# A nurse is assessing a client with suspected peripheral arterial disease. Which of the following findings should the nurse expect to observe during the physical examination?

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## 문제

A nurse is assessing a client with suspected peripheral arterial disease. Which of the following findings should the nurse expect to observe during the physical examination?

## 보기

1. Dependent rubor and edema in bilateral lower extremities
2. Warm, pink skin with strong pedal pulses bilaterally
3. Cool, pale extremities with diminished or absent pedal pulses **✔ 정답**
4. Brownish discoloration around the ankles with varicose veins

**정답: 3**

## 해설

Cool, pale extremities with diminished or absent pedal pulses are classic signs of arterial insufficiency in PAD. Other options suggest venous issues like dependent rubor, strong pulses, or venous stasis.

## 심화 해설

Understanding the Pathophysiology

Peripheral arterial disease (PAD) is a manifestation of systemic atherosclerosis affecting the lower extremities. The underlying problem is the progressive narrowing and hardening of the arterial lumen due to plaque buildup. This stenosis restricts blood flow to the tissues, and the clinical presentation depends on the severity of the occlusion and the metabolic demands of the muscle and skin. In the early stages, blood flow may be sufficient at rest but becomes inadequate during exercise, leading to claudication. As the disease advances, the perfusion deficit becomes critical even at rest, resulting in ischemic changes visible on physical examination.

Expected Physical Examination Findings

The correct answer is 3. When you assess a client with suspected PAD, the hallmark findings are directly linked to chronic low blood flow. The affected extremities will feel cool to the touch due to reduced circulation of warm blood from the core. The skin often appears pale and can be shiny and atrophic. A critical vascular assessment is the palpation of pedal pulses (dorsalis pedis and posterior tibial), which will be diminished or absent. These findings reflect the inability of the stenotic arteries to deliver adequate blood volume to the distal limb.

Why the Other Options Are Incorrect

- Option 1: Dependent rubor (redness when the leg is lowered) and edema are more characteristic of severe PAD with a reactive hyperemic response, but the classic early-to-moderate finding is pallor on elevation. Furthermore, significant bilateral edema is not a primary sign of arterial insufficiency; it is a hallmark of venous insufficiency or heart failure. PAD does not cause dependent edema.

- Option 2: Warm, pink skin with strong pedal pulses describes a normal arterial examination. This finding rules out significant arterial occlusive disease. In PAD, the skin temperature is cool, and pulses are weak or absent.

- Option 4: Brownish discoloration around the ankles (hemosiderin staining) and varicose veins are classic signs of chronic venous insufficiency, not arterial disease. Venous insufficiency results from incompetent valves leading to blood pooling, venous hypertension, and leakage of red blood cells into the tissues, which is a completely different pathophysiological process from the atherosclerotic obstruction seen in PAD.

Clinical Significance and Guideline-Based Approach

A thorough physical examination is the cornerstone of the office-based assessment for PAD as outlined in clinical guidelines. The finding of cool, pale extremities with diminished pulses should immediately raise your suspicion for PAD and prompt further evaluation, such as calculating the ankle-brachial index (ABI). Proper diagnosis is critical because PAD is associated with significant morbidity and mortality, not only from the risk of nonhealing ulcers, rest pain, and amputation but also as a powerful marker for concomitant coronary and cerebrovascular atherosclerotic disease [1].References (research sources)

- [1]Clinical Assessment of Peripheral Arterial Disease in the Office: What Do the Guidelines Say?GuidelineTummala S, Scherbel D. (2018) · DOI: 10.1055/s-0038-1676453

## 임상 시나리오

PAD Physical Assessment GuideKey Findings for Arterial Insufficiency
Inspect the skin for a pale, shiny, and atrophic appearance. The extremity will feel cool to the touch due to decreased blood flow.

Palpate the dorsalis pedis and posterior tibial pulses. Expect them to be diminished or absent. Compare bilaterally.

CautionDo not confuse with venous insufficiency, which presents with edema, brownish discoloration, and normal temperature. Elevation pallor and dependent rubor indicate severe PAD.

## 핵심 개념

- **Peripheral Arterial Disease (PAD)** — A circulatory condition in which narrowed arteries reduce blood flow to the limbs, most commonly the legs, due to atherosclerosis.
- **Intermittent Claudication** — Cramping pain in the legs during exercise caused by inadequate blood flow, which is relieved by rest; a classic symptom of PAD.
- **Pedal Pulses** — The dorsalis pedis and posterior tibial pulses palpated on the foot; their absence or diminishment is a key sign of arterial insufficiency.
- **Chronic Venous Insufficiency (CVI)** — A condition where the leg veins cannot pump enough blood back to the heart, leading to edema, brownish skin discoloration, and varicose veins.
- **Dependent Rubor** — A deep red color of the limb when it is in a dependent position, indicative of severe arterial disease and reactive hyperemia.

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