lOMoAR cPSD| 56342273
Peripheral Arterial Disease (PAD)
JoAnn Smith, 74 years old
Primary Concept
Perfusion
Interrelated Concepts (In order of emphasis)
1. Clotting
2. Pain
3. Clinical Judgment
4. Patient Education
5. Communication
6. Collaboration
, lOMoAR cPSD| 56342273
Unfolding Clinical Reasoning Case Study: STUDENT
Peripheral Arterial Disease (PAD) History
of Present Problem:
JoAnn Smith is a 74-year-old woman who has a history of myocardial infarction and systolic heart failure secondary to
ischemic cardiomyopathy with a current ejection fraction (EF) of 15 percent. Over the last two weeks she has noticed
achiness in her right leg and tingling in her toes after walking short distances. When she stops walking, the pain and
tingling resolve in 10–15 minutes. Now the pain/cramping in her right leg has been lasting longer–-up to 30 minutes the
last two days. Over the past month her right great toe has developed a black tip that is painless to the touch. JoAnn was
seen in the clinic today and her physician decided to directly admit her to the medical unit where you are the nurse
responsible for her care.
Personal/Social History:
JoAnn is a retired math teacher who has struggled with depression since her husband of 52 years died unexpectedly two
years ago from a myocardial infarction. She lives alone in an assisted living apartment.
What data from the histories is RELEVANT and has clinical significance to the nurse?
RELEVANT Data from Present Problem: Clinical Significance:
• 74 y.o. • Possible neuropathy
• Hx MI, systolic HF, ischemic • Indicative of alteration in perfusion to the peripheral
cardiomyopathy, EF 15%. extremities.
• Achiness in R leg, tingling in toes
after walking.
• Cramping lasts up to 30 minutes.
• Black tip on R great toe (painless)
RELEVANT Data from Social History: Clinical Significance:
• Retired • Lacks support system
• Depression since the passing of her
husband 2 years ago.
• Lives alone (assisted living)
What is the RELATIONSHIP of your patient’s past medical history (PMH) and current meds?
(Which medication treats which condition? Draw lines to connect)
PMH: Home Meds: Pharm. Classification: Expected Outcome:
x Diabetes mellitus type II 1. ASA 81 mg PO daily 1 . Prevention of second or
Peripheral Arterial Disease (PAD)
JoAnn Smith, 74 years old
Primary Concept
Perfusion
Interrelated Concepts (In order of emphasis)
1. Clotting
2. Pain
3. Clinical Judgment
4. Patient Education
5. Communication
6. Collaboration
, lOMoAR cPSD| 56342273
Unfolding Clinical Reasoning Case Study: STUDENT
Peripheral Arterial Disease (PAD) History
of Present Problem:
JoAnn Smith is a 74-year-old woman who has a history of myocardial infarction and systolic heart failure secondary to
ischemic cardiomyopathy with a current ejection fraction (EF) of 15 percent. Over the last two weeks she has noticed
achiness in her right leg and tingling in her toes after walking short distances. When she stops walking, the pain and
tingling resolve in 10–15 minutes. Now the pain/cramping in her right leg has been lasting longer–-up to 30 minutes the
last two days. Over the past month her right great toe has developed a black tip that is painless to the touch. JoAnn was
seen in the clinic today and her physician decided to directly admit her to the medical unit where you are the nurse
responsible for her care.
Personal/Social History:
JoAnn is a retired math teacher who has struggled with depression since her husband of 52 years died unexpectedly two
years ago from a myocardial infarction. She lives alone in an assisted living apartment.
What data from the histories is RELEVANT and has clinical significance to the nurse?
RELEVANT Data from Present Problem: Clinical Significance:
• 74 y.o. • Possible neuropathy
• Hx MI, systolic HF, ischemic • Indicative of alteration in perfusion to the peripheral
cardiomyopathy, EF 15%. extremities.
• Achiness in R leg, tingling in toes
after walking.
• Cramping lasts up to 30 minutes.
• Black tip on R great toe (painless)
RELEVANT Data from Social History: Clinical Significance:
• Retired • Lacks support system
• Depression since the passing of her
husband 2 years ago.
• Lives alone (assisted living)
What is the RELATIONSHIP of your patient’s past medical history (PMH) and current meds?
(Which medication treats which condition? Draw lines to connect)
PMH: Home Meds: Pharm. Classification: Expected Outcome:
x Diabetes mellitus type II 1. ASA 81 mg PO daily 1 . Prevention of second or
