About
Atherosclerosis of the arteries depriving the lower extremities of oxygen and circulation, causing tissue ulceration below the area of arterial occlusion or narrowing.
Assess
Decreased peripheral pulses, muscle pain, cramping, numbness, decreased sensation to extremities, presence of ulcers on foot or toe.
Complications
Injury, ulcers, clots, pain, surgery
Diagnosis
- Impaired tissue perfusion related to vascular changes
- Pain related to decreased oxygenation to peripheral tissues
Goals
- The client will maintain mobility and accommodate for impaired mobility.
- The client will maintain skin integrity.
- The client will be free from injury.
Interventions
- Monitor vital signs, electrolytes, fluid balance, intakes and outputs, telemetry, breath sounds.
- Implement safety precautions to prevent injury.
- Monitor circulation to extremities ( presence of ulcers, redness, erythema, decreased pulses, pallor, pain, decreased sensation, etc.).
- Assist client with ADL's, as needed.
- Maintain clutter-free environment free from physical barriers.
- Administer medications ( peripheral vasodilators, antiplatelets, analgesics, etc.) as ordered.
- Encourage active participation in ADL's as much as the client is able to tolerate.
- Encourage active participation in physical therapy and/ or occupational therapy.
- Teach client and family member about the disease and drug therapy.
- Teach client side effects and adverse reactions of medication therapy.
- Teach client techniques to maintain mobility and prevent injury ( including soft absorbent socks or shoes, checking for injury daily).
- Prepare for surgery ( fem-pop bypass, amputation, debridement) as indicated.
- Teach client lifestyle changes that may help with disease process ( exercise, smoking cessation, low fat diets, etc).
- Monitor for signs/ symptoms of complications.
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