Varicose Veins Care Plan
1. Acute Pain related to tissue ischemia secondary
Goal: Pain is lost or controlled
Intervention:
1) Assess the degree of pain. Note the behavior of protecting the extremities.
R / Degree of pain is directly related to the extent of the circulation shortfall, the inflammatory process.
2) Maintain bed rest during the acute phase.
R / Decrease discomfort in relation to muscle contraction and movement.
3) Elevate the affected extremity.
R / Pushing to facilitate venous return circulation, reduce static formation.
4) Encourage the patient to change positions frequently.
R / Reduce / prevent muscle weakness, helps minimize muscle spasm.
5) Collaboration of drugs as indicated.
R / Reduce pain and reduce muscle tension.
2. Impaired skin integrity related to vascular insufficiency.
Goal: Maintain the integrity of the skin.
Intervention:
1. Assess skin integrity, record changes in turgor, color noise, local warm, erythema, excoriation.
R / Skin condition is influenced by circulation, nutrition, and immobilization. Tissue can become brittle and prone to infection and damage.
2. Assess the extremities for venous obvious protrusion.
R / Superficial venous distension may occur in TVD because backflow through the veins branching.
3. Change position often, and avoid massaging the affected limb.
R / Improve circulation, massage the potential to solve / deploy thrombus causing embolus.
4. Range of motion exercises help to passive or active.
R / Improves circulation of body tissue, prevents stasis.
5. Perform warm compresses, moist heat to the extremities or the hospital if indicated.
R / Increase vasodilation and venous return and repair of local edema.
3. Impaired physical mobility related to activity limitations due to pain.
Goal: Demonstrate techniques / behaviors enabling activities.
Intervention:
1) Maintain proper body position.
R / Improving tissue stability (reducing the risk of injury), the functional position of the extremities.
2) Note the circulation, movement and sensation are frequent.
R / Edema can affect circulation to the extremities so that the potential occurrence of tissue necrosis.
3) Assist with range of motion active / passive.
R / Improve maintenance of tissue function.
4) Schedule of activities and treatments to provide uninterrupted rest period.
R / Prevent fatigue, maintain strength and patient tolerance of the activity.
5) Encourage the support and help of family / significant other on range of motion exercises.
R / Enabling a family / significant other to be active in patient care and provide more consistent treatment.
4. Imbalanced Nutrition, Less Than Body Requirements related to increased metabolic needs.
Goal: Demonstrate an increase in food intake, maintain / gain weight.
Intervention:
1) Perform a thorough nutritional assessment.
R / Identify deficiencies / needs to help choose interventions.
2) Provide eat small portions and often include dry food and interesting food for patients.
R / This could increase the input and requires less energy.
3) Provide a diet high in calories / protein with additional vitamins.
R / Help meet metabolic demands, maintain weight and tissue regeneration.
4) Encourage activity restrictions during the acute phase.
R / Lowering metabolic requirements to prevent degradation of calories and energy savings.
5) Consult with a dietitian.
R / Help assess the patient's nutritional needs change in digestion and bowel function.
5. Disturbed Body Image relateed to varicose veins.
Goal: Improved confidence in ability to cope with illness.
Intervention:
1) Encourage disclosure of concerns about the disease process, hope for the future.
R / Give a chance to identify the fear / guilt concept and deal with them directly.
2) Discuss the patient's perception of how the people closest to accept limitations.
R / Verbal cues / nonverbal people nearby could have a major effect on how patients view themselves.
3) Recognize and accept feelings of grief, resentment, dependence.
R / Constant pain would be tiresome, and feelings of anger and hostility are common.
4) Consider withdrawing behavior, or deny the use of too much attention to the body / changes.
R / Can indicate emotional or maladaptive coping methods, requiring further intervention / psychological support.
5) Arrange limits on maladaptive behavior. Help patients to identify the positive behaviors that can help coping.
R / Assisting patients to maintain self-control, which can increase feelings of self-worth.
6) Involve the patient in the treatment plan and schedule activities.
R / Increase feelings of competence / self-esteem, encourages independence and participation in therapy.
