The client with venous insufficiency is up in the chair and the nurse wants to facilitate venous return from the client's lower extremities. Which is the best nursing intervention to achieve the goal?

Question

1. Support client's feet on a foot rest or stool.
2. Place a firm pillow under the client's knees.
3. Instruct client to drink 1000 ml while sitting.
4. Support arms with pillows under the elbows.

Answer 1

1
1. The nurse facilitates venous return for the client with venous insufficiency by ele-vating the feet on a foot rest or stool, thereby decreasing the gravitational pull on the fluid in the lower extremities and facilitating venous return to the heart. The higher the feet are in relationship to the heart, the easier it is for the fluid to return to the heart. When the client ambulates, skeletal muscle action helps to move the fluid to-ward the heart.
2. Placing a pillow under the client's knees impedes venous return by obstructing venous blood flow.
3. Although sitting in the chair does not require the client to limit fluid intake, a liter of fluid is probably excessive intake unless it is spread out over time. Insufficient fluid intake can decrease venous return, increase the risk of deep venous thrombosis from thick, viscous blood, and dehydrate the client; excessive intake improves venous return by decreasing the blood's viscosity, but it also increases the risk of fluid overload and the risk of dependent edema.
4. Supporting the arms with pillows can help to mildly facilitate venous return from the upper extremities; however, facilitating venous return from the lower extremities help to return a potentially much larger volume of blood to the heart.