A nurse is assessing client with advanced peripheral arterial disease (PAD). Which of the following findings would the nurse expect?
Shiny, hairless lower extremities.
Warm lower extremities.
Thin toenails.
Lower extremity bilateral pulse 3+
The Correct Answer is A
A) Shiny, hairless lower extremities: In advanced peripheral arterial disease (PAD), the skin on the lower extremities often appears shiny and hairless due to reduced blood flow. The lack of hair growth and the shiny appearance are indicative of ischemia and poor circulation, making this a common finding in clients with advanced PAD.
B) Warm lower extremities: This finding is not typical in advanced PAD. Due to compromised blood flow, the lower extremities are more likely to feel cool or cold to the touch rather than warm. Warm skin can indicate good blood flow, which is usually absent in cases of significant arterial disease.
C) Thin toenails: In advanced PAD, toenails may become thin and brittle due to insufficient blood supply, which can lead to impaired nail growth. This change is consistent with the overall effects of reduced circulation and is an expected finding in clients with advanced PAD.
D) Lower extremity bilateral pulse 3+: A 3+ pulse indicates a strong and bounding pulse, which is not typically present in advanced PAD. In fact, patients with PAD often exhibit diminished or absent pulses in the affected extremities due to poor arterial circulation. Therefore, this finding does not align with the expected assessment results for advanced PAD.
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View Related questions
Correct Answer is A
Explanation
A) Intermittent claudication: This term describes the leg pain and cramping that occurs during physical activity, such as walking, and is relieved by rest. It is a classic symptom of peripheral arterial disease (PAD) and results from insufficient blood flow to the muscles due to narrowed or blocked arteries. The client's description aligns perfectly with this definition.
B) Neuropathy: While neuropathy can cause leg pain, it typically presents differently, often with sensations like tingling, numbness, or burning rather than cramping during activity. Neuropathy does not specifically correlate with the pattern of pain relief upon resting, which is characteristic of intermittent claudication.
C) Deep vein thrombosis (DVT): DVT generally presents with symptoms like swelling, warmth, and tenderness in the affected leg, rather than cramping pain that is related to activity. The pain associated with DVT is not typically relieved by rest, making this option inconsistent with the client’s symptoms.
D) Venous insufficiency: This condition is characterized by symptoms such as swelling, varicosities, and skin changes, primarily in the lower extremities. Pain related to venous insufficiency tends to occur after prolonged standing or sitting and is not typically relieved by rest in the same way as intermittent claudication. Therefore, this option does not accurately describe the client’s experience.
Correct Answer is C
Explanation
A) Apply cold therapy to the affected leg: Cold therapy may be used for certain conditions to reduce swelling and pain, but in the case of suspected deep vein thrombosis (DVT) indicated by redness, warmth, tenderness, and pain in the calf, cold therapy is not appropriate. Instead, the focus should be on confirming the diagnosis before applying any treatment.
B) Monitor Homan's sign: Homan's sign involves dorsiflexion of the foot to assess for pain in the calf, which can suggest DVT. However, it is no longer considered a reliable diagnostic tool. Instead, confirmation through imaging or other diagnostic measures is preferred, so simply monitoring this sign would not be sufficient in this situation.
C) Obtain a venous duplex ultrasound: A venous duplex ultrasound is the gold standard for
diagnosing DVT. Given the client’s symptoms—redness, warmth, tenderness, and pain in the calf—the appropriate order is to obtain this ultrasound to confirm the presence of a thrombus. This imaging study provides critical information for diagnosis and subsequent management.
D) Obtain impedance plethysmography: While impedance plethysmography can assess venous flow and help diagnose DVT, it is less commonly used than venous duplex ultrasound. The more direct and widely accepted method for diagnosing DVT in this scenario is the ultrasound, making this option less suitable as the initial order.