A nurse is reviewing the case of Mr. Thompson, who has advanced peripheral artery disease with critical limb ischemia, poorly controlled diabetes, and hypertension. Which nursing action is the priority to prevent further complications in Mr. Thompson's condition?

B) Arrange for an immediate consultation with a vascular surgeon for possible surgical intervention.

A) Educate Mr. Thompson on the importance of smoking cessation to improve blood flow.

B) Arrange for an immediate consultation with a vascular surgeon for possible surgical intervention.

C) Initiate a comprehensive review of Mr. Thompson's antihypertensive and diabetes medication regimen with the healthcare provider.

D) Encourage Mr. Thompson to increase his daily physical activity to enhance circulation.

A nurse is caring for Mr. Thompson, who has been diagnosed with critical limb ischemia secondary to peripheral artery disease. Given the current clinical findings, which of the following interventions should the nurse prioritize to address his condition effectively?

C) Prepare Mr. Thompson for a vascular imaging study to assess the need for surgical intervention.

A) Educate Mr. Thompson on the importance of maintaining a low-sodium diet to manage his hypertension.

B) Instruct Mr. Thompson to keep his legs elevated above heart level to improve circulation.

C) Prepare Mr. Thompson for a vascular imaging study to assess the need for surgical intervention.

D) Advise Mr. Thompson to engage in moderate exercise to promote collateral circulation.

Mr. Thompson, who has diabetes and worsening claudication, is experiencing decreased sensation in his right foot and has developed a small ulceration with erythema. Which nursing intervention is most critical to prioritize in his care plan to prevent further complications?

A) Educating Mr. Thompson on daily foot inspection and proper foot care techniques.

B) Increasing the frequency of blood glucose monitoring to improve glycemic control.

C) Encouraging Mr. Thompson to increase physical activity to improve circulation.

D) Administering prophylactic antibiotics to prevent potential infection.

Mr. Thompson, a patient with diabetes, is being treated for worsening claudication with cilostazol and has been experiencing difficulty differentiating temperatures in his right foot. During a foot examination, a small ulcer with erythema was noted. Which nursing intervention is most critical to prioritize based on this assessment?

B) Initiate immediate wound care and refer Mr. Thompson to a vascular specialist for further evaluation.

A) Educate Mr. Thompson on improving glycemic control to prevent further neuropathy progression.

B) Initiate immediate wound care and refer Mr. Thompson to a vascular specialist for further evaluation.

C) Adjust Mr. Thompson's exercise program to include more weight-bearing activities to improve circulation.

D) Schedule routine follow-ups to monitor the effectiveness of cilostazol therapy for claudication symptoms.

Mr. Thompson has been diagnosed with severe peripheral artery disease and peripheral neuropathy, contributing to a non-healing foot ulcer. Which nursing intervention is most appropriate to promote healing and prevent further complications in this patient?

D) Ensure the patient wears protective footwear to prevent injury

A) Encourage daily foot exercises to improve circulation

B) Elevate the affected limb above heart level to reduce edema

C) Apply a warm compress to the foot ulcer to enhance blood flow

D) Ensure the patient wears protective footwear to prevent injury

A nurse is planning care for Mr. Thompson, who has severe peripheral artery disease (PAD) and peripheral neuropathy, leading to a foot ulcer. Which nursing intervention is most critical to include in Mr. Thompson's care plan to address his current complications?

A) Encourage Mr. Thompson to perform daily foot inspections and report any new findings.

B) Instruct Mr. Thompson to elevate his legs above heart level to reduce edema.

C) Suggest the use of warm compresses on the affected foot to improve circulation.

D) Advise Mr. Thompson to limit physical activity to prevent further injury.

A nurse is caring for Mr. Thompson, who has a diabetic foot ulcer and is experiencing neuropathic pain. Despite ongoing wound care, his ulcer shows minimal healing, and his hemoglobin A1c remains elevated. Which of the following nursing interventions is the most appropriate to enhance wound healing in this patient?

B) Collaborate with the healthcare provider to adjust Mr. Thompson's diabetes medication regimen for better glycemic control.

A) Increase the frequency of hydrocolloid dressing changes to every 12 hours.

B) Collaborate with the healthcare provider to adjust Mr. Thompson's diabetes medication regimen for better glycemic control.

C) Initiate a high-protein diet to promote tissue repair and wound healing.

D) Encourage Mr. Thompson to perform daily foot exercises to improve circulation.

Mr. Thompson, a patient with a foot ulcer, has shown reduced erythema but minimal wound healing despite antibiotic therapy and specialized wound care. He also reports a new sharp, burning sensation in his right foot. Considering his elevated hemoglobin A1c and CRP levels, which nursing intervention should be prioritized to address the underlying factors impeding his recovery?

B) Educate the patient on strict glycemic control strategies.

A) Increase the frequency of wound debridement sessions.

B) Educate the patient on strict glycemic control strategies.

C) Initiate a referral to a pain management clinic.

D) Recommend an increased dosage of gabapentin.

