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Varicose vein

nursing management of varicose vein

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Varicose vein

  1. 1. PRESENTER:- Ms. Anshu M.Sc. Nursing KGMU Institute of Nursing
  2. 2.  • Dilated, swelled leg veins with back flow of blood caused by incompetent valve closure, which results in venous congestion and vein enlargement  • Usually affects the saphenous vein and its branches
  3. 3. Varicose veins are permanently distended and tortuous superficial veins that develop from the loss of valvular competence. Common sites:- Greater and lesser saphenous veins Perforator veins in the ankle
  4. 4. 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.
  5. 5. Primary varicose veins
  6. 6. • Primary varicose veins • Secondary varicose veins  Hemorrhoids Esophageal varices Varicocele
  7. 7. • Genetics • Age • Gender • Pregnancy • Overweight and obesity • Posture
  8. 8. • Congenital absent or defective venous valves. • Elevation of venous pressure • Incompetent venous valves • Chronic systemic disease • Infections and trauma Causes
  9. 9. Any risk factor/cause ↓ ↑ced venous pressure ↓ Dilation of veins ↓ Valves stretched ↓ Incompetent valve ↓ Reverse blood flow ↓ Calf muscles fail to pump blood ↓ Venous distention
  10. 10. • 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 ankle • Discoloration of skin surrounding the varicose veins
  11. 11. • Appearance
  12. 12. Hand held Doppler examination
  13. 13. • Duplex Ultrasonography
  14. 14. Trendelburg’s test
  15. 15. Air plethysmography:- it measures the changes in venous blood volume. Venography:- is not routinely performed to evaluate for valvular reflux.
  16. 16.  Conservative management - Elevation of the legs - Avoid prolonged sitting & standing - Compression stockings - Exercise - Lose weight
  17. 17.  Sclerotherapy:-  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 with blood.  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.
  18. 18. • 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
  19. 19. • 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.
  20. 20. • 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.
  21. 21. • Superficial thrombophlebitis
  22. 22. Lipodermatosclerosis
  23. 23. Venous ulceration
  24. 24. Venous eczema
  25. 25.  Assessment:-  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.
  26. 26.  1. Acute pain related to tissue ischemia secondary.  2. Impaired skin integrity related to vascular insufficiency.  3. Impaired physical mobility related to activity limitations due to pain.  4. Imbalanced Nutrition, Less Than Body Requirements related to increased metabolic needs.  5. Disturbed Body Image related to varicose veins.
  27. 27.  Goal: Pain will be lost or controlled  Intervention:  1) Assess the degree of pain. Note the behavior of protecting the extremities.  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.
  28. 28.  Goal: Maintain the integrity of the skin.  Intervention:  1. Assess skin integrity, record changes in turgor, color noise, local warm, erythema, excoriation.  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 causing embolus.  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 indicated.  R / Increase vasodilation and venous return and repair of local edema.
  29. 29.  Goal: Demonstrate techniques / behaviors enabling activities.  Intervention:  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 motion exercises.  R / Enabling a family / significant other to be active in patient care and provide more consistent treatment.
  30. 30.  Goal: Demonstrate an increase in food intake, maintain / gain weight.  Intervention:  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 for patients.  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 energy savings.  5) Consult with a dietitian.  R / Help assess the patient's nutritional needs change in digestion and bowel function.
  31. 31.  Goal: Improved confidence in ability to cope with illness.  Intervention:  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 view themselves.  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 / changes.  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- worth.  6) Involve the patient in the treatment plan and schedule activities.  R / Increase feelings of competence / self-esteem, encourages independence and participation in therapy.
  32. 32.  • Black M. Joyce “Medical-Surgical Nursing”Ed.6th; Saunders publication; 2007; (2); 1426-27.  • Smeltzer Suzanne “Brunner & Suddarth’s Textbook of medical surgical nursing” Ed 11th; Lippincott;2008; 1014-16  • veins-5-nursing-diagnosis-and.html  •https://nanda- care-plan-for-varicose-veins.html