Cardiovascular Disorders

Read the following Case Scenario. Answer the following questions. After answering the questions, create a care plan for this patient.

  • one diagnosis
  • two goals
  • two interventions (one for each goal) do not forget the rationale.
  • two evaluations (one for each intervention)

Mr. K. is a 57-year-old man who consulted his physician after noticing marked leg pains while playing golf. He had previously noticed increasing fatigue and discomfort in his legs associated with moderate exercise. When sitting for extended periods with legs dangling, his legs became red, and sometimes his feet felt numb. His history indicates he smokes cigarettes and is chronically overweight. His blood cholesterol and other lipid levels are abnormal, and his physician suspects peripheral atherosclerosis as the cause of his discomfort.

Case Study Questions

  1. Discuss the development of atherosclerosis, including the predisposing factors in this case and the pathophysiological changes. (See Atherosclerosis.)
  2. Discuss the complications that might develop in this patient. (See Atherosclerosis—Pathophysiology, Signs and Symptoms.)
  3. Discuss the treatments for all aspects of the patient’s condition, including slowing the progress of the atherosclerosis, maintaining circulation in the leg, and treating complications. (Include both pharmacological and non-pharmacological treatments – don’t forget to include any assessments or monitor that needs to happen with these treatments and any patient education required)
  4. What patient education would be important for this patient? What Social Determinants of Health and health promotion would be important to include in this patients education/planning.

Answer

Cardiovascular Disorders

Atherosclerosis is a long-lasting inflammatory disease that causes plaques to accumulate inside the arteries. Most plaques comprise lipids, which cause an inflammatory response that leads to turbulent blood flow and atherosclerotic cardiovascular disease (ASCVD) (Pahwa & Jialal, 2021). In this case study, we examine how atherosclerosis starts, what problems it can cause, how it is treated, what the patient needs to know, and make a care plan for the patient.

  1. Many factors contribute to atherosclerosis development. A complex interaction between risk factors like diabetes mellitus, high cholesterol, smoking, high blood pressure, and other genetic and lifestyle factors causes atherosclerosis (Jebari-Benslaiman et al., 2022). In the case of the 45-year-old male, the risk factors are smoking, being overweight for a long time, and having abnormal lipid levels. Pathophysiology of atherosclerosis is a continuous process of arterial wall damage resulting in an inflammatory response (Jebari-Benslaiman et al., 2022). This leads to the recruitment of immune cells and the accumulation of substances causing atherogenic progression. Over time, these substances build up into a plaque that narrows the lumen of the artery, stopping blood flow and causing symptoms.

  2. This patient may develop complications, which include limb ischemia, non-healing wounds, and gangrene, and may have to be amputated. Atherosclerosis can lead to heart attacks, strokes, and other fatal heart and blood vessel events (Libby, 2021).

  3. Atherosclerosis can be treated with both pharmacological and non-drug methods. The treatment goals are to slow the progression of atherosclerosis and improve blood flow to the legs. Non-pharmacological treatments may include diet adjustments, weight loss, exercise, and heart-healthy lifestyle changes, including stopping smoking. Every month, the patient’s symptom relief from claudication is evaluated to see if they are sticking to the scheduled regular activity schedule. Drugs used include statins that decrease cholesterol and aspirin that prevents blood clots (Rodriguez et al., 2019). To monitor treatment effectiveness, lipid levels in the blood must be measured every three months.

  4. Atherosclerosis treatment requires patient education. The instruction should emphasize weight loss, quitting smoking, exercise, and a heart-healthy diet. Patients should also be informed of potential side effects and drug interactions when using prescription drugs. Access to smoking cessation programs, safe places to exercise, and healthy food options are among the social factors that impact health that must be considered. Therefore, as part of your health promotion, encourage the patient to exercise, eat well, and quit smoking.

Care Plan

Assessment Diagnosis Goals Intervention Rationale Evaluation
Subjective data: 57-year-old man complaining of considerable leg pain during exercise with associated discomfort after prolonged sitting. He is a chronic smoker.

Objective data: abnormal lipid levels

Decreased peripheral perfusion linked to peripheral arterial disease as shown by leg pain after moderate exercise, discomfort upon sitting for long hours, and numbness of the feet. Improve the leg’s circulation Recommend frequent exercise like cycling at least 150 minutes per week. Improve blood flow to the leg (Pahwa & Jialal, 2021). Improved blood flow reduces inflammation and helps with tissue perfusion. Examine the patient’s capacity for regular activity and track the resolution of claudication symptoms every month.
Slow atherosclerosis progression Prescribe statins Lower cholesterol levels and slow the progression of atherosclerosis (Lloyd-Jones et al., 2019). Regularly check your lipid levels to determine how well the medicine is working, every three months.

References

Jebari-Benslaiman, S., Galicia-García, U., Larrea-Sebal, A., Olaetxea, J. R., Alloza, I., Vandenbroeck, K., Benito-Vicente, A., & Martín, C. (2022). Pathophysiology of atherosclerosis. International Journal of Molecular Sciences, 23(6), 3346. https://doi.org/10.3390/ijms23063346

Libby, P. (2021). Inflammation during the life cycle of the atherosclerotic plaque. Cardiovascular Research. https://doi.org/10.1093/cvr/cvab303

Lloyd-Jones, D. M., Braun, L. T., Ndumele, C. E., Smith, S. C., Sperling, L. S., Virani, S. S., & Blumenthal, R. S. (2019). Use of risk assessment tools to guide decision-making in the primary prevention of atherosclerotic cardiovascular disease: A special report from the American heart association and American college of cardiology. Circulation, 139(25). https://doi.org/10.1161/cir.0000000000000638

Pahwa, R., & Jialal, I. (2021). Atherosclerosis. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK507799/#:~:text=Atherosclerosis%20is%20a%20chronic%20inflammatory

Rodriguez, F., Maron, D. J., Knowles, J. W., Virani, S. S., Lin, S., & Heidenreich, P. A. (2019). Association of Statin Adherence With Mortality in Patients With Atherosclerotic Cardiovascular Disease. JAMA Cardiology, 4(3), 206. https://doi.org/10.1001/jamacardio.2018.4936

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