Teach re: avoidance of venous stasis, compression stockings, exercise, leg elevation
LYMPHATIC SYSTEM – WORKS WITH CIRCULATORY SYSTEM
LYMPHATIC SYSTEM – WORKS WITH CIRCULATORY SYSTEM
THORACIC DUCT
RIGHT LYMPHATIC DUCT
CAUSES OF LYMPHEDEMA INCLUDE:
CAUSES OF LYMPHEDEMA INCLUDE:
LYMPHANGITIS CELLULITIS
INSUFFICIENT NUMBER OF VESSELS
SECONDARY FACTORS
MALIGNANCY
TRAUMA
SURGICAL REMOVAL
Pain at site of injury
Pain at site of injury
Redness of skin
Fever and chills
Red streak on skin extending toward the lymph nodes
Lymph nodes enlarged
WBC, Blood & Wound cultures
Lymphangiography-IV dye, Xrays
Lymphoscintigraphy-simple,no SE
Moist heat
Moist heat
Elevation and immobilization of the extremity
Elastic stockings
Na restriction
Antibiotics/antifungals for infection
Diuretics
Analgesics
MR. CHARLES HORSE WAS ADMITTED TO THE HOSPITAL TODAY WHERE HE PRESENTED HIS CHIEF COMPLAINTS AND RECENT MEDICAL HISTORY. THIS PATIENT IS A FIFTY-THREE YEAR OLD WHITE MALE. MR. HORSE IS A RUGGED INDIVIDUAL WITH AN EXTENSIVE HISTORY.
MR. CHARLES HORSE WAS ADMITTED TO THE HOSPITAL TODAY WHERE HE PRESENTED HIS CHIEF COMPLAINTS AND RECENT MEDICAL HISTORY. THIS PATIENT IS A FIFTY-THREE YEAR OLD WHITE MALE. MR. HORSE IS A RUGGED INDIVIDUAL WITH AN EXTENSIVE HISTORY.
HE SMOKES 1 PACK OF CIGARETTES PER DAY FOR MORE THAN TWENTY
HE SMOKES 1 PACK OF CIGARETTES PER DAY FOR MORE THAN TWENTY
FIVE YEARS. AS A SINGLE LUMBERJACK HIS DIET HAS RELIED HEAVILY ON FAST FOODS. OVER THE PAST SEVERAL MONTHS MR. HORSE REPORTED HE HAD GRADUALLY BEEN EXPERIENCING PAIN IN THE LEFT LEG. THESE PAINFUL SYMPTOMS INCREASED TO A POINT WHERE HE CANNOT WALK MORE THAN TWO CITY BLOCKS WITHOUT SEVERE CRAMPING IN HIS LEFT LEG.
HE STATES HE MUST STOP, SIT AND RUB HIS LEG UNTIL THE CRAMPING STOPS. MR. HORSE HAS GRADUALLY ADJUSTED HIS ACTIVITIES AROUND THESE SYMPTOMS.
HE STATES HE MUST STOP, SIT AND RUB HIS LEG UNTIL THE CRAMPING STOPS. MR. HORSE HAS GRADUALLY ADJUSTED HIS ACTIVITIES AROUND THESE SYMPTOMS.
THIS MORNING, MR. HORSE AWOKE FROM A DEEP SLEEP TO SUDDEN, SEVERE PAIN IN THE LEFT LEG. THE PAIN DIMINISHED SLIGHTLY WHEN HE SAT UP AND HUNG HIS LEGS OVER THE SIDE OF THE BED.
HE NOTICED CHANGES IN SKIN COLOR AND TEMPERATURE. CONCERNED ABOUT THE SUDDEN CHANGES, MR. HORSE HEADED DIRECTLY TO THE EMERGENCY ROOM.
HE NOTICED CHANGES IN SKIN COLOR AND TEMPERATURE. CONCERNED ABOUT THE SUDDEN CHANGES, MR. HORSE HEADED DIRECTLY TO THE EMERGENCY ROOM.
