Chapter 18: Nursing Management: Patients With Vascular Disorders and Problems of Peripheral Circulation  

*The following is a sample care plan meant for adaptation. Always revise to meet your facility’s protocols and the latest research and nursing
diagnoses.

PLAN OF NURSING CARE

The Patient With Peripheral Vascular Problems
NURSING DIAGNOSIS: Ineffective peripheral tissue perfusion related to compromised circulation
GOAL: Increased arterial blood supply to extremities
Nursing Interventions Rationale Expected Outcomes
1. Lower the extremities below the 1. Dependency of lower extremities ● Has extremities warm to touch

level of the heart (if condition is enhances arterial blood supply. ● Has extremities with improved color

arterial in nature). ● Experiences decreased muscle

2. Encourage moderate amount of 2. Muscular exercise promotes blood
pain with exercise
walking or graded extremity flow and the development of

exercises if no contraindications collateral circulation.

exist.
GOAL: Decrease in venous congestion
Nursing Interventions Rationale Expected Outcomes
1. Elevate extremities above heart 1. Elevation of extremities counteracts ● Elevates lower extremities as

level (if condition is venous in gravity, promotes venous return, prescribed

nature). and prevents venous stasis. ● Has decreased edema of


2. Discourage standing still or sitting
for prolonged periods.
3. Encourage walking.
GOAL: Promotion of vasodilation and prevention of vascular compression
Nursing Interventions
1. Maintain warm temperature and
avoid chilling.
2. Discourage use of tobacco
products.
3. Counsel in ways to avoid emotional
upsets; stress management.
4. Encourage avoidance of
constrictive clothing and
2. Prolonged standing still or sitting
promotes venous stasis.
3. Walking promotes venous return by
activating the “muscle pump.”
Rationale
1. Warmth promotes arterial flow by
preventing the vasoconstriction
effects of chilling.
2. Nicotine in all tobacco products
causes vasospasm, which impedes
peripheral circulation.
3. Emotional stress causes peripheral
vasoconstriction by stimulating the
sympathetic nervous system.
4. Constrictive clothing and
accessories impede circulation and
extremities
● Avoids prolonged standing still or
sitting
● Gradually increases walking time
daily
Expected Outcomes
● Protects extremities from exposure
to cold
● Avoids all tobacco products
● Uses stress management program
to minimize emotional upset
● Avoids constricting clothing and
accessories
● Avoids crossing legs
● Takes medication as prescribed
 accessories. promote venous stasis.
5. Encourage avoidance of crossing 5. Crossing the legs causes

the legs. compression of vessels with

subsequent impediment of

circulation, resulting in venous

stasis.
6. Administer vasodilator medications 6. Vasodilators relax smooth muscle;

and adrenergic blocking agents as adrenergic blocking agents block

prescribed, with appropriate the response to sympathetic nerve

nursing considerations. impulses or circulating

catecholamines.
NURSING DIAGNOSIS: Chronic pain related to impaired ability of peripheral vessels to supply tissues with oxygen
GOAL: Relief of pain
Nursing Interventions Rationale Expected Outcomes
1. Promote increased circulation. 1. Enhancement of peripheral ● Uses measures to increase arterial

circulation increases the oxygen blood supply to extremities

supplied to the muscle and ● Uses analgesic agents as

decreases the accumulation of prescribed

metabolites that cause muscle

 spasms.
2. Administer analgesic agents as 2. Analgesic agents help reduce pain

prescribed, with appropriate and allow the patient to participate

nursing considerations. in activities and exercises that

promote circulation.
NURSING DIAGNOSIS: Risk for impaired skin integrity related to compromised circulation
GOAL: Attainment/maintenance of tissue integrity
Nursing Interventions Rationale Expected Outcomes
1. Instruct in ways to avoid trauma to 1. Poorly nourished tissues are ● Inspects skin daily for evidence of

extremities. susceptible to trauma and bacterial injury or ulceration

invasion; healing of wounds is ● Avoids trauma and irritation to skin

delayed or inhibited due to poor ● Wears protective shoes

tissue perfusion. ● Adheres to meticulous hygiene

regimen
2. Encourage wearing protective 2. Protective shoes and padding ● Eats a healthy diet that contains

shoes and padding for pressure prevent foot injuries and blisters. adequate protein and vitamins A

areas; wear new shoes for short and C

period of time and inspect feet for

signs of injury.
3. Encourage meticulous hygiene: 3. Neutral soaps and lotions prevent

bathing with neutral soaps, drying and cracking of skin; avoid

applying lotions, and carefully lotion between toes as the

trimming nails. increased moisture can lead to

maceration of tissue.
4. Caution to avoid scratching or 4. Scratching and rubbing can cause

vigorous rubbing. skin abrasions and bacterial

invasion.
5. Promote good nutrition; adequate 5. Good nutrition promotes healing

intake of vitamins A and C, protein, and prevents tissue breakdown.

and zinc; and control of obesity.

NURSING DIAGNOSIS: Deficient knowledge regarding self-care activities
GOAL: Adherence to the self-care program
Nursing Interventions Rationale Expected Outcomes
1. Include family/significant others in 1. Adherence to the self-care program ● Practices frequent position changes

teaching program. is enhanced when the patient as prescribed

receives support from family and ● Practices postural exercises as

from appropriate self-help groups prescribed

and agencies. ● Takes medications as prescribed

2. Provide written instructions about
foot care, leg care, and exercise
program.
3. Assist to obtain properly fitting
clothing, shoes, and stockings.
4. Refer to self-help groups as
indicated, such as smoking
cessation clinics or stress
management, weight management,
and exercise program.
2. Written instructions serve as ● Avoids vasoconstrictors
reminder and reinforcement of ● Uses measures to prevent trauma
information. ● Uses stress management program
3. Constrictive clothing and
● Accepts condition as chronic but
accessories impede circulation and
amenable to therapies that will
promote venous stasis.
4. Reducing risk factors may reduce decrease symptoms
symptoms or slow disease
progression.