The nurse assesses a client with arterial occlusive disease in the lower extremities. Which does the nurse implement in the client's plan of care?
1. Uses Doppler device to locate pulses
2. Massages feet and ankles twice daily
3. Elevates legs slightly when in the chair
4. Measures circumference of thighs daily
1
1. The nurse uses a Doppler device to locate peripheral pulses for a client with arterial occlusive disease because arteries in this health alteration are often difficult to locate because they slowly narrow and impair oxygenated blood flow. The nurse uses the Doppler device to assess arterial perfusion by locating peripheral pulses and by assessing skin temperature, color, and sensation to establish baseline information. To use the Doppler, the nurse applies conductive gel to the sensor and scans the surface in question by moving the Doppler in a perpendicular motion across the region of the artery.
2. Massaging areas of impaired arterial perfusion is contraindicated because the client is already at risk for breakdown; although massage potentially increases blood flow to tissue, it is contraindicated at the ankles and feet because this skin covers many bony prominences.
3. The legs of the client with arterial occlusive disease usually need to be dependent to use gravity to help pull oxygenated blood to the periphery. Elevating the legs promotes venous return and increases the difficulty of oxygenating the tissue because the vessels need to deliver oxygenated blood through inadequate arteries.
4. Thigh measurement is indicated for thromboembolic events, venous insufficiency, or other disorders that impair venous return.
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