Making Best Practice, Every Day Practice
Peripheral arterial disease (PAD) forms part of the same generalised vascular disease as coronary heart disease and cerebrovascular disease. Recent National Institute for Health and Clinical Excellence (NICE) guidelines emphasise the importance of a standardised approach in primary care. The aims of this article are to provide an update for practice nurses, and to highlight the importance of asymptomatic PAD as an independent risk factor for cardiovascular morbidity and mortality.
Peripheral arterial disease (PAD) has had a lower profile than other vascular diseases, but it is moving up the agenda following recent publication of guidelines from the National Institute for Health and Clinical Excellence (NICE). Take a look at NICE’s priorities for implementation, and you will see that using the ankle brachial pressure index (ABPI) to check for PAD is set to become part of routine cardiovascular risk assessment in primary care.
Symptomatic peripheral arterial disease (PAD) affects 3-5% of the population over 60 years of age. Many patients with PAD are unaware of their diagnosis, and hence may not have mentionedthe classical symptoms to their GP. The Edinburgh questionnaire is a validated tool thathelps identify susceptible patients. The questionnaire was administered to patients routinelyattending annual influenza immunisation clinics, in order to identify patients potentially at risk ofPAD. In all, 2.9% of the >65yr cohort were identified by the questionnaire as at risk of PAD.Opportunity was made for these patients to have their risk factors reviewed, and managementwas adjusted in line with the Target PAD algorithm. Reducing the risk factor profile of suchpatients improves quality of life scores, morbidity, and mortality. Periodic screening of an ‘atrisk’population may identify individuals who would gain considerable benefit from furtherevidence-based management.
Erectile dysfunction (ED) and vascular disease share the same risk factors and commonly co-exist. The presence of ED in otherwise asymptomatic men is, therefore, often a useful early warning sign of silent vascular disease. This fundamental concept highlights the importance of ‘looking beyond the penis’ in the evaluation of the ED patient, and challenges practice nurses to consider ED and sexual activity as part of their routine evaluation of patients. Once diagnosed, there is a range of effective treatments for ED, and guidance on how to use them safely in patients with cardiovascular disease (CVD).
Over the years, many of the conversations I have had with patients and nurses have been about leg ulcers. It seems that there is a fear or stigma about leg ulcers, as if labelling a wound on the lower leg an ulcer will somehow make it harder to heal. In a busy practice it may seem pointless to perform a full assessment on a patient presenting with a small traumatic wound on their lower leg. But it is important to acknowledge the risk of progression from a simple wound to chronic leg ulceration and to assess patients fully for any problems that may influence wound healing or may have contributed to the tissue damage.
It is Friday afternoon and, checking your screen, you see your last free appointment has been given to a patient you have seen in the past for routine blood tests. This time when she enters the room you observe that her legs are covered with what looks like kitchen roll, and she is wearing supermarket carrier bags over her feet to protect her shoes. For many of us, this is a ‘heart sink’ patient – with heavy, wet and oedematous legs that are difficult to manage. To be able to manage this type of condition we first need to understand the possible causes of oedema, to identify patients who may be at risk for developing the problem, and to be aware when early intervention could be of benefit.
Target PAD is a multidisciplinary group of expert clinicians, working to improve outcomes and quality of life for patients with peripheral arterial disease (PAD). PAD is an important and common condition, which is currently under-diagnosed and underrated worldwide and in the UK. Target PAD’s mission is to improve education and awareness of the disease among patients, health professionals and […]
Around one-third of patients with peripheral arterial disease (PAD) fail to receive appropriate antiplatelet treatment, warns a review from an expert panel, which highlights the huge cost of sub-optimal treatment of PAD on the NHS, the economy as a whole and on the individuals affected.
The arteries that supply the penis are very small and may be more prone to atherosclerosis than larger vessels. This means that the penis may be the first area in a man’s body to suffer from a reduction in blood flow and so signal cardiovascular disease.
Peripheral arterial disease (PAD), also known as peripheral vascular disease (PVD), is a vascular condition which affects the legs. It is caused by atherosclerosis – narrowing and hardening of the arteries – and has previously been described as being similar to angina in the legs. Sufferers get cramping pains in their legs when they walk, which is relieved by rest. This is similar to the chest pain that occurs in people with coronary heart disease (CHD). The similarities between CHD and PAD do not end there: the causes and treatments also overlap. In this article, we explore how two patients presented with symptoms suggestive of PAD and how they were treated.
Practice and other community-based nurses play a central role in achieving high quality wound care in patients treated initially in general practice and in those who have been discharged from hospital. This article summarises some of the wound management products available for chronic wounds, and the importance of continued wound care in the primary care setting, before focusing on one of the latest approaches – total negative pressure (TNP).
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