NURSING ADVICE

Nursing Advice

Nursing Advice

Introduction

The paper covers the prescription for elderly patients being diagnosed with peripheral arterial disease and given treatment through antiplatelets. Peripheral arterial disease (PAD) involves obstruction of large arteries. Patients with peripheral arterial disease following the narrowing of the arteries of the legs may experience painful cramps in the legs or buttocks when walking, also known as intermittent claudication (IC). This group of patients is at high risk of heart attack, stroke and death. As a lower limb vascular nurse I would refer to the guidelines mentioned under NICE and GMMMG.

Treating Peripheral Arterial Disease through Antiplatelets

Antiplatelet drugs make the blood thinner and thus block the formation of blood clots; thereby, preventing clogging of the arteries can cause a heart attack and stroke. The antiplatelet therapies include drugs such as aspirin, clopidogrel and dipyridamole, but evidence of the benefits of antiplatelet therapy in patients with IC is limited to date.

Antiplatelet agents are the most commonly used drugs for secondary prevention of stroke, with the exception of cases of cardioembolic etiology (where anticoagulants are used) and other rare situations (hematological diseases and systemic arterial dissection). Acetylsalicylic acid (ASA) at doses of 100 to 300 mg / day, is the treatment of choice, since it has been shown to reduce the incidence of stroke by about 25%, figures comparable to the reduction of other events vascular obtained in patients with ischemic heart disease or EAP (ATC, 2002, pp. 71). Classically used higher doses of aspirin in patients with stroke than in coronary patients, but no differences were found regarding the efficacy of dose, and yes an increased risk of bleeding with higher doses. With clopidogrel, the CAPRIE study showed a slightly higher reduction in the combined risk of stroke, myocardial infarction and vascular death compared to aspirin (8.7% reduction), with lower incidence of gastrointestinal bleeding. The reduction of events compared to aspirin was greater in the subgroup of patients with prior vascular disease (stroke or myocardial infarction) (Ringleb, et al., 2004, pp. 528), as is indicated in patients who are intolerant or have contraindications to aspirin and those at high risk for vascular (Ustrell and Serena, 2007, pp. 753). It seems that the combination of clopidogrel and aspirin at reducing the incidence of stroke, as seen in the CHARISMA and MATCH studies, which also showed higher rates of bleeding problems (Diener et al, 2004, pp. 331).

Some of the arteries commonly affected are the coronary arteries, common carotid, carotid bifurcation and the splanchnic arteries, but can be compromised any artery in the body. In the lower limbs are affected the most superficial femoral artery in the transition to the popliteal artery, common femoral artery in its rear wall, the infrarenal aorta, especially in the birth of the inferior mesenteric artery, iliac artery, popliteal artery mean and trifurcation. Multiple atherosclerotic commitment aggravate the prognosis of these patients. Blood flow is directly proportional to blood pressure and inversely proportional to the peripheral resistance.

Blood pressure is determined by cardiac output, peripheral resistance and blood ...