Peripheral Arterial Disease Nursing Care

In PAD, atherosclerotic plaque narrows the arteries supplying the limbs, so muscle and skin don’t get enough oxygenated blood — especially when demand rises. The risk factors mirror coronary artery disease (smoking is the biggest, plus diabetes, hypertension, hyperlipidemia, age), and PAD is a marker that the same disease is in the heart and brain.

The cardinal symptom is intermittent claudication — reproducible cramping leg pain brought on by walking and relieved by rest, because rest lowers oxygen demand back below the limited supply. As disease worsens, pain comes at rest too, classically at night when the legs are elevated in bed and gravity no longer helps perfuse them — patients dangle the leg off the bed for relief.

The ankle-brachial index (ABI) is the key bedside test: ankle systolic pressure divided by arm systolic pressure. A normal ratio is about 1.0–1.4; ≤0.90 confirms PAD, and values below ~0.5 indicate severe disease with rest pain and threatened limb. A falsely high ABI (>1.4) occurs with non-compressible, calcified vessels — common in diabetes — and is itself abnormal. The number quantifies what the pulses and skin already suggest.

Assess the 6 P’s of arterial compromise — pain, pallor, pulselessness, paresthesia, paralysis, poikilothermia (coolness) — and compare limbs side to side. Document pulses (dorsalis pedis, posterior tibial) by exact location and quality, capillary refill, skin temperature line, hair loss, and the appearance and exact site of any ulcer. The emergency to never miss is acute limb ischemia: sudden onset of the 6 P’s means an arterial occlusion and is a vascular emergency — time is tissue.

Smoking cessation is the conversation that matters most and the hardest to have well. Lectures fail; partnership works — ask permission to discuss it, connect the specific symptom to the specific cause (“the cramping is your muscles starving; nicotine tightens those same vessels”), and offer concrete help (cessation programs, pharmacotherapy) rather than willpower demands. For patients facing possible amputation, acknowledge the fear directly and frame foot care and walking as the things within their control that change the odds.

Teach daily foot inspection (a mirror for the soles), proper footwear and never going barefoot, no heating pads or hot soaks, and prompt attention to any cut or blister. Reinforce the walking program, smoking cessation, and tight control of diabetes, blood pressure, and cholesterol as the disease-modifying triad. Explain the positioning rule plainly — don’t prop these legs up — and review antiplatelet therapy (aspirin or clopidogrel) and its purpose. Red flags to call about: a new non-healing sore, a cold/pale/painful limb, or rest pain that’s worsening.