pn 200 fundamentals of nursing 2 concept map: Peripheral Artery Disease A 65 year old man was sent from the clinic for worsening of left calf severe pain and decrease in exercise tolerance due to left calf pain. The patient had a 3-month history of intermittent left calf pain and denied trauma, back pain, fever, but does report heaviness of the left leg and weakness. Otherwise, the medical history was significant for hyperlipidema. He was a former smoker anf stopped smoking 6 months ago; however, he smoked 1 pack of cigarettes per day for the past 40 years before quitting. The patient denied use of alcohol or recreational drugs. His medications were low-dose asprin and high-intensity atorvastatin. On physical examination, vital signs were normal. Body mass index was 28kg/m2. Femoral pulses were diminished bilaterally. Popliteal posterior tibialis pulses were not palpable. Cardiac examination was normal. Otherwise, the physical examination was unremarkale. He was enrolled in a supervised exercise program 3 months ago, but the patient reported no improvement despite adherence to the exercise program, and his symptoms progressed. A. Are there any Airway, Breathing or Circulation issues? If so, what are they specifically AND why do you suspect the patient has these issues? B. Does this patient have any pain (acute or chronic), or Dextrose / Disability issues? If so, what are they specifically AND why do you suspect the patient has these issues? C. Are there any specific skin, mobility, or infection issues with this patient? Why do you suspect the patient has these issues? D. What Maslow’s, Ericson’s or Piaget concerns do you have for this patient? Why do you suspect the patient has these issues? E. Given your answers above, what 3 concerns would you want to address first? Disease Process Defined: Nursing Diagnosis #1: Interventions: Positive outcomes: Negative Outcomes: Evaluation: ————– Nursing Diagnosis #2 Interventions: Positive outcomes: Negative Outcomes: Evaluation:
The patient does not present immediate airway, breathing, or circulation issues. However, the diminished femoral pulses and non-palpable popliteal and posterior tibialis pulses indicate impaired circulation, particularly in the lower extremities. This suggests a circulatory concern.
The patient experiences chronic left calf pain, heaviness, and weakness, which have been worsening over the past 3 months. This chronic pain affects his mobility, exercise tolerance, and overall quality of life. Disability issues are evident due to his limited physical activity and inability to benefit from the supervised exercise program.
The diminished peripheral pulses and compromised circulation raise concerns about tissue perfusion and potential skin issues, such as ulcers or necrosis, in the affected leg. Reduced mobility due to calf pain and weakness further increases the risk of skin breakdown. While there are no apparent signs of infection, the compromised circulation may predispose the patient to higher infection risk if skin integrity is compromised.
Maslow’s Hierarchy of Needs: The patient’s chronic pain and limited mobility may impact his sense of belongingness and self-esteem, as he cannot actively participate in activities he once enjoyed. Addressing his pain and restoring mobility are essential for meeting these needs.
Erikson’s Stages of Psychosocial Development: The patient may experience a sense of stagnation or despair if his symptoms continue to worsen and limit his independence and physical activity.
1. Pain Management: Addressing the patient’s chronic calf pain is a top priority to improve his quality of life and adherence to the treatment plan. Adequate pain control can also enhance his participation in rehabilitation efforts.
2. Circulatory Assessment and Management: Evaluating and managing the patient’s compromised circulation is crucial to prevent further deterioration, skin issues, and potential complications like tissue necrosis.
3. Psychosocial Support: Recognizing the psychosocial impact of his condition and providing emotional support can help alleviate feelings of despair or frustration and improve his motivation for self-care and rehabilitation.
Interventions
Assess peripheral pulses regularly.
Administer prescribed medications (e.g., antiplatelet agents, anticoagulants).
Collaborate with the healthcare team for possible revascularization procedures (e.g., angioplasty, stenting).
Educate the patient on the importance of foot care and skin monitoring.
Encourage smoking cessation and adherence to medications.
Positive Outcomes
Improved peripheral circulation.
Prevention of tissue damage and ulceration.
Enhanced quality of life.
Negative Outcomes
Progression of tissue necrosis.
Development of ulcers or gangrene.
Increased risk of limb amputation.
Evaluation: Continuously monitor peripheral pulses, skin integrity, and patient-reported pain levels. Assess for any signs of deterioration and adjust interventions accordingly.
Interventions
Assess the location, intensity, and characteristics of pain regularly.
Administer prescribed analgesics and monitor their effectiveness.
Implement non-pharmacological pain management strategies (e.g., positioning, relaxation techniques).
Collaborate with the healthcare team for possible interventions to improve circulation.
Provide patient education on pain management techniques and encourage adherence to the plan.
Positive Outcomes
Reduction in pain levels.
Improved mobility and participation in rehabilitation.
Enhanced overall well-being and quality of life.
Negative Outcomes
Persistent, debilitating pain.
Limited mobility and decreased adherence to treatment.
Negative impact on psychosocial well-being.
Evaluation: Continuously assess the patient’s pain levels and response to interventions. Adjust the pain management plan based on the patient’s feedback and progress.
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