A nurse is planning care for a client who has peripheral arterial disease. Which of the following interventions should the nurse include in the plan?

Nursing management of peripheral arterial disease (PAD) focuses on improving arterial blood flow, reducing ischemic pain, and preventing tissue injury. PAD occurs when atherosclerotic narrowing reduces oxygen-rich blood supply to the extremities, commonly causing intermittent claudication, cool skin, diminished pulses, and delayed wound healing. Positioning and skin care are important because poor circulation increases the risk of ulcers and necrosis. Interventions should support perfusion while protecting fragile tissues from further damage. Rationale: A. Placing the client’s feet below the level of the heart is appropriate because gravity helps promote arterial blood flow to the lower extremities. Clients with PAD often experience pain relief when the legs are in a dependent position because it improves tissue perfusion. Elevating the legs can worsen ischemia and intensify discomfort by further reducing arterial circulation. B. Applying knee-high stockings is inappropriate because compression stockings are mainly used for venous disorders, not arterial insufficiency. In PAD, external compression can further reduce already limited arterial blood flow and worsen tissue ischemia. The priority is improving perfusion, not restricting circulation to the affected extremities. C. Applying a heating pad to the client’s feet is unsafe because reduced sensation and poor circulation increase the risk of burns and tissue injury. Clients with PAD may not detect excessive heat due to neuropathy or ischemic nerve changes. Warmth should be provided with protective measures like socks or blankets rather than direct heat sources. D. Scrubbing the lower extremities vigorously when washing is contraindicated because the skin is fragile and prone to breakdown due to poor blood supply. Harsh friction can cause abrasions or ulcers that heal poorly and may become infected. Gentle cleansing with mild soap and careful drying is the safer approach for skin care.