altered tissue perfussion peripheral care plan

Daytonite, BSN, RN · Dec 7, 2006

hi, cristhian1986!

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
diabetes
hypercholesterolemia
hyperhomocysteinemia

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:

claudication
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!

http://www.fpnotebook.com/sur9.htm - venous stasis ulcer management

nursing interventions:

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:

http://www.emedicinehealth.com/peripheral_vascular_disease/article_em.htm - 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.

http://www.emedicine.com/emerg/topic862.htm - peripheral vascular disease

http://www.emedicine.com/med/topic391.htm - peripheral arterial occlusive disease

http://www.emedicine.com/orthoped/topic362.htm - vascular occlusive syndromes of the upper extremity

http://www.emedicinehealth.com/raynaud_phenomenon/article_em.htm - 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.

http://www.emedicine.com/med/topic253.htm - buerger disease (thromboangiitis obliterans)

http://www.emedicine.com/plastic/topic467.htm - vascular ulcers

http://www.emedicine.com/pmr/topic165.htm - vascular diseases and rehabilitation

http://www.emedicine.com/orthoped/topic601.htm - 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! :welcome:

Cristhian1986 · Dec 7, 2006

thanks a lot for your help, it is going to help me so much...By the way, I'm going to LA in a couple of weeks, I hope is warm by that time. Thank You.

Daytonite, BSN, RN · Dec 8, 2006

It warms up during the day, but it's cold at night. No cloud cover here so any heat that accumulates during the day rises and floats away. Bring a heavy sweater or light jacket for the evenings and nights. We may be in the middle of our rainy season by the time you get here as well.

genwrites · Jun 8, 2012

I found a site that explains it and nursing interventions really well:

The Differences Between Arterial And Venous Ulcers