- Ulceration -> decreased nutrients, WB areas / bony prominences
o :### Integumentary Changes with PAD
- Sensory Disturbances
- Paresthesia
- Intolerance to heat/ cold
- Diminished / absent LE pulse
- Muscle weakness/ atrophy d/t disuse
- Pain @ rest d/t increasing ischemia
o :### Manifestations of PAD
1. Promote postures / activities that increase blood flow to extremities through collateral
circulation
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2. Decrease pain
3. Maintain/ improve function
4. ROM/ strengthening
5. Endurance training
6. Prevent/ to ulcers
o :### Goals of Tx for pt with PAD
1. Graded exercise -> focus on circulation & decreased claudication
2. Graded exercise -> focus on promotion of distal circulation
3. Warm up & cool down
4. Improve tolerance by increasing time between claudication onset
5. Promote vasodilation
6. LE DEPENDENT postures -> gravity influences on circulation -> forces blood to reach distal LE
7. AROM -> increase local circulation better than PROM
8. EDUCATION HEP -> Foot/skin care ; positioning
o :### Tx options for pt with PAD
- Femoral
- Popliteal
- Dorsalis
- Pedis
*pt supine & TEST BILATERALLY*
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o :### Pulse Examination Assessments
0 = Absent
1 = Diminished
2 = Normal
3 = Bounding
o :### Grading scale for Pulse examination
Indirect measure of peripheral perfection - systolic BP ankle / systolic BP brachium
- Normal ABI measurement is 0.9 - 1.19
- *Lower ABI indicate arterial insufficiency
o :### Ankle Branchial Index (ABI)
Noninvasive test used to indirectly assess arterial flow in the LE
1. Place the pt in supine *note color of plantar surface*
2. Elevate pt LE 60° for 1 minute *Note color of plantar surface*
- *Normal arterial flow will show MIN to no color change with elevation
- * Arterial sufficient limbs will become PALE with elevation
3. Return LE to start position & record time for return to original color
o :### Rubor of Dependency
Pts with peripheral artery insufficiency disease
- Intended to improve circulation to the LE & Feet
- Exercises are repeated 3-6 times at each sitting & done several times a day
Master01: DO NOT COPY AND PASTE!! August 21, 2024 Latest Update
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