The client has peripheral vascular disease and nurse performs a dressing change to the client's lower extremity. Which does the nurse implement to secure the dressing in place?

Question

1. Uses a circular wrap of transparent film
2. Wraps dressing with a light mesh covering
3. Applies wrap in proximal to distal direction
4. Asks client to elevate legs in supine position

Answer 1

2
2. The nurse needs to secure the dressing in place on the client's leg without impairing perfusion to the extremity; therefore, the nurse secures the dressing in place with paper tape and protects the wound and the dressing with the mesh covering. The mesh holds the dressing in place without restricting blood flow because it is a very resilient material.
1. The nurse avoids using a circular wrap of transparent film on the client with peri-pheral vascular disease (PVD). If the nurse applies the wrap tight enough to secure the dressing, the circular wrap potentially constricts blood flow to the extremity. This is especially likely when the client positions the legs in a dependent position because gravity pulls fluid into the tissue and increases the circumference of the leg. Moreo-ver, clients who have PVD often position their lower extremities in a dependent posi-tion to relieve pain. The dependent positioning, then, places additional pressure on the transparent film wrap and potentially impairs blood flow. If the nurse applies the film loosely to allow adequate perfusion, the film will not remain in place, defeating the purpose.
3. If the nurse uses a circular or circumferential wrap, the nurse applies the wrap in a distal to proximal manner to promote venous return; however, the wrap is not a good choice for a client with PVD because it can impair perfusion to the extremity.
4. Elevating the legs during the client's dressing change is likely to cause pain because the client depends on extra perfusion achieved with the gravitational pull of dependent positions, so the nurse avoids this position.