When caring for a patient who has intermittent claudication, nurse advises the patient to

JIPMER Nursing Officer-2017

Medical & Surgical Nursing

Hard

Appeared in: JIPMER Nursing Officer-2017

Explanation

Intermittent claudication is ischemic muscle pain caused by Peripheral Arterial Disease (PAD), occurring during exercise and relieved by rest.
Walking as tolerated is the primary non-pharmacological treatment for intermittent claudication.
A structured walking program (walking until moderate pain, resting, then resuming) promotes the development of collateral circulation.
Collateral circulation involves the growth of new blood vessels that bypass blockages, improving blood flow and increasing pain-free walking distance.

Option A: Graduated compression stockings are contraindicated in PAD. They are used for venous insufficiency and would further restrict already poor arterial blood flow, worsening ischemia.
Option B: Elevating the legs works against gravity, reducing arterial blood flow to the extremities and exacerbating ischemic pain in patients with PAD.
Option C: Avoiding exercise is counterproductive. While severe pain should be avoided, a structured, progressive exercise program is essential for building collateral circulation and improving symptoms.

Clinical Relevance

Nursing practice connection: Use the key finding related to Management of Intermittent Claudication to guide bedside assessment, documentation, and the next nursing action.
Patient education is a critical nursing role in managing PAD. Nurses must clearly explain the 'walk-rest-walk' exercise regimen and the rationale behind it to ensure patient adherence.
A key patient-safety intervention is teaching patients with PAD to avoid constrictive clothing, compression stockings, and leg elevation, as these actions can critically worsen limb ischemia.
What if the patient's pain occurs at rest (rest pain), not just with walking? This signifies a progression to critical limb ischemia, a medical emergency. The advice would change from encouraging walking to advising rest with the leg in a dependent position and seeking immediate medical evaluation for potential revascularization procedures.

How to Approach the Question

First, identify the core medical condition in the question: 'intermittent claudication'.
Recall the pathophysiology of this condition. Intermittent claudication is the classic symptom of peripheral ARTERIAL disease (PAD), meaning there is a problem with blood flowing TO the legs.
Evaluate each option based on its effect on arterial blood flow. Does it help or hinder blood getting to the feet?
Option A (compression) and Option B (elevation) both hinder arterial flow. Option C (no exercise) prevents the long-term solution.
Option D (walking) is a form of exercise that is known to stimulate the growth of new blood vessels (collateral circulation), which is the primary treatment goal. Therefore, this is the correct advice.

Concept Tested & Keywords

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