PN 200 Fundamentals of Nursing II Concept Map – Peripheral Vascular Disease Sam Paul is a 65-year-old retired painter who is experiencing right calf pain

QUESTION

PN 200 Fundamentals of Nursing II Concept Map – Peripheral Vascular Disease Sam Paul is a 65-year-old retired painter who is experiencing right calf pain. The pain began approximately 2 years ago but has become significantly worse in the pas 4 months. The pain is precipitated by exercise and is relieved by rest. Two years ago, Mr. Paul could walk 2 city blocks before having to stop because of leg pain. Today he can barely walk across the kitchen. Mr. Paul has smoked 2 to 3 packs of cigarettes a day for the past 45 years. He has a history of coronary artery disease, hypertension, peripheral vascular disease, and osteoarthritis. Surgical history includes quadruple coronary artery bypass graft 3 years ago. He has had no further symptoms of cardiopulmonary disease since that time despite the fact that he has not been compliant with the exercise regime his cardiologist prescribed, continues to eat anything he wants, and continues to smoke 2-3 packs a day. Other surgery includes open reduction internal fixation of the right femoral fracture 20 years ago. In clinic today, Mr. Paul’s weight is 261 pounds; height 5′ 10"; vital signs are B/P 163/91. pulse 82, respirations 16 and afebrile. His fasting lipids are: cholesterol 239 mg/dL triglycerides 150 mg/dL HDL 28 mg/dL LDL 181 mg/dL Medications include: Lisinopril 20 md/day Metoprolol 25 mg/day Aspirin 325 mg/day Simvastatin 40 mg/day

1. What are the 2 Nursing Diagnosis for this case?

2. What are 8 interventions for this case?

3. What are the 2 positive outcomes?

4. What are the 2 negative outcomes?

5. What are the 2 evaluation for this case?

ANSWER

1. Nursing Diagnoses

a. Ineffective Peripheral Tissue Perfusion related to atherosclerotic changes in the peripheral vascular system as evidenced by right calf pain and decreased ability to walk.
b. Ineffective Health Maintenance related to continued smoking, sedentary lifestyle, and poor dietary habits as evidenced by Mr. Paul’s history of smoking, lack of exercise, and uncontrolled lipid profile.

2. Interventions

a. Assess and monitor Mr. Paul’s peripheral vascular status regularly, including assessing peripheral pulses, capillary refill, and skin temperature and color.
b. Educate Mr. Paul about the importance of smoking cessation and provide resources for smoking cessation programs.
c. Collaborate with the healthcare team to modify Mr. Paul’s medication regimen if necessary to optimize blood pressure control and lipid levels.
d. Develop an individualized exercise plan that takes into account Mr. Paul’s current physical limitations and gradually increases his physical activity.
e. Provide dietary counseling to promote a heart-healthy diet, including reducing saturated fat and cholesterol intake.
f. Monitor and manage Mr. Paul’s pain effectively to improve his willingness to engage in physical activity.
g. Educate Mr. Paul about the signs and symptoms of worsening peripheral vascular disease and when to seek immediate medical attention.
h. Collaborate with Mr. Paul’s cardiologist and other specialists to ensure comprehensive care and address any cardiac-related concerns.

3. Positive Outcomes

a. Improved peripheral tissue perfusion as evidenced by decreased calf pain and increased walking distance.
b. Successful smoking cessation and adoption of a healthier lifestyle, leading to improved overall cardiovascular health.

4. Negative Outcomes

a. Continued deterioration of peripheral tissue perfusion, potentially leading to tissue necrosis or gangrene.
b. Uncontrolled cardiovascular risk factors, such as persistent smoking and poor adherence to medications, resulting in further progression of atherosclerosis and increased risk of cardiac events.

5. Evaluations

a. Monitor Mr. Paul’s progress in terms of pain relief and increased walking distance to assess the effectiveness of interventions aimed at improving peripheral tissue perfusion.
b. Evaluate Mr. Paul’s commitment to smoking cessation and lifestyle modifications through regular follow-up appointments and monitoring of blood pressure and lipid profiles to gauge the success of health maintenance interventions.