WHEN YOU ASSESS THIS PATIENT ATTENTION IS DIRECTED TOWARD HIS LEFT LEG. THE SKIN IS COOL TO TOUCH. ASSESSING PERIPHERAL PULSES YOU NOTE THAT HIS FEMORAL AND POPLITEAL PULSES ARE STRONG AND PALPABLE BILATERALLY.
HOWEVER, HIS POSTERIOR TIBIAL AND DORSALIS PEDIS PULSES ON THE LEFT LEG ARE NOT PALPABLE. A DOPPLER READING INDICATES THERE IS SOME DEGREE OF CIRCULATION PRESENT. NAIL BEDS ARE CYANOTIC; CAPILLARY FILLING IS SLOW (> 3 SECONDS) IN ALL DIGITS ON THE LEFT FOOT.
HOWEVER, HIS POSTERIOR TIBIAL AND DORSALIS PEDIS PULSES ON THE LEFT LEG ARE NOT PALPABLE. A DOPPLER READING INDICATES THERE IS SOME DEGREE OF CIRCULATION PRESENT. NAIL BEDS ARE CYANOTIC; CAPILLARY FILLING IS SLOW (> 3 SECONDS) IN ALL DIGITS ON THE LEFT FOOT.
ATTEMPTING TO IMPROVE MR. HORSE’S COMFORT, THE NURSE ELEVATES HIS FEET. MR. HORSE REPORTS THE PAIN IS SIGNIFICANTLY WORSE!
WHAT INFORMATION DOES INSPECTION OF THE PATIENT’S LEG PROVIDE?
WHAT INFORMATION DOES INSPECTION OF THE PATIENT’S LEG PROVIDE?
COLOR OF SKIN
COLOR OF NAIL BEDS
WHAT CAN PALPATION TELL YOU ABOUT THIS PATIENT’S CONDITION?
WHAT CAN PALPATION TELL YOU ABOUT THIS PATIENT’S CONDITION?
TEMPERATURE
PULSES
WHAT POSITION WOULD BE THE MOST COMFORTABLE FOR MR. HORSE?
WHAT POSITION WOULD BE THE MOST COMFORTABLE FOR MR. HORSE?
WHAT PROBLEM DO YOU THINK MR. HORSE HAS WITH HIS LEFT LEG?
WHAT WOULD PREDISPOSE MR. HORSE TO DEVELOPING THIS TYPE OF PROBLEM?
WHAT WOULD PREDISPOSE MR. HORSE TO DEVELOPING THIS TYPE OF PROBLEM?
WHAT IS THE CLINICAL TERM FOR A CONDITION CAUSING PERIODIC CRAMPING BROUGH ON BY WALKING?
WHAT ARE THE 5 P’s YOU SHOULD LOOK FOR?
WHAT ARE THE 5 P’s YOU SHOULD LOOK FOR?
