Nursing Care of Patients With Peripheral Vascular Disease, Research Paper Example

Introduction

The cardiovascular system is made up of the heart which acts as a pump and an intricate network of blood vessels which supply fresh oxygenated blood necessary for vital functions via arteries and concurrently serves to carry away the deoxygenated blood from organs via veins (www.texasheart.org). For optimum functioning, the blood vessels need to be pliant and patent for an effective rate of flow which is regulated by the body’s homeostatic mechanisms under the influence of hormones and stimuli from the brain. Any aberration, such as clogging or loss of tone in any of the blood vessels, either acute or chronic is an alarming situation. Unless the normal functioning is restored, there are chances of ischemia to the particular organ being supplied and its malfunctioning which can jeopardize life itself (www.nhlbi.nih.gov). Atherosclerosis is a condition in which plaque gradually builds up in the arteries as one ages and narrows the lumen leading to obstruction of blood flow (www.nhlbi.nih.gov).  The resultant peripheral arterial disease can lead to increased risks of cerebrovascular, cardiovascular diseases which might lead to death (Federman et al, 2004). Prevention as well as treatment of PAD is a therefore vital health concern and a nurse has an important role in providing information to and caring for patients afflicted with the condition (Thesis Statement).

Modern sedentary lifestyles in combination with high consumption of refined foods have already resulted in the emergence of obesity as a chronic problem. Excess weight in individuals puts undue stress on the heart as it has to work harder in order to meet the increased demand of excess tissue. Deposition of fat starts in the liver initially and with continued over indulgence in junk food, it slowly starts spreading to other organs until it establishes itself in the blood vessels too. This might lead to clogging of the blood vessels thereby reducing their functionality. Narrowing of blood vessels results in atherosclerosis and can spread to the major blood vessels including those supplying the heart. Incidence of peripheral arterial disease (PAD) which involves the condition in which there is abnormal or reduced flow to the lower extremities or legs has been increasing over the years in all age groups and particularly in adults and the elderly population (Federman et al, 2004). It increases exponentially with age and in older people above 80 years of age, the incidence is as high as 50% (Federman et al, 2004). Proper treatment and care of such elderly patients is a primary nursing concern as they need assistance in carrying out their daily activities as well as compliance with the prescribed medication schedule. Older patients generally tend to forget oral directions and need to be reminded for their dosage schedules and lifestyle changes that are suggested to them by the physician (Treichel, 2008). Usually, elderly patients have cognitive disorders and concurrent co morbidities which complicate matters. The problem is further reinforced by the fact that elderly patients are usually single, have less family support and might have had eminent roles in their professional capacities during their active life which makes them too proud to seek assistance. The elements of dignity and helplessness are juxtaposed in such a manner that caring for such patients needs the best of nursing professional competence. They need to be handled with professional firmness as well as meticulous patience in order to deliver a high standard of care which can be extremely difficult in practical terms (Lewis et al, 2007).

The complication with PAD is that it is a highly asymptomatic disorder which can go undiagnosed and cause permanent damage before any intervention can even be tried (Federman et al, 2004). The patients may have learnt to live with the minor discrepancies in life attributing them to old age and not present themselves to a healthcare facility at the appropriate time. Cursory examination at the clinics also might contribute to missing an appropriate diagnosis unless recommended tests are carried out. Proper examination with the recommended tests is therefore essential whenever a patient is suspected or confirmed with atherosclerosis as an existing pathology. Patient age, medical history and professional examination on presentation at the healthcare facility can serve as important markers for a proper diagnosis.

The history taking process upon presentation of the patient in a clinic is vital for obtaining clues to carry out further tests. History of sedentary lifestyle, irregular eating habits, smoking and obesity in combination with abnormal heart rate and blood pressure values upon preliminary examination should serve as indicators to carry out special diagnostic procedures. History of pain in buttocks, hips, thighs, inferior back muscles and calves are also signs of atherosclerosis in distal aorta and the iliac arteries (Aronow, 2007). A proper symptoms based questionnaire has been recognized as giving a high degree of sensitivity as well as specificity (Federman et al, 2004). A vital indicator is intermittent claudication which means pain and weakness while walking which is relieved with rest (Aronow, 2007). The Leng and Fowkes 6 question survey is considered as a standard which can lead to positive diagnosis of PAD. This, in combination with physical examination for foot abnormalities which include unilateral foot cooling, abnormal pedal pulse and prolongation of venous filling time are enough for the recommendation of confirmatory diagnostic procedures (Federman et al, 2004). Confirmation can be done by calculating the ankle brachial index (ABI) with a hand held Doppler, Segmental leg blood pressures, Doppler waveform analysis with color duplex imaging and finally magnetic resonance angiography (MRA) (Federman et al, 2004). Low value of ABI is a certain diagnosis which can be confirmed with angiography. Abnormal ankle and brachial artery systolic blood pressure values are other non invasive techniques which can be used to diagnose peripheral artery disease.

