Peripheral Vascular Disease Case Studies

A 52-year-old man complained of pain and cramping in his right calf caused by walking two blocks. The pain was relieved with cessation of activity. The pain had been increasing in frequency and intensity. Physical examination findings were essentially normal except fordecreased hair on the right leg. The patient’s popliteal, dorsalis pedis, and posterior tibialpulses were markedly decreased compared with those of his left leg.

Studies

Results

Routine laboratory work

Within normal limits (WNL)

Doppler ultrasound systolic pressures

Femoral: 130 mm Hg; popliteal: 90 mm Hg; posterior tibial: 88 mm Hg; dorsalis pedis: 88 mm Hg (normal: same as brachial systolic blood pressure)

Arterial plethysmography

Decreased amplitude of distal femoral, popliteal, dorsalis pedis, and posterior tibial pulse waves

Femoral arteriography of right leg

Obstruction of the femoral artery at the midthigh level

Arterial duplex scan

Apparent arterial obstruction in the superficial femoral artery

Diagnostic Analysis

With the clinical picture of classic intermittent claudication, the noninvasive Doppler and plethysmographic arterial vascular study merely documented the presence and location of the arterial occlusion in the proximal femoral artery. Most vascular surgeons prefer arteriography to document the location of the vascular occlusion. The patient underwent a bypass from the proximal femoral artery to the popliteal artery. After surgery he was asymptomatic.

Critical Thinking Questions

1. What was the cause of this patient’s pain and cramping?
2. Why was there decreased hair on the patient’s right leg?
3. What would be the strategic physical assessments after surgery to determine the
   adequacy of the patient’s circulation?
4. What would be the treatment of intermittent Claudication for non-occlusion?

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Peripheral Vascular Disease Case Studies

A 52-year-old man complained of pain and cramping in his right calf caused by walking two blocks. The pain was relieved with cessation of activity. The pain had been increasing in frequency and intensity. Physical examination findings were essentially normal except fordecreased hair on the right leg. The patient’s popliteal, dorsalis pedis, and posterior tibialpulses were markedly decreased compared with those of his left leg.

Studies

Results

Routine laboratory work

Within normal limits (WNL)

Doppler ultrasound systolic pressures

Femoral: 130 mm Hg; popliteal: 90 mm Hg; posterior tibial: 88 mm Hg; dorsalis pedis: 88 mm Hg (normal: same as brachial systolic blood pressure)

Arterial plethysmography

Decreased amplitude of distal femoral, popliteal, dorsalis pedis, and posterior tibial pulse waves

Femoral arteriography of right leg

Obstruction of the femoral artery at the midthigh level

Arterial duplex scan

Apparent arterial obstruction in the superficial femoral artery

Diagnostic Analysis

With the clinical picture of classic intermittent claudication, the noninvasive Doppler and plethysmographic arterial vascular study merely documented the presence and location of the arterial occlusion in the proximal femoral artery. Most vascular surgeons prefer arteriography to document the location of the vascular occlusion. The patient underwent a bypass from the proximal femoral artery to the popliteal artery. After surgery he was asymptomatic.

Critical Thinking Questions

1. What was the cause of this patient’s pain and cramping?
2. Why was there decreased hair on the patient’s right leg?
3. What would be the strategic physical assessments after surgery to determine the
   adequacy of the patient’s circulation?
4. What would be the treatment of intermittent Claudication for non-occlusion?

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Nursing Clinical Problem—- 

cical problem that you have identified in your area of nursing practice (as identified in Module 1). Critically appraise the research and summarize the knowledge available on the clinical problem (minimum requirement of 6 scholarly journal articles reviewed and appraised for application to practice problem). Outline a strategic plan for implementation of a practice change in your clinical practice environment based upon your findings. Describe how you intend to operationalize the practice change in your practice environment. What theoretical model will you use and how will you overcome barriers to implementation? What sources of internal evidence will you use in providing data to demonstrate improvement in outcomes? Describe evaluation methods of implementation clearly. Are there any ethical considerations? Refe

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 APA paper about topic ( 4 pages not including title and reference page) 

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• Soap Note 1 Acute Conditions (15 Points) Due 06/15/2019

  Pick any Acute Disease from Weeks 1-5 (see syllabus)
  Soap notes will be uploaded to Moodle and put through TURN-It-In (anti-Plagiarism program)

  Turn it in Score must be less than 50% or will not be accepted for credit, must be your own work and in your own words. You can resubmit, Final submission will be accepted if less than 50%. Copy paste from websites or textbooks will not be accepted or tolerated. Please see College Handbook with reference to Academic Misconduct Statement.
  Late Assignment Policy
  Assignments turned in late will have 1 point taken off for every day assignment is late, after 7 days assignment will get grade of 0. No exceptions 
  Follow the MRU Soap Note Rubric as a guide:
  Grading Rubric

  Student______________________________________
  This sheet is to help you understand what we are looking for, and what our margin remarks might be about on your write ups of patients. Since at all of the white-ups that you hand in are uniform, this represents what MUST be included in every write-up.

  1)      Identifying Data (___5pts): The opening list of the note. It contains age, sex, race, marital status, etc. The patient complaint should be given in quotes. If the patient has more than one complaint, each complaint should be listed separately (1, 2, etc.) and each addressed in the subjective and under the appropriate number.

  2)      Subjective Data (___30pts.): This is the historical part of the note. It contains the following:

  a) Symptom analysis/HPI(Location, quality , quantity or severity, timing, setting, factors that make it better or worse, and associate manifestations.(10pts).
  b) Review of systems of associated systems, reporting all pertinent positives and negatives (10pts).
  c) Any PMH, family hx, social hx, allergies, medications related to the complaint/problem (10pts). If more than one chief complaint, each should be written u in this manner.

