Case Study 3
Jena Boen
Lakeview College of Nursing
N309
January 27, 2012

Case Study 3
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 most common side effects of the cholesterol lowering medication are “dizziness, fainting, and fast or irregular heartbeat” ("Simvastatin," 2011, para. 3).  This medication could be a part of the issues that Gordon is experiencing.  For example, a less common side effect of this medication is body aches and pain.  ("Simvastatin," 2011).
2.	What is intermittent claudication?
Intermittent claudication is “narrowing of the arteries in the legs which may present as cramping pain in the legs or buttocks on walking” ("Peripheral Artery Disease," 2010, para. 1).  This is also the complaint Gordon had about his legs and getting pain in them when he walked his dog.  This should be a main concern with his health care provider.
3.	What are common risk factors for peripheral vascular disease?
There are several common risk factors that directly relate to Gordon.  Peripheral vascular disease is most common in men aged 60 to 70.  Also, cigarette smoking and diabetes mellitus are some of the biggest risk factors.(Porth, 2011) In regards to smoking and peripheral vascular disease, “80% of persons with the disorder being current of former smokers” (Porth, 2011, p. 418).
4.	What is the common pathophysiology of peripheral vascular disease?
The common pathophysiology of peripheral vascular disease is related to atherosclerosis.  This is where the arteries harden because of the “formation of fibro-fatty lesions in the intimal lining of the large and medium-sized arteries” (Porth, 2011, p. 411).  LDL can also play a role in atherosclerosis because of it’s high content of cholesterol. (Porth, 2011)
5.	What are bruits?
Bruits are “an abnormal blowing or swishing sound or murmur heard while auscultating a carotid artery, aorta, organ or gland” (Mosby’s, 2009, p. 264).  A bruit is from blood that is flowing through an artery that is occluded or narrowed in any way.  The bell of the stethoscope is used to hear bruits. (Mosby’s, 2009)
6.	Using the Hartford Institute for Geriatric Nursing Web site, Consultgeri.org, 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 is used to detect patients with arterial disease in the legs to prevent the progression of the disease or to detect patients with a high risk for a cardiovascular disease.  (Coke, 2010, para. 2)  An ABI of .90 is normal and the lower the number goes, the more likely it is that the patient has an obstruction of some kind.  It can be helpful to assess the ABI of an elderly patient at a routine exam because you may catch an arterial or cardiovascular disease before it progresses to something very serious.  
7.	What lifestyle changes might you recommend to Gordon?
I would obviously recommend to Gordon that he cut down on his smoking.  I would also recommend that Gordon look at his diet and make sure it is low in high fat foods and that he is eating healthy.  Exercise may also be a beneficial activity to Gordon.
8.	What medications might Gordon benefit from using?
Gordon might benefit from using another blood pressure medication that maybe he would comply with.  It would be smart for the nurse to ask him why he won’t comply with his medication regimen for his blood pressure.  Also, another cholesterol medication would help Gordon.what about antiplatelet like aspirin 81mg or an anticoagulant?
9.	What signs should Gordon watch for to indicate that the disease may be progressing?
Some signs that the disease is progressing could be more pain in his lower extremities and more edema.  I wouldn’t care a lot about Gordon knowing when the disease is progressing because I would want to help him get the disease under control before it progressed.  It would be easier to for him to control the disease if he got it under control before it progressed.
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
Coke, L. A. (2010). Vascular risk assessment of the older cardiovascular patient:The ankle-brachial index (ABI). Retrieved from http://consultgerirn.org/uploads/File/trythis/try_this_sp4.pdf
Mosby’s Dictionary of Medicine, Nursing & Health Professions (8th ed.). (2009). : .
Peripheral Artery Disease- legs. (2010). Retrieved from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001223/
Porth, C. M. (2011). Essentials of pathophysiology (3rd ed.). : .
Simvastatin. (2011). Retrieved from http://www.mayoclinic.com/health/drug-information/DR601991/DSECTION=side-effects