Vascular
A client seeks treatment in a vascular surgeon's office for unsightly varicose veins, and radiofrequency ablation (RFA) is recommended. Before leaving the examining room, the client says to the nurse, "Can you tell me again how this is done?" Which statement should the nurse make? "The varicosity is surgically removed." "A heating element is used to occlude the vein." "The vein is tied off at the upper end to prevent stasis from occurring." "The vein is tied off at the lower end to prevent stasis from occurring."
"A heating element is used to occlude the vein." Radiofrequency ablation (RFA) is a treatment for varicose veins that uses a radiofrequency heat element to ablate (occlude) the affected vessel. This procedure is less invasive than a ligation and removal of veins procedure. Using ultrasound guidance, the clinician advances a catheter into a vein and injects an anesthetic agent around it. Then the vessel is ablated while the catheter is slowly removed. This causes collapse and sclerosis of the vein causing the occlusion.
The home care nurse is providing instructions to a client with an arterial ischemic leg ulcer about home care management and self-care management. Which statement, if made by the client, indicates a need for further instruction? "I need to be sure not to go barefoot around the house." "If I cut my toenails, I need to be sure that I cut them straight across." "It is all right to apply lanolin to my feet, but I shouldn't place it between my toes." "I need to be sure that I elevate my leg above the level of my heart for at least an hour every day."
"I need to be sure that I elevate my leg above the level of my heart for at least an hour every day." Foot care instructions for the client with peripheral arterial disease are the same as those for a client with diabetes mellitus. The client with arterial disease, however, should avoid raising the legs above the level of the heart unless instructed to do so as part of an exercise program or if venous stasis is also present. The client statements in the remaining options are correct statements and indicate that the teaching has been effective.
The nurse is preparing to care for a client with esophageal varices who needs a Sengstaken-Blakemore tube inserted because other treatments were unsuccessful. The nurse gathers supplies, knowing that which item must be kept at the bedside at all times? An obturator A Kelly clamp An irrigation set A pair of scissors
A pair of scissors The Sengstaken-Blakemore tube is a triple-lumen gastric tube that may be used to treat bleeding esophageal varices if other interventions are contraindicated or are ineffective. The tube has an inflatable esophageal balloon, an inflatable gastric balloon, and a gastric aspiration lumen. The gastric balloon applies pressure at the cardioesophageal junction to compress gastric varices directly and decrease blood flow to esophageal varices. Traction is applied to maintain the gastric balloon in place. When the client has a Sengstaken-Blakemore tube, a pair of scissors must be kept at the client's bedside at all times. The client must be observed for sudden respiratory distress, which occurs if the gastric balloon ruptures and the entire tube moves upward. If this occurs, the nurse immediately cuts all balloon lumens and removes the tube. An obturator and a Kelly clamp are kept at the bedside of a client with a tracheostomy. An irrigation set may be kept at the bedside, but it is not the priority item.
Which is the priority assessment in the care of a client who is newly admitted to the hospital for acute arterial insufficiency of the left leg and moderate chronic arterial insufficiency of the right leg? Monitor oxygen saturation with pulse oximetry. Assess activity tolerance before and after exercise. Observe the client's cardiac rhythm with telemetry. Assess peripheral pulses with an ultrasonic Doppler device.
Assess peripheral pulses with an ultrasonic Doppler device. Acute arterial insufficiency is associated with interruption of arterial blood flow to an organ, tissue, or extremity. It is associated with an acutely painful pasty-colored leg. The priority is for the nurse to perform a comprehensive assessment of peripheral circulation. When pulses are difficult to palpate, the Doppler device is useful to determine the presence of blood flow to the area. The Doppler directs sound waves toward the artery being examined, which emits an audible sound. The nurse must document that the pulse was present via Doppler and not palpation. Although the remaining options may be components of the assessment, they are not the priority.
A client with a diagnosis of varicose veins is scheduled for treatment by sclerotherapy and is receiving education about the procedure from the nurse. Which statement by the client indicates that the teaching has been effective? "It involves tying off the veins so that circulation is redirected in another area." "It involves surgically removing the varicosity, so anesthesia will be required." "It involves tying off the veins to prevent sluggishness of blood from occurring." "It involves injecting an agent into the vein to damage the vein wall and close it off."
