Page 1719 - Saunders Comprehensive Review For NCLEX-RN

the feet at rest but to refrain from elevating them above the level of the
heart, because extreme elevation slows arterial blood flow to the feet. In
severe cases of peripheral arterial disease, clients with edema may
sleep with the affected limb hanging from the bed, or they may sit
upright (without leg elevation) in a chair for comfort.
a. Assess pain.
b. Monitor the extremities for color,
motion and sensation, and pulses.
c. Obtain BP measurements.
d. Assess for signs of ulcer formation or
signs of gangrene.
e. Assist in developing an individualized
exercise program, which is initiated
gradually and increased slowly to
improve arterial flow through the
development of collateral circulation.
f. Instruct the client to walk to the point of
claudication pain, stop and rest, and
then walk a little farther.
g. Instruct the client with peripheral
arterial disease to avoid crossing the
legs, which interferes with blood flow.
h. Instruct the client to avoid exposure to
cold (causes vasoconstriction) to the
extremities and to wear socks or
insulated shoes for warmth at all
times.
i. Instruct the client never to apply direct
heat to the limb, such as with a heating
pad or hot water, because the
decreased sensitivity in the limb can
cause burning.
j. Instruct the client to inspect the skin on
the extremities daily and to report any
signs of skin breakdown.
k. Instruct the client to avoid tobacco and
caffeine because of their
vasoconstrictive effects.
l. Instruct the client in the use of
hemorheological and antiplatelet
medications as prescribed.
4. Procedures to improve arterial blood flow
a. Percutaneous transluminal angioplasty,
with or without intravascular stent
b. Laser-assisted angioplasty
c. Atherectomy
d. Peripheral arterial bypass surgery:
Graft material is sutured above and
below the occlusion to facilitate blood

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