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what is the major cause of PAD?
smoking, DM, HTN
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PAD prevalence increases with age, for women more than men (who are higher risk earlier then risk
lowers below that of older women). The prevalance of PAD is 1 in how many patients?
1:3 patients in primary care have PAD
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Rank these ethnic groups by their population with PAD. from highest incidence to lowest
NHW
Black
Hispanic
Asian
- 1. Black
- 2. NHW
- 3. Hispanic
- 4. Asian
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Does PAD incude the coronary arteries?
no, although CAD and PAD often co-exist
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the incidence of MI, strokes,&heart disease is higher among which group...patients with CAD or those with PAD?
- PAD.
- FACT: Patients with PAD have a 6x greater chance of dying from associated heart disease compared with age related controls.
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why are individuals with PAD at increased risk
for CV events?
d/t concommitant CAD
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these are risk factors for what?
-age <50 with DM and one additional PAD risk factors-smoking, dyslipidemia, HTN, hyperhomoocysteinemia.
-age 50-69 and hx of smoking or DM
-70 or older
-leg sx at rest (cladication) or ischemic rest pain
-abnormal LE pulses
-known atherosclerotic coronary,carotid, or renal disease.
lower extremity PAD,screen with ABI
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what ia a normal ABI value?
0.9-1.3
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a history of walking impairment , claudication, and ischemic rest pain is recommended as part of the ROS for clients 50+ who have atherosclerotic risk factors (and for those 70 yrs+). What are the risk factors?
smoking, DM,HTN, hypercholesterol, hyperhomocysteinemia and elevated C-reactive protein
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client complains his legs get tired and achy when he walks too far what might this be?
intermittant claudication, it can be pain, aches, fatigue or numbness but when the cause is PAD, it will always get better when activity stops.
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client c/o pain in hip and buttocks where is his arterial ischemia likely to be?
aorto iliac
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client c/o pain in his thigh, what vessel might his PAD ischemia be associated with?
femoral or aorto illiac
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client with PAD risk factors c/o pain in his lower calf where might the ischemia be? what artery?
popliteal
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the vascular report shows ischemia in the tibial and peroneal artery for your patint. where would you expect his pain to be located?
foot
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the foot is pale when elevated and red when dependant, what vasular disease are you considering?
PAD
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ROS for PAD. history questions.
- limb pain with exertion?
- where is the pain located?
- describe pain pattern-does pain stop when activity stops? how far can u walk before pain occurs? do U have pain at rest?
- any cold, numbness, loss of sensation or pallor in limbs?
- any hair lss over anterior tibial surface?
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What does the vascular exam include?
- inspect skin-hair loss, color, trophic skin, hypertrophic nails.
- cardiac exam
- BP both arms
- check carotid, abdomen, aorta for bruits
- pulses, including abdomen aortic size
- LE color, temp, integrity, sensation
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Recommendations for "At Risk" for LE PAD ( screen with ABI)
- age <50 with DM +1 otheer-smoke, dyslipidemia, HTN or Hyperhomocysteinemia
- age 50-69 + hx of smoking and DM
- age 70 and over
- leg sx with exertion or ischemic rest pain
- abnormal LE pulses
- known atherosclerotic coronary, carotid or renal artery disease
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what questions should be included in ROS for person>50 with atherosclerotic risk fators. This is also for true of everyone 70 and over.
- any walking impariment (sedimentary)
- claiudication
- ischemic rest pain.
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inclines, cold weather or a recent meal may reduce the distance ap erson is able to walk before they experience leg pain, True or False?
True!
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you notice muscle wasting on one limb, with a coller temperature and weaker pulse. There is loss of hair on both limbs with thick yellow nails and dry flakey feet. the legs appear red and when they are elvated become pale within 30 seconds, what dx are you considering?
PAD
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name 3 differential dx when considering PAD?
- peripheral neuropathy
- spinal stenosis or degenerative disk disease
- venous insufficency
- vasospactic disorders
- endocrinopathies
- vasculitis
- acute peripheral occlusion
- Causa Equina syndromes
- Buergers disease
- Leg cramps
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individuals with PAD present in linical practice with distinct syndromes what are they?
- Asymptomatic
- Classic Caudication
- Atypical leg pain (LE discomfort that is exertional, but does not consistently resolve with rest, or occur at a reproduceable distance.
- critical limb ischemia iscemic rest pain, non-healing wound, or gangreen
- acute limb iscemia five p's suiggest limb ischemia
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you are assessing MR. Smith who has neuropathic leg pain. He complains the neurotin is not working as well. you find his pulse in his right foot is abssecent, the foot is cool to the touch and pale, (his other foot is red/brown). he has n vibration sensation or discreminatory sense in the foot. what are you thinking?
acute limb ischemia, an emergency situation, he needs to go to ER call 911!
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What labs should you order if you suspect PAD?
CBC, CMP, Lipids
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