Your nursing interventions should focus on providing foot care, monitoring your patient's
response to the prescribed drugs and promoting circulation after surgery.
Foot Care
The primary goal of nursing care in patients with diabetes and peripheral vascular disease is to
help reduce the risk of foot and leg amputations. Therefore, protect the patient's legs and feet from even
minor traumas, which can lead to infection, ulcers, and ultimately loss of function.
Thoroughly assess your patient's legs and feet for signs of impaired skin integrity, such as
pressure areas or skin tears. If your patient has peripheral or autonomic neuropathy, she may have decreased
sensations of touch, pain, or temperature, so examine her legs and feet routinely for signs of breakdown.
Check her pedal pulses, foot temperature, capillary refill, and skin color. Also, assess her for changes in
feeling, such as numbness or tingling.
Provide your patient with meticulous foot care. To prevent pressure on her legs and feet, make
sure she changes position every 2 hours and performs range-of-motion exercises, if possible. Wash her feet
with warm water and mild soap, and dry them well, particularly between the toes. Inspect her feet and apply
moisturizing cream every day but not between her toes. Use protective padding, foot cradles, or an
alternating-pressure mattress to reduce the risk of pressure injuries. To prevent constriction and impaired
circulation, don't use elastic antiembolism stockings.
Although your patient's activity may be restricted, make sure she wears appropriate footwear,
even for short distances. Shoes or slippers that don't fit properly can cause further injury and lengthen her
hospital stay.
Monitor your patient for signs and symptoms of wound infection, including redness, swelling, or
foul-smelling, purulent drainage. Obtain a culture of any open or draining lesion, and begin antibiotic
therapy as prescribed. If your patient is taking antibiotics, make sure she drinks at least eight 8-ounce
glasses of fluid every day, and assess her renal function daily. Dress an infected wound with a wet-to-dry
dressing and change it several times a day to achieve mechanical debridement. (Remember that the dressing
helps lift off dead surface skin, which promotes new tissue growth.) If the wound isn't infected, dress it
with an occlusive dressing that retains moisture and enhances cell migration and healing.
Drug Response
If your patient is taking pentoxifylline, check for headaches, dizziness, nausea, or vomiting.
Monitor her WBC count for signs of neutropenia. If she's taking ticlopidine, closely monitor her complete
blood cell count and WBC differential for adverse effects, such as neutropenia. Also, evaluate her liver
function tests for elevated alanine aminotransferase and aspartate aminotransferase levels, which indicate
liver dysfunction.
Postoperative Circulation
If your patient has a bypass graft, your primary goal after surgery is to promote and maintain
circulation through the new grafts. So monitor the neurovascular status of her feet and legs. Immediately
report signs or symptoms of graft occlusion, such as severe pain, loss of pulses, cold hands or feet, or new
complaints of numbness or tingling.
Position your patient so that her knees aren't flexed, which might impair her circulation and
compromise the potency of the graft. Also, make sure she doesn't sit in one position for a long period.
Elevate the affected leg to reduce edema. Instruct her not to cross her legs and to avoid keeping the
affected leg in a dependent position for a prolonged period.
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