Health Promotion and Maintenance Q 87
A nurse is providing discharge information to a patient with peripheral vascular disease. Which of the following information should be included in the instructions?
A. Walk barefoot whenever possible.
B. Use a heating pad to keep feet warm.
C. Avoid crossing the legs.
D. Use antibacterial ointment to treat skin lesions at risk of infection.
Correct Answer: C. Avoid crossing the legs.
Patients with peripheral vascular disease should avoid crossing the legs because this can impede blood flow. Place the client’s legs in a dependent position in relation to the heart to improve peripheral blood flow. Keep the client in a neutral, flat, supine position if in doubt about the nature of his peripheral vascular problems.
Option A: Walking barefoot is not advised, as foot protection is important to avoid trauma that may lead to serious infection. Randomized trials have shown supervised exercise therapy programs to have significant improvement in claudication symptoms. A meta-analysis of 27 studies found exercise significantly improved pain-free walking distance by 269 feet and total walking distance by nearly 400 feet.
Option B: Heating pads can cause injury, which can also increase the risk of infection. Never apply a direct heat source to the extremities. Limited blood flow combined occurs with normal circulation. Provide insulating warmth with gloves, socks, and other outerwear as appropriate.
Option D: Skin lesions at risk for infection should be examined and treated by a physician. If overreplacement of glucocorticoid is indicated, inform the client about the purpose of therapy and possible adverse effects such as cushingoid appearance, weight gain, acne, hirsutism, peptic ulcer, diabetes mellitus, osteoporosis, infection, muscular weakness, mood swings, cataracts, and hypertension.