Arteriosclerosis Obliterans

  1. General information
    1. A chronic occlusive arterial disease that may affect the abdominal aorta or the lower extremities. The obstruction to blood flow with resultant ischemia usually affects the femoral, popliteal, aortal, and iliac arteries.
    2. Occurs most often in men ages 50-60
    3. Caused by atherosclerosis
    4. Risk factors: cigarette smoking, hyperlipidemia, hypertension, diabetes mellitus
  2. Medical management
    1. Drug therapy
      1. Vasodilators: papaverine, isoxsuprine HCl (Vasodilan), nylidrin HCl (Arlidin), nicotinyl alcohol (Roniacol), cyclandelate (Cyclospasmol), tolazoline HCl (Priscoline) to improve arterial circulation; effectiveness questionable
      2. Analgesics to relieve ischemic pain
      3. Anticoagulants to prevent thrombus formation
      4. Lipid-reducing drug: cholestyramine (Questran), colestipol HCl (Cholestid), dextrothyroxine sodium (Choloxin), clofibrate (Atromid-S), gemfibrozil (Lopid), niacin, lovastatin (Mevacor) (see Unit 2)
    2. Surgery: bypass grafting, endarterectomy, balloon catheter dilation; lumbar sympathectomy (to increase blood flow), amputation may be necessary
  3. Assessment findings
    1. Pain, both intermittent claudication and rest pain, numbness or tingling of the toes
    2. Pallor after 1-2 minutes of elevating feet, and dependent hyperemia/rubor; diminished or absent dorsalis pedis, posterior tibial and femoral pulses; trophic changes; shiny, taut skin with hair loss on lower legs
    3. Diagnostic tests
      1. Oscillometry may reveal decrease in pulse volume
      2. Doppler ultrasound reveals decreased blood flow through affected vessels
      3. Angiography reveals location and extent of obstructive process
    4. Elevated serum triglycerides; sodium
  4. Nursing interventions
    1. Encourage slow, progressive physical activity (out of bed at least 3-4 times/day, walking 2 times/day).
    2. Administer medications as ordered.
    3. Assist with Buerger-Allen exercises q.i.d.
      1. Client lies with legs elevated above heart for 2-3 minutes
      2. Client sits on edge of bed with legs and feet dependent and exercises feet and toes--upward and downward, inward and outward--for 3 minutes
      3. Client lies flat with legs at heart level for 5 minutes
    4. Assess for sensory function and trophic changes.
    5. Protect client from injury.
    6. Provide client teaching and discharge planning concerning
      1. Restricted kcal, low-saturated-fat diet; include family (see Related Links: Special Diets)
      2. Importance of continuing with established exercise program
      3. Measures to reduce stress (relaxation techniques, biofeedback)
      4. Importance of avoiding smoking, constrictive clothing, standing in any position for a long time, injury
      5. Importance of foot care, immediately taking care of cuts, wounds, injuries
    7. Prepare client for surgery if necessary.