Nursing care for peripheral arterial disease
外周动脉疾病的护理
A. Description 说明
1. Peripheral arterial disease refers to the chronic disorder in which partial or total arterial occlusion deprives the lower extremities of oxygen and nutrients.
外周动脉疾病指动脉部分或全部闭合导致下肢缺氧和营养的慢性疾病。
2. Tissue damage occurs below the level of the arterial occlusion.
组织损坏，但程度低于动脉闭合。
3. Atherosclerosis is the most common cause of peripheral arterial disease.
动脉粥样硬化是最常见的外周动脉疾病病因。
B. Interventions 干预
Because swelling in the extremities prevents arterial blood flow, the client with peripheral arterial disease is instructed to elevate the feet at rest but to refrain from elevating them above the level of the heart, because extreme elevation slows arterial blood flow to the feet. In severe cases of peripheral arterial disease, clients with edema may sleep with the affected limb hanging from the bed or they may sit upright (without leg elevation) in a chair for comfort.
由于肢体肿妨碍了动脉血流，应教育外周动脉疾病患者休息时将脚抬高，但不得高于心脏水平位置，因为抬得过高会减缓到脚的动脉血流。对于严重的外周动脉疾病病例，水肿患者睡觉时可将患肢悬于床外，或端坐（不抬腿）在椅，这样更舒适些。
1. Preoperative interventions 术前干预
a. Assess baseline vital signs and peripheral pulses.
评估基线生命体征和周围脉搏
b. Insert an IV line and urinary catheter as prescribed.
按处方插入IV导管和尿导管
c. Maintain a central venous catheter and/or arterial line if inserted.
如已插入，维护中心静脉导管和/或动脉线。
2. Postoperative interventions 术后干预
a. Assess vital signs and notify the PHCP if changes occur.
评估生命体征，若有变化，通知PHCP。
b. Monitor for hypotension, which may indicate hypovolemia
监测有无低血压，它可提示血容量不足。
c. Monitor for hypertension, which may place stress on the graft and cause clot formation.
监测有无高血压，它可对移植物产生压力，引起栓块形成。
d. Maintain bed rest for 24 hours as prescribed. 按处方卧床24小时。
e. Instruct the client to keep the affected extremity straight, limit movement, and avoid bending the knee and hip.
指导患者伸直患肢，限止运动，避免屈膝屈髋。
f. Monitor for warmth, redness, and edema, which often are expected outcomes because of increased blood flow.
监测有无温热、红、水肿。这些都是预期的结果，因为血液增加了。
g. Monitor for vessel or graft occlusion, which often occurs within the first 24 hours.
监测有无血管或移植物闭合，头24小时经常会发生这种情况。
h. Assess peripheral pulses and for adverse changes in color and temperature of the extremity.
评估周围脉搏，评估有无肢体颜色和温度不利变化。
i. Assess the incision for drainage, warmth, or swelling. 评估切口有无渗液、温热或肿胀
j. Monitor for excessive bleeding(a small amount of bloody drainage is expected).
监测有无大量出血（预期会有少量带血渗液）
k. Monitor the area over the graft for hardness, tenderness, and warmth, which may indicate infection; if this occurs, notify the PHCP immediately.
监测移植物上方部位有无硬、触痛或温热，这些可能提示感染；如果出现这些情况，立即通知PHCP。
l. Instruct the client about proper foot care and measures to prevent ulcer formation.
指导患者正确护理足部及如何预防溃疡形成。
m. Assist the client in modifying lifestyle to prevent further plaque formation.
协助患者改变生活方式以预防斑块的进一步形成。
n. Following arterial revascularization, monitor for a sharp increase in pain, because pain is frequently the first indicator of postoperative graft occlusion. If signs of graft occlusion occur, notify the PHCP immediately.
动脉血运重建后，监测疼痛是否急剧加剧，因为疼痛常常是术后移植物闭合的第一指标。如果出现移植物闭合体征，立即通知PHCP。
★Vocabulary for Today ★
peripheral arterial disease – 外周动脉疾病
occlusion – n. 闭塞，阻塞
arterial occlusion – 动脉闭塞
deprive – v. 剥夺，夺去
atherosclerosis – n. 动脉粥样硬化
peripheral pulses – 周围脉搏
urinary catheter -- 尿导管
hypovolemia – n. 血容量不足
incision – n. 切口
plaque – n. 斑块
revascularization – n. 血运重建
★Video ★
Peripheral Vascular Diseases
★Test ★
1. A client is admitted to the hospital with peripheral vascular disease (PVD) of the lower extremities. He is scheduled for an amputation of the left leg. The client says, “I’ve really tried to manage my condition well.” Which of the following routines should the nurse evaluate as having been appropriate for him?
A. Resting with his legs elevated above the level of his heart.
B. Walking slowly but steadily for 30 minutes twice a day.
C. Minimizing activity.
D. Wearing antiembolism stockings at all times when out of bed. 2. A client with absent peripheral pulses and pain at rest is scheduled for an arterial Doppler study of the affected extremity. When preparing the client for this test, the nurse should: A. Have the client sign a consent form for the procedure. B. Administer a pretest sedative as appropriate. C. Keep the client tobacco-free for 30 minutes before the test. D. Wrap the client’s affected foot with a blanket.
1. B. Walking slowly but steadily for 30 minutes twice a day.
Rationale: Slow, steady walking is a recommended activity for clients with peripheral vascular disease because it stimulates the development of collateral circulation. The client with PVD should not remain inactive. Elevating the legs above the heart or wearing antiembolism stockings is a strategy for alleviating venous congestion and may worsen peripheral arterial disease. 2. C. Keep the client tobacco-free for 30 minutes before the test.
Rationale: The client should be tobacco-free for 30 minutes before the test to avoid false readings related to the vasoconstrictive effects of smoking on the arteries. Because this test is noninvasive, the client does not need to sign a consent form. The client should receive an opioid analgesic, not a sedative, to control the pain as the blood pressure cuffs are inflated during the Doppler studies to determine the ankle-to-brachial pressure index. The client’s ankle should not be covered with a blanket because the weight of the blanket on the ischemic foot will cause pain. A bed cradle should be used to keep even the weight of a sheet off the affected foot.
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