Assuntos
Doença Arterial Periférica/epidemiologia , Apneia Obstrutiva do Sono/epidemiologia , Fatores Etários , Enfermagem Cardiovascular , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doença Arterial Periférica/fisiopatologia , Fatores de Risco , Fatores Sexuais , Apneia Obstrutiva do Sono/fisiopatologiaRESUMO
There are >12 million patients with peripheral artery disease in the United States. The most severe form of peripheral artery disease is critical limb ischemia (CLI). The diagnosis and management of CLI is often challenging. Ethnic differences in comorbidities and presentation of CLI exist. Compared with white patients, black and Hispanic patients have higher prevalence rates of diabetes mellitus and chronic renal disease and are more likely to present with gangrene, whereas white patients are more likely to present with ulcers and rest pain. A thorough evaluation of limb perfusion is important in the diagnosis of CLI because it can not only enable timely diagnosis but also reduce unnecessary invasive procedures in patients with adequate blood flow or among those with other causes for ulcers, including venous, neuropathic, or pressure changes. This scientific statement discusses the current tests and technologies for noninvasive assessment of limb perfusion, including the ankle-brachial index, toe-brachial index, and other perfusion technologies. In addition, limitations of the current technologies along with opportunities for improvement, research, and reducing disparities in health care for patients with CLI are discussed.
Assuntos
Extremidades/patologia , Isquemia/diagnóstico , Doença Arterial Periférica/diagnóstico , American Heart Association , Índice Tornozelo-Braço , Equipamentos e Provisões , Etnicidade , Medicina Baseada em Evidências , Extremidades/irrigação sanguínea , Disparidades em Assistência à Saúde , Humanos , Isquemia/epidemiologia , Doença Arterial Periférica/epidemiologia , Fluxo Sanguíneo Regional , Estados Unidos/epidemiologiaAssuntos
American Heart Association , Terapia por Exercício/métodos , Claudicação Intermitente/terapia , Isquemia/terapia , Extremidade Inferior/irrigação sanguínea , Doença Arterial Periférica/terapia , Consenso , Teste de Esforço , Terapia por Exercício/efeitos adversos , Humanos , Claudicação Intermitente/diagnóstico , Claudicação Intermitente/epidemiologia , Claudicação Intermitente/fisiopatologia , Isquemia/diagnóstico , Isquemia/epidemiologia , Isquemia/fisiopatologia , Doença Arterial Periférica/diagnóstico , Doença Arterial Periférica/epidemiologia , Doença Arterial Periférica/fisiopatologia , Qualidade de Vida , Recuperação de Função Fisiológica , Resultado do Tratamento , Estados Unidos/epidemiologiaAssuntos
Pressão Sanguínea , Antebraço , Braço , Determinação da Pressão Arterial , Humanos , PesquisaRESUMO
TBP and TBI are considered more accurate in assessing lower extremity perfusion in those patients with a falsely elevated ABI suspected from medial arterial calcification. Like the ABI, a TBI may be obtained by the nurse through a similar procedure using a sphygmomanometer and hand-held Doppler. Knowledge by the vascular nurse of this noninvasive technique will assist in a more timely recognition of PAD and may improve long-term patient outcomes.
Assuntos
Índice Tornozelo-Braço , Pressão Sanguínea/fisiologia , Doença Arterial Periférica/diagnóstico , Dedos do Pé/fisiologia , Artéria Braquial , Humanos , Fluxo Sanguíneo Regional , Dedos do Pé/irrigação sanguíneaRESUMO
Venous thromboembolism is defined as an acute venous thrombotic event that targets two disease entities: deep vein thrombosis (DVT), pulmonary embolism, or both. The most common site of DVT origin is in the lower extremities, with 50% of patients exhibiting no symptoms. Although anticoagulation is the gold standard for DVT, early clot removal, especially of proximal iliofemoral DVT, is felt to reduce the incidence of postthrombotic syndrome (PTS) by preserving valve function. Up to one-half of all patients with an iliofemoral DVT treated only with anticoagulation subsequently develop long-term complications, including PTS. Beside anticoagulation, DVT treatment options may include pharmaceutical and/or mechanical therapies. Mechanical therapies consist of either endovascular percutaneous catheter-directed (PCD) interventions or open operative thrombectomy. There are several different PCD procedures available, consisting of catheter-directed thrombolysis, mechanical thrombectomy, combination pharmacomechanical devices, and postthrombus extraction (angioplasty and/or stenting). Endovascular therapies in the management of acute iliofemoral DVT are evolving with a variety of devices available to treat this disease entity. The purpose of this article is to provide an overview of the PCD therapies used when treating patients experiencing an acute iliofemoral DVT along with associated nursing considerations. Off-label device use is not included.
Assuntos
Cateterismo Periférico , Procedimentos Endovasculares/métodos , Veia Femoral , Veia Ilíaca , Trombose Venosa/terapia , Angioplastia , Anticoagulantes/uso terapêutico , Procedimentos Endovasculares/instrumentação , Humanos , Stents , Terapia Trombolítica/métodosAssuntos
Angioplastia/enfermagem , Enfermagem Cardiovascular , Estenose das Carótidas/enfermagem , Endarterectomia das Carótidas/enfermagem , Stents , Estenose das Carótidas/patologia , Estenose das Carótidas/terapia , Medicina Baseada em Evidências , Humanos , Educação de Pacientes como Assunto , Cuidados Pós-Operatórios/enfermagem , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento , Estados UnidosRESUMO
Clinical practice guidelines are statements to assist in healthcare decisions for patients with the same illness or procedure. Guidelines comprise elements that describe different aspects of the patient's condition and the required care. Many organizations publish guidelines, including the Society for Vascular Nursing. Evidence is the foundation of guidelines and their practice recommendations. This evidence is primarily from research. Developing a grading system for the research and the associated practice elements improves the strength of a guideline's statements. This article discusses the grading system selected by the Society for Vascular Nursing (SVN) Practice and Research Committee when creating the forthcoming carotid stent nursing practice guideline.
Assuntos
Doenças das Artérias Carótidas/enfermagem , Doenças das Artérias Carótidas/cirurgia , Enfermagem Baseada em Evidências/métodos , Processo de Enfermagem/normas , Guias de Prática Clínica como Assunto , Humanos , Sociedades de Enfermagem , Stents , Estados UnidosRESUMO
A postoperative nursing goal in a patient with peripheral artery disease requiring lower-extremity arterial reconstruction surgery is to maintain blood flow and tissue oxygenation to the revascularized extremity. This may be achieved through extremity positioning. Transcutaneous oxygen (TcPO(2)) measurements provide a noninvasive objective determination of oxygen at the skin surface and assessment of underlying circulation and tissue oxygenation. The purpose of this study was to determine which lower-extremity position afforded the highest TcPO(2) in 10 subjects with a lower-extremity arterial revascularization procedure preoperatively and 24 and 48 hours postoperatively. Hypotheses included comparing preoperative and postoperative TcPO(2) measurements, leg skin temperatures, and limb volumes. The subjects were studied in three different leg/body positions: supine with legs extended, sitting with legs extended, and supine with legs-elevated 20 degrees using the Radiometer TCM30 (Radiometer; Copenhagen) and PhysitempTH-5 Thermalert (Physitemp; Clifton, NJ) monitors. There was no change in the postoperative leg TcPO(2) measurements or limb volumes compared with preoperative measurements (P = .12-.92). A small sample size and lack of peripheral artery disease stratification were among study limitations. Significant to the nursing care of patients with vascular dsease is the finding that any of the leg/body positions in this study could be used postoperatively on the revascularized extremity without decreasing TcPO(2) measurements.