Treatment of peripheral artery disease involves both pharmacological as well as non-pharmacological approaches. Effective drugs are available to control the dyslipidemia, hypertension, diabetes and endocrinological disorders which decrease the risk for mortality or permanent disability but the non pharmacological interventions such as cessation of smoking, altered lifestyle and appropriate nutrition and exercise are the vital components of therapy which increase the quality of life as well as reduce the risk of complications which might lead to premature death. Cessation of smoking, bringing down the blood pressure to attainable optimum values by hypertension medications like angiotensin-converting enzyme inhibitors and beta blockers, treatment of diabetes, dyslipidemia, and use of antiplatelet drugs like clopidogrel and aspirin along with gradual induction of exercise regimens are the therapeutic approaches which need nursing assistance for full compliance (Federman et al, 2004). Patient compliance is therefore an important aspect and it is here that a nurse’ role is eminent. A nurse has to convince the patient about the gravity of the situation and the necessity for altering lifestyle. Regularity and dose compliance with the recommended medication has to be ensured in order to enable the patient to attain a better quality of life. It is for the nurse to ensure that the prescribed therapeutic modalities are communicated effectively to ensure 100% compliance.

Conclusion

Peripheral arterial disease, due to the high statistical figures for its incidence in the aged population at present has significant effects on quality of life as well as life expectancy of the patient. It is a malady which usually escapes diagnosis and needs clinical experience and expertise to diagnose. Reliable non invasive diagnostic tests are available which should be used judiciously to establish diagnosis and suggest appropriate remedies based upon the individual conditions of the patient. A properly designed therapeutic regimen involves the use of pharmacological agents coupled with lifestyle changes and recommended exercise regimens. To ensure compliance after a positive diagnosis, a nurse’ role assumes primary importance as the elderly patients are subject to self negligence and inability to remember and grasp the nuances of the treatment regimens prescribed for them. They have to be gently convinced and trained to take control of themselves to improve their quality of life and eliminate the risk of premature disability as well as mortality. The nurse’s main role is to identify the patients who need additional assistance to ensure compliance with the recommended lifestyle changes and dosage schedules recommended by the physician. She has to be attentive at the diagnostic stage too and watch for the indicators for suspecting the existence of PAD as described in the literature, which ordinarily might be overlooked during examination of the patient. The recommended tests need to be employed to establish the diagnosis. The nurse also needs to establish effective communication with the patient to ensure that instructions are conveyed orally as well in written form. Regular follow up of the patient through phone calls and reminders for medication compliance and future hospital visits combined with nursing care at home are also necessary for such patients.

Note:  Based on the rubric there were 6 major objectives to be addressed in the body paragraph based on nursing. So it is clear to me that you have met the outcomes please, copy and paste the paragraphs from the essay that meet these points. The points have been written out below!

Here they are:

• Description of how the findings from this essay research influenced or guided nursing practice has depth and breadth.

Please copy and paste the part of the essay that addresses this objective……( Proper treatment and care of such elderly patients is a primary nursing concern as they need assistance in carrying out their daily activities as well as compliance with the prescribed medication schedule. Older patients generally tend to forget oral directions and need to be reminded for their dosage schedules and lifestyle changes that are suggested to them by the physician (Treichel, 2008). Usually, elderly patients have cognitive disorders and concurrent co morbidities which complicate matters. The problem is further reinforced by the fact that elderly patients are usually single, have less family support and might have had eminent roles in their professional capacities during their active life which makes them too proud to seek assistance. The elements of dignity and helplessness are juxtaposed in such a manner that caring for such patients needs the best of nursing professional competence. They need to be handled with professional firmness as well as meticulous patience in order to deliver a high standard of care which can be extremely difficult in practical terms (Lewis et al, 2007).

