Cardiac: PVD: Peripheral Venous Disease

The client has varicose veins asks the nurse, "What caused me to have these?" Which statement by the nurse would be most appropriate? 1. "You have incompetent valves in your legs." 2. "Your legs have decreased oxygen to the muscle." 3. "There is an obstruction in the saphenous muscle." 4. "Your blood is thick and can't circulate properly."

1. "You have incompetent valves in your legs." Rationale: Varicose veins are irregular, tortuous veins with incompetent valves that do not allow venous blood to ascend the saphenous vein. Why it's not the rest: Decreased O2 to the muscle occurs with arterial occlusive disease. Option 3 is a description of a DVT. Thick, poorly circulating blood could be an explanation for diabetic neuropathy.

Which client would be most at risk for developing varicose veins? 1. A Caucasian female who is a nurse. 2. An African American male who is a bus driver. 3. An Asian female with no children. 4. An elderly male with diabetes.

1. A Caucasian female who is a nurse. Rationale: Varicose veins are more common in white females in occupations that involve prolonged standing. Why it's not the rest: Driving a bus does not require prolonged standing. Studies suggest that the increased risk is common during pregnancy. Diabetes may lead to diabetic neuropathy and arterial occlusive disease, but does not lead to varicose veins.

Which assessment data would support that the client has a venous stasis ulcer? 1. A superficial pink open area on the medial part of the ankle. 2. A deep pale open area over the top side of the foot. 3. A reddened blister area on the heel of the foot. 4. Necrotic gangrenous area on the dorsal side of the foot.

1. A superficial pink open area on the medial part of the ankle. Rationale: The medial part of the ankle usually ulcerates because of edema that leads to stasis, which in turn, causes the skin to break down. Why it's not the rest: Option 2 describes an arterial ulcer. Option 3 could be a description of a blister found on a person after wearing shoes that were too tight or rubbing the heel. Gangrene does not usually occur with venous problems.

The nurse is completing a neurovascular assessment on a client with chronic venous insufficiency. What should be included in this assessment? Select all that apply. 1. Assess for parasthesia. 2. Assess for pedal pulses. 3. Assess for paralysis. 4. Assess for pallor. 5. Assess for polar (temperature).

1. Assess for parasthesia. 2. Assess for pedal pulses. 3. Assess for paralysis. 4. Assess for pallor. 5. Assess for polar (temperature). Rationale: The nurse should perform a neurovascular assessment (the 6 P's) and look to see if the client has any numbness or tingling, pedal pulses (the presence of which indicates there is no circulatory compromise), can move their feet and legs, if the feet are pink or pale, and if the feet are cold or warm.

The UAP is caring for the client diagnosed with chronic venous insufficiency. Which action would warrant immediate intervention from the nurse? 1. Removing compression stockings before assisting the client to bed. 2. Taking the client's blood pressure manually after using the machine. 3. Assisting the client by opening the milk carton on the lunch tray. 4. Calculating the client's shift intake and output with a pen and paper.

1. Removing compression stockings before assisting the client to bed. Rationale: Research shows that removing the compression stockings while the client is in bed promotes perfusion of the subcutaneous tissue. The foot of the bed should be elevated. Why it's not the rest: The other options are all tasks that the UAP can do.

The client with varicose veins is six (6) hours postoperative vein ligation. Which nursing intervention should the nurse implement first? 1. Assist the client to dangle the legs of the side of the bed. 2. Assess and maintain pressure bandages on the affected leg. 3. Apply a sequential compression device to the affected leg. 4. Administer the prescribed prophylactic intravenous antibiotic.

2. Assess and maintain pressure bandages on the affected leg. Rationale: Pressure bandages are applied for up to six (6) weeks after a vein ligation to help prevent bleeding and to help venous return from the lower extremities when in the standing or sitting position. Why it's not the rest: Standing and sitting are prohibited during the initial recovery period to prevent increased pressure in the lower extremities. Sequential compression devices are used to help prevent DVT. Antibiotics would be ordered prophylactically for surgery, but this isn't a first intervention.

