Getting Ready for Certification

Abstract

Published by Lippincott Williams & WilkinsL ower extremity artery disease (LEAD) is a disease of the lower extremities caused by narrowing and/or blockage of arteries in the lower extremity resulting in decreased blood flow. This decrease in blood flow leads to reduced transportation of oxygen and essential nutrients to the limbs. 1 As a result, patients may experience pain, numbness, infection, and, in cases with severe occlusion, gangrene, which often leads to amputation. 1 Lower extremity artery disease includes artery disease affecting the leg arteries but excludes artery diseases of the aorta, carotid, upper extremity, or visceral arteries. 2 It is more prevalent among older adults 65 years of age and older. The main cause of LEAD is atherosclerosis. Risk factors for LEAD include smoking, diabetes, hypertension, hyperlipidemia, and obesity. It tends to be undiagnosed until later stages of the disease, as it is often asymptomatic in its early stages. 1 A thorough subjective history is a key component of any lower extremity assessment. The patient should be questioned about pain and if it is exacerbated by elevation and activity. Additional questions include relieving factors of whether resting provides relief, or timing of the pain, such as experiencing night pain. The Certified Wound Care Nurse (CWCN) or Advanced Practice Certified Wound Care Nurse (CWCN-AP) understands the importance of these focused questions to identify symptoms of LEAD. Patients reporting pain that begins with exercise and is relieved by rest are significant symptoms of intermittent claudication.Key skills a Wound Ostomy Continence Nursing Certification Board (WOCNCB) certified nurse involve performing a thorough physical exam. When performing a physical exam for LEAD, one will first need to inspect the general appearance of the skin comparing bilateral limbs. Sparse hair distribution or even shiny hairless skin are classic presentations of LEAD. The patient will often present with pallor and varicosities, especially around the ankle. One will also want to palpate the skin, which will usually present with a cool temperature. Edema is not always noted but can be present with mixed disease. Assess the patient's functional status and range of motion, which could be impeded due to pain or loss of mobility. Sensation is often decreased. It is essential to assess perfusion beginning