"It involves injecting an agent into the vein to damage the vein wall and close it off." Sclerotherapy is the injection of a sclerosing agent into a varicosity. The agent damages the vessel and causes aseptic thrombosis, which results in vein closure. With no blood flow through the vessel, distention will not occur. The surgical procedure for varicose veins is vein ligation and stripping. This procedure involves tying off the varicose vein and large tributaries and then removing the vein with the use of a hook and wires applied through multiple small incisions in the leg. Other treatments include the application of radiofrequency (RF) energy, in which the vein is heated from the inside by the RF energy and shrinks; collateral veins nearby take over. Laser treatment is another alternative to surgery; in this treatment, a laser fiber is used to heat and close the main vessel that is contributing to the varicosity.
A client calls the nurse at the clinic and reports that ever since the vein ligation and stripping procedure was performed, she has been experiencing a sensation as though the affected leg is falling asleep. The nurse should make which response to the client? "Apply warm packs to the leg." "Keep the leg elevated as much as possible." "Your primary health care provider needs to be contacted to report this problem." "This normally occurs after surgery and will subside when the edema goes down."
"Your primary health care provider needs to be contacted to report this problem." A sensation of pins and needles or feeling as though the surgical limb is falling asleep may indicate temporary or permanent nerve damage after surgery. The saphenous vein and the saphenous nerve run close together, and damage to the nerve will produce paresthesias. The remaining options are inaccurate responses. An alternative to surgery is endovenous ablation of the saphenous vein. Ablation involves the insertion of a catheter that emits energy. This causes collapse and sclerosis of the vein. Potential complications include bruising, tightness along the vein, recanalization (reopening of the vein), and paresthesia. Endovenous ablation also may be done in combination with saphenofemoral ligation or phlebectomy. Transilluminated powdered phlebectomy involves the use of a powdered resector to destroy the varices and then removes the pieces via aspiration.
A postpartum client with femoral thrombophlebitis has developed sudden shortness of breath and appears very anxious. What is the nurse's priority action for this client? Check the client's blood pressure immediately. Elevate the head of the bed to 30 to 45 degrees. Initiate an intravenous line if one is not already in place. Administer oxygen by face mask as per protocol at 8 to 10 L/min.
Administer oxygen by face mask as per protocol at 8 to 10 L/min. This client is at increased risk for pulmonary embolus and is exhibiting symptoms. Because pulmonary circulation is compromised in the presence of an embolus, cardiorespiratory support is initiated by oxygen administration. Although the remaining options may be implemented, none of these is the priority nursing action.
A client is receiving a continuous intravenous infusion of heparin sodium to treat deep vein thrombosis. The client's activated partial thromboplastin time (aPTT) is 65 seconds. The nurse anticipates that which action is needed? Discontinuing the heparin infusion Increasing the rate of the heparin infusion Decreasing the rate of the heparin infusion Leaving the rate of the heparin infusion as is
Leaving the rate of the heparin infusion as is The normal aPTT varies between 30 and 40 seconds (30 and 40 seconds), depending on the type of activator used in testing. The therapeutic dose of heparin for treatment of deep vein thrombosis is to keep the aPTT between 1.5 (45 to 60) and 2.5 (75 to 100) times normal. This means that the client's value should not be less than 45 seconds or greater than 100 seconds. Thus, the client's aPTT is within the therapeutic range and the dose should remain unchanged.
The nurse is giving discharge instructions to a client who has just undergone vein ligation and stripping. The nurse evaluates that the client understands activity and positioning limitations if the client states that which action is appropriate to do? Walk for as long as possible each day. Cross the legs at the ankle only, not at the knee. Sit in a chair 3 times a day for 3 hours at a time. Lie down with the legs elevated and avoid sitting.
Lie down with the legs elevated and avoid sitting. The client who has had vein ligation and stripping should avoid standing or sitting for prolonged periods. The client should remain lying down unless performing a specific activity for the first few days after the procedure. Prolonged standing or sitting increases the risk of edema in the legs by decreasing blood return to the heart. The client should avoid crossing the legs at any level for the same reason.
The nurse creates a plan of care for a client with deep vein thrombosis. Which client position or activity in the plan should be included? Out-of-bed activities as desired Bed rest with the affected extremity kept flat Bed rest with elevation of the affected extremity Bed rest with the affected extremity in a dependent position
Bed rest with elevation of the affected extremity For the client with deep vein thrombosis, elevation of the affected leg facilitates blood flow by the force of gravity and also decreases venous pressure, which in turn relieves edema and pain. A flat or dependent position of the leg would not achieve this goal. Bed rest is indicated to prevent emboli and to prevent pressure fluctuations in the venous system that occur with walking.