FOLLOWING A SUCCESSFUL REVASCULARIZATION PROCEDURE, MR. HORSE WAS D/C’d TO HOME IN GOOD CONDITION. HIS LEFT LEG WAS WARM, PINK IN COLOR AND ALL TOES WERE MOBILE. MR. HORSE WAS PLACED ON MEDICATIONS TO MANAGE HIS CHF, WHICH WAS DISCOVERED DURING IHIS MEDICAL HISTORY AND PHYSICAL EXAM. TWO WEEKS LATER THIS PATIENT RETURNED TO THE HOSPITAL…
FOLLOWING A SUCCESSFUL REVASCULARIZATION PROCEDURE, MR. HORSE WAS D/C’d TO HOME IN GOOD CONDITION. HIS LEFT LEG WAS WARM, PINK IN COLOR AND ALL TOES WERE MOBILE. MR. HORSE WAS PLACED ON MEDICATIONS TO MANAGE HIS CHF, WHICH WAS DISCOVERED DURING IHIS MEDICAL HISTORY AND PHYSICAL EXAM. TWO WEEKS LATER THIS PATIENT RETURNED TO THE HOSPITAL…
PRESENTING WITH DYSPNEA, ORTHOPNEA AND BILATERAL +3 PITTING EDEMA. MR. HORSE WAS READMITTED TO THE HOSPITAL WITH A DX OF CHF. DIGOXIN (A CARDIOTONIC) WAS STARTED AND LASIX (A DIURETIC) ALSO WAS ADDED TO HIS MEDICATION PROFILE. ONCE AGAIN MR. HORSE WAS D/C’d TO HOME AND PROVIDED WITH A HOME HEALTH AIDE TO ASSIST HIM WITH HIS ADL’s. HE WAS INSTRUCTED TO REMAIN ON BED REST
PRESENTING WITH DYSPNEA, ORTHOPNEA AND BILATERAL +3 PITTING EDEMA. MR. HORSE WAS READMITTED TO THE HOSPITAL WITH A DX OF CHF. DIGOXIN (A CARDIOTONIC) WAS STARTED AND LASIX (A DIURETIC) ALSO WAS ADDED TO HIS MEDICATION PROFILE. ONCE AGAIN MR. HORSE WAS D/C’d TO HOME AND PROVIDED WITH A HOME HEALTH AIDE TO ASSIST HIM WITH HIS ADL’s. HE WAS INSTRUCTED TO REMAIN ON BED REST
FOR ONE WEEK. HE IS SEEN BY THE VISITNING NURSE IN HIS HOME ON F/U TO ASSESS HIS STATUS. THE NURSE TAKES NOTICE OF MR. HORSE’S +2 PITTING EDEMA IN HIS RIGHT LEG, EXTENDING FROM THE FOOT TO THE LOWER THIGH. SKIN COLOR IS NOTED TO HAVE A REDDISH/ PURPLE HUE AND THE SURFACE TEMP IS INCREASED LOCALLY. THE LIMB IS TENDER TO TOUCH AND PAIN INCREASES WITH DORSIFLEXION.
FOR ONE WEEK. HE IS SEEN BY THE VISITNING NURSE IN HIS HOME ON F/U TO ASSESS HIS STATUS. THE NURSE TAKES NOTICE OF MR. HORSE’S +2 PITTING EDEMA IN HIS RIGHT LEG, EXTENDING FROM THE FOOT TO THE LOWER THIGH. SKIN COLOR IS NOTED TO HAVE A REDDISH/ PURPLE HUE AND THE SURFACE TEMP IS INCREASED LOCALLY. THE LIMB IS TENDER TO TOUCH AND PAIN INCREASES WITH DORSIFLEXION.
THE NURSE ALSO NOTES THAT PERIPHERAL PULSES ARE MODERATELY DIMINISHED ON THE RIGHT SIDE ONLY. MR. HORSE COMPLAINS THAT HIS RIGHT LEG FEELS HEAVY AND THROBS.
THE NURSE ALSO NOTES THAT PERIPHERAL PULSES ARE MODERATELY DIMINISHED ON THE RIGHT SIDE ONLY. MR. HORSE COMPLAINS THAT HIS RIGHT LEG FEELS HEAVY AND THROBS.
WHAT DOES INSPECTION OF HIS RIGHT LEG REVEAL?
WHAT DOES INSPECTION OF HIS RIGHT LEG REVEAL?
SKIN COLOR
GIRTH / TENSION
WHAT DOES PALPATION TELL YOU ABOUT THE STATUS OF HIS RIGHT LEG?
WHAT DOES PALPATION TELL YOU ABOUT THE STATUS OF HIS RIGHT LEG?
TEMPERATURE
EDEMA
WHAT DO YOU THINK THE PROBLEM IS WITH MR. HORSE’S RIGHT LEG?
WHAT DO YOU THINK THE PROBLEM IS WITH MR. HORSE’S RIGHT LEG?
WHAT DO YOU THINK CAUSED MR. HORSE’S RECENT COMPLICATIONS?
HOW COULD THESE PROBLEMS HAVE BEEN AVOIDED?
