CASE STUDY

Peripheral Arterial Disease

SUBMITTED TO: MRS.DEANNA BOTENGAN, RN, MAN

CLINICAL INSTRUCTRESS

SUBMITTED BY: ESTACIO, ENRICO CARLO

PERSONAL DATA: Name: Jimmy Cornelio Gatlec Age: 42 Sex: Male Civil Status: Single Address: 137, North Sanitary Camp Baguio City, Benguet Religion: Roman Catholic Occupation: Maintenance Worker Nationality: Filipino Chief complaint: Painful Unhealed Wound Admitting diagnosis: Peripheral Arterial Disease Final diagnosis: Peripheral Arterial Disease I. FAMILY BACKGROUND Mr. Jimmy Cornelio Gatlec, 42 years old, is presently residing at Mataag137, North Sanitary Camp Baguio City, Benguet wherein he is living with his family, Jimmy is a maintenance worker wherein he suffers long hours of standing while lifting heavy objects, he has a daughter who is currently studying criminology, while his wife assisted in their home works, he later claims that their family line has a history of sickle cell disease and diabetes mellitus although lab results confirmed that his blood morphology is normal and glucose level is stable. II. DEVELOPMENTAL DATA
A. Havighursts Theory of Developmental Task According to Havighurst, learning is fundamental to life and in order to have a deeper insight on growth and development, one must understand it and recognize the premise that human being continues to learn throughout life. Happiness is being achieved when a particular task of a certain age is achieved by the person successfully but if not, failure occurs which is a feeling of unhappiness and disapproval from people surrounding the client. My patient, 40 years of age, belong to the MIDDLE AGE, in which the following tasks are very important to accomplish. ACHIEVING ADULT CIVIC AND SOCIAL RESPONSIBILTY Patient Jimmy claimed that in this aspect, he was able to carry out his role as an adult and an individual of the society. He usually participates in barangay activities such as clean and green program as well as barangay fiestas. He greatly believes that joining in such activities is vital since one is a part of the community and that, one should abide by it. ASSISTING TEENAGE CHILDREN TO BECOME RESPONSIBLE AND HAPPY ADULTS He verbalized that from the start his children are growing up, he had taught them the proper values and attitudes to live by in order to become better and fulfilled adults in the future. He also considers that the most important thing that he has shared to his children is the virtue of being God-fearing and responsible as well. RELATING ONESELF TO ONES SPOUSE AS A PERSON He also admits that though there were times of argument, but through proper communication, they easily resolve it. He also added that throughout the years, they have been fulfilled because of the love and harmony they have always shared together. ACCEPTING AND ADJUSTING TO THE PHYSIOLOGIC CHANGES OF MIDDLE AGE In this aspect, our client stated that his physical and physiologic activity gradually decreases from time to time and he is aware of this thing and somehow, accepts the process of aging due to degenerative changes. ESTABLISHING AND MAINTAINING AN ECONOMIC STANDARD OF LIVING As the head of the family and as a provider he works hard to sustain their family needs, he works as a tricycle driver and his earnings is placed only an important matter and he makes sure to spend the money wisely.

DEVELOPING ADULT LEISURE TIME ACTIVITIES Patient Jimmy enjoys to be performing some leisure activities. He loves chatting with his co drivers while waiting for passenger. At home, his past time is reading bannawag magazines, newspapers and listening to radio. He is also fond of planting vegetables in their backyard. ADJUSTING TO AGING PARENT Patient Jimmy verbalized that he finally adjusted to this stage since his father passed away his middle adolescence. ANALYSIS: when he was in

Patient Jimmy achieved the expected attitude and behavior at his age although some are partially met. His relationship with his children is also good since they maintain good closure and communication although, there are times that conflict arises, but they believes that its normal to a familys life. This implies that he is physically, mentally, emotionally and socially prepared to whatever crisis or unexpected event that may occur. B. ERIK ERIKSONS PSYCHOLOGICAL DEVELOPMENT THEORY Patient Jimmy 42 years of age belongs to the stage of adulthood since his age belongs to the 25-65 year old age bracket. Erikson consider life as composed of sequence of levels of achievement and each stage indicates a certain task to be achieved. An achievement would mean a healthier personality while failure would also mean that the person will not be able to go to the next level and probably will lead to regression. Patient Jimmys primary developmental task is to achieve GENERATIVITY which includes creativity, productivity and concern for others. Generativity is defined as the concern for establishing and guiding the next generation. STAGNATION, on the contrast, is those people who are unable to expand their interests at the time and who do not assume the responsibilities of a middle age suffer from a sense of boredom and impoverishment, thus, people have difficulty accepting their aging bodies and become withdrawn and isolated. Self-indulgence, self-concern, lack of interests and commitment would mean a negative resolution. In the case of Patient Jimmy , we could simply say that he was able to partially achieve the task appropriate for his age. The idea about generativity is reflected with his family of procreation and he does everything in order to keep his family in a stable state not only in the economic aspect but as well as in the social, emotional and physical aspects. He told us that no matter what happens in his life, he strongly believes that everything was planned by the Holy Father. He was able to fully realize his worth of life when he established his own family and gifted with a daughter who made his feel special.

