Mike, a 43-year old construction worker, has a history of hypertension. He smokes two packs of cigarettes a day, is nervous about the possibility of being unemployed, and has difficulty coping with stress. His current concern is calf pain during minimal exercise that decreased with rest. The nurse assesses Mike’s symptoms as being associated with peripheral arterial occlusive disease. The nursing diagnosis is probably:
A. Alteration in tissue perfusion related to compromised circulation.
B. Dysfunctional use of extremities related to muscle spasms.
C. Impaired mobility related to stress associated with pain.
D. Impairment in muscle use is associated with pain on exertion.
Correct Answer: A. Alteration in tissue perfusion related to compromised circulation.
Insufficient arterial blood flow causes decreased nutrition and oxygenation at the cellular level. Decreased tissue perfusion can be temporary, with few or minimal consequences to the health of the patient, or it can be more acute or protracted, with potentially destructive effects on the patient.
Option B: Patients with peripheral arterial disease (PAD) have decreased lower extremity arterial perfusion which is commonly referred to as “poor circulation.” In most cases of PAD, atherosclerotic plaques narrow the arterial flow lumen which restricts blood flow to the distal extremity. Reduced blood flow can cause thigh or calf pain with walking due to temporary ischemia of the leg muscles during exertion
Option C: Walking pain from PAD is referred to as intermittent claudication which means “to limp.” Many patients with PAD have either no symptoms or atypical complaints that do not strictly conform to the definition of claudication. Others may develop limb-threatening compromise of blood flow, necessitating emergent surgery.
Option D: Patients with PAD usually have enough collateral blood flow that they only have symptoms during activities that increase energy demand such as walking. Rarely, the PAD becomes progressively more severe, and the blood flow cannot meet the resting metabolic demands of the lower extremity. Poor perfusion to the nerves can result in ischemic rest pain which is often described as an intractable, burning pain in the soles of the feet.
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