Mariann M. Harding

“S.P. is a 68-year-old retired painter who is experiencing right leg calf pain. The pain began approximately
2 years ago but has become significantly worse in the past 4 months. The pain is precipitated by exercise
and is relieved with rest. