Question

1. Matthew Helm, 67 years of age, is a male patient who is admitted with the diagnosis of peripheral arterial occlusive disease in the right femoral and popliteal arteries. The patient undergoes a right femoral-to-popliteal graft operation. Preoperatively, the patient presented with the following assessment: the right leg skin is taut and shiny; very little hair is present; and the toenails are thick and opaque. The leg has pallor when lying on the bed flat, but when the patient places the leg over the side of the bed it has rubor and the toes are bluish in coloration. The patient states the pain in his leg as a constant excruciating pain that he rates as an 8 on the pain scale. No pedal or posterior tibial pulses are detectable with Doppler in the right leg and the popliteal artery is diminished and the femoral pulse is also diminished. The left leg is also shiny, taut, and has very little hair present and the nails are thick and opaque. The patient develops rubor when the leg is held over the side of the bed. The pulses are palpable and slightly diminished at all sites in the left leg. The patient has smoked one pack of cigarettes per day for 50 years. He presents with the following vital signs: BP, 160/110 mm Hg; pulse, 88; respiration, 22; and temperature, 98°F. He does not take any medications currently. (Learning Objective 3)

a. The patient returns to the unit after the right femoral-to-popliteal graft operation. What nursing care should the nurse provide?

b. The surgeon postoperatively prescribed aspirin 160 mg every day and rosuvastatin calcium (Crestor) 5 mg once daily. What is the rationale for each of the medications ordered in relation to the patient’s diagnosis and treatment plan?

c. What patient education should the nurse provide?

Answer 1

a)Nursing care to be provided after right femoral -to- popliteal operation are as follows:

• Monitor vital signs and temperature of the patient
• Place the knee in slight flexion inorder to avoid starin to be reapired blood vessela nd graft.
• Surgical site wound care and strict asepsis
• Monitor dorsalis pedis pulse rate and look for any signs of reduced blood flow such as cyanosis,absence of pulse
• Aminstration of prescribed medications
• Psychological and emotional support

b)Aspirin is an antiplatelet drug used as a prophylactic agent to prevent thrombus formation in the blood vessel following surgey.

Crestor is a HMG-CoA reductase inhibitor which is is an antilipidemic agent which slows the process of atherosclerosis and reduces the chances of revascularization.

Both of these drugs are used to maintain the graft patency.

c)Patient education to be provided are as follows:

• Smoking cessation
• Wound site care
• Avoid strain
• Medication schedule and need for the drugs and its actions to be explained
• Report to the physician if there is any signs of infection,pain,discoloration of the limb,chest heaviness,