THE CLIENT WITH VARICOSE VEINS

varicose veins are irregular, tortuous veins with incompetent valves. hemorrhoids and varices in the esophagus.
usually affect long saphenous vein

INCIDENCE AND RISK FACTORS

Women over 35, r/t venous stasis in pregnancy, aging a possible risk factor, decreased exercise, prolonged standing,
whites more affected, family history. contributed by obesity, venous thrombosis, congenital arteriovenous
malformation, sustained pressure on abdomen, effects of gravity.

PATHOPHYSIOLOGY

primary - no involvement of deep veins; secondary - caused by the obstruction of deep veins. long-standing increases
venous pressure and stretches the vessel wall. sustained stretching impairs the ability of venous valves to close.
standing, leg veins resemble vertical columns and must withstand the full force of venous blood pressure.

MANIFESTATIONS

may be asymptomatic; most cause sever aching leg, leg fatigue, leg heaviness, itching or feelings of heat in the legs.
Menstrual cycle worsens symptoms. If varicose veins are long standing, the skin above the ankles may be thin and
discolored.

COMPLICATIONS

venous insufficiency, stasis ulcers, chronic stasis dermatitis, superficial venous thrombosis

INTERDISCIPLINARY CARE

DIAGNOSIS

doppler, trendelenberg test

TREATMENTS

compression stockings, walking, prolonged sitting discouraged, elevate legs

COMPRESSION SCLEROTHERAPY

a sclerosing solution is injected into the varicose vein and compression bandage is applied for a period of time. This
obliterates the vein. Venous blood is rerouted through healthy vessels whose valves are not compromised. Maybe be
used to treat small symptomatic varicosities. May be primary treatment or in conjunction with varicose vein surgery.
May be used for cosmetic reasons... complications phlebitis, tissue necrosis or infection may occur.

SURGERY

reserved for patients who are very symptomatic, experience recurrent superficial venous thrombosis, and/or develope
stasis ulcers. involves extensive ligation and stripping.

NURSING CARE

HEALTH PROMOTION

teach benefit of exercise over lifetime, discuss effects of prolonged sitting or standing, encourage ambulation and
elevation of legs; encourage normal weight for height.

ASSESSMENT

health history, leg pain, aching heaviness, fatigue, ankle swelling, hx venous thrombosis
physical examination, visible dilated tortuous superficial veins in lower extremities.
 NURSING DIAGNOSIS AND INTERVENTIONS

focus is on managing the symptoms, there is no cure. surgery clients focus on wound healing and preventing infection

CHRONIC PAIN

varicose veins can lead to pooling of venous blood in the lower extremities, can cause dull ache or feeling of pressure,
esp after prolonged standing, pain is progressive

INEFFECTIVE TISSUE PERFUSION: PERIPHERAL

improve venous flow; assess pulses, cap refill, skin color, temperature and edema. compression stockings, elevate legs
and sleep with legs elevated above the heart

RISK FOR IMPAIRED SKIN INTEGRITY

tissues are vulnerable due to injury as a result to decreased circulation; assess lower extremity color, temp, moisture
and for evidence of pressure or breakdown; teach foot and skin care measures such as cleansing with nondrying soap,
adequate nutrition and fluid in take.

RISK FOR PERIPHERAL NEUROVASCULAR DYSFUNCTION

chronic venous insufficiency, impaired arterial circulation, and disrupted sensation. increased risk for injury and
infection because minor trauma may not be noticed. teach measures to protect the extremities from injury.

COMMUNITY BASED CARE

leg elevation and exercise program, compression stockings, foot and leg care, measures to avoid injury and skin
breakdown, symptoms and complications to report to dr.