Question

Matthew Helm, 67 years of age, is a male patient who is admitted with the diagnosis of peripheral arterial occlusive disease in the right femoral and popliteal arteries. The patient undergoes a right femoral-to-popliteal graft operation. Preoperatively, the patient presented with the following assessment: the right leg skin is taut and shiny; very little hair is present; and the toenails are thick and opaque. The leg has pallor when lying on the bed flat, but when the patient places the leg over the side of the bed it has rubor and the toes are bluish in coloration. The patient states the pain in his leg as a constant excruciating pain that he rates as an 8 on the pain scale. No pedal or posterior tibial pulses are detectable with Doppler in the right leg and the popliteal artery is diminished and the femoral pulse is also diminished. The left leg is also shiny, taut, and has very little hair present and the nails are thick and opaque. The patient develops rubor when the leg is held over the side of the bed. The pulses are palpable and slightly diminished at all sites in the left leg. The patient has smoked one pack of cigarettes per day for 50 years. He presents with the following vital signs: BP, 160/110 mm Hg; pulse, 88; respiration, 22; and temperature, 98°F. He does not take any medications currently.

a. The patient returns to the unit after the right femoral-to-popliteal graft operation. What nursing care should the nurse provide?

b. The surgeon postoperatively prescribed aspirin 160 mg every day and rosuvastatin calcium (Crestor) 5 mg once daily. What is the rationale for each of the medications ordered in relation to the patient’s diagnosis and treatment plan?

c. What patient education should the nurse provide?

Answer 1

a. surgical site wound care , strict asepsis inorder to prevent infection, maintain the knee in slight flexion inorder to avoid strain on the repaired blood vessel and graft, regular vital monitoring and administarion of sheduled drugs.monitor pulse rate - dorsalis pedis , use a pulse oxy meter to see pulse volume and saturation of operated limb, look for signs of reduced blood flow such as discoloration , reduced capillary filling of toes, monitor the temperature of the patient.

b.aspirin is an antitrombotic agent which if given as a prophylatic agent in order to prevent the development of a thrombus in the vessel following surgery. crestor is used to slow the process of atherosclerosis and reduces the chances of revascularisation surgeries in future since the patient is high risk category(above 50 yrs of age).these medicines are prescribed so as to maintain the patency of the graft.

c.patient is advised to avoid smoking, care of wound keep clean, how to bath and avoid strain, proper drug intake shedule to be explained.to report to hospital in case of fever, excessive pain, limb discoloration, numbness / sweating/chest heaviness/breathing difficulty,drainage form incision site.