If your patient is receiving drug therapy, monitor the effects of the prescribed drugs. Assess the neurovascular status of his legs and report any deterioration in circulation.
Place lamb's wool between the patient's toes to prevent pressure necrosis. If he has ulcers, provide wound care as needed. Assess the ulcer for signs and symptoms of infection. Cover the ulcer with a dry sterile dressing, topical antibiotic, or other wound care product, as ordered.
If your patient has had surgery for peripheral vascular disease, check his leg for color, temperature, sensation, movement, and pulses during the immediate postoperative period. Report any loss of pulse immediately. Observe the incision site for redness, swelling, and drainage.
Turn and reposition your patient every 2 hours. Tell him to not cross his legs and to avoid severe hip or knee flexion. To aid circulation, add a footboard to the bed, use a sheepskin under his legs, or place him on an air, pressure, or other special mattress.
If the patient has undergone percutaneous trans luminal angioplasty or another form of surgical catheterization, assess the site for bleeding, edema, ecchymosis, and hematoma. Monitor his peripheral pulses every 15 to 30 minutes for the first hour, every hour for the next 4 hours, and then once every 4 hours after that. Assess his leg for sudden changes in color and temperature. Also, monitor him for muscle cramping, pain at rest, and changes in motor and sensory function. Administer heparin, monitor his PTT, and adjust the infusion rate, as needed.
Some More Facts
Teach your patient how to promote circulation. Help him devise a progressive exercise program to develop collateral circulation and enhance venous return. Instruct him to stop exercising if he feels pain. Also, tell him to inspect his feet daily for color changes, mottling, scabs, skin texture changes, skin breakdown, and hair growth changes.
Advise the patient to change positions frequently to avoid blood pooling in the feet. Teach him how to promote perfusion by keeping his legs and feet warm and by avoiding vasoconstrictive substances, such as caffeine and nicotine. Tell him that wearing tight, restrictive clothing on the legs can hinder blood flow.
If the physician has prescribed an anticoagulant, review its therapeutic effect, dosage, and adverse effects with your patient. Tell him that he'll have to undergo frequent blood tests that monitor the drug's effectiveness.
If your patient will have a home care nurse, tell him that she'll assess his legs and feet and evaluate any changes. She'll also evaluate wounds and incisions, provide wound care, and assess susceptible areas for infection. She'll reinforce proper foot care and teach him to perform self-care. And she may observe him as he sits and rests so that she can recommend better positions for sitting and for elevating his legs.