Mr. Thompson has undergone a percutaneous transluminal angioplasty (PTA) to address significant stenosis in the superficial femoral artery, leading to improved blood flow and healing of his foot ulcer. As his nurse, which postoperative nursing intervention is most critical to ensure the success of the procedure and promote healing?

B) Monitor the distal pulses of the affected extremity frequently.

A) Encourage Mr. Thompson to ambulate early to improve circulation.

B) Monitor the distal pulses of the affected extremity frequently.

C) Apply warm compresses to the affected extremity to enhance blood flow.

D) Instruct Mr. Thompson to keep the affected extremity elevated at all times.

Mr. Thompson's case of peripheral artery disease is leading to delayed wound healing and neuropathic pain. After a successful percutaneous transluminal angioplasty, what is the primary nursing intervention to monitor for complications and ensure the effectiveness of the procedure?

B) Assess pedal pulses and capillary refill regularly.

A) Encourage increased fluid intake to maintain hydration.

B) Assess pedal pulses and capillary refill regularly.

C) Apply warm compresses to the affected foot to promote circulation.

D) Limit ambulation to reduce strain on the lower extremities.

peripheral artery disease - Nursing Case Study

Pathophysiology

• Primary mechanism: Atherosclerosis - This is the buildup of fatty deposits, or plaques, in the arterial walls, leading to narrowed and stiffened arteries. This restricts blood flow to the limbs, causing symptoms like pain and cramping.

• Secondary mechanism: Endothelial Dysfunction - Damage to the endothelial lining from factors like smoking, hypertension, or diabetes results in impaired vasodilation and increased inflammation, exacerbating plaque formation and further reducing blood flow.

• Key complication: Critical Limb Ischemia - Severely reduced blood flow can lead to tissue necrosis, non-healing wounds, and gangrene, significantly increasing the risk of limb amputation if not promptly managed.

Patient Profile

Demographics:

65-year-old male, retired construction worker

History:

• Key past medical history: Hypertension, Type 2 Diabetes, Smoking history (40 pack years)

• Current medications: Metformin, Lisinopril, Atorvastatin, Aspirin

• Allergies: No known drug allergies

Current Presentation:

• Chief complaint: Leg pain during walking

• Key symptoms: Intermittent claudication in the right calf, numbness in toes, decreased pulse in the right foot

• Vital signs: Blood pressure 150/90 mmHg, Heart rate 85 bpm, Respiratory rate 18 breaths per minute, Temperature 98.6°F, Oxygen saturation 95% on room air

Section 1

As Mr. Thompson's case progresses, he begins to exhibit signs indicative of advancing peripheral artery disease complications. During a routine follow-up appointment, the nurse notes that Mr. Thompson's leg pain has intensified and now occurs even at rest, particularly at night. Additionally, the numbness in his toes has progressed to a tingling sensation, and there is a noticeable decrease in hair growth on his right leg. Upon examination, the nurse observes that the skin on his right foot appears shiny, pale, and cool to the touch. The pedal pulse is faint and requires a Doppler to detect. Ankle-brachial index (ABI) testing reveals a significant reduction in blood flow with a reading of 0.5 on the right side, confirming the suspicion of critical limb ischemia.

Laboratory tests indicate worsening blood glucose control, with an HbA1c level of 8.2%, suggesting suboptimal management of his diabetes. Additionally, his lipid profile shows elevated LDL cholesterol levels despite compliance with atorvastatin therapy, indicating the need for further evaluation of medication efficacy and lifestyle modifications. The nurse also notes the persistence of hypertension with a blood pressure reading of 160/95 mmHg, suggesting a need to reassess his antihypertensive regimen.

These findings necessitate further action to prevent tissue damage and potential limb loss. The healthcare team considers adjusting Mr. Thompson's current treatment plan, potentially introducing a more aggressive pharmacological strategy, including the addition of cilostazol to improve claudication symptoms and revisiting his diabetes management strategy. There is also a discussion about the potential need for vascular imaging to evaluate the extent of arterial blockages and to determine if surgical intervention, such as angioplasty or bypass, might be warranted. The urgency of addressing these complications is emphasized to Mr. Thompson to prevent progression to non-healing ulcers or gangrene.

Section 2

Following the initial assessment, the healthcare team decided to initiate cilostazol therapy to address Mr. Thompson's worsening claudication symptoms. Over the course of the next few weeks, Mr. Thompson was closely monitored for response to the new medication regimen as well as for any potential side effects. During a follow-up appointment, Mr. Thompson reported some improvement in his ability to walk short distances before experiencing pain, although he still experienced significant discomfort at rest.

In addition to the pharmacological intervention, a comprehensive review of Mr. Thompson's diabetes management plan was undertaken. His diabetes educator worked with him to refine his dietary habits, emphasizing glycemic control, and incorporated a tailored exercise program that took into account his limited mobility. Despite his efforts, a follow-up HbA1c test revealed only a marginal improvement to 7.9%, indicating the need for possible adjustments in his insulin therapy and further lifestyle modifications.

