Case Scenario: Peripheral Arterial Disease

Question Case Scenario: Peripheral Arterial Disease  A.T is a 65-year-old black female patient was admitted with a chief complain of numbness and burning sensation in the lower extremities. Her admitting diagnosis is claudication secondary to peripheral arterial disease (PAD). She has a history of coronary artery disease, myocardial infarction, heart failure, endarterectomy, hypertension, hyperlipidemia, type 1 diabetes mellitus, and asthma. She was referred to the Division of Vascular Surgery at complaining of fatigue and heaviness in her lower thighs and calves during walking. Resting ankle-brachial index (ABI) was 0.50 and 0.70 at the right and left dorsalis pedis, respectively. She was prescribed cilostazol and encouraged to “…walk through the pain as much as possible.” Due to worsening claudication, A.T. underwent an abdominal aortogram with arteriogram of the lower extremities. Results showed aortoiliac disease with multiple stenoses of varying degrees. Areas of calcification were noted from the lower aorta and iliac artery to the anterior tibial artery affecting both the left and right limbs. Results from a stress echocardiogram showed cardiac wall motion abnormalities consistent with exercise-induced ischemia. She exercised for 5.8 minutes on the Bruce protocol, limited by general fatigue. The electrocardiogram displayed left bundle branch block, resting ejection fraction was 40%, peak blood pressure was 160/80 mmHg, and peak heart rate was 120 b·min-1. No symptoms were reported. Her medications are cilostazol, carvedilol, amlodipine, isosorbide dinitrate, clopidogrel, simvastatin, potassium, triamcinolone, ipratropium, and pirbuterol. She began supervised exercise training in cardiac rehabilitation following a hospitalization for angina. At rest her blood pressure was 120/50 mmHg, heart rate was 79 b·min-1, blood glucose was 6.89 mmol·L-1 (266 mg·dL-1) and her HbA1c was 8.0%. Her initial exercise sessions were limited by bilateral claudication of her thighs and calves. Moderate pain occurred after 9 minutes of walking on day 1. A pain-rest walking program was initiated and followed for 12 weeks. She then joined the Henry Ford PREVENT program, which provides patients with a low-cost, long-term supervised exercise environment.She now exercises at least 3 d·wk-1 for 60 minutes each session. She splits her exercise time between a seated stepper and a treadmill. On most days she is now able to walk 30 continuous minutes without limiting claudication pain.FORMULATE PATHOPHYSIOLOGY FLOWCHART WITH EXPLANATION (BOOK-BASED AND CLIENT-BASED)FORMULATE SAMPLE NURSING CHARTING (SUBJECTIVE, OBJECTIVE, ASSESSMENT, PLANNING, INTERVENTION. EVALUATION) Health Science Science Nursing PB HLTH MISC Share QuestionEmailCopy link Comments (0)

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