Question

rterial and Venous Insufficiency

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A 50-year-old male presents to the community clinic. He has just relocated to the area and has no primary provider. He is a long distance truck driver and requires a physical examination to maintain his continued employment.

Physical examination demonstrates a BMI of 33, blood pressure of 180/90 mm Hg, diminished femoral pulses and bilateral varicose veins with non pitting edema in both ankles. He has a 30 year history of smoking two packs of cigarettes per day.

Initial Discussion Post:

• What additional information is needed from the patient history and physical assessment to determine if this patient has arterial or venous insufficiency?
• Compare and contrast evidence based nursing interventions for the patient diagnosed with arterial insufficiency and the patient diagnosed with venous insufficiency.

Answer 1

In patients with arterial or venous insufficiency,

• the patient often gives the history of cramp like muscle pain in legs while walking which is relieved on resting. This symptom is called intermittent claudication.
• Patient complaints of paresthesia in night time, stasis dermatitis
• Patient may also experience sexual dysfunction.
• Physical assessment may show presence of gangrene or ulcer on foot, the skin is thin and shiny, cold feet to touch.
• Patients may also show signs and symptoms of atherosclerosis dyspnea on exertion, pallor, cyanosis etc.

Nursing Intervention for patients with arterial and venous insufficiency are:

1. Positioning of legs: the legs are kept elevated atleast 15 - 30 minutes every two hourly. This will help to reduce edema by increasing venous return and will give symptomatic relieve.
2. Encourage the patients to avoid prolonged sitting or standing, and encourage walking.
3. Instruct clients to avoid cross legging as it interferes blood flow towards limbs.
4. Avoid too tight clothing like tight pants,under wears, shorts.
5. Maintain skin integrity and prevention of infection. Skin should be kept clean and dry, prevent any trauma to skin. Use foot wears and use lotions to prevent dryness.
6. Use of compression stockings will reduces the venous pooling of blood.
7. Monitor for potential complications. Watch for urine output, pulse in lower limbs, blood pressure.
8. Prepare patient for surgery if indicated and monitor for adequate circulation post operatively.
9. Keep the environment warm, avoid exposure to cold.
10. Quit smoking
11. Assess the patient's ability to manage independently. Encourage to make lifestyle modifications and to seek medical aid if symptoms worsen