The nurse is providing postoperative care for a client who had a percutaneous insertion of an inferior vena cava filter and was on heparin therapy before surgery. The nurse should be most concerned about monitoring for which potential complications? Bleeding and infection Thrombosis and infection Bleeding and wound dehiscence Wound dehiscence and evisceration
Bleeding and infection After inferior vena cava filter insertion, the nurse inspects the surgical site for bleeding and signs and symptoms of infection. Heparin therapy also predisposes the client to bleeding. Thrombosis is unlikely because the client is on heparin therapy. Wound dehiscence and evisceration are not concerns because no abdominal incision is made.
A client with angina pectoris is experiencing chest pain that radiates down the left arm. The nurse administers a sublingual nitroglycerin tablet to the client. The client's pain is unrelieved, and the nurse determines that the client needs another nitroglycerin tablet. Which vital sign is the most important for the nurse to check before administering the medication? Temperature Respirations Blood pressure Radial pulse rate
Blood pressure Nitroglycerin acts directly on the smooth muscle of the blood vessels, causing relaxation and dilation. As a result, hypotension can occur. The nurse would check the client's blood pressure before administering the second nitroglycerin tablet. Although the respirations and apical pulse may be checked, these vital signs are not affected by this medication. The temperature also is not associated with administration of this medication.
he nurse is caring for a client who had a resection of an abdominal aortic aneurysm yesterday. The client has an intravenous (IV) infusion at a rate of 150 mL/ hr, unchanged for the last 10 hours. The client's urine output for the last 3 hours has been 90, 50, and 28 mL (28 mL is most recent). The client's blood urea nitrogen level is 35 mg/dL (12.6 mmol/L), and the serum creati¬nine level is 1.8 mg/dL (159 mcmol/L), measured this morning. Which nursing action is the priority? Check the serum albumin level. Check the urine specific gravity. Continue monitoring urine output. Call the primary health care provider (PHCP).
Call the primary health care provider (PHCP). Following abdominal aortic aneurysm resection or repair, the nurse monitors the client for signs of acute kidney injury. Acute kidney injury can occur because often much blood is lost during the surgery and, depending on the aneurysm location, the renal arteries may be hypoperfused for a short period during surgery. Normal reference levels are BUN 10 to 20 mg/dL (3.6 to 7.1 mmol/L), and creatinine 0.6 to 1.2 mg/dL (53 to 106 mcmol/L) for males and 0.5 to 1.1 mg/dL (44 to 97 mcmol/L) for females. Continuing to monitor urine output or checking other parameters can wait. Urine output lower than 30 mL/hr is reported to the PHCP for urgent treatment
The nurse is developing a plan of care for a client with varicose veins in whom skin breakdown occurred over the varicosities as a result of secondary infection. Which is a priority intervention? Keep the legs aligned with the heart. Elevate the legs higher than the heart. Clean the skin with alcohol every hour. Position the client onto the side during every shift.
Elevate the legs higher than the heart. In the client with a venous disorder, the legs are elevated above the level of the heart to assist with the return of venous blood to the heart. Alcohol is very irritating and drying to tissues and should not be used in areas of skin breakdown. Option 4 specifies infrequent care intervals, so it is not the priority intervention.
The nurse is planning care for a client with deep vein thrombosis of the right leg. Which interventions would the nurse anticipate the physician to most likely prescribe? Select all that apply. Strict bedrest Elevation of the right leg Administration of acetaminophen Application of moist heat to the right leg Monitoring for signs of pulmonary embolism
Elevation of the right leg Administration of acetaminophen Application of moist heat to the right leg Monitoring for signs of pulmonary embolism Standard management for the client with DVT includes maintaining the activity level as prescribed by the physician; limb elevation; relief of discomfort with warm, moist heat; and analgesics as needed. Strict bedrest is not likely to be prescribed; recent research is showing that ambulation does not cause pulmonary embolism and does not cause the existing DVT to worsen. Additionally, bedrest can cause complications such as skin integrity problems, weakness due to immobility, and respiratory problems.
The primary health care provider prescribes limited activity (bed rest and bathroom only) for a client who developed deep vein thrombosis (DVT) after surgery. What interventions should the nurse plan to include in the client's plan of care? Select all that apply. Encourage coughing with deep breathing. Place in high-Fowler's position for eating. Encourage increased oral intake of water daily. Place thigh-length elastic stockings on the client. Place sequential compression boots on the client. Encourage the intake of dark green, leafy vegetables.
