Amanda  good on information but you need to cite all references with the author and the date. If it is a direct quote you need a page number but not necessary if not direct quote
13/15
Case Study Three
Amanda L. Miller
N309 Nursing of the Gerontological Client
January 29, 2012

Case Study Three
	Some of the side effects of medications lowering cholesterol include asthenia, headache, abdominal pain, constipation, diarrhea, and upper respiratory tract infection (Nursing, p1232). Mr. Toguid smokes so he is at a higher risk for upper respiratory tract infections. He also drinks which is cautioned while on Simvastatin. It is important that while on this drug, Mr. Toguid report any muscle aches and pains or tenderness or weakness with malaise or fever (Nursing, p. 1233)
	Intermittent claudication is the ischemic muscle pain that occurs with exercise and subsides with rest. It is the result of the emboli or vessel entrapment concurrent with peripheral arterial disease (CINHL Nursing Guide).
	The risk factors for PVD is smoking, diabetes, obesity, high blood pressure, high cholesterol over 240mg/dl, increasing age, family history, and excess levels of homocysteine, a protein component that helps build and maintain tissue (Mayo Clinic)
	The common pathophysiology of peripheral vascular disease is when the blood flow to the limps decreases. Typically the legs are effected because blood flow is decreases so much that id can’t keep up with the demand causing pain when walking (Mayo Clinic). Treatment, especially for Mr. Toguid would be to continue walking, and exercise, but to quit using tobacco products. 
	Bruits is a sound or murmur heard while auscultating an organ or blood vessel, especially an abnormal one (Porth. p. 1208).
The ABI, ankle-brachial index, is used to “detect asymptomatic disease in the legs to prevent progression to claudication or limp ischemia” (Coke, 2010).  It is useful for those older than 40 years of age to be screened because it is a non-invasive way to detect early cardiovascular risk reduction measures (Coke, 2010). 
	Some lifestyle changes, I would suggest to Mr. Toguid would be to continue his medications as prescribed, maintain a healthy lifestyle, but it is important that he quit smoking and drinking alcohol. I would also discuss why he doesn’t want to take blood pressure medications. What is a factor? Is it cost, side effects? It is important to find out the root of the reason for non-compliance for blood pressure medications.  He needs to restart the BP med and add a antiplatlet like asprin 81 mg and maybe an anticoagulant
	The signs that PAD is progressing is fact that his dorsal pedis arteries are weak and hard to locate. The skin on the legs are dry and mottled. Upon touch, his skin is cool. The ABI measurements are also off. His left leg is bigger than right. These are all indications that blood flow to the legs are diminished.   

References
Caple, C. (2011). Claudication. CINAHL Nursing Guide
Coke, Lola A. (2010). Vascular Risk Assesment of the Older Cardiovascular Patient; The Ankle 
Bracial Index (ABI). Hartford Institute for Geriatric Nursing, New York University, 
College of Nursing. 
Deglin, J., & Vallerand, A. (2011). Davis's drug guide for nurses (12th ed.). 
Philadelphia, PA: F.A. Davis. 
Mayo Clinic Staff. (2010). Peripheral artery disease. com/health/peripheral-arterial-
disease/DS00537/DSECTION=risk-factors
Porth, C. A. Essentials of pathophysiology (3rd ed.). Philadelphia: Lippincott Williams and 
Wilkins.