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Difficulty: HardBasic Care and Comfort

An older adult client with a history of severe bilateral peripheral arterial disease (PAD) reports intense, burning pain in the lower extremities that wakes them during the night. The client's lower extremities are hairless, with thin, dry skin that is cool to the touch. The nurse is planning basic care to promote comfort and sleep. Which nursing action is most appropriate?

  1. A
    Elevate the client's lower extremities on two pillows above the level of the heart during sleep.
  2. B
    Delegate the unlicensed assistive personnel (UAP) to apply warming lotion and vigorously massage the client's calves.
  3. Assist the client to sit on the side of the bed and dangle the legs over the edge when the pain occurs.Answer
  4. D
    Reassure the client that this nocturnal discomfort is a normal, expected physiological consequence of the aging process.

Answer

Assist the client to sit on the side of the bed and dangle the legs over the edge when the pain occurs.
Clients with severe peripheral arterial disease (PAD) often experience ischemic rest pain at night due to decreased cardiac output during sleep and the horizontal position of the legs in bed, which further reduces arterial perfusion. Assisting the client to dangle their legs over the side of the bed places the extremities in a dependent position, allowing gravity to enhance arterial blood flow to the distal tissues and providing significant comfort.

Step-by-Step Solution

1
Analyze the client's clinical presentation and medical history.
The client has severe peripheral arterial disease (PAD) and is experiencing nocturnal ischemic rest pain due to poor perfusion.
Identifying the underlying pathophysiology (arterial versus venous insufficiency) is required to determine the correct physiological comfort measure.
2
Evaluate the hemodynamic goal for a client with arterial insufficiency.
The primary goal is to maximize arterial blood flow to the lower extremities.
Arterial flow is severely compromised by narrowed or blocked arteries, causing ischemic pain when the legs are in a horizontal position during sleep.
3
Select the appropriate positioning intervention to achieve this hemodynamic goal.
Placing the legs in a dependent position (dangling over the edge of the bed) is selected.
Gravity assists arterial blood flow to the distal tissues, relieving the ischemic pain.

Key Concept

Basic care and comfort for peripheral arterial disease involves positioning the extremities in a dependent position to promote arterial circulation.
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Topics

Basic Care and Comfort

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