PERIPHERAL ARTERY DISEASE Patient Profile S.J., a 76-yr-old African American man

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PERIPHERAL ARTERY DISEASE
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
•Has a 45 pack-yr history of tobacco use
•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
•aspart (NovoLog) insulin with meals
•diltiazem sustained release 240 mg/day PO
•aspirin 325 mg/day PO
•Fish oil daily (self-prescribed)

Objective Data
•BP 148/92 mm Hg; irregular apical HR 90/min, RR 22/min, Temp 97.9° F (36.6° C)
•Alert and oriented but anxious
•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

•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. What treatment modalities are possible for S.J.?
2. What are the priority nursing responsibilities in caring for
S.J.?

 

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