Vascular Disorders Case Study
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Patient Profile
S.J., a 76-yr-old African American man, is admitted to
the hospital with rest pain in both legs and a nonhealing ulcer of the big toe on the right foot.
Subjective Data
• History of a myocardial infarction, stroke, hypertension, heart failure, and type 1 diabetes mellitus
• Underwent a left femoral-popliteal bypass 5 yr ago
• Has a 45 pack-yr history of tobacco use
• Has been using insulin for 30 yr
• Complains of sudden, intense increase in right foot pain for past 2 hr
• Has slept in recliner with right leg in dependent position for several
months
Current Medications
• furosemide 40 mg/day PO
• isosorbide dinitrate/hydralazine hydrochloride (BiDil) 1 tablet q8hr
• aspart (NovoLog) insulin with meals
• glargine insulin 50 U/day subcutaneously
• diltiazem sustained release 240 mg/day PO
• aspirin 325 mg/day PO
• Fish oil daily (self-prescribed)
Objective Data
Physical Examination
• BP 148/92 mm Hg; irregular apical HR 90/min, respiratory rate 22/min,
temperature 97.9° F (36.6° C)
• Alert and oriented but anxious, no apparent physical or mental deficits
from previous stroke
• Has a diminished right femoral pulse, popliteal pulse by Doppler only,
posterior tibial pulse by Doppler only, and dorsalis pedis pulse absent
(not palpable or present by Doppler); left leg pulses are weakly palpable
• Right leg ABI: 0.20; left leg ABI: 0.68
• Has a 2-cm necrotic ulcer on tip of right big toe
• Has thickened toenails; shiny, thin skin on legs; and hair absent on both
lower legs
• Right foot is very cool, pale, and mottled in color with decreased
sensation
• No peripheral edema present
• Bedside glucose measurement 298 mg/dL (last meal 4 hr before
admission)
Discussion Questions
1. Assess S.J.’s risk factors for peripheral artery disease (PAD).
2. Differentiate S.J.’s signs and symptoms of chronic PAD and acute
arterial ischemia.
3. Identify the possible cause(s) for the sudden, intense increase in right
foot pain.
4. How would you interpret S.J.’s ABI findings?
5. What additional diagnostic tests can be performed to assess the
extent of his PAD?
6. Given the physical examination data, what initial medication(s) would
you expect the physician to prescribe?
7. What treatment modalities are possible for S.J.?
8. Priority Decision: What are the priority nursing responsibilities in
caring for S.J.?
9. Delegation Decision: Identify activities that can be delegated to unlicensed assistive personnel.
10. Priority Decision: Based on the assessment data presented, what
are the priority nursing diagnoses? Are there any collaborative
problems?
11. Evidence-Based Practice: When teaching S.J., what evidence-based
advice would you give him regarding the use of dietary supplements
such as fish oil?
Vascular Disorders Case Study Essay
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