58

Cardiovascular system

TREATMENT

Postoperatively

Light exercise such as walking

Surgery (for acute occlusion): atherectomy, balloon angioplasty, bypass graft, embolectomy, laser angioplasty, patch grafting,
stent placement, thromboendarterectomy, or
amputation

Monitor the clients vital signs. Continuously assess his circulatory function by
inspecting skin color and temperature and
by checking for distal pulses. In charting,
compare earlier assessments and observations. Watch closely for signs of hemorrhage
(tachycardia, hypotension) and check dressings for excessive bleeding to prevent or detect
postoperative complications.
In carotid, innominate, vertebral, or
subclavian artery occlusion, assess neurologic
status frequently for changes in level of consciousness or muscle strength and pupil size
to ensure prompt treatment of deteriorating
neurologic status.
In mesenteric artery occlusion, connect a
nasogastric tube to low intermittent suction.
Monitor intake and output. (Low urine output
may indicate damage to renal arteries during
surgery.) Assess abdominal status. Increasing
abdominal distention and tenderness may indicate extension of bowel ischemia with resulting
gangrene, necessitating further excision, or
peritonitis.
In saddle block occlusion, check distal
pulses for adequate circulation. Watch for
signs of renal failure and mesenteric artery
occlusion (severe abdominal pain) and
cardiac arrhythmias, which may precipitate
embolus formation, to ensure prompt recognition and treatment of complications.
In iliac artery occlusion, monitor urine
output for signs of renal failure from
decreased perfusion to the kidneys as a result
of surgery. Provide meticulous catheter care
to prevent complications.
In both femoral and popliteal artery occlusions, monitor peripheral pulses. Assist with
early ambulation, but discourage prolonged
sitting to encourage circulation to the extremities.
After amputation, check the clients stump
carefully for drainage and record its color and
amount and the time to detect hemorrhage.
Elevate the stump, and administer adequate
analgesic medication to treat edema and pain.
Because phantom limb pain is common,
explain this phenomenon to the client to
reduce the clients anxiety.
When preparing the client for discharge,
instruct him to watch for signs of recurrence
(pain, pallor, numbness, paralysis, absence of
pulse) that can result from graft occlusion or

Drug therapy
Anticoagulants: heparin, dalteparin
(Fragmin), enoxaparin (Lovenox), warfarin
(Coumadin)
Antiplatelets: aspirin, pentoxifylline
(Trental)
Thrombolytic agents: alteplase (Activase),
streptokinase (Streptase)

INTERVENTIONS AND RATIONALES

Advise the client to stop smoking and to
follow the prescribed medical regimen to
modify risk factors and promote compliance.

Preoperatively (during an acute episode)

Renal failure may

occur as a result of
arterial occlusion
and tissue damage.

313419NCLEX-RN_Chap03.indd 58

Assess the clients circulatory status by

checking for the most distal pulses and by
inspecting his skin color and temperature.
Decreased tissue perfusion causes mottling; skin
also becomes cooler and skin texture changes.
Provide pain relief as needed to help
decrease ischemic pain.
Administer I.V. heparin as needed to prevent thrombi. Use an infusion pump to ensure
the proper flow rate.
Reposition the foot frequently to prevent
pressure on any one area. Strictly avoid elevating or applying heat to the affected leg.
Directly heating extremities causes increased
tissue metabolism; if arteries dont dilate normally, tissue perfusion decreases and ischemia
may occur.
Watch for signs of fluid and electrolyte
imbalance, and monitor intake and output
for signs of renal failure (urine output less
than 30 ml/hour). Electrolyte imbalances and
renal failure are complications that may occur
as a result of arterial occlusion and tissue
damage.
If the client has a carotid, innominate,
vertebral, or subclavian artery occlusion,
monitor him for signs of stroke, such as
numbness in an arm or leg and intermittent
blindness, to detect early signs of decreased
cerebral perfusion.

4/8/2010 7:01:50 PM