Primary Nursing Diagnoses

Altered tissue perfusion (peripheral) related to decreased arterial flow.

OUTCOMES. Fluid balance; Muscle function; Tissue integrity: Peripheral

INTERVENTIONS. Circulatory care; Circulatory precautions; Fluid management; Medication management; Peripheral sensation management; Positioning; Pressure ulcer prevention; Skin surveillance; Embolus precautions; Exercise therapy

U PLANNING AND IMPLEMENTATION Collaborative

SURGICAL. Surgery is indicated for patients who have advanced arterial disease or for those with severe pain that impairs activities. Surgical procedures include arterial bypass surgery, embolectomy, angioplasty, sympathectomy, and amputation.

If arteriosclerosis obliterans is rapidly progressing or has not responded to conservative management and intermittent claudication has become disabling, lower-extremity arterial bypass is performed. The femoropopliteal arterial segment is the most common site of occlusion. The diseased femoropopliteal segment can be bypassed with a synthetic prosthetic material (Teflon or Dacron) or an autogenous vein graft, such as with the saphenous vein, can be performed. Care following femoropopliteal bypass is the same as for other arterial surgery.

Arterial Occlusive Disease 105

PERIOPERATIVE CARE. In the preoperative stage, assess the patient's circulatory status by observing skin color and temperature and checking peripheral pulses. Provide analgesia as needed. Use an infusion monitor or pump to administer heparin intravenously. Note any signs of cerebrovascular accident, such as periodic blindness or numbness in a limb.

Pharmacolog

ic Highlights

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