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Difficulty: Very hardBasic Care and Comfort

The healthcare provider prescribes knee-high graduated compression stockings for a client who is immobile. The practical nurse prepares to apply the stockings at the beginning of the morning shift. Arrange the following actions in the correct chronological sequence.

  1. 1Maintain the client in a supine position for at least 15 minutes.
  2. 2Measure the circumference of the calf and the length of the lower leg.
  3. 3Turn the stocking inside out down to the heel pocket.
  4. 4Slip the foot portion of the stocking over the toes and align the heel.
  5. 5Smoothly pull the remaining fabric upward over the calf without rolling the top band.

Answer

The correct sequence begins with positioning the client supine for 15 minutes, followed by measuring the leg, inverting the stocking down to the heel, slipping it over the foot and heel, and finally pulling it smoothly up the calf.
Applying graduated compression stockings requires ensuring the leg is free of dependent edema before sizing and application. The client must be supine for 15 to 30 minutes to promote venous return. Once edema is minimized, precise measurements of the calf and leg length determine the correct size. To apply the tight garment, the nurse turns it inside out down to the heel, anchors it over the foot and heel, and smoothly pulls the rest over the calf. The nurse must never roll the top edge, as this restricts circulation.

Step-by-Step Solution

1
Maintain the client in a supine position for at least 15 minutes.
Venous return is promoted and lower extremity edema is reduced.
If legs are dependent, blood pools and swells the leg, which leads to measuring for an incorrect size and potentially trapping fluid when the stocking is applied.
2
Measure the circumference of the calf and the length of the lower leg.
The appropriate size of compression stocking is selected.
An incorrectly sized stocking can either provide inadequate compression or act as a dangerous tourniquet, compromising arterial and venous blood flow.
3
Turn the stocking inside out down to the heel pocket.
The foot portion of the stocking is isolated for initial application.
Compression stockings are highly elastic and tight; this specific inversion technique minimizes friction and struggling during the application process.
4
Slip the foot portion of the stocking over the toes and align the heel.
The stocking is properly anchored onto the client's foot.
Correct heel placement ensures the gradient pressure is distributed properly according to the manufacturer's therapeutic design.
5
Smoothly pull the remaining fabric upward over the calf without rolling the top band.
The stocking is completely applied without wrinkles or constricting bands.
Wrinkles or a rolled top edge can constrict blood flow, causing skin breakdown and drastically increasing the risk of deep vein thrombosis.

Key Concept

Application Sequence for Graduated Compression Stockings
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Topics

Basic Care and Comfort

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