However, new complications began to emerge. Mr. Thompson reported increasing difficulty in differentiating hot and cold temperatures with his right foot, an alarming symptom suggestive of neuropathy progression. Furthermore, the nurse noted the development of a small ulceration on the plantar surface of his right foot during a routine foot examination. The ulcer appeared superficial but was surrounded by a halo of erythema, raising concerns about potential infection. This finding prompted a swift response to initiate wound care management and a referral to a vascular specialist for further evaluation, underscoring the critical need to prevent further deterioration and the risk of limb-threatening complications.

Section 3

The new complications in Mr. Thompson's condition prompted a series of diagnostic tests to better understand the underlying issues. A Doppler ultrasound of the lower extremities was conducted, revealing a significantly reduced ankle-brachial index (ABI) of 0.6 on the right side, indicating severe peripheral artery disease. This finding suggested compromised blood flow, which likely contributed to both his claudication symptoms and the delayed healing of the foot ulcer. Additionally, a nerve conduction study confirmed the presence of peripheral neuropathy in the right foot, aligning with his reported sensory disturbances. These results underscored the multifactorial challenges in managing his condition, as both vascular and neurological elements were at play.

In assessing Mr. Thompson's vascular status, his vital signs remained relatively stable with a blood pressure of 140/85 mmHg and a heart rate of 78 bpm. However, the presence of the foot ulcer and its surrounding erythema was concerning for infection, leading to a decision to initiate empirical antibiotic therapy while awaiting culture results. The healthcare team also arranged for Mr. Thompson to receive specialized wound care, including debridement and the application of a hydrocolloid dressing, to promote optimal healing conditions.

This comprehensive approach to addressing Mr. Thompson's new complications required careful coordination among the multidisciplinary team. The vascular specialist recommended further imaging, such as a CT angiography, to evaluate the potential need for revascularization procedures. Meanwhile, adjustments in his diabetes management were prioritized to enhance glycemic control and prevent further neuropathic damage. As these interventions were implemented, the healthcare team remained vigilant in their monitoring, recognizing the importance of adapting their strategy based on Mr. Thompson's response to treatment and any emerging clinical changes.

Section 4

As Mr. Thompson's treatment plan was put into action, the healthcare team closely monitored his progress, paying particular attention to his response to the interventions. Within a week, there were noticeable changes in his clinical status. The erythema surrounding the foot ulcer began to reduce, indicating a positive response to the antibiotic therapy. However, the wound itself showed minimal signs of healing, prompting concern among the clinicians. The specialized wound care regimen, including regular debridement and hydrocolloid dressing changes, was maintained, but the team decided to re-evaluate his condition with a focus on potential underlying issues that might be impeding the healing process.

During a routine follow-up visit, Mr. Thompson reported increased pain in his right foot, now described as a sharp, burning sensation that was more pronounced at night. This new development raised suspicions of complex regional pain syndrome (CRPS), a condition that can arise following nerve injuries. In light of these symptoms, the pain management specialist recommended a trial of gabapentin to address the neuropathic pain, while also considering the need for a referral to a pain management clinic for more comprehensive evaluation and treatment.

Laboratory tests were repeated to assess Mr. Thompson's overall health status and potential factors affecting his recovery. His hemoglobin A1c level remained elevated at 8.2%, despite efforts to optimize his diabetes management, indicating the need for more aggressive glycemic control measures. Additionally, inflammatory markers, such as C-reactive protein (CRP), were elevated, suggesting ongoing systemic inflammation. These findings highlighted the interplay of his diabetes, vascular insufficiency, and neuropathic complications, emphasizing the need for an integrated approach to manage his condition effectively. The healthcare team discussed potential adjustments to his diabetes regimen and the consideration of more advanced vascular interventions, such as angioplasty, to improve blood flow and facilitate the healing of his ulcer.

Section 5

As Mr. Thompson's condition continued to be closely monitored, the team decided to focus on new diagnostic results that could provide further insight into his prolonged healing process and persistent symptoms. A duplex ultrasound of his lower extremities was performed to assess the vascular status more thoroughly. The results revealed significant stenosis in the superficial femoral artery, contributing to the inadequate perfusion of his right foot. This finding corroborated the clinical suspicion of worsening peripheral artery disease, which was likely exacerbating the delayed wound healing and neuropathic pain.

In light of these findings, the healthcare team recognized the necessity of enhancing Mr. Thompson's blood flow to promote ulcer healing and alleviate symptoms. An interventional radiologist was consulted, and after a thorough evaluation, the decision was made to proceed with percutaneous transluminal angioplasty (PTA) to address the arterial stenosis. The procedure aimed to restore adequate blood flow, thereby improving tissue oxygenation and facilitating the healing process of the foot ulcer.

The results of the angioplasty were promising, with post-procedural imaging showing a significant improvement in blood flow to the affected area. Following the intervention, Mr. Thompson's pain began to diminish, and there was an observable increase in granulation tissue around the wound, indicating the initial stages of healing. These developments underscored the importance of addressing vascular insufficiency in patients with complex diabetic foot ulcers and highlighted the need for ongoing interdisciplinary collaboration to optimize outcomes. The healthcare team continued to adjust his diabetes management and pain control strategies, ensuring comprehensive care tailored to his evolving clinical needs.