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Mr. A., a 67 year old African American male is here at the clinic for medication...

Mr. A., a 67 year old African American male is here at the clinic for medication refill and annual physical exam. He doesn't remember all of his meds since he didn't write them down, but he remmbers taking St. John's Wort over the counter, ASA 81mg daily, Digoxin 0.125mg daily. He has a history of Rheumatic Heart Disease, Mitral valve replacement with mechanical device, and heart failure. He reported today that he has been feeling easily tired today. He has 2+ pitting edema in both legs. He also c/o pain when he walks but the pain subsides when he stopped working. The doctor just gave him an order for outpatient Chest xray. In the meantime, the doctor examined the patient and found the following: VS--96.8, 24, 66, 136/88, sats on RA--90%; crackles bilateral lower lobes, 2+ edema of the legs, abd tenderness, and dyspnea with exertion. Lower 1/3 of lower legs are shiny, cool to touch, and hairless w/ dark discoloration

1. What do you need to know about his support system?

2. Which referrals do you anticipate he will need

Solutions

Expert Solution

ANSWER:INFORMATION ABOUT HIS SUPPORT SYTEM:

  • IT IS REQUIRED TO KNOW IF THE PATIENT IS UNDER HOME EXERCISE PROGRAMME WHICH INCLUDES LEG EXERCISES OR WALKING ON A TREADMILL.
  • IT IS ESSENTIAL TO KNOW IF THE PATIENT IS UNDER SUPERVISED WALKING OR ANY OTHER EDUCATIONAL PROGRAMME ,THE EFFFECT OF WHICH IS FOUND ALMOST EQUAL TO THAT OF ANGIOPLASTY AND IMPROVES THE QUALITY OF LIFE.

REFERRALS THAT THE PATIENT REQUIRES:

  • THE LOWER ONE-THIRD OF HIS LEGS ARE SHINY,COOL TO TOUCH ,AND HAIRLESS WITH DARK DISCOLORATION IS DUE TO ACCUMULATION OF FLUID IN THE LOWER EXTREMITIES WHICH SHOWS THAT THE PATIENT IS IN THE STATE OF CHRONIC CONGESTIVE HEART FAILURE.IT IS ESSENTIAL TO KNOW ABOUT THE LEG ASSESSMENT SYSTEM.SO THE PATIENT MUST BE REFERRED TO THE LEG ASSESSMENT HEALTH PROFESSIONAL.
  • COMPLAINTS OF PAIN WHILE HE WALKS AND SUBSIDES WHEN HE STOPS WORKING REFERS TO A CONDITION CALLED INTERMITTENT CLAUDICATION.THIS CONDITION IS MORE COMMON IN THE AFRICO-AMERICAN RACE AND IS DUE TO PERIPHERAL ARTERIAL DISEASE.THEPATIENT IS REFERRED TO THE SURGEONS IF HE REQUIRES VASCULAR BYPASS SURGERY, OR ANGIOPLASTY .

Nightingale answered 2 years ago
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