Question: S.P. Is A 68-year-old Retired Painter Who Is Experiencing Right Leg Calf Pain. The Pain Began Approximately 2 Years Ago But Has Become Significantly Worse In The Past 4 Months. The Pain Is Precipitated By Exercise And Is Relieved With Rest. Two Years Ago, S.P. Could Walk 2 City Blocks Before Having To Stop Because Of Leg Pain. Today, He Can Barely Walk …

S.P. is a 68-year-old retired painter who is experiencing right leg calf pain. The pain began approximately 2 years ago but has become significantly worse in the past 4 months. The pain is precipitated by exercise and is relieved with rest. Two years ago, S.P. could walk 2 city blocks before having to stop because of leg pain. Today, he can barely walk across the yard. S.P. has smoked 2 to 3 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 quadruple coronary artery bypass graft 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, continues to eat anything he wants, and continues to smoke 2 to 3 PPD. Other surgical history includes open reduction and 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 gets worse with exercise, the pain does not go away promptly with rest, some days are worse than others, and his condition is not affected by a resting position. Chart View General Assessment Weight Height BP Pulse Respiratory rate Temperature Laboratory Testing (Fasting) Cholesterol Triglycerides HDL LDL 261 lb (118.4 kg) 5 ft, 10 in (178 cm) 163/91 82 16 98.4°F (36.9°C) 239 mg/dL (6.2 mmol/L) 150 mg/dL (1.69 mmol/L) 28 mg/dL (0.73 mmol/L) 181 mg/dL (4.69 mmol/L) Current Medications Ramipril (Altace) Metoprolol (Lopressor) Aspirin Atorvastatin (Lipitor) 10 mg daily 25 mg twice a day 81 mg daily 20 mg daily 1. What are the likely sources of his calf pain and hip pain? 2. S.P. has several risk factors for PAD. From his history, list 2 risk factors, and explain the reason they are risk factors. 3. You decide to look at S.P.’s lower extremities. What signs do you expect to find with PAD? Select all that apply. Page 1 of 3 NUR- SWEDISH INSTITUTE Medical Surgical Nursing I Peripheral Arterial Disease a. Ankle edema b. Thick, brittle nails c. Cool or cold extremity d. Thin, shiny, and taut skin e. Brown discoloration of the skin f. Decreased or absent pedal pulses 4. You ask further questions about the clinical manifestations of PAD. Which of these would you expect S.P. to have given the diagnosis of PAD? Select all that apply. a. Paresthesia b. Elevation pallor c. Dependent rubor d. Rest pain at night e. Pruritus of the lower legs f. Constant, dull ache in his calf or thigh 5. What is the purpose of the daily aspirin listed in S.P.’s current medication? CASE STUDY PROGRESS: S.P.’s primary care provider has seen him and wants you to schedule him for an ankle-brachial index (ABI) test to determine the presence of arterial blood flow obstruction. You confirm the time and date of the procedure and then call S.P. at home. 6. What will you tell S.P. to do to prepare for the tests?