HOW COULD THESE PROBLEMS HAVE BEEN AVOIDED?
LIST EXAMPLES THAT PREDISPOSE A PATIENT TO DVT
LIST EXAMPLES THAT PREDISPOSE A PATIENT TO DVT
Which of the following clients should the nurse assess first?
Which of the following clients should the nurse assess first?
A.The 76-year-old woman who has had laser-assisted angioplasty of the right distal femoral artery 30 minutes ago
B.The 65-year-old man with a history of hypertensive crisis who is on a labetalol drip and current blood pressure is 149/80
C.The 60-year-old woman with a history of peripheral vascular disease who has a venous leg ulcer draining purulent yellow fluid
D.The 55-year-old man with a history of axillofemoral bypass 5 years earlier who is currently admitted for a diagnostic cardiac catheterization
Which of the following statements indicates the caregiver does not understand proper care of the client with peripheral arterial disease of the lower legs?
Which of the following statements indicates the caregiver does not understand proper care of the client with peripheral arterial disease of the lower legs?
A.“The client should drink fluids to decrease risk for viscous blood.”
B.“We must remind the client to refrain from wearing restrictive clothing.”
C.“The client should apply heat directly to the legs in order to promote blood circulation.”
D.“The client should be encouraged to stop smoking because it increases the vasoconstriction of the arteries.”
You are caring for a 75-year-old man admitted to the hospital for lower leg cellulitis. On admission, the nurse notes that his blood pressure is 190/100 and notifies the physician. Of the following orders, which would you have the LPN implement?
You are caring for a 75-year-old man admitted to the hospital for lower leg cellulitis. On admission, the nurse notes that his blood pressure is 190/100 and notifies the physician. Of the following orders, which would you have the LPN implement?
A.Assess cardiac and respiratory status.
B.Administer Clonidine patch for hypertension.
C.Obtain an order from the doctor for dietary consult.
D.Develop plan for discharge and assess homecare needs.
A group of new graduate nurses is in orientation to work on a cardiothoracic stepdown unit. Which statement, if made by one of the nurses, demonstrates the need for further teaching regarding the difference between arteriosclerosis and atherosclerosis?
A group of new graduate nurses is in orientation to work on a cardiothoracic stepdown unit. Which statement, if made by one of the nurses, demonstrates the need for further teaching regarding the difference between arteriosclerosis and atherosclerosis?
A.“Arteriosclerosis is a thickening, or hardening, of the arterial wall.”
B.“Atherosclerosis is a type of arteriosclerosis that involves the formation of plaque within the arterial wall and is the leading contributor to coronary artery and cerebrovascular disease.”
C.“Atherosclerosis is caused by vascular damage.”
D.“Arteriosclerosis happens when platelets aggregate and then a group of blood lipids accumulate.”
Because Mr. Palan's condition has progressed to severe rest pain that is now threatening loss of his limb, an arterial revascularization has to be performed. Which statement, if made by Mr. Palan, demonstrates that further teaching is needed related to his postoperative care?
Because Mr. Palan's condition has progressed to severe rest pain that is now threatening loss of his limb, an arterial revascularization has to be performed. Which statement, if made by Mr. Palan, demonstrates that further teaching is needed related to his postoperative care?
A.“I should be concerned if my foot turns blue.”
B.“I should not get a fever or any drainage after the surgery.”
C.“I may get a feeling of tenseness after the surgery.”
D.“Warmth, redness, and swelling are expected after surgery.”
5.Clara is teaching a young woman ways to prevent venous thromboembolism during hospitalization. Which statement, if made by the client, indicates the need for further teaching?
5.Clara is teaching a young woman ways to prevent venous thromboembolism during hospitalization. Which statement, if made by the client, indicates the need for further teaching?
A.“I need to stop taking my birth control pill.”
B.“I should drink a lot of water so I don't get dehydrated.”
C.“I should exercise my legs when I have been sitting or standing for a long time.”
D.“If I wear pantyhose, I don't have to wear the stockings that the hospital gives me.”
