12/15
                                 You need to get out your APA book but body of paper was not bad.

Case Study #3
Kalyn Madej
Lakeview College of Nursing 
N309: Nursing of the Gerontological Client
Aline Davis / Mary Edwards
January 29,2012

Case Study #3
1.	Some side effects of taking the lowering cholesterol medication were stated by PubMed Health as constipation, stomach pain, nausea, and headache. More serious side effects that should result in the discontinuance of Simvastatin would be muscle pain, tenderness, weakness, dark red urine, decreased urination, lack of energy, loss of appetite, pain in upper right part of stomach, yellowing of the eyes, fever, flushing, blisters, rash, hives, itching, difficulty breathing, joint pain and sensitivity to light. (PubMed Health). I do not believe that the medication that Gordon is taking is resulting in the issue. However since there are signs of muscle pain and weakness these may be considerations that the doctor might want to look into. If he does not take his medications than I could see this being the cause of the issue but since he takes the medication that is unlikely to be the cause.
2.	Intermittent claudication is described as the pain that a person develops in the muscles of the legs while walking or exercising. This is experienced mostly in the calf muscles and is described as cramping of discomfort. This condition is relieved by resting. This can be seen in patients with peripheral vascular disease. (Damien Mosquera BSc MB ChB FRCS FRACS MD)
3.	Common risk factors for peripheral vascular disease according to Mayo Clinic are as follows, “ Smoking, diabetes, obesity with a B.M.I over 30, high blood pressure 140/90mmHg, high cholesterol over 240 mg/dL, increasing age, family history of PAD, heart disease or stroke, excessive levels of homocystein”( Mayo Clinic Staff).
4.	Peripheral vascular disease is a circulatory problem where the arteries become narrowed which results in reduced blood flow to the limbs. This is seen in your extremities usually in the legs when you do not receive enough blood flow to keep up with the demand. Peripheral artery disease can also be an accumulation of fatty deposits in the arteries. This can result in the reduction of blood flow to your heart and brain. (Mayo Clinic Staff)
5.	According to Jarvis bruits are, “turbulence due to a local vascular cause, such as atherosclerotic narrowing” (Jarvis, 2008, 498). A bruit can also described as the turbulent blood flow that can be a result of a partial occlusion. 
swooshing sound
6.	According to the website article by Coke it states, “The Ankle Brachial Index (ABI) is a tool used to detect asymptomatic arterial disease in the legs to prevent progression to claudication or limb ischemia and detect individuals at high risk of cardiovascular events” (Coke, 2010). The ABI is the ratio of systolic blood pressure taking at the ankle over the systolic blood pressure taken in the arm. The patient is supine and this is recorded using a sphygmomanometer and Doppler ultra sound probe. This exam should be done in older patients it is harder to find the pulses so using the Doppler will give you more accurate results.
7.	Some lifestyle changes that I would recommend to Gordon would be that he should stop smoking because that contributes to constriction and damage of the arteries. I would also suggest that Gordon exercise because this will help to condition your muscles so that they will use more oxygen efficiently. Gordon should have a heart healthy diet in low saturated fats to help control his blood pressure and cholesterol levels. He should also make sure he is having a diet rich in nutrition and vitamins. He should also make sure that he is using careful foot care. This includes washing, drying completely, and moisturizing daily. He should also wear well fitted shoes and thick socks. He should avoid walking barefoot.  (Mayo Clinic Staff)
8.	Gordon may be advised to take medications that will lower his cholesterol to reduce his LDL. He should also take medications for high blood pressure. Medications can be taken to prevent blood clots to reduce blood flow to your limbs. He can also take symptom relief medications to increase blood flow to the limbs both preventing blood clots by widening of the blood vessels. (Mayo Clinic Staff)
   Gordon could benefit from daily low-dose aspirin (81 mg) or a prescription anticoagulant.

9.	Signs that Gordon should watch out for are painful cramping, leg numbness or weakness, coldness in your lower leg or foot, sores on your feet or legs that won’t heal, change in color of your legs, hair loss on your legs, slower growth of your toenails, shiny skin on your legs, no pulse or weak pulse on your feet or legs, and erectile dysfunction. He should also look out for pain that may occur when he is at rest or lying down. ( Mayo Clinic Staff)
      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

Resources

Coke, PhD ACNS-BC, Lola . "The Hartford Institute for Geriatric Nursing." Vascular Risk 

Assessment of the Older Cardiovascular Patient: The Ankle-Brachial Index (ABI). N.p., 

n.d. Web. 29 Jan. 2012. http://consultgerirn.org

Jarvis, Carolyn. "20." Physical examination & health assessment. 5th ed. St. Louis, Mo.: 

	Saunders/Elsevier, 2008. 498. Print.

Mayo Clinic Staff. "Peripheral Artery Disease (PAD): Risk Factors." Mayo Clinic. 21 Apr. 2010. 

Web. 29 Jan. 2012. <http://www.mayoclinic.com/health/peripheral-arterial-

	disease/DS00537/DSECTION=risk-factors>.

Mosquera BSc MB ChB FRCS FRACS MD, Damien. "INTERMITTENT CLAUDICATION, 

Cause, Symptoms and Treatment of Leg Pain." Vascular.co.nz. Www.vascular.co.nz, 13 

Oct. 2011. Web. 29 Jan. 2012. 

<http://www.vascular.co.nz/intermittent_claudication.htm>.

"Simvastatin - PubMed Health."National Center for Biotechnology Information. N.p., 15 Dec. 

	2011. Web. 29 Jan. 2012. <http://www.ncbi.nlm.nih.gov/pubmedhe