diagnosed early, most cases of PVD will respond to lifestyle treatments. One way to measure improvement is to determine how far you can walk without pain. With effective treatment, you should be able to gradually increase the distance. What other resources are available that can help with education and support? Home health care, PCP follow-up, a local pharmacy, physical rehabilitation (depending on circumstance) When should you seek further medical attention? your leg looks pale or blue your leg becomes cold chest pain accompanies leg pain your leg becomes red, swollen, or hot new sores or ulcers develop and do no heal you experience fever, chills, weakness, or other signs of infection