A patient is in the postanesthesia care unit (PACU) after surgery for arterial revascularization with graft placement. Which procedure does the nurse use to check the patency of the graft?

a. Check the extremity every 15 minutes for the first hour, then hourly, for changes in color, temperature, and pulse intensity.
b. Check the dorsalis pedis pulse every 15 minutes for the first hour, then hourly.
c. Ask the patient if there is any pain or loss of sensation anywhere in the extremity, and withhold patient-controlled analgesia.
d. Gently palpate the site every 15 minutes for the first hour and assess for warmth, redness, and edema.


Answer: a. Check the extremity every 15 minutes for the first hour, then hourly, for changes in color, temperature, and pulse intensity.

Nursing

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