CHRONIC ARTERIAL INSUFFICIENCY 6ChronicArterial insufficiency
Peripheral artery insufficiencyis a condition that results when there is insufficient blood flow tothe extremities. If the symptoms have been present for weeks ormonths, the condition is defined as chronic (Buttaro, 2013). Themajor cause of chronic arterial insufficiency is atherosclerosis. Theclassic symptom of peripheral artery insufficiency is claudication.On physical examination muscle wasting, loss of hair, hypothermia inaffected limb may be noted, as well as, decreased peripheral pulses(femoral, popliteal) (Hauk, 2012).
Severalsymptoms may arise from this condition and severity deepens on theextent of involvement and the available collateral circulation.Symptoms may range from intermittent claudication to pain at rest.Intermittent claudication refers to pain that occurs in the affectedlimbs during exercises and is relieved with rest. The pain normallyoccurs due to the arterial narrowing and obstruction. The pain thatresults from arterial insufficiency is localized mostly on the calf,buttocks, thighs or legs. In some aspects, patients may experienceleg cramping when walking and in the abdomen when eating. Othersymptoms include skin ulcers, cold skin, poor nail, tissue death,coronary artery disease and stroke.
Researchshows that symptoms of arterial insufficiency are common in 5% to 15%of adult population who are over 55 years. The prevalence andincident rates increases as one advances in age and it is rare inpatients who are below 40 years old. Epidemiological research furtherstates that males are affected more by arterial insufficiency thanfemales in patients under 70 years old. Risk factors of arterialinsufficiency include age, gender, genetic predisposition, smoking,hypertension, obesity, physical inactivity, Hyperglycemia anddiabetes mellitus.
Othercases of Chronic Peripheral arterial insufficiency arises from highcholesterol, mental and emotional stressors. The symptoms of ChronicPeripheral artery insufficiency (PAD) progresses with time and over70% of patients may report no change or improvement in a 5 to 10years period time. However, about 20 to 30 % of the patient haveprogressive symptoms and requires early intervention with 10%requiring amputation. According to 2010 study, about 202 millionpeople suffered from PAD worldwide in this case about 5.3% of 45 to50 years old and 18% of 85 to 90 years old suffered from PAD indeveloped countries(Fowkes, Rudan, Rudan, Aboyans, Denenberg, McDermott, Norman, Sampsonet al. 2013).
PeripheralChronic disease is diagnosed by taking the blood pressure at theankle and the arms. Differences in blood pressure between the ankleand arms may signify the presence of arterial insufficiency disorder.The normal ankle brachial pressure index (ABPIABI) ranges from 1.00to 1.40, patients with PAD have an ABPI of <0.90. Acute PAD condition is graded as mild if occurring between theranges of 0.41 and 0.09 and readings below 0.40 indicates severe caseof PAD (Hauk,2012).
Theimplication of Chronic Peripheral arterial insufficiency isinsufficient supply of blood in the patient extremities such as thelegs and arms. This leads to pain in the arms and legs while walking(intermittent claudication). Peripheral artery disease arises due towidespread accumulation of fatty deposits in the arteries reducingblood flow to the heart and the brain. Patients may have tissue loss,rest pain, change in the color of the affected limbs and diminishedhair loss. However the main implication is more pain when using theaffected muscles such as during walking or resting.
Thewhite American native culture is predominantly European in form andhad high value on heath and medication. Although, the white Americannatives values good health, their dietary and lifestyle predisposethem to PAD conditions. Most white Americans are smokers and are lessactive conditions that make them vulnerable to conditions such asPAD. The most preferred cuisine is roasted beefs and apple pie,French fries and coke(Ruiz-Canela and Martínez-González, 2014).
Inaddition the white natives’ exhibit orderliness, respect and mutualfriendliness while interacting with other people. These culturalaspects as important in clinical set up while attending white nativepatients. Patient cultural history is important in clinical set up asit helps to improve physicians’ knowledge on preferred food,genetics and cultural activities. Because of their orderliness, thewhite Americans are keen on details and require doctors to exhibitcautious attention while treating patients. In particular, whiteAmericans prefer personalized attention especially the sick and agedpatients. This makes them have trust and relate well with the medicalpractitioner offering medical services.
Theinterview report collected from the white native patient indicatesthat the patient had suffered from intermittent cramping addiscomfort in his legs for over 6 months. The patient had a medicalhistory of Hypertension and Coronary artery and had been feelingdiscomfort in his extremities. The patient feels discomfort whileexercising or driving and only stopped while at rest. These symptomssupport literature data on symptomatic signs of peripheral arterydisorder. Collected data indicates that the patients’ familybackground has a history of heart, cancer and diabetes conditions.According to the literature review on chronic peripheral arterydisease, the historical conditions suffered by other family memberssuch as cancer, diabetes and heart attack predispose the patient toPAD(Allison, Denenberg and Criqui, 2011).
Inaddition, the patient was a smoker for over 20 years his gender ismale and over 50years. In this analysis, the white patient meets allthe conditions necessary for PAD condition suffered. Other symptomssuffered include nasal congestion when cold, sharp chest pain,coldness in the legs and pain. According to literature review, thepatient is suffering from chronic peripheral artery insufficiency.Most white Americans believes in the effective treatment and havehigh expectations that their diseases will be cured or wellmanagement through powerful drugs and technology (Hauk,2012).As such, patients make follow-ups on their medical practitioners tillthey are fully recovered (Hauk,2012).This is why the white male patient has followed up with medicationand diagnosis to ensure that his condition is cured. Severalpopulation based studies indicates that PAD is dependent on thegeographic location of patient, sex and age.
Medicalpractitioners recommend physical examination to determine theproximal site of the pulse deficits or obstruction. Noninvasivetesting provides physicians with important information that is usedfor diagnosis and follow-up purposes. However, it is important toassess if patients are suffering from diabetes mellitus. Majormethods of diagnosing PAD involve toe systorical pressure testing andankle brachial index measurements(Lin, Olson, Johnson and Whitlock, 2013).Arterial disorders are linked with persons suffering from diabetes.
Majorintervention measures involve exercise therapy for persons withintermittent claudication, smoking cessation, drug therapy and theapplication of Antithrombotic Therapy(Hauk, 2012).In particular, effective management of PAD requires absolutelifestyle changes such as managing diabetes, hypertension and havingregular exercises(Violi, Basili, Berger and Hiatt, 2012).Peripheral arterial condition requires effective personalized careespecially for an aged white American. The rationale for personalizedcare is to enhance the physician to follow-up on the effects of eachtreatment. However, greater input is required by the patient byobserving lifestyle changes such as regular physical exercise,smoking cessation and eating healthy diets(Fokkenrood, Bendermacher, Lauret, Willigendael, Prins and Teijink,2013).
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