Encourage coughing with deep breathing. Encourage increased oral intake of water daily. Place thigh-length elastic stockings on the client. The client with DVT may require bed rest to prevent embolization of the thrombus resulting from skeletal muscle action, anticoagulation to prevent thrombus extension and allow for thrombus autodigestion, fluids for hemodilution and to decrease blood viscosity, and elastic stockings to reduce peripheral edema and promote venous return. While the client is on bed rest, the nurse prevents complications of immobility by encouraging coughing and deep breathing. Venous return is important to maintain because it is a contributing factor in DVT, so the nurse maintains venous return from the lower extremities by avoiding hip flexion, which occurs with high-Fowler's position. The nurse avoids providing foods rich in vitamin K, such as dark green, leafy vegetables, because this vitamin can interfere with anticoagulation, thereby increasing the risk of additional thrombi and emboli. The nurse also would not include use of sequential compression boots for an existing thrombus. They are used only to prevent DVT because they mimic skeletal muscle action and can disrupt an existing thrombus, leading to pulmonary embolism.
The nurse is assessing a client with an abdominal aortic aneurysm. Which assessment finding by the nurse is unrelated to the aneurysm? Pulsatile abdominal mass Hyperactive bowel sounds in the area Systolic bruit over the area of the mass Subjective sensation of "heart beating" in the abdomen
Hyperactive bowel sounds in the area Hyperactive bowel sounds are not related specifically to an abdominal aortic aneurysm. Not all clients with an abdominal aortic aneurysm exhibit symptoms. Those who do may describe a feeling of the "heart beating" in the abdomen when supine or being able to feel the mass throbbing. A pulsatile mass may be palpated in the middle and upper abdomen. A systolic bruit may be auscultated over the mass.
The nurse is reviewing the laboratory results of a client admitted to the hospital with a diagnosis of venous thrombosis. The nurse expects the platelet aggregation to be reported as which level in this client? Normal Increased Decreased Insignificant
Increased The adherence of platelets to one another is defined as platelet aggregation. Platelets usually aggregate in less than 5 minutes. This test determines abnormalities in the rate and percentage of platelet aggregation. Increased platelet aggregation may occur after surgery or with acute illness, venous thrombosis, and pulmonary embolism.
A client complains of calf tenderness, and thrombophlebitis is suspected. The nurse should next assess the client for which finding? Bilateral edema Increased calf circumference Diminished distal peripheral pulses Coolness and pallor of the affected limb
Increased calf circumference The client with thrombophlebitis, also known as deep vein thrombosis, exhibits redness or warmth of the affected leg, tenderness at the site, possibly dilated veins (if superficial), low-grade fever, edema distal to the obstruction, and increased calf circumference in the affected extremity. Peripheral pulses are unchanged from baseline because this is a venous, not an arterial, problem. Often thrombophlebitis develops silently; that is, the client does not present with any signs and symptoms unless pulmonary embolism occurs as a complication.
A hemodialysis client with a left arm fistula is at risk for arterial steal syndrome. The nurse should assess for which manifestations of this complication? Warmth, redness, and pain in the left hand Ecchymosis and audible bruit over the fistula Edema and reddish discoloration of the left arm Pallor, diminished pulse, and pain in the left hand
Pallor, diminished pulse, and pain in the left hand Steal syndrome results from vascular insufficiency after creation of a fistula. The client exhibits pallor and a diminished pulse distal to the fistula. The client also complains of pain distal to the fistula, caused by tissue ischemia. Warmth and redness probably would characterize a problem with infection. Ecchymosis and a bruit are normal findings for a fistula.
The nurse is performing an admission assessment on a client with a diagnosis of Raynaud's disease. How should the nurse assess for this disease? Checking for a rash on the digits Observing for softening of the nails or nail beds Palpating for a rapid or irregular peripheral pulse Palpating for diminished or absent peripheral pulses
Palpating for diminished or absent peripheral pulses Raynaud's disease produces closure of the small arteries in the distal extremities in response to cold, vibration, or external stimuli. Palpation for diminished or absent peripheral pulses checks for interruption of circulation. Skin changes include hair loss, thinning or tightening of the skin, and delayed healing of cuts or injuries. The nails grow slowly, become brittle or deformed, and heal poorly around the nail beds when infected. Although palpation of peripheral pulses is correct, a rapid or irregular pulse would not be noted.
