hope things are a lot warmer in miami than they are in los angeles today!
here are two links to lists of student case studies. however, in just going through the list and pulling up several likely candidates, i do not see any that have ineffective (or altered) tissue perfusion as a listed nursing diagnosis. you might, however, want to bookmark these sites for future reference!
to get back to tissue perfusion. . .here are two nursing diagnosis websites from online care plan constructors where you can get some information about this nursing diagnosis.
you are likely to see problems of peripheral tissue perfusion in people who have been heavy smokers for many years, people who are very obese, people with hypertension, and patients who are very old. medical diseases and conditions that you are likely to see with peripheral tissue perfusion problems are:
- peripheral arterial disease
- peripheral vascular disease
- raynaud's disease (this is slightly different from raynaud's phenomenon)
- buerger's disease
- varicose veins
these patients usually have some degree of venous or arterial stenosis. signs and symptoms are going to be a bit different for each type of vascular problem, so you will need to distinguish between arterial and venous peripheral disease. you can read about the pathophysiology of these diseases in the links i've listed below. symptoms of both types include things like:
- presence of peripheral bruits over major arteries
- absence of or diminished peripheral pulses
- decreased skin temperature
- dry, scaly, shiny atrophic skin
- skin hairless over lower extremity (e.g. shin)
- dystrophic, brittle toenails
- distal extremity color changes with position
- skin rubor when legs are dependent
- skin pallor when legs are elevated for more than one minute (color returns within 15 seconds in mild cases, or delays more than 40 seconds suggest severe ischemia)
- tan or reddish brown skin color changes
- weeping and excoriated skin
- pedal edema
- skin ulcerations
outcome includes things such as:
- development of stasis ulcers
- ulcerations that do not heal and develop gangrene
- amputation of the limb(s)
patients with peripheral vascular or arterial disease usually also have coronary artery disease and their risk of having a cva (cerebrovascular accident), or stroke, is high. they can also develop thrombophlebitis.
testing for this will include duplex ultrasonound (b-mode and directional pulse) and venography
these patients are going to be asked to stop smoking, to participate in exercise programs and start doing some walking! the medications likely to be ordered for them will be things like aspirin, phosphodiesterase inhibitors, pentoxifylline, vasodilators, adrenergic blocking agents and diuretics. surgical treatment might include angioplasty, atherectomy, or arterial bypass before ultimately having to resort to amputation. things the physician might order may include things such as elevating the legs above the heart, compression stockings, intermittent pneumatic compression pumps, and dressings for ulcers (wet or dry). a note about having patients elevating their legs. . .only do it if ordered by the physician as there is evidence indicating that in some patients elevating the extremities slows the arterial blood flow to the feet--something you definitely don't want to happen!
- venous stasis ulcer management
- assessing for pain
- obtaining blood pressure measurements
- assessing for signs of ulcer formation
- assessing for signs of gangrene
- monitoring peripheral pulses, sensation and skin color for any changes
- the importance of following the doctor's recommendations
- teaching foot care
- teaching the patient about atherosclerosis or other disease related to the peripheral vascular problem
- teaching about smoking cessation
- teaching about weight loss
- teaching about the drug therapies
- teaching about skin care
- showing patients some of the things they need to do to protect the skin of their feet and legs
- teaching patients not to cross their legs and why
here's some more information for you to read:
- this is an 18-pages of consumer information on peripheral vascular disease written in easy to read language that includes a very nice overview of everything you want to know about this subject. you can go through the pages sequentially, or link into specific pages by the subjects listed.
- peripheral vascular disease
- peripheral arterial occlusive disease
- vascular occlusive syndromes of the upper extremity
- this is a 14-pages of consumer information on raynaud phenomenon written in easy to read language that includes a very nice overview of everything you want to know about this subject. you can go through the pages sequentially, or link into specific pages by the subjects listed.
- buerger disease (thromboangiitis obliterans)
- vascular ulcers
- vascular diseases and rehabilitation
- foot infections (includes a section on pvd and gangrene)
now, that you are almost an expert on this subject, good luck on your test! welcome to allnurses!