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S.P  is a 68-year-old retired painter who is experiencing right leg calf pain. The pain began approximately two years ago but has worsened significantly in the past 4 months. The pain is precipitated by exercise and is relieved with rest. Two years ago, S.P. could walk two city blocks before having to stop because of leg pain. Today, he can barely walk across the yard. S.P. has smoked two to three packs of cigarettes per day (PPD) for the past 45 years.

He has a history of coronary artery disease (CAD), hypertension (HTN), peripheral artery disease (PAD), and osteoarthritis. Surgical history includes a quadruple coronary artery bypass graft (CABG×4) 3 years ago. He has had no further symptoms of cardiopulmonary disease since that time, even though he has not been compliant with the exercise regimen his cardiologist prescribed. He continues eating anything he wants and smoking two to three PPD. Other surgical history includes open reduction internal fixation of a right femoral fracture 20 years ago.

S.P is in the clinic today for a routine semiannual follow-up appointment with his primary care provider. As you take his vital signs, he tells you that in addition to the calf pain, he is experiencing right hip pain that worsens with exercise; the pain goes away promptly with rest. 

 

Identify a minimum of three subjective cues (risk factors) that are clinically significant and provide a brief rationale for each cue.
Based on the clinically significant data, What health condition is the client experiencing
Using your words, describe the pathophysiology consistent with this condition.
What objective signs will you anticipate on inspection and palpation
Discuss one health promotion teaching topic
Based on the information, discuss one older adult’s consideration. 

 

Case 2  

H.L is a 46-year-old man who is relatively healthy but obese (weight: 250 lb; height: 5 ft, 9 in). He comes to the clinic to see the nurse practitioner with the following statement: “I must have pulled something in my right leg. I was walking when I felt some soreness in my lower right leg, and now there is some swelling. It really hurts to walk.” He states that he is a self-employed developer of computer software programs. Reports sitting for hours at the computer with few breaks. Occasionally remembers to exercise feet and lower legs.

Right calf pain and swelling began 3 days ago. Reports discomfort increases when walking. Swelling and pain improve when the leg is elevated. Reports no color or temperature changes in his arms or left leg, and no pain in the left leg, but reports having mild to moderate pain in the right lower leg, especially when he is up and moving around. States he has taken acetaminophen 1,000 mg 2-3 times per day to relieve leg pain.

He has hypertension and hyperlipidemia, both controlled by medication. Has had no angina since his coronary artery bypass graft (CABG) 5 years ago. He developed pulmonary embolism following surgery. No other previous surgeries on veins or arteries. Nonsmoker and drinks occasionally and exercises by walking a few blocks most days. Denies problems with sexual activity. 
 

 

7.    Identify a minimum of three subjective cues (risk factors) that are clinically significant and provide a brief rationale for each cue
8.    Based on the clinically significant data, what health condition is the client experiencing  
9.    Using your words, describe the pathophysiology consistent with this condition
10.     What objective signs will you anticipate on inspection and palpation 
11.    Discuss one health promotion teaching 

12. Based on the information, discuss one older adult’s consideration 

 

CITE YOUR SOURCE 

SCIENCE
HEALTH SCIENCE
NURSING
NURSING NR304

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