Peripheral arterial disease: the limb

Chronic arterial insufficiency of a limb is recognized by its own pattern — cramping pain brought on by walking and relieved by standing still, progressing to pain at rest that eases when the leg hangs down, diminished or absent pulses with delayed capillary refill, a cool pale limb that blanches on elevation and flushes dusky red when dependent, thin shiny hairless skin, thickened nails and painful punched-out ulcers on the toes and pressure points, confirmed by comparing ankle with arm pressure — and because the fault is inflow rather than outflow the nursing care runs opposite to venous care: the limb kept level or dependent rather than elevated, warm without applied heat or cold, never compressed, and protected from injury by meticulous foot care, while the disease itself is slowed by the risk-factor work that belongs to the patient — stopping smoking above everything else, controlling diabetes, blood pressure and lipids, taking the prescribed antiplatelet and statin, and walking to the point of claudication, resting and walking on again in a structured program rather than resting the leg.