Question

The nurse is developing a plan of care for a client with varicose veins in whom skin breakdown occurred over the varicosities as a result of secondary infection. Which is a priority intervention?

1. Keep the legs aligned with the heart.
2.Elevate the legs higher than the heart.
3.Clean the skin with alcohol every hour.
4.Position the client onto the side during every shift.

Answer 1

The priority intervention for a client with varicose veins and secondary skin breakdown is to target infection control, maintain hygiene, monitor for signs of infection, and ensure compliance with antibiotic therapy. Elevating the legs and using compression stockings can also be beneficial.

Step-by-step explanation:

The priority intervention for a client with varicose veins and secondary skin infection leading to skin breakdown is to manage the infection and promote healing. This includes maintaining proper hygiene, monitoring for signs of infection, and complying with antibiotic therapy.

Additionally, it's important to alleviate pressure on the affected areas to improve circulation and prevent further damage. To prevent further skin breakdown, it is recommended to avoid standing or sitting for long periods, elevate the legs frequently, and use graduated compression stockings.

However, for the specific situation of a client with skin breakdown over varicosities due to a secondary infection, interventions would be directly targeting the infection control and skin integrity. This would likely include antibiotic treatment, regular assessment of the affected area, applying dressings as needed, and ensuring the administration of any prescribed anti-inflammatory medications.