KGMU Institute of Nursing
• Dilated, swelled leg veins
with back flow of blood
caused by incompetent
valve closure, which results
in venous congestion and
• Usually affects the
saphenous vein and its
Varicose veins are permanently distended
and tortuous superficial veins that develop
from the loss of valvular competence.
Greater and lesser saphenous veins
Perforator veins in the ankle
Primary varicose veins:-Congenital or
familial predisposition that leads to loss of
elasticity of the vein wall.
This does not involve deep veins.
Secondary varicosities :-occur due to
trauma, obstruction, DVT, or inflammation
causes damages to the vein valves.
This results from obstruction of deep vein.
• Enlarged veins that are visible on skin
• Mild swelling of ankles and feet
• Painful, achy, or “heavy” legs
• Throbbing or cramping in legs
• Itchy legs, especially in the lower leg and
• Discoloration of skin surrounding the
Air plethysmography:- it measures the
changes in venous blood volume.
Venography:- is not routinely performed to
evaluate for valvular reflux.
- Elevation of the legs
- Avoid prolonged sitting & standing
- Compression stockings
- Lose weight
Sclerosant agent: sodium tetradecyl sulphate
dose: 0.25 - 1ml at one site and maximum can be
4 ml at 4 different sites in superficial vein.
Action: irritation to the intima of the vein wall,
causes hardening of vein so that they no longer fill
Blood that would normally return to the heart
through these veins returns to the heart by way of
other veins. The veins that received the injection
will eventually shrivel and disappear. The scar
tissue is absorbed by the body.
• Vein stripping and ligation:
This procedure involves tying off all
varicose veins associated with the leg's
main superficial vein and removing it from
the leg. The removal of veins from the leg
will not affect the blood circulation in the
leg as deeper veins will be able to take
care of the increased blood circulation
• Laser treatment: This procedure uses
no incisions or injections. Light energy
from a laser is used to make the vein fade
away. Laser surgery is typically used to
treat smaller varicose veins.
• Endovenous ablation therapy:
A tiny incision is made in the skin & small
catheter is inserted into the vein. A device
at the tip of the catheter heats up inside
the vein, which causes it to close off.
Assessment for Varicose Veins
Assess the degree and type of pain.
The level of activity, movement disorders: the causes,
signs, symptoms and effects of movement disorders.
Assess the quality of peripheral pulses.
Temperature changes in both lower limbs.
Check the edema and the degree of edema, especially in
both lower limbs.
Assess nutritional status.
History of previous disease-related.
1. Acute pain related to tissue ischemia
2. Impaired skin integrity related to vascular
3. Impaired physical mobility related to
activity limitations due to pain.
4. Imbalanced Nutrition, Less Than Body
Requirements related to increased metabolic
5. Disturbed Body Image related to varicose
Goal: Pain will be lost or controlled
1) Assess the degree of pain. Note the behavior of protecting the
R / Degree of pain is directly related to the extent of the circulation shortfall,
the inflammatory process.
2) Maintain bed rest during the acute phase.
R / Decrease discomfort in relation to muscle contraction and movement.
3) Elevate the affected extremity.
R / Pushing to facilitate venous return circulation, reduce static formation.
4) Encourage the patient to change positions frequently.
R / Reduce / prevent muscle weakness, helps minimize muscle spasm.
5) Collaboration of drugs as indicated.
R / Reduce pain and reduce muscle tension.
Goal: Maintain the integrity of the skin.
1. Assess skin integrity, record changes in turgor, color noise, local warm,
R / Skin condition is influenced by circulation, nutrition, and immobilization.
Tissue can become brittle and prone to infection and damage.
2. Assess the extremities for venous obvious protrusion.
R / Superficial venous distension may occur in TVD because backflow
through the veins branching.
3. Change position often, and avoid massaging the affected limb.
R / Improve circulation, massage the potential to solve / deploy thrombus
4. Range of motion exercises help to passive or active.
R / Improves circulation of body tissue, prevents stasis.
5. Perform warm compresses, moist heat to the extremities or the hospital if
R / Increase vasodilation and venous return and repair of local edema.
Goal: Demonstrate techniques / behaviors enabling activities.
1) Maintain proper body position.
R / Improving tissue stability (reducing the risk of injury), the functional
position of the extremities.
2) Note the circulation, movement and sensation are frequent.
R / Edema can affect circulation to the extremities so that the potential
occurrence of tissue necrosis.
3) Assist with range of motion active / passive.
R / Improve maintenance of tissue function.
4) Schedule of activities and treatments to provide uninterrupted rest period.
R / Prevent fatigue, maintain strength and patient tolerance of the activity.
5) Encourage the support and help of family / significant other on range of
R / Enabling a family / significant other to be active in patient care and
provide more consistent treatment.
Goal: Demonstrate an increase in food intake, maintain / gain weight.
1) Perform a thorough nutritional assessment.
R / Identify deficiencies / needs to help choose interventions.
2) Provide eat small portions and often include dry food and interesting food
R / This could increase the input and requires less energy.
3) Provide a diet high in calories / protein with additional vitamins.
R / Help meet metabolic demands, maintain weight and tissue regeneration.
4) Encourage activity restrictions during the acute phase.
R / Lowering metabolic requirements to prevent degradation of calories and
5) Consult with a dietitian.
R / Help assess the patient's nutritional needs change in digestion and
Goal: Improved confidence in ability to cope with illness.
1) Encourage disclosure of concerns about the disease process, hope for the future.
R / Give a chance to identify the fear / guilt concept and deal with them directly.
2) Discuss the patient's perception of how the people closest to accept limitations.
R / Verbal cues / nonverbal people nearby could have a major effect on how patients
3) Recognize and accept feelings of grief, resentment, dependence.
R / Constant pain would be tiresome, and feelings of anger and hostility are common.
4) Consider withdrawing behavior, or deny the use of too much attention to the body /
R / Can indicate emotional or maladaptive coping methods, requiring further
intervention / psychological support.
5) Arrange limits on maladaptive behavior. Help patients to identify the positive
behaviors that can help coping.
R / Assisting patients to maintain self-control, which can increase feelings of self-
6) Involve the patient in the treatment plan and schedule activities.
R / Increase feelings of competence / self-esteem, encourages independence and
participation in therapy.
• Black M. Joyce “Medical-Surgical
Nursing”Ed.6th; Saunders publication; 2007;
• Smeltzer Suzanne “Brunner & Suddarth’s
Textbook of medical surgical nursing” Ed
11th; Lippincott;2008; 1014-16