Nursing Management PDF

10/19/23, 3:30 AM Realizeit for Student Nursing Management Nursing care for the patient who has had endovascular revascularization procedures mostly mirrors the care of patients who have had endovascular repair to aortic aneurysms (see later section). The patient who has had an endovascular proced...

10/19/23, 3:30 AM Realizeit for Student Nursing Management Nursing care for the patient who has had endovascular revascularization procedures mostly mirrors the care of patients who have had endovascular repair to aortic aneurysms (see later section). The patient who has had an endovascular procedure may be discharged home the day of the procedure, or by the following day. Maintaining Circulation The primary objective in the postoperative period is to maintain adequate circulation through the arterial repair. Pulses, Doppler assessment, color and temperature, capillary refill, and sensory and motor function of the affected extremity are checked and compared with those of the other extremity; these observations are recorded initially every 15 minutes and then at progressively longer intervals if the patient’s status remains stable. Doppler evaluation of the vessels distal to the bypass graft should be performed, because it is more sensitive than palpation for pulses. The ABI is monitored at least once every 8 hours for the first 24 hours (not usually assessed with pedal artery bypasses due to the risk of compression of the anastomosis by the cuff) and then once each day until discharge; the typical hospital length of stay is 3 to 5 days. An adequate circulating blood volume should be established and maintained. Disappearance of a pulse that was present may indicate thrombotic occlusion of the graft; the surgeon is immediately notified. Monitoring and Managing Potential Complications Continuous monitoring of urine output, central venous pressure, mental status, and pulse rate and volume permits early recognition and treatment of fluid imbalances. Bleeding can result from the heparin given during surgery or from an anastomotic leak. A hematoma may form as well. The nurse should review the operative report to determine if the heparin was reversed (usually with protamine sulfate) in the operating room. Leg crossing and prolonged extremity dependency are avoided to prevent thrombosis. Edema is a normal postoperative finding due to increased arterial flow; however, elevating the extremities and encouraging the patient to exercise the extremities while in bed reduces edema. Graduated compression or anti-embolism stockings may be prescribed for some patients, but care must be taken to avoid compressing distal vessel bypass grafts, inducing pressure injuries, and obscuring visualization of the extremity. Severe edema of the extremity, pain, and decreased sensation of toes or fingers can be an indication of compartment syndrome. Promoting Home, Community-Based, and Transitional Care Discharge planning includes assessing the patient’s ability to manage activities of daily living (ADLs) independently. The nurse determines whether the patient has a network of family and friends to assist with ADLs. The patient is encouraged to make the lifestyle changes necessitated by the onset of https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IagsrRDoag8O5uY%2buyG45kbB3bvIg9mMgs36U0K0gCcv… 1/2 10/19/23, 3:30 AM Realizeit for Student disease, including pain management and modifications in diet, activity, and hygiene (skin care). The nurse ensures that the patient has the knowledge and ability to assess for any postoperative complications such as infection, occlusion of the artery or graft, and decreased blood flow. The nurse assists the patient in developing and implementing a plan to stop using tobacco products. https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IagsrRDoag8O5uY%2buyG45kbB3bvIg9mMgs36U0K0gCcv… 2/2