FCNs Must Test for PAD

Foot-care-trained nurses are quick to spot troubling symptoms in their patients’ lower limbs and feet

Peripheral artery disease (PAD), sometimes called Peripheral Vascular Disease (PVD), is a disease in which plaque may build up in the arteries outside the heart that carry blood to the head, organs, and limbs. This plaque is made up of fat, cholesterol, calcium, fibrous tissue, and other substances in the blood. When it builds up in the arteries, the condition is called atherosclerosis. Unless prevented or treated, plaque can narrow the flow of blood in the arteries.

This limits the flow of oxygen to organs and other parts of the body which can ultimately lead to death of a patient. It can happen in any organ but is more often in the legs. (PAD can also be from other causes than atherosclerosis.)

According to the CDC, PAD can be asymptomatic, causing a dangerous situation for sufferers as it can lead to coronary artery disease and cerebrovascular disease, which could lead to a heart attack or stroke. For this reason, patients with risk factors should be tested for PAD to allow early diagnosis of the disease, if it is present.

Risk Factors for PAD are:    

 Smoking
 High blood pressure
 Atherosclerosis
 Diabetes
 High cholesterol
 Older than age 60

Foot Care Nurses must be fully educated about this disease. Studies show that about half the cases remain unrecognized, allowing a high risk of ischemic events in the future of these patients. Therefore, if a patient has pain, numbness, aching, or heaviness in the leg muscles (possibly claudication) with exertion which is relieved with rest, it’s time for a complete exam and to test of PAD.

Check for these symptoms:
 Weak or absent pulses in the legs or feet
 Sores or wounds on the toes, feet, or legs that heal slowly, poorly, or not at all
 A pale or bluish color to the skin
 A lower temperature in one leg compared to the other leg
 Poor nail growth on the toes and decreased hair growth on the legs
 Erectile dysfunction, especially among men who have diabetes
 Muscle atrophy
 Hair loss and smooth shiny skin

Diagnosis of PAD
In patients with these symptoms, the ankle-brachial index (ABI) is indicated. It’s a simple and quick, non-invasive test that measures the blood pressure in the ankles and compares it with the blood pressure in the arms at rest and after exercise. If the ABI is <0.9, the patient must be immediately referred to a vascular specialist. This physician will prescribe imaging tests such as a Doppler ultrasound, magnetic resonance angiography (MRA), and computed tomographic (CT) angiography. These tests provide additional information in diagnosing PAD.

Conclusion: Foot Care Nurses with knowledge of PAD can save lives through responsible practices. If a patient 1) has symptoms that indicate PAD or 2) has the risk factors for PAD, the FCN must conduct an ABI. This test will determine potentials for the presence of PAD and whether he or she should be referred to a specialist.