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Difficulty: MediumBasic Care and Comfort

A nurse is planning care for a 72-year-old client diagnosed with peripheral arterial disease (PAD) who reports experiencing severe burning pain in the lower legs that frequently disrupts sleep. Which of the following nursing interventions is most appropriate to promote client comfort?

  1. Assist the client to sit on the side of the bed with the legs dangling.Answer
  2. B
    Elevate the client's legs on two pillows while resting in bed.
  3. C
    Delegate the unlicensed assistive personnel (UAP) to evaluate the characteristics and severity of the client's pain.
  4. D
    Explain to the client that nighttime leg pain is an expected physiological change associated with advancing age.

Answer

Assist the client to sit on the side of the bed with the legs dangling.
For clients with peripheral arterial disease, placing the legs in a dependent position (such as dangling them over the side of the bed) allows gravity to assist arterial blood flow to the distal extremities. This improves tissue perfusion, thereby reducing ischemic rest pain and promoting comfort.

Step-by-Step Solution

1
Analyze the client's diagnosis and reported symptoms.
The client has peripheral arterial disease and is experiencing ischemic rest pain at night.
Understanding the pathophysiology of the condition is essential for selecting appropriate, safe comfort measures.
2
Evaluate the physiological impact of positioning on arterial blood flow.
Dependent positioning enhances gravitational blood flow to the lower extremities, whereas elevation impairs it.
Positioning is a primary non-pharmacological nursing intervention for managing peripheral vascular pain.
3
Identify the correct nursing intervention from the available choices.
Dangling the legs is the appropriate action to relieve the client's discomfort.
This position directly addresses the underlying cause of the pain by improving arterial tissue perfusion.

Key Concept

Non-pharmacological Comfort Measures and Positioning in Peripheral Arterial Disease
Estimated Time:1m 0s
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Topics

Basic Care and Comfort

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