Physiological Adaptation Q 71
A nurse is caring for a patient with peripheral vascular disease (PVD). The patient complains of burning and tingling of the hands and feet and cannot tolerate touch of any kind. Which of the following is the most likely explanation for these symptoms?
A. Inadequate tissue perfusion leading to nerve damage.
B. Fluid overload leading to compression of nerve tissue.
C. Sensation distortion due to psychiatric disturbance.
D. Inflammation of the skin on the hands and feet.
Correct Answer: A. Inadequate tissue perfusion leading to nerve damage.
Patients with peripheral vascular disease often sustain nerve damage as a result of inadequate tissue perfusion. Intermittent claudication results when blood flow distal to the occlusion is sufficiently compromised, resulting in fixed oxygen delivery that is unable to match oxygen demand. The most severe form of PAD is critical limb ischemia, which is defined as limb pain at rest or impending limb loss.
Option B: Fluid overload is not characteristic of PVD. Atherosclerotic plaque builds up slowly over decades within the wall of the vessel. Plaque accumulation results in vascular stenosis and frequent vascular dilation to maximize end-organ perfusion. Once the vessel dilation capacity is maximized, the plaque continues to accumulate, which further compromises the lumen occasionally, leading to critical narrowing of the artery.
Option C: There is nothing to indicate psychiatric disturbance in the patient. The overall prognosis of patients with peripheral vascular disease must take into account patient risk factors, cardiovascular health, and disease severity. In terms of limb health at 5 years, nearly 80% of patients will have stable claudication symptoms. Only 1% to 2% of patients will progress to critical limb ischemia in 5 years. Twenty to 30% of patients with PAD will die within 5 years, with 75% of those deaths attributed to cardiovascular causes.
Option D: Skin changes in PVD are secondary to decreased tissue perfusion rather than primary inflammation. Examination of the limbs should involve assessment for pulselessness, pallor, muscular atrophy, cool or cyanotic skin, or pain with palpation. Lower extremity ulcers may be arterial, venous, neuropathic, or a combination of two or more. Ulcers secondary to arterial insufficiency are tender and typically have ragged borders with a dry base and pale or necrotic centers.