Does PVD include both PAD and CVI?

[Lemon Bars]

Hi. I'm studying for the NCLEX and having trouble understanding a review question and the answer to the question. The question is a select all that apply question and the scenario involves discharge teaching for a patient with "peripheral vascular disease." One of the correct answers is to "keep extremities elevated on pillows" because it promotes venous return. My confusion is that I thought the term "peripheral vascular disease" included both peripheral arterial disease and chronic venous insufficiency. I thought that peripheral vascular disease either meant both or was usually taken to mean PAD moreso than CVI. If the patient has PAD, then elevating the extremities would impede arterial circulation in the extremities.

So, if the question asks about PVD, how do I know if they are referring to PAD or CVI? Thanks for any help!

[KrCmommy522, BSN, RN]

Peripheral vascular disease (PVD) involves circulatory problems that can be due to EITHER arterial or venous pathology.

The signs, symptoms, and treatment of PVD can be opposite, depending on the source of the pathology. Therefore, careful assessment is VERY important.

Predisposing Factors:

• Arterial: Atherosclerosis (95% of all cases are caused by atherosclerosis), advanced age
  
• Venous: Hx of DVT, valvular incompetence
  

Associated Diseases:

• Arterial
  
  • Raynaud's disease (nonatherosclerotic, triggered by extreme heat/cold, spasms of arteries)
    
    
  • Buerger disease (occlusive inflammatory disease, strongly associated with smoking)
    
    
  • Diabetes
    
    
  • Acute occlusion (emboli/thrombi)
    
    

  [*]Venous

  • Varicose veins
    
    
  • Thrombophlebitis
    
    
  • Venous stasis ulcers
    
    

Skin

• Arterial: Smooth, shiny, loss of hair, thick nails
  
• Venous: Brown pigment around ankles
  

Color

• Arterial: Pallor on ELEVATION, rubor when DEPENDENT
  
• Venous: Cyanotic when DEPENDENT
  

Temperature

• Arterial: Cool
  
• Venous: Warm
  

Pulses

• Arterial: Decreased or absent
  
• Venous: Normal
  

Pain

• Arterial
  
  • Sharp
    
    
  • Increase with walking and elevation
    
    
  • Intermittent claudication (
    CLASSIC
    presenting symptom, occurs in skeletal muscles during exercise; relieved by rest)
    
    
  • Rest Pain (occurs when extremities are horizontal; may be relieved by dependent position; often appears when collateral circulation fails to develop)
    
    

  [*]Venous

  • Persistent, aching, full feeling, dull sensation
    
    
  • Pain relieved when horizontal (
    ELEVATED EXTREMITIES
    and use elastic stockings)
    
    
  • Nocturnal cramps
    
    

Ulcers

• Arterial
  
  • Client may describe as very painful
    
    
  • Occur on lateral lower leg, toes, heel
    
    
  • Demarcated edges
    
    
  • Small, but deep
    
    
  • Circular in shape
    
    
  • Necrotic
    
    
  • Not edematous
    
    

  [*]Venous

  • Described by client as dull ache or heaviness
    
    
  • Occur on medial leg, ankle
    
    
  • Uneven edges
    
    
  • Superficial, but large
    
    
  • Marked by edema
    
    
  • Highly exudative
    
    

Treatment

Arterial: Bed rest/immobilization

Venous: Limb elevation

Nursing

Encourage rest at first sign of pain

Encourage keeping extremities elevated (if venous) when sitting, and change position often

Hope this helps!