VII. Nursing Management
Provide proper positioning
• Place the client’s legs in a dependent position in relation to the heart to improve peripheral blood flow
• Avoid raising the client’s feet above heart level unless specifically prescribed by the health care providers
• Keep the client in a neutral, flat, supine position if in doubt about the nature of his peripheral vascular problems.
Promote vasodilation.
• Provide insulating warmth with gloves, socks and other outerwear as appropriate.
• Keep room temperatures comfortably warm.
• Instruct the client to warm himself with warm drinks or baths.
• Never apply a direct heat source to the extremities. Limited blood flow combined occur with normal circulation.
• Teach the client about the vasoconstrictive effects of nicotine and caffeine, emotional stress, and chilling, discuss ways to avoid or minimize these risk factors.
• Teach the client to avoid constricting clothes, such as garters, knee-high stockings and belts.
• If overreplacement of glucocortiocoid is indicated, inform the client about the purpose of therapy and possible adverse effects such as cushingoid appearance, weight gain, acne, hirsutism, peptic ulcer, diabetes mellitus, osteoporosis, infection, muscular weakness, mood swings, cataracts and hypertension.
Promote activity and mobility.
• For a client with decreased arterial function but without activity-limiting tissue damage, encourage a program of balanced exercise and rest to promote development of collateral circulation.
Provide care for a client undergoing angiography or percutaneous transluminal angioplasty.
• Before the procedure, provide information related to the procedure, validate that the informed consent has been obtained, mark peripheral pulses, obtain diagnostic data as ordered and withhold food and fluids as prescribed.
• After the procedure, maintain bed rest as prescribed, keeping the involved extremity extended, monitor vital signs and assess peripheral pulses and circulation every 15 minutes for 2 hours and then every hour for 4 hours.
• Assess for bleeding, hematoma, or edema at the catheter insertion site, encourage oral fluid and monitor urine output.
Provide care for a client receiving an autogenous saphenous vein or a synthetic bypass graft.
• Prepare the client for surgery and mark the site of the peripheral pulses
• Monitor the client carefully after the procedure (especially for the first 24 hours) for signs of graft occlusion as manifested by decreased arterial perfusion.
• Anticipate and take steps to prevent complications of any surgical procedure involving general anesthesia, particularly respiratory problems and infection.
Provide care for a client who has received an axillofemoral or axillobifemoral bypass graft or an endarterectomy (i.e. removal of atheromatous plaque).
• Avoid positioning the client on the side of the graft or incision after the procedure
• Warn the client not to wear tight clothing which can lead to graft occlusion
• Instruct the client on signs and symptoms of infection to report to the health care provider.
Provide care for client undergoing an amputation.
Promote and teach skin and foot care