Question

A 50-year-old male presents to the community clinic. He has just relocated to the area and has no primary provider. He is a long distance truck driver and requires a physical examination to maintain his continued employment.

Physical examination demonstrates a BMI of 33, blood pressure of 180/90 mm Hg, diminished femoral pulses and bilateral varicose veins with nonpitting edema in both ankles. He has a 30-year history of smoking two packs of cigarettes per day.

Initial Discussion Post:

What additional information is needed from the patient history and physical assessment to determine if this patient has arterial or venous insufficiency?

Compare and contrast evidence-based nursing interventions for the patient diagnosed with arterial insufficiency and the patient diagnosed with venous insufficiency.

Answer 1

1. ANS: Additional information needed for the patient history and physical assessment:

Risk factors for arterial insufficiency associated with this patient are his nicotine use, his high blood pressure, sedentary lifestyle, BMI, and increasing age. Risk factors for venous insufficiency would be a sedentary lifestyle and BMI, pitting edema and the presence of the varicose veins.

A physical assessment of the extremities could determine whether arterial or venous insufficiency is occurring. Arterial pulses are diminished or absent would qualify as arterial. Further skin characteristic can determine the kind of insufficiency such as is the skin shiny and lacks hair (arterial) or is it tough and reddish blue in color (venous). Question for history would be any diabetes or hyperlipidemia, and heart disease (arterial) or any varicosities or cancer history(venous) (Hinkle, J. and Cheever, K., 2014)

2. ANS: Evidence-based nursing intervention:

As far as similar nursing interventions, no matter what the issue a trusting relationship between the nurse, the patient, and the family needs to be established. This can be done during the conversation about medical history and the physical assessment. The determination of the patient's health literacy is also important to determine the plan of care that will be successful. Both PAD and PVD diet and sedentary lifestyle need to be discussed with the patient. A diet will not only work towards a healthier weight and lower BMI and may also lower the patient's blood pressure. Smoking cessation should also be in the discussion. A few differences between the two would be skincare. Patients with PVD need to take care of their feet and skin and not have constricting garments. The use of compression stockings should be determined by the physician. Foot care is important with PVD, making sure feet are not dry and cracked and toenails are kept trimmed. Different exercise will have to be determined also f dealing with venous or arterial insufficiency. The patient with PAD has pain during exercise and is relieved during rest, so certain restrictions will have to be made (Ignatavicus, D., & Workman, L., 2015)

Reference:

Hinkle, J., & Cheever, K. (2014). Brunner and Suddarth’s textbook of medical-surgical nursing (13th ed.). Philadelphia, PA: Wolters Kluwer Health.

Ignatavicus, D., & Workman, L.,(2015). Medical-Surgical Nursing (8th ed.) Elsevier Health Sciences.