• In-depth discussion of how the ideas you presented influence your development as a nurse; is thoroughly referenced and supported. Please copy and paste the part of the essay that addresses this objective……(paste The history taking process upon presentation of the patient in a clinic is vital for obtaining clues to carry out further tests. History of sedentary lifestyle, irregular eating habits, smoking and obesity in combination with abnormal heart rate and blood pressure values upon preliminary examination should serve as indicators to carry out special diagnostic procedures. History of pain in buttocks, hips, thighs, inferior back muscles and calves are also signs of atherosclerosis in distal aorta and the iliac arteries (Aronow, 2007). A proper symptoms based questionnaire has been recognized as giving a high degree of sensitivity as well as specificity (Federman et al, 2004). here).
• In-depth discussion of how you think this new knowledge will shape your nursing practice; is thoroughly referenced supported. Please copy and paste the part of the essay that addresses this objective……(paste Cessation of smoking, bringing down the blood pressure to attainable optimum values by hypertension medications like angiotensin-converting enzyme inhibitors and beta blockers, treatment of diabetes, dyslipidemia, and use of antiplatelet drugs like clopidogrel and aspirin along with gradual induction of exercise regimens are the therapeutic approaches which need nursing assistance for full compliance (Federman et al, 2004). Patient compliance is therefore an important aspect and it is here that a nurse’ role is eminent. A nurse has to convince the patient about the gravity of the situation and the necessity for altering lifestyle. Regularity and dose compliance with the recommended medication has to be ensured in order to enable the patient to attain a better quality of life. It is for the nurse to ensure that the prescribed therapeutic modalities are communicated effectively to ensure 100% compliance. here).
• In-depth illustration of how the concepts or findings are important or not to nursing demonstrates critical inquiry and is thorough, clear and specific. Please copy and paste the part of the essay that addresses this objective……(paste The complication with PAD is that it is a highly asymptomatic disorder which can go undiagnosed and cause permanent damage before any intervention can even be tried (Federman et al, 2004). The patients may have learnt to live with the minor discrepancies in life attributing them to old age and not present themselves to a healthcare facility at the appropriate time. Cursory examination at the clinics also might contribute to missing an appropriate diagnosis unless recommended tests are carried out. Proper examination with the recommended tests is therefore essential whenever a patient is suspected or confirmed with atherosclerosis as an existing pathology. Patient age, medical history and professional examination on presentation at the healthcare facility can serve as important markers for a proper diagnosis. 

Explanation of how this literature is part of the development of the profession and the emerging trends in nursing has breadth and depth. Please copy and paste the part of the essay that addresses this objective……(paste Proper treatment and care of such elderly patients is a primary nursing concern as they need assistance in carrying out their daily activities as well as compliance with the prescribed medication schedule. Older patients generally tend to forget oral directions and need to be reminded for their dosage schedules and lifestyle changes that are suggested to them by the physician (Treichel, 2008). Usually, elderly patients have cognitive disorders and concurrent co morbidities which complicate matters. The problem is further reinforced by the fact that elderly patients are usually single, have less family support and might have had eminent roles in their professional capacities during their active life which makes them too proud to seek assistance. The elements of dignity and helplessness are juxtaposed in such a manner that caring for such patients needs the best of nursing professional competence. They need to be handled with professional firmness as well as meticulous patience in order to deliver a high standard of care which can be extremely difficult in practical terms (Lewis et al, 2007).

Explanation of how the ideas from the literature might change nurses work, patient care and or the public’s image the nurse has. Please copy and paste the part of the essay that addresses this objective……(paste To ensure compliance after a positive diagnosis, a nurse’ role assumes primary importance as the elderly patients are subject to self negligence and inability to remember and grasp the nuances of the treatment regimens prescribed for them. They have to be gently convinced and trained to take control of themselves to improve their quality of life and eliminate the risk of premature disability as well as mortality. The nurse’s main role is to identify the patients who need additional assistance to ensure compliance with the recommended lifestyle changes and dosage schedules recommended by the physician. She has to be attentive at the diagnostic stage too and watch for the indicators for suspecting the existence of PAD as described in the literature, which ordinarily might be overlooked during examination of the patient. The recommended tests need to be employed to establish the diagnosis. The nurse also needs to establish effective communication with the patient to ensure that instructions are conveyed orally as well in written form. Regular follow up of the patient through phone calls and reminders for medication compliance and future hospital visits combined with nursing care at home are also necessary for such patients.

References

Atherosclerosis, online information accessed March 7, 2010 at:  http://www.nhlbi.nih.gov/health/dci/Diseases/Atherosclerosis/Atherosclerosis_WhatIs.html

Anatomy, online information accessed march 7, 2010 at: http://www.texasheart.org/HIC/Anatomy/index.cfm

Aronow, W S. 2007. Peripheral arterial disease – Management of peripheral arterial disease in the elderly, Geriatrics, Volume 62, Number 1, pp. 19-25

Federman, D G, Bravata, D M & Kirsner, R S. 2004. Peripheral arterial disease – A systemic disease extending beyond the affected extremity, Geriatrics, Volume 59, No.4, pp.26-36

Lewis M., Nevoa, I., Paniaguaab, A et al 2007. Uncomplicated general anesthesia in the elderly results in cognitive decline: Does cognitive decline predict morbidity and mortality?, Medical Hypothesis, Volume 68, Issue 3, pp.484-492

Treichel, J A 2008. Cognitive Impairment Affects 1 in 5 Elderly Americans, Psychiatric News, Volume 43 Number 8, Pg 25

What is the heart, How the Heart Works, online article accessed March 7, 2010 at: http://www.nhlbi.nih.gov/health/dci/Diseases/hhw/hhw_whatis.html