Case Study 3 (11.4)
Nina Fainter
Lakeview College of Nursing
N309
January 28, 2012

Case Study 3 (11.4)
Some of the side effects that Zocor causes are muscle cramps, myalgia, myositis, and rhabdomyolysis (Mosby’s, 2011). Myalgia is muscle aching or stiffness. Myositis is inflamed skeletal muscles that are controlled voluntarily. Rhabdomyolysis is the deterioration of muscle fibers which in turn may also cause myalgia (Medline, 2012). The Zocor could potentially be the cause of the intermittent leg pain that Gordon is experiencing since the medication has side effects of muscle cramps, stiffness, and inflammation. 
Intermittent claudication is cramping leg pain that comes and goes. It’s a typical symptom in people who have peripheral artery disease. It is most common when exercising due to lack of blood flow and oxygen in the legs. Symptoms usually appear when walking and disappear after a few minutes of resting. The popliteal artery is the most common artery that is affected; therefore it is common to have cramping in the calf muscles (University, 2011).
Some common risk factors for peripheral vascular disease are high cholesterol, diabetes, heart disease, hypertension, kidney disease, smoking, and stroke. Gordon has high cholesterol, hypertension, and smokes at least a pack of cigarettes a day. Therefore, he is at risk for peripheral vascular disease (PubMed, 2010). 
Peripheral vascular disease develops after plaque develops in the walls of arteries. This causes the artery walls to harden and makes it harder for the walls of arteries to expand for larger amounts of blood flow. When exercising, like when Gordon walks, muscles in his legs need a greater amount of blood and oxygen but after time the arteries have narrowed and hardened  and cannot compensate for this need even when resting. Men are at a greater risk for this especially after the age of 50 (PubMed, 2010).
Bruits are known as turbulent blood flow and usually imply stenosis at the site in which it is detected. They should be assessed in a quiet room. A stethoscope is used and they most commonly sound like a “swishing” sound (Kurtz, 1990).
The ankle-brachial index is a measure of blood pressure taken at both the legs and arms. Cuffs are placed on both extremities and after being inflated a Doppler measures the systolic measurement of both. The systolic measurement of the legs is divided by the highest arm pressure to determine the ABI. This is a reliable procedure and non-invasive to help determine PVD or help determine if PVD has gotten worse in individuals who already have it. It is good for older adults to have this done for this reason but also because it can help assess the development of future problems such as wound healing issues or bypass surgeries. It can also help predict the risk of stroke and heart attacks. The lower the ABI value is, the higher the risk of developing such problems (Vascular, 2010). 
It would be beneficial for Gordon to quit smoking since this is a risk factor of peripheral artery disease. Also, a diet in lower cholesterol is recommended since this is also a risk factor. Since he is hypertensive, I would recommend getting his blood pressure controlled with diet, exercise, or medication to help prevent PVD or prevent it from worsening. 
Gordon would probably benefit from an anti-hypertensive drug to control his blood pressure. Since he smokes a pack a day it is probably going to be difficult to stop smoking on his own. He may want to talk to his primary care physician about a medication to help aid in the process of not smoking. He is already taking medication to control his cholesterol so it is probably best to stay on that as long as it is not contraindicated in any other medication he may be prescribed. Also with the PVD, they may want to prescribe an anticoagulant to prevent blood clots or an antiplatelet or anticoagulant since he’ll be at higher risk for these with narrow arteries. He may also want to ask his primary care physician if he is allowed to take any over the counter medications, such as ibuprofen, for the leg cramping. 
Gordon should watch for increased cramping in the legs along with any color changes. If he begins to feel weak or his feet begin to feel colder than normal consult his primary care physician. If there is numbness in the extremities or sores develop he should consult his physician.  
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
Kurtz, K. J. (1990). Bruits and hums of the head and neck. Bookshelf: U.S. National Library of Medicine National Institutes of Health. Retrieved January 27, 2012 from http://www.ncbi.nlm.nih.gov/books/NBK289/
Medline Plus. (2012, January 13). Myositis. Retrieved January 26, 2012, from  http://www.nlm.nih.gov/medlineplus/myositis.html
Medline Plus. (2012, January 12). Rhabdomyolysis. Retrieved January 26, 2012, from http://www.nlm.nih.gov/medlineplus/ency/article/000473.htm
Mosby's Nursing Drug Reference (24th ed.). (2011). Philadelphia: Elsevier Mosby.
PubMed Health. (2010, June 17). Peripheral artery disease: Legs. Retrieved January 28, 2012 from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001223/
University of Maryland Medical Center. (2011). Peripheral artery disease and intermittent claudication: symptoms. Retrieved January 26, 2012, from http://www.umm.edu/patiented/articles/intermittent_claudication_other_symptoms_of_peripheral_artery_disease_000102_2.htm
Vascular Disease Foundation. (2010, December 21). ABI. Retrieved January 28, 2012 from http://www.vdf.org/diseaseinfo/pad/anklebrachial.php