I was at the library last tues and thought I seen you but you never came to see me
13.5/15

Case Study 11.4
Brittany M. Hicks
Lakeview College of Nursing
N-309
January 27, 2012

Case Study 11.4
Gordon is taking Simvastatin to help lower his cholesterol, some of the side effects of this medication are: nausea, constipation, diarrhea, abdominal pain, liver dysfunction, pancreatitis, rash, muscle cramps, myositis, rhabdomyolysis, and upper respiratory infection (Skidmore-Roth, 2011). I don’t believe that the cholesterol medication Simvastatin is causing Gordon’s issues. Some of the contraindications of this drug are hypersensitivity and active hepatic disease (Skidmore-Roth, 2011). Claudication is a term referred to pain due to lack of sufficient blood flow (Mayo Clinic, 2012). It can be termed intermittent if it is not constant, it is back and forth. Most of the time claudication occurs in the feet, but can also affect hands. There are several risk factors associated with peripheral vascular disease, some of these are: family history, smoking, high cholesterol, hypertension, obesity, diabetes, and patients over 50 years of age (Mayo Clinic, 2012). Typically the patients who smoke and have diabetes are more susceptible to peripheral vascular disease (Mayo Clinic, (2012). 
Peripheral vascular disease is a widespread circulatory disease that is caused by reduction in the arteries, therefore causing decreased blood flow (Mayo Clinic, 2012). Many times the contributing factor related to peripheral vascular disease is atherosclerosis (Mayo Clinic, 2012). Atherosclerosis is characterized by fatty residue in the arteries, typically the legs (Mayo Clinic, 2012). Bruits otherwise known as a thrill, is characterized by turbulent limited blood flow in the arteries, many times related to vascular pathology. Bruits are heard when you auscultate the arteries during a physical exam. The measuring system for the ankle-brachial index the levels are as follows: above .90 is normal, .71-.90 is mild obstruction, .41-.70 is moderate obstruction, and below .41 is severe obstruction (Coke, 2010). Assessing the ankle-brachial is a screening tool, it can often indicate the high risk of cardiac episode and it can be helpful in inhibiting the development of claudication (Coke, 2010). 
Some of the lifestyle changes that I feel Gordon needs to modify are increase exercise, to stop smoking (#1), and eating healthier. In my opinion Gordon would benefit from taking an antihypertensive medication, hypertension can lead to more complications associated with the heart. He will probably need an antiplatelet (Asprin 81mg) or an anticoagulant. Hypertension can often lead to stroke and other cardiovascular diseases. Some signs that Gordon can look for are: constant claudication, often a discoloration in limbs, and he could also make sure that he is compliant with his appointments to have his ankle-brachial index evaluated. 
Gordon should be vigilant about foot care. Any wounds or infections should receive immediate care as he is at risk for severe infections, such as gangrene

References
Claudication. (1998-2012). Retrieved January 27, 2012, from http://www.mayoclinic.org/health/DS01052
Coke, L. A. (2010). Vascular risk assessment of the older cardiovascular patient: The ankle- brachial index (ABI). Hartford Institute of Geriatric Nursing. Retrieved from http://consultgerirn.org/uploads/File/trythis/try_this_sp4.pdf
Hill, R. D., & Smith, III, R. B. (1990). Examination of the extremities: Pulse, bruits, and phlebitis. Retrieved from http://www.ncbi.nlm.nih.gov/books/NBK350
Peripheral Artery Disease. (1998-2012). Retrieved January 27, 2012, from http://www.mayoclinic.org/health/peripheral-arterial-disease/DS00537
Peripheral Artery Disease. (1998-2012). Retrieved January 27, 2012, from http://www.mayoclinic.org/health/peripheral-arterial-disease/DS00537/DSECTION=risk-factors
Skidmore-Roth , L. (2011). Mosby's 2012 nursing drug reference. (pp. 165-1086). St. Louis: Mosby.