Claudicating Clara — Peripheral Arterial Disease vs Venous Insufficiency
Cold, pale legs that hurt with walking and improve with dangling — arterial disease is the opposite of venous
Clara complains that her right calf cramps every time she walks two blocks and eases when she stops, while her left leg is swollen, brownish at the ankle, and aches worse the longer she stands.
Clara's legs tell two completely different stories depending on which vessels fail. Peripheral arterial disease causes intermittent claudication — cramping leg pain with walking that resolves with rest — along with cool, pale, hairless skin and pain that worsens with elevation. Venous insufficiency instead causes brownish discoloration, edema, and aching that worsens with standing but improves with elevation. Mixing up the positioning instructions between the two can worsen tissue ischemia or venous stasis.
Read Claudicating Clara's full story →The story arc
The setup
Clara has a 30-year smoking history, diabetes, and varicose veins that have gone untreated for over a decade.
The turn
Her right foot becomes cool and pale when elevated, with diminished pedal pulses, while her left ankle shows brawny, brownish skin discoloration and pitting edema.
The crisis
A small wound develops on her right great toe with a pale, punched-out wound bed and no bleeding, while her left medial ankle has a shallow, irregular, weeping ulcer.
The save
The nurse positions Clara's arterial leg in a dependent position to promote blood flow and keeps the venous leg elevated with compression therapy, teaching Clara the opposite positioning rules for each condition.
NCLEX study section — Peripheral Arterial Disease vs Venous Insufficiency
What this chapter is testing: the recognition cues, the numbers and the priority action.
Study section: Cardiovascular
Take this chapter into practice questions on the same topic.