Professional Documents
Culture Documents
Varicose veins (varicosities) are abnormally dilated, tortuous, superficial veins caused by incompetent venous valves. Most commonly, this condition occurs in the lower extremities, the saphenous veins, or the lower trunk; however, it can occur elsewhere in the body, such as esophageal varices. It is estimated that varicose veins occur in up to 60% of the adult population in the United States, with an increased incidence correlated with increased age. The condition is most common in women and in people whose occupations require prolonged standing, such as salespeople, hair stylists, teachers, nurses, ancillary medical personnel, and construction workers. A hereditary weakness of the vein wall may contribute to the development of varicosities, and it is not uncommon to see this condition occur in several members of the same family. Varicose veins are rare before puberty. Pregnancy may cause varicosities. The leg veins dilate during pregnancy because of hormonal effects related to distensibility, increased pressure by the gravid uterus, and increased blood volume which all contribute to the development of varicose veins.
PATHOPHYSIOLOGY
Varicose veins may be considered primary (without involvement of deep veins) or secondary (resulting from obstruction of deep veins). A reflux of venous blood in the veins results in venous stasis. If only the superficial veins are affected, the person may have no symptoms but may be troubled by the appearance of the dilated veins.
1|VARICOSITIES CHRISTIANS IV
CLINICAL MANIFESTATIONS
Symptoms, if present, may take the form of dull aches, muscle cramps, and increased muscle fatigue in the lower legs. Ankle edema and a feeling of heaviness of the legs may occur. Nocturnal cramps are common. When deep venous obstruction results in varicose veins, patients may develop the signs and symptoms of chronic venous insufficiency: edema, pain, pigmentation, and ulcerations. Susceptibility to injury and infection is increased.
PREVENTION
The patient should avoid activities that cause venous stasis, such as wearing tight socks or a constricting panty girdle, crossing the legs at the thighs, and sitting or standing for long periods. Changing position frequently, elevating the legs when they are tired, and getting up to walk for several minutes of every hour promote circulation. The patient should be encouraged to walk 1 or 2 miles each day if there are no contraindications. Walking up the stairs rather than using the elevator or escalator is helpful in promoting circulation. Swimming is also good exercise for the legs. Elastic compression stockings, especially knee-high stockings, are useful. Patients are more likely to use knee-high stockings than thigh-high stockings. The overweight patient should be encouraged to begin a weight-reduction plan.
2|VARICOSITIES CHRISTIANS IV
MEDICAL MANAGEMENT
Surgery for varicose veins requires that the deep veins be patent and functional. The saphenous vein is ligated and divided. The vein is ligated high in the groin, where the saphenous vein meets the femoral vein. Additionally, the vein may be removed (stripped). After the vein is ligated, an incision is made in the ankle, and a metal or plastic wire is passed the full length of the vein to the point of ligation. The wire is then withdrawn, pulling (removing, stripping) the vein as it is removed (Fig. 31-18). Pressure and elevation keep bleeding at a minimum during surgery.
SCLEROTHERAPY
In sclerotherapy, a chemical is injected into the vein, irritating the venous endothelium and producing localized phlebitis and fibrosis, thereby obliterating the lumen of the vein. This treatment may be performed alone for small varicosities or may follow vein ligation or stripping. Sclerosing is palliative rather than curative. After the sclerosing agent is injected, elastic compression bandages are applied to the leg and are worn for approximately 5 days. The health care provider who performed sclerotherapy removes the first bandages. Elastic compression stockings are then worn for an additional 5 weeks. After sclerotherapy, patients are encouraged to perform walking activities as prescribed to maintain blood flow in the leg. Walking enhances dilution of the sclerosing agent.
NURSING MANAGEMENT
Surgery can be performed in an outpatient setting, or patients can be admitted to the hospital on the day of surgery and discharged the next day, but nursing measures are the same as if the patient were hospitalized. Bed rest is maintained for 24 hours, after which the patient begins walking every 2 hours for 5 to 10 minutes. Elastic compression stockings are used to maintain compression of the leg. They are worn continuously for about 1 week after vein stripping. The
3|VARICOSITIES CHRISTIANS IV
nurse assists the patient to perform exercises and move the legs. The foot of the bed should be elevated. Standing still and sitting are discouraged.
REFERENCE
Smeltzer, S. C., Bare, B. G., Hinkle, J. L., & Cheever, K. H. (2006). Brunner & Suddarths Textbook of Medical-Surgical Nursing (10th Ed.). Philadelphia: Lippincott Williams & Wilkins.
4|VARICOSITIES CHRISTIANS IV