- The patient is a male named Cash Money who was born in the late 1990s/early 2000s. He has a history of CAD, kidney transplant, hypertension, diabetes, stroke, anemia, right leg amputation, and PAD. He lives with his wife and works in construction. - He is being treated for PAD in his legs with lifestyle changes and medication. His diagnoses include impaired mobility due to being an amputee and using a wheelchair, and risk for vascular trauma from a recent nail injury to his foot. - The nurse's interventions include assessing circulation, educating on activity levels, and teaching about PAD self-care including medication adherence, exercise, foot care, and available resources. The nurse

2. Patient Information:
Name- Cash Money
DOB- The 99’s and 00’s
*History*
Medical history- CAD, prior kidney transplant in 2018, hypertension, DMT2,
prior CVA in 2015, chronic anemia, prior right BKA at OSH, and known PAD
Psychosocial history-pt is a male, married living with his wife on the beach
in Jacksonville FL. Has two grown living children and deceased parents. Pt
was currently working doing construction until incident at home, pt is now
getting short term disability until able to return back to work.
Family History- Pt has a family hx on maternal side for Diabetes, HTN,
CKD, and cancer. On paternal side is Diabetes and HTN
Medical diagnoses- PAD

4. Peripheral artery disease
(PAD) in the legs or lower extremities is the
narrowing or blockage of the vessels that
carry blood from the heart to the legs. It is
primarily caused by the buildup of fatty
plaque in the arteries, which is called
atherosclerosis.
Causes: It is primarily caused by the buildup
of fatty plaque in the arteries. PAD can
happen in any blood vessel, but it is more
common in the legs than the arms.

5. Signs/Symptoms: The
classic symptom of PAD is
pain in the legs with
physical activity, such as
walking, that gets better
after rest. However, up to 4
in 10 people with PAD have
no leg pain. Symptoms of
pain, aches, or cramps
with walking (claudication)
can happen in the buttock,
hip, thigh, or calf.

6. Medical Treatment: Treatments for peripheral artery
disease includes lifestyle changes and sometimes,
medication. Lifestyle changes can help improve
symptoms, especially early during peripheral artery
disease. If you smoke, quitting is the single most
important thing you can do to reduce the risk of
complications.

7. *Nursing Diagnoses*
(Impaired physical mobility)- patient is a lower left
extremity amputee with wound vac on lower right
extremity to heel. Pt does have left prosthetic leg to help
ambulate but due to wound vac on right heel pt is
wheelchair bound and is a two person assist.
(Risk for Vascular Trauma)- Pt is currently on
wound vac on lower right extremity due to
stepping on rusty nail. Pt has current diagnosis
of peripheral artery disease.

9. *Interventions*
PAD- Assess peripheral circulation, arterial disorders affect the arteries
that bring oxygenated blood to the tissues. This most often affects the
extremities where the vessels are smaller. You may see cool, pale skin,
or feel diminished pulses; it’s imperative to monitor peripheral perfusion
to prevent necrosis of tissue or the need for amputation.
Educate patient on appropriate levels of activity. Intermittent
claudication is muscle pain that occurs with a predictable amount of
activity and goes away with rest. It is indicative of ischemia to the
muscle tissue. The patient should be taught not to exercise past the
claudication. They should stop when it occurs and rest until it
dissipates.

10. *Teaching Plan*
PAD- With peripheral artery disease being the narrowing
or blockage of the vessels that carry blood from the heart
to the legs, I will educate about things to help
accommodate this disease. Taking your anti platelet and
anti coag medications will help stop the spread and the
severity of the process of this disease. Also doing
exercises and range of motions to help keep the blood
flow going and avoiding any more symptoms that you
may already have. Keeping your blood pressure under
control and maintaining your cholesterol plays a big part
of PAD, it is very important to take your medication as
prescribed to avoid any other obstacles that may prevent
you from getting better. Practice good foot care. Check
your feet every day for cuts, blisters, red spots, sores,
cracks and swelling. Wash your feet with slightly warm
water every day. Do not soak them because this will dry
them out. Always check inside your shoes for worn areas
or things that might cause sores on your feet. Use lotion
and cream for dry skin, but not between your toes. I
would also give resources like pamphlets about how to
care for yourself with dealing with PAD. Informing the
patient that there are a lot of websites and programs to

11. *Evaluation*
To make sure that my patient and his family has a good
understanding of the diagnosis and information just given, I would
tell them to repeat back what I just explained. I would check to see if
they have any questions, provide feedback when needed, and be
available to their needs. See if they need help accessing the websites
I provided and helping them call the programs I referred to them. I
would also call other healthcare professionals associated with this
patients treatment to plan to answer and questions about other
things that are out of my scope of practice like PT, social worker,
pharmacist, etc…