ANALYSIS: Patient Jimmy had satisfactorily achieved the initial task required at his age under Erikson. Thereby, this means that he is ready to face any challenges and can easily adjust to any problems that may happen. Overall, He is still struggling generativity in its optimum level.

III. HEALTH HISTORY Past personal health history The patient did not suffered from any illness or surgery during the past few years Present personal health history 1month PTC, patient sustained Laceration on the left foot while lifting a heavy shipment 2 weeks PTA, the patient complaints of worsening and pain on his wound 1 hr PTA, patient gone to OPd for checke up, assessed, and was adviced for admission there was noted bleeding and exudation and 10/10 pain on the left foot

PATHOPHYSIOLOGY Based on the patient Prolonged standing while lifting heavy objects Thrombocytosis- increased amount of pletelets (Lab)

Constantly repeating Lack of Circulation due to force of gravity

formation of blood clots

Obstruction of peripheral arteries (femoral)

Lack of circulation on the extremity (Left Foot)

Prolonged wound healing, Necrosis

Severe Pain on the Left Foot Gangrene Pedal Edema Pedal Pallor

PERIPHERAL ARTERIAL DISEASE

Inclusive date of confinement: October 29 10:45 am Health Agency: Baguio General Hospital and Medical Center 4th floor med, room 1

IV. MEDICAL TREATMENT AND MANAGEMENT INCLUDING PROCEDURES AND ITS IMPLICATION TO NURSING Surgical: Wound Exploration And Debridement The Surgical treatment chosen to treat the condition of the Patient to Correct the deformities caused by the trauma the patient experienced Postero-fibular Arterial Bypass Chose to create a path of circulation to the lower extermity Included to the plan of care of the patient is postoperative care wherein we have to prevent further complications caused by infection Laboratory: Hematology Examination Hemoglobin Hematocrit WBC Count Neutrophils Lymphocytes Eosinophils Bands Bleeding time Clotting time Result 140 0.43 13.15 0.60 0.34 0.04 1.00 2 minutes 1 minute Reference M: 120-150 g/L M: 0.37- 0.47 5.0- 10.0 x 109/L 0.50- 0.70 0.20- 0.40 0-0.07 0-0.05 1-5 minutes 2-6 minutes

An Increase in White blood cells indicates Infection the Infection is due to the surgical lacerations, a portal of entry for microorganisms An increase in clotting time is the reason why the patient is prescribed with Cilostazol, a platelet aggregation inhibitor Pharmacological: Cilostazol 100mg 1 Tab BID Therapeutic class: Phosphodiesterase III inhibitor, platelet aggregation inhibitor which is why the patient is prescribed with Losartan, an antihypertensive drug Plan of care includes assessment for bleeding tendency and blood pressure monitoring Physical: PATIENT ADVISED NOT TO RAISE HIS LEFT FOOT as this may contribute to the lack of circulation to his affected extremity

VII. EVALUATION AND IMPLICATION OF THIS STUDY TO: a. Nursing Practice I was able to apply the knowledge that I have learned especially in peripheral- vascular anatomy wherein the system is critical to the nutrition and oxygenation of the extremities if these system is interfered the result will be catastrophic b. Nursing Education I learned that in handling these kind post operative patients, there are 3 major health care provision: First is the prevention of infection, Second is providing assistance of the patient due to his physical inability regardless of what extremities or bones affected, and third is the providing pain management procedures c. Nursing Research This study could be alluded or associated to researches related or sorted to effective means of maintaining peripheral circulation on of long standing-related job workers.

VIII. Referral and follow-up: The patient is still admitted at the hospital (BGH-MC) under the care of Dr. Dulay and Dr.Tuba-ang.