Group Case Study

1
Group Case Study

• P.J. is an 81 year old widowed male.
• c/o sore right foot, trouble walking for few
  years, worse in the last month.
• Hx Type 2 DM, HTN, diabetic neuropathy, former
  smoker

2

• 3 children, all live out of state.
• c/o recent poor appetite.
• 2 dime sized ulcers on right foot, yellow, black
  toes.
• sensation to bilateral feet.

3
Assessment

• Denies severe pain, 2/10 at toes.
• BP 180/92, HR 88 and regular, RR 20 and
  unlabored, T 36.7
• S1, S2.
• DP/PT pulse 1 left, not able to doppler or
  palpate on right.

4

• Bilateral feet cool, RL
• Cap refill R 3 sec., L 3 sec.
• Scattered expiratory wheezes RUL, RA, SpO2 95.
• AAOX3, pleasant, conversant.
• c/o hunger, havent eaten yet today (time is
  now 610pm)
• Denies bowel/bladder problems.

5
Group Concept Map Design

• Risk Factors
• 81 y.o. Type 2 DM HTN X-Smoker
  Stress

6
Pathophysiology

• 81 y.o. Type 2 DM HTN X-Smoker
  Stress
• Decreased Increased lipid
  Vasoconstriction
• Elasticity/ production
• Fragile vessels
• Decreased perfusion

7
Diagnosis/Presenting Problem

• 81 y.o. Type 2 DM HTN X-Smoker
  Stress
• Decreased Increased lipid
  Vasoconstriction
• Elasticity/ production
• Fragile vessels
• Decreased perfusion
• PVD

8
Assessment Findings

• 81 y.o. Type 2 DM HTN X-Smoker
  Stress
• Decreased Increased lipid
  Vasoconstriction Widowed
• Elasticity/ production
  
  3 children, dont
• Fragile vessels
  
  live close
• Decreased perfusion
  AAOX3, pleasant, conversant
• 180/92, 88 PVD ? 2 dime
  sized, yellow ulcers R foot
• S1, S2 reg. Feet cool,
  RL temp 36.7
• 
  R toes X5 black, hard, uneven
• 
  sensation bilat. feet
• 
  2/10 pain R toes with palp.
• RA SpO2 95 1
  DP/PT left, No pulses R foot
  
• Exp. wheezes RUL Cap
  refill R foot 3 sec., L 3 sec.
• RR 20
• Hungry, has not eaten
  today
• BTs X4 quads
• Denies bowel/bladder prob. has not
  voided

9
Diagnostics

• 81 y.o. Type 2 DM HTN X-Smoker
  Stress
• 
  BS 168
• Decreased Increased lipid
  Vasoconstriction Widowed
• Elasticity/ production
  
  3 children, dont
• Fragile vessels HDL 38,
  LDL 242
  live close
• Decreased perfusion
  AAOX3, pleasant, conversant
• 180/92, 88 PVD ? 2 dime
  sized, yellow ulcers R foot ? ABI R .15
• S1, S2 reg. Feet cool,
  RL temp 36.7 ABI L .40
• Na/K 142/3.9 R
  toes X5 black, hard, uneven
• 
  sensation bilat. Feet H/H
  38/12.2
• 
  2/10 pain R toes with palp.
• RA SpO2 95 1
  DP/PT left, No pulses R foot
  
• Exp. wheezes RUL Cap
  refill R foot 3 sec., L 3 sec.
• RR 20
• Hungry, has not eaten
  today
• BTs X4 quads
• BUN/CR Denies bowel/bladder prob.
  has not voided

10
Medications

• 81 y.o. Type 2 DM HTN X-Smoker
  Stress
• 
  BS 168 Glucotrol 5 mg qd
• Decreased Increased lipid
  Vasoconstriction
  Widowed
• Elasticity/ production
  
  3 children, dont
• Fragile vessels HDL 38,
  LDL 242 Lipitor 20 mg qd live
  close
• Decreased perfusion
  AAOX3, pleasant, conversant
• 180/92, 88 Metoprolol PVD ? 2 dime
  sized, yellow ulcers R foot ? ABI R .15
• S1, S2 reg. 25 mg bid Feet
  cool, RL temp 36.7 ABI L .40
• Na/K 142/3.9 R
  toes X5 black, hard, uneven
• 
  sensation bilat. Feet H/H
  38/12.2
• 
  2/10 pain R toes with palp.
• RA SpO2 95 1
  DP/PT left, No pulses R foot Trental 400mg
  tid
• Exp. wheezes RUL Cap
  refill R foot 3 sec., L 3 sec.
• RR 20
• Hungry, has not eaten
  today
• BTs X4 quads
• BUN/CR Denies bowel/bladder prob.
  has not voided

11
Care Plan

• 81 y.o. Type 2 DM HTN X-Smoker
  Stress
• 
  BS 168? Glucotrol 5 mg qd
• Decreased Increased lipid
  Vasoconstriction
  Widowed
• Elasticity/ production
  
  3 children, dont
• Fragile vessels HDL 38,
  LDL 242 ? Lipitor 20 mg qd live
  close
• Decreased perfusion
  AAOX3, pleasant, conversant
• 180/92, 88? Metoprolol PVD ? 2 dime sized,
  yellow ulcers R foot ? ABI R .15
• S1, S2 reg. 25 mg bid Feet
  cool, RL temp 36.7 ABI L .40
• Na/K 142/3.9 R
  toes X5 black, hard, uneven
• 
  sensation bilat. Feet H/H
  38/12.2
• 
  2/10 pain R toes with palp.
• RA SpO2 95 1
  DP/PT left, No pulses R foot Trental 400mg
  tid
• Exp. wheezes RUL Cap
  refill R foot 3 sec., L 3 sec.
• RR 20
• Hungry, has not eaten
  today
• BTs X4 quads
• BUN/CR Denies bowel/bladder prob.