Module 3 Case Study
Gregory Cahill
Lakeview College of Nursing

1.  List some of the side effects of the cholesterol lowering medication that Gordon is using.  Could the medication be the cause of Gordon’s issues?
Some of the side effects of simvastatin (Zocor) include; Abdominal cramps, elevated liver enzymes, pancreatitis, pruitus, rhabdomyolysis, arthralgia and myalgia (Deglin & Vallerand, 2007).  Simvastatin can cause myalgia (muscle pain) and rhabdomyolysis (breakdown of muscle fiber).  The side effects rhabdomyolysis include muscle pain and fatigue.

2.  What is intermittent claudication?
Intermittent claudication is pain or cramping in the calf typically felt while walking and subsides with rest.  The most common cause of claudication in the legs is peripheral artery disease (PAD).  PAD is caused by cholesterol plaque lining arteries (atherosclerosis) and blocks blood flow to the affected area.  PAD could be depriving Gordon’s legs of the oxygen they require when he is walking causing his legs to hurt (Cunha).

3. What are common risk factors for peripheral vascular disease?
Risk factors for peripheral vascular disease include high cholesterol, diabetes, heart disease, high blood pressure, smoking and stroke.

4.  What is the common pathophysiology of peripheral vascular disease?
Peripheral vascular disease starts with atherosclerosis distal to the aorta with the sign and symptoms being gradual.  The artery slowly becomes blocked to the point the patient begins to feel symptoms, the most common of which is intermittent claudication.  The patient may also experience a thinning of the skin and subcutaneous tissue of the lower leg and a decrease in the size of the calf muscle.  When the artery is blocked to the point that the minimum oxygen level needed at rest is no longer met the patient will experience pain at rest, ulceration, gangrene and tissue necrosis.  Treatment is directed at protecting the effected area preservation of function.  Surgery is used in severe cases to bypass the affected artery or place a stint.  If the tissue is necrotic it can be fatal and the necrotic tissue is usually removed (Porth, 2011)  

5.  What are bruits?
A bruit is an abnormal turbulent sound of an artery.  Swooshing sound

6.  Using the Hartford Institute for Geriatric Nursing web site, what is a measurement of the ankle-brachial index?  Why can it be helpful to assess an ankle-brachial index during a routine exam of elderly patients?
The ankle-brachial index measures the difference in blood pressure between the brachial and ankle at rest and after 5 minutes of light exercise.  A difference greater than .9 indicates the presence of peripheral vascular disease.  It is important to asses an ankle-brachial index in the elderly because they are at a higher risk for PAD and the index is inexpensive and easy to do (Coke).

7.  What lifestyle changes might you recommend to Gordon?
I would recommend that Gordon quit smoking and that he continues to walk as tolerated.  I would educate Gordon on a low fat/ low cholesterol diet and encourage him to take blood pressure medications.  Gordon also needs to make sure he takes care of his feet and any cuts or bruises as his ability to heal is diminished.

8.  What medications might Gordon benefit from using?
Getting Gordon’s blood pressure under control is very important.  Gordon might benefit from taking an anticoagulant like Plavix.  Useful medications also include cilostazal and pentoxifylline or aspirin (Porth).    

9.  What signs should Gordon watch for indicate that the disease may be progressing? 
Increase pain or leg pain while resting and if his legs Blanche while elevated could be signs that the disease is progressing (Porth, 2011).  

References
Coke, L. Vascular risk assessment of the older cardiovascular patient: The ankle-brachial 
     	index (abi) [Web log message]. Retrieved from       	http://consultgerirn.org/uploads/File/trythis/try_this_sp4.pdf
Cunha, J. (n.d.). Medicinenet.com. Retrieved from 
	http://www.medicinenet.com/claudication/article.htm
Deglin, J., & Vallerand, A. (2007). Davis's drug guide for nurses. (10th ed.). Philadelphia,  
	PA: F.A. Davis Company.
Shabir, B. (2010, June 17). Pubmed. Retrieved from 
	http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001223/