Question

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

3. What do you think his Medical Diagnosis is?

4. Which medication do you anticipate will be ordered today?

Answer 1

ANSWER 3: MEDICAL DIAGNOSIS :

• THE PAIN EXPERIENCED WHILE WALKING AND SUBSIDES WHILE STOPPING THE WORK IS REFERRED TO AS INTERMITTENT CLAUDICATION,WHICH OCCURS AS AN EARLY SYMPTOM OF PERIPHERAL ARTERIAL DISEASE AND IT OCCURS DUE TO A BLOCK IN THE PERIPHERAL VESSELS .
• THE LOWER ONE-THIRD OF THE LOWER LEGS ARE SHINY, COOL TO TOUCH, AND HAIRLESS WITH DARK DISCOLORATION  WHICH IS A SIGN OF ACCUMULATION OF FLUID DUE TO CRONIC CONGESTIVE HEART FAILURE.

ANSWER 4:

• DRUGS TO IMPROVE BLOOD FLOW TO THE LOWER EXTREMITIES.
• ANTI-PLATELET DRUGS TO REDUCE THE RISK OF HEART PROBLEMS DUE TO PERIPHERAL ARTERIAL DISEASE.