  3)      Objective Data(__25pt.): Vital signs need to be present. Height and Weight should be included where appropriate.

  a)      Appropriate systems are examined, listed in the note and consistent with those identified in 2b.(10pts).
  b)      Pertinent positives and negatives must be documented for each relevant system.
  c)        Any abnormalities must be fully described. Measure and record sizes of things (likes moles, scars). Avoid using “ok”, “clear”, “within normal limits”, positive/ negative, and normal/abnormal to describe things. (5pts).

  4)      Assessment (___10pts.): Diagnoses should be clearly listed and worded appropriately.

  5)      Plan (___15pts.): Be sure to include any teaching, health maintenance and counseling along with the pharmacological and non-pharmacological measures. If you have more than one diagnosis, it is helpful to have this section divided into separate numbered sections.

  6)      Subjective/ Objective, Assessment and Management and Consistent (___10pts.): Does the note support the appropriate differential diagnosis process? Is there evidence that you know what systems and what symptoms go with which complaints? The assessment/diagnoses should be consistent with the subjective section and then the assessment and plan. The management should be consistent with the assessment/ diagnoses identified.

  7)      Clarity of the Write-up(___5pts.): Is it literate, organized and complete?

  Comments:

  Total Score: ____________                                                          Instructor: __________________________________

  • Soap Note 1 Acute ConditionsAssignment
• Case Study 3 & 4

  Case Study 3 & 4 (10 Points) Due 06/29/2019
  Students much review the case study and answer all questions with a scholarly response using APA and include 2 scholarly references. Answer both case studies on the same document and upload 1 document to Moodle.

   Case Study 3 & 4 S Inflammatory Bowel Disease and Urinary Obstruction 
  Case Studies will be uploaded to Moodle and put through TURN-It-In (anti-Plagiarism program)
  Turn it in Score must be less than 50% or will not be accepted for credit, must be your own work and in your own words. You can resubmit, Final submission will be accepted if less than 50%. Copy paste from websites or textbooks will not be accepted or tolerated. Please see College Handbook with reference to Academic Misconduct Statement.

  Late Assignment Policy
  Assignments turned in late will have 1 point taken off for every day assignment is late, after 7 days assignment will get grade of 0. No exceptions

  • Case Study 3 & 4Assignment
• Soap Note 2 Chronic Conditions

  Soap Note 2 Chronic Conditions (15 Points) Due 7/13/2019

  Pick any Chronic Disease from Weeks 6-10

  Soap notes will be uploaded to Moodle and put through TURN-It-In (anti-Plagiarism program)

  Late Assignment Policy
  Assignments turned in late will have 1 point taken off for every day assignment is late, after 7 days assignment will get grade of 0. No exceptions

   Follow the MRU Soap Note Rubric as a guide:
  Grading Rubric

  Student______________________________________
  This sheet is to help you understand what we are looking for, and what our margin remarks might be about on your write ups of patients. Since at all of the white-ups that you hand in are uniform, this represents what MUST be included in every write-up.

  1)      Identifying Data (___5pts): The opening list of the note. It contains age, sex, race, marital status, etc. The patient complaint should be given in quotes. If the patient has more than one complaint, each complaint should be listed separately (1, 2, etc.) and each addressed in the subjective and under the appropriate number.

  2)      Subjective Data (___30pts.): This is the historical part of the note. It contains the following:

  a) Symptom analysis/HPI(Location, quality , quantity or severity, timing, setting, factors that make it better or worse, and associate manifestations.(10pts).
  b) Review of systems of associated systems, reporting all pertinent positives and negatives (10pts).
  c) Any PMH, family hx, social hx, allergies, medications related to the complaint/problem (10pts). If more than one chief complaint, each should be written u in this manner.

  3)      Objective Data(__25pt.): Vital signs need to be present. Height and Weight should be included where appropriate.

  a)      Appropriate systems are examined, listed in the note and consistent with those identified in 2b.(10pts).
  b)      Pertinent positives and negatives must be documented for each relevant system.
  c)        Any abnormalities must be fully described. Measure and record sizes of things (likes moles, scars). Avoid using “ok”, “clear”, “within normal limits”, positive/ negative, and normal/abnormal to describe things. (5pts).

  4)      Assessment (___10pts.): Diagnoses should be clearly listed and worded appropriately.

  5)      Plan (___15pts.): Be sure to include any teaching, health maintenance and counseling along with the pharmacological and non-pharmacological measures. If you have more than one diagnosis, it is helpful to have this section divided into separate numbered sections.

  6)      Subjective/ Objective, Assessment and Management and Consistent (___10pts.): Does the note support the appropriate differential diagnosis process? Is there evidence that you know what systems and what symptoms go with which complaints? The assessment/diagnoses should be consistent with the subjective section and then the assessment and plan. The management should be consistent with the assessment/ diagnoses identified.

  7)      Clarity of the Write-up(___5pts.): Is it literate, organized and complete?

  Comments:

  Total Score: ____________                                                          Instructor: __________________________________

  • Soap Note 2 Chronic ConditionsAssignment
• Case Study 5 & 6

  Case Study 5 & 6 (10 Points) DUE 07/27/2019

  Students much review the case study and answer all questions with a scholarly response using APA and include 2 scholarly references. Answer both case studies on the same document and upload 1 document to Moodle.

  Case Study 5 & 6 Knee Injury and Testicular Cancer
  Case Studies will be uploaded to Moodle and put through TURN-It-In (anti-Plagiarism program)
  Turn it in Score must be less than 50% or will not be accepted for credit, must be your own work and in your own words. You can resubmit, Final submission will be accepted if less than 50%. Copy paste from websites or textbooks will not be accepted or tolerated. Please see College Handbook with reference to Academic Misconduct Statement.

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