NurseSavvy Cheat SheetDisease
Peripheral Arterial Disease — PAD
Pathophysiology & Risk Factors
Atherosclerotic narrowing of the arteries supplying the lower extremities progressively reduces perfusion. Risk factors accelerate plaque buildup; smoking is the single most modifiable driver.
Signs & Symptoms
EarlyProgresses →
Intermittent claudication Hallmark
Cramping leg pain with activity, resolves within minutes of restDiminished pedal pulses
Cool, pale extremity
Shiny, hairless skin
Thin skin with thickened toenails from chronic ischemiaElevation pallor
Foot blanches when raised above heart levelLate / Severe
Dependent rubor
Reddish-blue color when legs dangled — reactive hyperemiaRest pain
Pain at rest, worse at night; relieved by dangling legsAbsent pulses
Arterial Vs Venous
The highest-yield discriminator on the NCLEX is distinguishing an arterial (PAD) leg from a venous-insufficiency leg — they call for opposite positioning.
Arterial (PAD) vs Venous insufficiency
Arterial (PAD)Venous
PainIntermittent claudication; worse on elevation, relieved when dependentAching heaviness; worse when dependent, relieved on elevation
SkinCool, pale, shiny, hairlessWarm; brown hyperpigmentation; edema
PulsesDiminished or absentPresent
UlcerDistal toes / lateral malleolus; 'punched-out'; minimal drainageMedial malleolus; irregular edges; heavy drainage
Arterial (PAD)
- Pain
- Intermittent claudication; worse on elevation, relieved when dependent
- Skin
- Cool, pale, shiny, hairless
- Pulses
- Diminished or absent
- Ulcer
- Distal toes / lateral malleolus; 'punched-out'; minimal drainage
Venous
- Pain
- Aching heaviness; worse when dependent, relieved on elevation
- Skin
- Warm; brown hyperpigmentation; edema
- Pulses
- Present
- Ulcer
- Medial malleolus; irregular edges; heavy drainage
Diagnostics & Labs
0.9 = PAD cutoff
0.4 = severe
1.3 = calcified
Severe ischemia (tissue-loss risk)
PAD confirmed
Normal
Calcified / noncompressible
0
0.4
0.9
1.3
1.4
ABI
Interventions & Priorities
Promote smoking cessation Hallmark
Priority modifiable interventionPosition legs dependent Hallmark
Flat or slightly below heart; gravity augments arterial flowNever elevate above heartHold
Elevation worsens arterial perfusion in PADStructured walking program
Walk to onset of claudication, then restMeticulous foot protection
Protect feet from injury; inspect dailyAvoid compression stockingsHold
Contraindicated when ABI < 0.9 — restricts arterial inflowTreatments & Medications
Antiplatelet therapy
e.g., aspirin or clopidogrel to reduce thrombotic eventsStatin
Lipid-lowering to slow atherosclerosisCilostazolBlack Box
FDA boxed warning: CONTRAINDICATED in heart failure of any severity (PDE3 inhibitors decrease survival in HF). Improves claudication walking distance.Patient Teaching
Stop smoking Hallmark
Daily foot inspection
Check for injury, blisters, non-healing woundsWalk to claudication then rest
Keep legs dependent, not elevated
Wear well-fitting shoes
Avoid going barefoot; prevent foot traumaComplications
Critical limb ischemia
Advanced PAD; rest pain, non-healing ulcersNon-healing arterial ulcer
Distal toes / pressure points; will not heal without restored flowTissue loss / gangrene
Report Nowescalate immediately
Acute limb ischemia Hallmark
Sudden severe pain + 6 P's = vascular emergencyPain (sudden, severe, at rest)
Unrelieved by positioning — distinguishes occlusion from chronic claudicationPallor
Pulselessness (new asymmetry)
New absent pulse vs contralateral limb signals occlusionParesthesia
New numbness/tinglingParalysis
Inability to dorsiflex — most ominous P; imminent tissue lossPoikilothermia
Cool, mottled limb that matches ambient temperatureClinical Pearl
Arterial = pale, pulseless, painful with walking — hangs DOWN for relief. Venous = warm, edematous, brown staining — goes UP for relief.