The nurse is caring for the client with chronic venous insufficiency. Which statement indicates the client understands the discharge instructions? 1. "I shouldn't cross my legs for more than 15 minutes." 2. I need to elevate the foot of my bed while sleeping." 3. "I should take a baby aspirin every day with food." 4. I should increase my fluid intake to 3,000 mL a day."

2. I need to elevate the foot of my bed while sleeping." Rationale: Elevating the foot of the bed while sleeping helps the venous blood to return to the heart and decreases pressure in the lower extremity. Why it's not the rest: The client should not cross the legs at all because this further impedes the blood from ascending saphenous veins. Antiplatelet therapy is for arterial blood, nor venous. Fluid intake will not help prevent or improve chronic venous insufficiency.

The 80-year-old client is being discharged home after having surgery to deride a chronic venous ulcer on the right ankle. Which referral would be most appropriate for the client? 1. Occupational therapist. 2. Social worker. 3. Physical therapist. 4. Cardiac rehabilitation.

2. Social worker. Rationale: The social worker would assess the client to determine if home health-care services or financial interventions were appropriate for the client. The client is elderly, immobility is a cancer, and wound care must be a concern when the client is discharged home. Why it's not the rest: OT assists the client with ADLs. PT addresses gait training and transferring. Cardiac rehabilitation helps clients recovering from MI, cardiac bypass surgery, or CHF recover.

The nurse has just received the a.m. shift report. Which client would the nurse assess first? 1. The client with venous stasis ulcer who is complaining of pain. 2. The client with varicose veins who has a dull, aching muscle cramps. 3. The client with arterial occlusive disease who cannot move the foot. 4. The client with deep vein thrombosis who has a positive Homans' sign.

3. The client with arterial occlusive disease who cannot move the foot. Rationale: The inability to move the foot means that a severe neurovascular compromise has occurred, and the nurse should assess this client first. Why it's not the rest: The client with a venous stasis ulcer should experience pain, so this is an expected finding. Dull, aching muscle cramps are to be expected with varicose veins. A positive Homan's sign is expected with a DVT.

The nurse is teaching a class on venous insufficiency. The nurse would identify which conditions the most serious complication of chronic venous insufficiency? 1. Arterial thrombosis. 2. Deep vein thrombosis. 3. Venus ulcerations. 4. Varicose veins.

3. Venus ulcerations. Rationale: Venous ulcerations are the most serious complications of chronic venous insufficiency. It is very difficult for these ulcerations to heal, and often require clients to be seen in wound care clinics for treatments. Why it's not the rest: Arterial thrombosis is related to an artery, not a vein. DVT is not a chronic venous insufficiency, but it may be a cause. Varicose veins may lead to chronic venous insufficiency, but they are not a complication.

Which assessment data would the nurse expect to find in the client diagnosed with chronic venous insufficiency? 1. Decreased pedal pulses. 2. Cool skin temperature. 3. Intermittent claudication. 4. Brown discolored skin.

4. Brown discolored skin. Rationale: Chronic venous insufficiency leads to chronic edema that in turn causes a brownish pigmentation to the skin. Why it's not the rest: Pedal pulses are normal in venous insufficiency. Skin is warm in venous insufficiency. Intermittent claudication occurs with arterial insufficiency.

The client is employed in a job that requires extensive training. Which intervention should the nurse include when discussing how to prevent varicose veins? 1. Wear low-heeled, comfortable shoes. 2. Wear clean white cotton socks. 3. Move the legs back and forth often. 4. Wear graduated compression hose.

4. Wear graduated compression hose. Rationale: Graduated compression hose help decrease edema and increase circulation back to the heart; helps prevent varicose veins. Why it's not the rest: Low-heeled, comfortable shoes should be recommended to lower foot pain. Clean, white socks will help prevent irritation, but not varicose veins. Moving the legs back and forth may prevent DVT, not varicose veins.