1. Acute Pain related to tissue ischemia secondary
Goal: Pain is lost or controlled
Intervention:
1) Assess the degree of pain. Note the behavior of protecting the extremities.
R / Degree of pain is directly related to the extent of the circulation shortfall, the inflammatory process.
2) Maintain bed rest during the acute phase.
R / Decrease discomfort in relation to muscle contraction and movement.
3) Elevate the affected extremity.
R / Pushing to facilitate venous return circulation, reduce static formation.
4) Encourage the patient to change positions frequently.
R / Reduce / prevent muscle weakness, helps minimize muscle spasm.
5) Collaboration of drugs as indicated.
R / Reduce pain and reduce muscle tension.
2. Impaired skin integrity related to vascular insufficiency.
Goal: Maintain the integrity of the skin.
Intervention:
1. Assess skin integrity, record changes in turgor, color noise, local warm, erythema, excoriation.
R / Skin condition is influenced by circulation, nutrition, and immobilization. Tissue can become brittle and prone to infection and damage.
2. Assess the extremities for venous obvious protrusion.
R / Superficial venous distension may occur in TVD because backflow through the veins branching.
3. Change position often, and avoid massaging the affected limb.
R / Improve circulation, massage the potential to solve / deploy thrombus causing embolus.
4. Range of motion exercises help to passive or active.
R / Improves circulation of body tissue, prevents stasis.
5. Perform warm compresses, moist heat to the extremities or the hospital if indicated.
R / Increase vasodilation and venous return and repair of local edema.
3. Impaired physical mobility related to activity limitations due to pain.
Goal: Demonstrate techniques / behaviors enabling activities.
Intervention:
1) Maintain proper body position.
R / Improving tissue stability (reducing the risk of injury), the functional position of the extremities.
2) Note the circulation, movement and sensation are frequent.
R / Edema can affect circulation to the extremities so that the potential occurrence of tissue necrosis.
3) Assist with range of motion active / passive.
R / Improve maintenance of tissue function.
4) Schedule of activities and treatments to provide uninterrupted rest period.
R / Prevent fatigue, maintain strength and patient tolerance of the activity.
5) Encourage the support and help of family / significant other on range of motion exercises.
R / Enabling a family / significant other to be active in patient care and provide more consistent treatment.
4. Imbalanced Nutrition, Less Than Body Requirements related to increased metabolic needs.
Goal: Demonstrate an increase in food intake, maintain / gain weight.
Intervention:
1) Perform a thorough nutritional assessment.
R / Identify deficiencies / needs to help choose interventions.
2) Provide eat small portions and often include dry food and interesting food for patients.
R / This could increase the input and requires less energy.
3) Provide a diet high in calories / protein with additional vitamins.
R / Help meet metabolic demands, maintain weight and tissue regeneration.
4) Encourage activity restrictions during the acute phase.
R / Lowering metabolic requirements to prevent degradation of calories and energy savings.
5) Consult with a dietitian.
R / Help assess the patient's nutritional needs change in digestion and bowel function.
5. Disturbed Body Image relateed to varicose veins.
Goal: Improved confidence in ability to cope with illness.
Intervention:
1) Encourage disclosure of concerns about the disease process, hope for the future.
R / Give a chance to identify the fear / guilt concept and deal with them directly.
2) Discuss the patient's perception of how the people closest to accept limitations.
R / Verbal cues / nonverbal people nearby could have a major effect on how patients view themselves.
3) Recognize and accept feelings of grief, resentment, dependence.
R / Constant pain would be tiresome, and feelings of anger and hostility are common.
4) Consider withdrawing behavior, or deny the use of too much attention to the body / changes.
R / Can indicate emotional or maladaptive coping methods, requiring further intervention / psychological support.
5) Arrange limits on maladaptive behavior. Help patients to identify the positive behaviors that can help coping.
R / Assisting patients to maintain self-control, which can increase feelings of self-worth.
6) Involve the patient in the treatment plan and schedule activities.
R / Increase feelings of competence / self-esteem, encourages independence and participation in therapy.
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