Risk for Ineffective Tissue Perfusion | Nursing Care Plan for Bariatric Surgery

Risk factors may include
Diminished blood flow, hypovolemia
Decreased hemoglobin concentration in the blood
Impaired oxygen transport
Interruption of venous blood flow (thrombosis)

Possibly evidenced by
(Not applicable; presence of signs and symptoms establishes an actual diagnosis)

Desired Outcomes/Evaluation Criteria—Client Will
Circulation Status
Maintain perfusion as individually appropriate—skin warm and dry, peripheral pulses present and strong, and vital signs within acceptable range.
Risk Control
Identify causative or risk factors.
Demonstrate behaviors to improve or maintain circulation.

Nursing intervention with rationale:
1. Monitor vital signs, palpate peripheral pulses routinely, and evaluate capillary refill and changes in mentation. Note 24-hour fluid balance.
Rationale: Indicators of circulatory adequacy.

2. Encourage frequent range-of-motion (ROM) exercises for legs and ankles. Maintain schedule of sequential compression devices (SCD) on lower extremities when used.
Rationale: Stimulates circulation in the lower extremities, reduces highrisk complications associated with venous stasis, such as DVT and pulmonary embolus (PE).

3. Assess for redness, edema, and discomfort in calf.
Rationale: Indicators of thrombus formation, but warning signs may not always be present in obese individuals.

4. Encourage early ambulation; discourage sitting and dangling legs at the bedside.
Rationale: Sitting constricts venous flow, whereas walking encourages venous return.

5. Provide adequate and appropriate equipment, including trapeze for turning, transfer device, walker, and wheelchair, and sufficient staff for handling client.
Rationale: Helpful in dealing with obese client for moving and ambulating. Reduces risk of traumatic injury to both client and caregivers.

6. Evaluate for complications, such as rigid abdomen, nonincisional abdominal pain, fever, tachycardia, and low blood pressure.
Rationale: Although rare, client can develop abdominal complications, such as abdominal compartment syndrome, sepsis or septic shock secondary to anastomotic leak or wound infection, requiring intensive interventions or return to surgery.

7. Administer heparin therapy, as indicated.
Rationale: May be used prophylactically to reduce risk of thrombus formation or to treat thromboemboli.

8. Monitor hemoglobin (Hgb), hematocrit (Hct), and coagulation studies, such as prothrombin time (PT) and International Normalized Ratio (INR).
Rationale: Provides information about circulatory volume and alterations in coagulation and indicates therapy needs and effectiveness.