A client is admitted to the hospital for an acute episode of angina pectoris. Which parameter is the priority for the nurse to monitor? Pulse and blood pressure Temperature and respirations Food tolerance and urinary output Right upper quadrant pain and fatigue
Pulse and blood pressure Angina pectoris is transient chest pain or discomfort that is caused by an imbalance between myocardial oxygen supply and demand. The discomfort typically occurs in the retrosternal area; may or may not radiate; and is described as a tight, heavy, squeezing, burning, or choking sensation. The two major types of angina pectoris are stable (classic exertional) angina and unstable angina. Stable angina, the most common type, is usually precipitated by physical exertion or emotional stress, lasts 3 to 5 minutes, and is relieved by rest and nitroglycerin. Acute intervention for the client who has an anginal attack includes vital signs, oxygen, pain relief, and continuous electrocardiographic monitoring
A client is having a follow-up primary health care provider (PHCP) office visit after vein ligation and stripping. The client describes a sensation of "pins and needles" in the affected leg. Which would be an appropriate action by the nurse based on evaluation of the client's comment? Report the complaint to the PHCP. Instruct the client to apply warm packs. Reassure the client that this is only temporary. Advise the client to take acetaminophen until it is gone.
Report the complaint to the PHCP. Hypersensitivity or a sensation of pins and needles in the surgical limb may indicate temporary or permanent nerve injury following surgery. The saphenous vein and saphenous nerve run close together in the distal third of the leg. Although complications from this surgery can occur, they are relatively rare so this symptom should be reported. The actions in the remaining options are incorrect and could be harmful; in addition, they delay the possible need for intervention about the client's complaint. Although nerve damage can occur and is usually temporary and minimal and resolves within a few months, it is not appropriate to tell the client that this occurrence is only temporary. The complaint needs to be further assessed.
A client has been diagnosed with thromboangiitis obliterans (Buerger's disease). The nurse is identifying measures to help the client cope with lifestyle changes needed to control the disease process. The nurse plans to refer the client to which member of the health care team? Dietitian Medical social worker Pain management clinic Smoking cessation program
Smoking cessation program Buerger's disease is a vascular occlusive disease that affects the medium and small arteries and veins. Smoking is highly detrimental to the client with Buerger's disease, so stopping smoking completely is recommended. Because smoking is a form of chemical dependency, referral to a smoking cessation program may be helpful for many clients. For many clients with Buerger's disease, symptoms are relieved or alleviated once smoking stops. A dietitian, a medical social worker, and a pain management clinic are not specifically associated with the lifestyle changes required in this disorder, although they may be needed if secondary problems arise.
The nurse is preparing discharge instructions for a client with Raynaud's disease. The nurse should plan to provide which instruction to the client? Use nail polish to protect the nail beds from injury. Wear gloves for all activities involving the use of both hands. Stop smoking because it causes cutaneous blood vessel spasm. Always wear warm clothing, even in warm climates, to prevent vasoconstriction.
Stop smoking because it causes cutaneous blood vessel spasm. Raynaud's disease is peripheral vascular disease characterized by abnormal vasoconstriction in the extremities. Smoking cessation is one of the most important lifestyle changes that the client must make. The nurse should emphasize the effects of tobacco on the blood vessels and the principles involved in stopping smoking. The nurse needs to provide information to the client about smoking cessation programs available in the community. It is not necessary to wear gloves for all activities, nor should warm clothing be worn in warm climates.
The nurse is assessing the neurovascular status of a client who returned to the surgical nursing unit 4 hours ago after undergoing aortoiliac bypass graft. The affected leg is warm, and the nurse notes redness and edema. The pedal pulse is palpable and unchanged from admission. How should the nurse correctly interpret the client's neurovascular status? The neurovascular status is normal because of increased blood flow through the leg. The neurovascular status is moderately impaired, and the surgeon should be called. The neurovascular status is slightly deteriorating and should be monitored for another hour. The neurovascular status is adequate from an arterial approach, but venous complications are arising.
The neurovascular status is normal because of increased blood flow through the leg. An expected outcome of aortoiliac bypass graft surgery is warmth, redness, and edema in the surgical extremity because of increased blood flow. The remaining options are incorrect interpretations.
The nurse is assessing the neurovascular status of a client who returned to the surgical nursing unit 4 hours ago after undergoing aortoiliac bypass graft. The affected leg is warm, and the nurse notes redness and edema. The pedal pulse is palpable. How should the nurse interpret the client's neurovascular status? The neurovascular status is normal because of increased blood flow through the leg. The neurovascular status is moderately impaired, and the surgeon should be called. The neurovascular status is slightly deteriorating and should be monitored for another hour. The neurovascular status shows adequate arterial flow, but venous complications are arising.
The neurovascular status is normal because of increased blood flow through the leg. An expected outcome of aortoiliac bypass graft surgery is warmth, redness, and edema in the surgical extremity because of increased blood flow. The remaining options are incorrect interpretations.
