Chapter 40: Application of Elastic Antiembolic Stockings

Antiembolic Stockings and Sequential Compression Devices

• Antiembolic stockings promote venous return and prevent thrombus formation by applying external pressure to the muscles of the lower extremities.
• Sequential compression devices (SCDs) have plastic or fabric sleeves that wrap around the leg and secure with hook-and-loop closures, attached to an electric pump that alternately inflates and deflates the sleeve around the leg.
• SCDs and IPCs require a prescription.

Positioning Techniques

• Positioning techniques reduce compression of leg veins and promote blood return to the heart.
• ROM exercises cause skeletal muscle contractions, which promote blood return.
• Specific exercises that help prevent thrombophlebitis include ankle pumps, foot circles, and knee flexion.

Client Education

• Avoid crossing legs, sitting for long periods, wearing restrictive clothing on the lower extremities, putting pillows behind the knees, and massaging legs.
• Perform ankle pumps, foot circles, and knee flexion hourly while awake.
• Increase fluid intake, and change positions frequently.

Complications

• Thrombophlebitis and deep-vein thrombosis are inflammation of a vein (usually in the lower extremities) that result in clot formation.
• Manifestations of thrombophlebitis include pain, edema, warmth, and erythema at the site.
• Complications can lead to pulmonary embolism.

Assessment and Nursing Actions

• Assess skin, circulation, and presence of edema in the legs.
• Measure calf and/or thigh circumference and length of the leg to select the correct size stocking.
• Remove stockings every 8 hours to assess for redness, warmth, or tenderness.
• Avoid pressure at the site of inflammation and anticipate giving anticoagulants.
• Keep stockings clean and dry.

Social Isolation

• Alterations in every physiological system in adults
• Alterations in family and social systems, job identity, and self-esteem

Respiratory System

• Maintain airway patency, achieve optimal lung expansion, and gas exchange
• Mobilize airway secretions
• Assess every 2 hours
• Observe chest wall movement for symmetry
• Auscultate lungs for diminished breath sounds, crackles, or wheezes
• Observe for productive cough, and note the color, amount, and consistency of secretions

Older Adults

• Alterations in balance resulting in a major risk for falls and injuries
• Steady loss of bone mass resulting in weakened bones
• Slower walk with smaller steps
• Decreased coordination
• Increased dependence on staff and family, which can become long-term
• Alterations in functional status

SCDs (Sequential Compression Devices)

• Use tape measure and sequential stockings
• Document the application and removal of the stockings

Pulmonary Embolism

• Potentially life-threatening occlusion of blood flow to one or more pulmonary arteries by a clot
• Clot or embolus often originates in the venous system of the lower extremities
• Manifestations: shortness of breath, chest pain, hemoptysis, decreased blood pressure, and rapid pulse

Nursing Actions

• Reposition every 1 to 2 hours
• Remove abdominal binders every 2 hours and replace correctly
• Use chest physiotherapy
• Auscultate lungs to determine the effectiveness of chest physiotherapy or other respiratory therapy
• Monitor the ability to expectorate secretions
• Use suction if unable to expectorate secretions
• Prepare to give thrombolytics or anticoagulants
• Position client in a high-Fowler's position
• Obtain pulse oximetry
• Administer oxygen
• Prepare to obtain blood gas analysis
• Monitor vital signs frequently

Client Education

• Turn, cough, and breathe deeply every 1 to 2 hours while awake
• Yawn every hour while awake
• Use an incentive spirometer while awake
• Consume at least 2,000 mL fluid per day, unless intake is restricted

Cardiovascular System

• Maintain cardiovascular function, increase activity tolerance, and prevent thrombus formation
• Assess orthostatic blood pressure and pulse (lying to sitting to standing), and assess for dizziness
• Palpate the apical and peripheral pulses
• Auscultate the heart at the apex for S3 (an early indication of heart failure)

Elimination

• Maintain urinary and bowel elimination
• Assess I&O
• Measure orthostatic blood pressure and pulse (lying to sitting to standing), and assess for dizziness
• Observe urine for color, amount, clarity, and frequency
• Palpate the apical and peripheral pulses
• Auscultate bowel sounds
• Observe feces for color, amount, frequency, and consistency
• Palpate for edema in the sacrum, legs, and feet
• Maintain hydration (at least 2,000 mL/day unless fluid is restricted)
• Give a stool softener, laxative, or enema as needed
• Teach bladder and bowel training