*Nursing care plan* assessment and examination Elicit a history of previous illnesses or surgeries that were

vascular in nature; ask if the patient has been diagnosed with *arterial occlusive disease* in the past. Determine if
a positive family history exists for hypertension or vascular disorders in first-order relatives. Ask if the patient
smokes cigarettes; eats a diet high in fats; leads a sedentary lifestyle; or is subject to emotional stress, anxiety, or
ulcers. Determine if the patient has experienced any pain, swelling, redness, or pallor. Establish a history of signs
and symptoms that may point to the site of occlusion. Nursing care plan Determine if the patient has experienced
any transient ischemic attacks (TIAs) because of reduced cerebral circulation. Elicit a history of such signs and
symptoms as unilateral sensory or motor dysfunction, difficulty in speaking (aphasia), confusion, difficulty with
concentration, or headaches, all of which are signs of possible carotid artery involvement. Ask if the patient has
experienced signs of vertebrobasilar artery involvement, such as binocular visual disturbances, vertigo, dysarthria,
or episodes of falling down. Determine if the patient has experienced lameness in the right arm (claudication),
which is a sign of possible innominate artery involvement. The specific finding in PAOD is intermittent claudication.

The pain is insidious in onset, occurring with exercise and relieved by resting for 2 to 5 minutes; determining how
much physical activity is needed before the onset of pain is crucial. The onset of pain is often related to a particular
walking distance in terms of street blocks, helps to quantify patients with some standard measure of walking
distance before and after therapy. Determine if the patient’s mesenteric artery is involved by asking if he or she
has experienced acute abdominal pain, nausea, vomiting, or diarrhea.

Ask the patient if she or he has experienced numbness, tingling (paresthesia), paralysis, muscle weakness, or
sudden pain in both legs, which are all signs of aortic bifurcation occlusion. Determine if the patient has
experienced sporadic claudication of the lower back, buttocks, and thighs or impotence in male patients, all of
which are indicators of iliac artery occlusion. Elicit a history of sporadic claudication of the patient’s calves after
exertion; ask if the patient has experienced pain in the feet—these are signs of femoral and popliteal artery
involvement. Observe both legs, noting alterations in color or temperature of the affected limb. Cold, pale legs may
suggest aortic bifurcation occlusion. Inspect the patient’s legs for signs of cyanosis, ulcers, or gangrene. Limb
perfusion may be inadequate, resulting in thickened and opaque nails, shiny and atrophic skin, decreased hair
growth, dry or fissured heels, and loss of subcutaneous tissue in the digits. Check the patient’s skin on a daily
basis. The most important part of the examination is palpation of the peripheral pulses. Absence of a normally
palpable pulse is the most reliable sign of occlusive disease. Comparison of pulses in both extremities is helpful.
Ascertain, also, whether the arterial wall is palpable, tortuous, or calcified. Auscultation over the main arteries is
useful, as a bruit (sound produced by turbulent flow of blood through an irregular or stenotic lumen) often indicates
an atheromatous plaque. A bruit over the right side of the neck is a possible indication of innominate artery
involvement. Occlusive diseases are chronic or lead to chronic illness. They are usually slow in onset, and much
irreversible vascular damage may have occurred before symptoms are severe enough to bring the patient for
treatment. Treatment is often long and tedious and brings additional concerns regarding finances, curtailment of
usual social outlets, and innumerable other problems. Assess the patient’s ability to cope with a chronic illness.
Primary Nursing Diagnosis of this *Nursing care plan*: Altered tissue perfusion (peripheral) related to decreased
arterial flow. *Nursing care plan* intervention and treatment Emphasize to the patient the need to quit smoking or
using tobacco and limit caffeine intake. Recommend maintaining a warm environmental temperature of about
21°C (70°F) to prevent chilling. Teach the patient to avoid elevating the legs or using the knee Gatch on the bed,
to keep legs in a slightly dependent position for periods during the day, to avoid crossing the legs at the knees or
ankles, and to wear support stockings. Explain why the patient needs to avoid pressure on the affected extremity
and vigorous massage, and recommend the use of padding for ischemic areas. Stress the importance of regular
aerobic exercise to the patient. Explain that activity improves circulation through muscle contraction and
relaxation. Exercise also stimulates collateral circulation that increases blood flow to the ischemic area.
Recommend 30 to 40 minutes of activity with warm-up and cool-down activities on alternate days. Also suggest
walking at a slow pace and performing ankle rotations, ankle pumps, and knee extensions daily. Recommend
Buerger-Allen exercises, if indicated. If intermittent claudication is present, stress to the patient the importance of
allowing adequate time for rest between exercise and of monitoring one’s tolerance for exercise. Provide good
skin care, and teach the patient to monitor and protect the skin. Recommend the use of moisturizing lotion for dry
areas, and demonstrate meticulous foot care. Advise the patient to wear cotton socks and comfortable, protective
shoes at all times and to change socks daily. Advise the patient to seek professional advice for thickened or
deformed nails, blisters, corns, and calluses. Stress the importance of avoiding the application of direct heat to the
skin. The patient also needs to know that arterial disorders are usually chronic. Medical follow-up is necessary at
the onset of skin breakdown such as abrasions, lesions, or ulcerations to prevent advanced disease with necrosis.
*Nursing care plan* discharge and home health care guidelines To prevent *arterial occlusive disease* from
progressing, teach the patient to decrease as many risk factors as possible. Quitting cigarette smoking and tobacco
use is of utmost importance and may be the most difficult lifestyle change. Behavior modification techniques and
support groups may be of assistance with lifestyle changes. Be sure the patient understands all medications,
including the dosage, route, action, adverse effects, and need for routine laboratory monitoring for anticoagulants.
Ensure that the patient understands that the condition is chronic and not curable. Stress the importance of
adhering to a balanced exercise program, using measures to prevent trauma and reduce stress. Include the
patient’s family in the plans. Related