Med Surg Case Study #20: Peripheral Arterial Occlusive Disease

Mr. Harold Thompson | 62 years old | Male

Chief Complaint: Complaints of pain in the lower extremities.

Medical History:

• Hypertension

• Type 2 Diabetes Mellitus

• Hyperlipidemia

• Smoking history (30 pack-years)

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0800

Nurse's Note: Mr. Thompson admitted with complaints of cramping pain in both legs, especially during walking. States the pain is relieved with rest. Reports numbness and tingling in his toes. Capillary refill in toes delayed. Peripheral pulses in both feet diminished.

Vital Signs:

• Blood Pressure: 148/92 mmHg

• Heart Rate: 78 bpm

• Respiratory Rate: 18 breaths/min

• Temperature: 98.6°F (37°C)

1200

Nurse's Note:Mr. Thompson's pain persists. Administered prescribed analgesics as ordered. Continued monitoring for signs of worsening peripheral perfusion. Encouraged elevation of legs and provided warm blankets for comfort.

Vital Signs

• Blood Pressure: 144/88 mmHg

• Heart Rate: 82 bpm

• Respiratory Rate: 20 breaths/min

• Temperature: 98.8°F (37.1°C)

1600

Nurse's Note: Peripheral pulses remain weak. Documented 2 episodes of elevated blood glucose levels. Instructed patient on the importance of maintaining optimal blood glucose levels to prevent further vascular compromise. Noted that patient is compliant with prescribed medications.

Vital Signs:

• Blood Pressure: 150/94 mmHg

• Heart Rate: 80 bpm

• Respiratory Rate: 16 breaths/min

• Temperature: 98.5°F (36.9°C)

Physician's Orders:

1. Doppler ultrasound of lower extremities.

2. Administer analgesics for pain relief.

3. Monitor blood glucose levels (AC/HS)

4. Initiate antiplatelet therapy (aspirin 81 mg PO daily).
   

Question 1: What are the key symptoms of Peripheral Arterial Occlusive Disease?

Question 2: Why is it important to monitor blood glucose levels in a patient with PAOD?

Question 3: Why is antiplatelet therapy (aspirin) initiated in this patient?

Answers to Questions Below

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Answers

Question 1: What are the key symptoms of Peripheral Arterial Occlusive Disease?

Key symptoms include intermittent claudication (pain during physical activity), numbness or tingling in the affected limbs, delayed capillary refill, and diminished peripheral pulses.

Question 2: Why is it important to monitor blood glucose levels in a patient with PAOD?

Patients with PAOD often have comorbid conditions such as diabetes, which can exacerbate vascular compromise. Elevated blood glucose levels can further contribute to impaired peripheral perfusion, delaying wound healing and increasing the risk of infection.

Question 3: Why is antiplatelet therapy (aspirin) initiated in this patient?

Antiplatelet therapy is initiated to reduce the risk of thrombus formation in the narrowed arteries. Aspirin inhibits platelet aggregation, decreasing the likelihood of blood clot formation and improving blood flow to the affected extremities.