Peripheral Artery Disease: Assessment (Nursing)

00:01 Now, we can do some kind of fancy looking stuff and we do the Ankle-Brachial Index.

00:06 Okay, so this is called the ABI.

00:08 It can be a useful tool in cases of peripheral artery disease.

00:12 This simple, its non-invasive test compares the blood pressure in your ankle to the blood pressure in your arm.

00:18 A low ABI can indicate a blockage or narrowing in the peripheral arteries, which is the hallmark of peripheral artery disease.

00:27 I love that the artists put these in here for you, just as a reminder.

00:31 You'll notice that you see a blood pressure cuff.

00:32 You're used to seeing that and you will see that they've designated the brachial artery.

00:37 Also, there is a device right over that brachial artery.

00:42 You want to make sure you get a very clear auscultation of those sounds.

00:46 So, a stethoscope may not be strong enough if these pulses are really weak.

00:50 So, look at using a Doppler or some type of ultrasound device to make sure it's very clear this pressures.

00:57 Now, let's do some math.

00:59 For the Ankle-Brachial Index. Stick with me, I promise this one is not really difficult.

01:04 But you see there it says ABI less than 0.9 indicates PAD.

01:10 So, how do we get the ABI? Well, you take the leg systolic pressure divided by the arm systolic pressure, and if it is less than 0.9, this indicates peripheral arterial disease.

01:23 If the ABI is greater than 1.3, it's not as clear.

01:26 And you have to consider that it may indicate that the vessel was really stiff.

01:30 It was non-compressible because of calcification.

01:34 So, consider measuring a blood pressure in the first toe or use a Doppler and ultrasound.

01:42 A treadmill exercise test is another test that you can do to assess for peripheral arterial disease.

01:48 Remember, a treadmill, you're going to have that exercise where you can observe them.

01:53 So this is indicated patients who have a classic history suggesting PAD and a normal resting ABI.

02:01 ABI is are measured before and after exercise to watch how the patient responds.

02:07 Now, for normal physiology, the API should be increased or stay the same.

02:12 In peripheral arterial disease after exercise, the ABI decreases by greater than or equal to 20%.

02:21 Some other more expensive tests that can be done include a Doppler ultrasound, you can also do a CTA, which is a computed tomography with angiography looking closely at those vessels, and MRI or an MRA, which is a Magnetic Resonance Imaging with angiography or a digital subtraction arteriography.

02:42 Now, this is super cool.

02:43 First, they take some X-rays, then they inject dye and they take some more X-rays, and they subtract all those things out that were in the first picture, so they can get an even better picture of the vessels.

02:56 Super cool if you ever get to see one.

02:58 As far as lab studies, can't really do a lab that says you have PAD.

03:03 But we know that there's classic things and cues you should be looking for to evaluate the patient's risk factors for organ injury.

03:11 One example is a lipid profile.

03:13 If we think they have PAD, and they've got hyperlipidemia, that's going to be something we're wanting to watch closely.

03:20 Hemoglobin A1C, would let us know what the patient's blood sugar is.

03:24 and if they're at risk for diabetes, or how well controlled they are? Homocysteine is something if it's elevated, that is yet another risk factor for PAD.

03:35 Now, creatinine is going to tell us how the kidneys are doing and how they're being perfused.