Primary Nursing Diagnosis

Altered tissue perfusion (peripheral) related to increased venous pressure and obstruction OUTCOMES. Tissue perfusion: Peripheral

INTERVENTIONS. Circulatory care; Positioning; Pain management

H PLANNING AND IMPLEMENTATION Collaborative

MEDICAL. Treatment for varicose veins is aimed at improving blood flow, reducing injury, and reducing venous pressure. Pharmacologic treatment is not indicated for varicose veins. To give support and promote venous return, physicians recommend wearing elastic stockings. If the varicosities are moderately severe, the physician may recommend antiem-bolism stockings or elastic bandages or, in severe cases, custom-fitted heavy-weight stockings with graduated pressure. When obesity is a factor, the patient is placed on a weight loss regimen. Experts also recommend that the patient stop smoking to prevent vasoconstriction of the vessels.

A nonsurgical treatment is the use of sclerotherapy for varicose and spider veins. Sclerother-apy is palliative, not curative, and is often done for cosmetic reasons after surgical intervention. A sclerosing agent, such as sodium tetradecyl sulfate (Sotradecol), hypertonic saline, aethoxysclerol, or hyperosmolar salt-sugar solution, is injected into the vein, followed by a compression bandage for a period of time.

SURGICAL. A surgical approach to varicose veins is vein ligation (tying off) or stripping (removal) of the incompetent veins. Removal of the vein is performed through multiple short incisions from the ankle to the groin. A compression dressing is applied after surgery and is maintained for 3 to 5 days. Patients are encouraged to walk immediately postoperatively. Elevate the foot of the bed 6 to 9 inches to keep the leg above the heart when the postoperative client is in bed.

Independent

Nursing interventions are aimed at educating the patient to decrease venous stasis, promote venous return, and prevent tissue injury. To prevent vein distension by compression of superficial veins, teach the patient to apply elastic support stockings before standing and to avoid long periods of standing. The patient should be encouraged to engage in an exercise program of walking to strengthen leg muscles. Teach the patient to avoid crossing the legs when sitting and to elevate the legs when sitting or lying down. The patient should be taught to observe the

938 Ventricular Dysrhythmias skin when removing stockings to check for signs of irritation, edema, decreased nerve sensation, and discoloration. Preventive measures are similar to those for a patient with thrombophlebitis.

For patients who have had sclerotherapy, teaching should focus on activity restrictions. The patient should learn to avoid heavy lifting. Teach the patient to wait 24 to 48 hours after the procedure before showering and to avoid tub baths. Teach the patient to wear supportive stockings as ordered. Prepare the patient by advising him or her to expect ecchymosis and some scarring, which will fade in several weeks. Caution the patient that some residual brown staining may remain at the injection sites. Inform the patient that the sclerotherapy may need to be repeated in other areas.

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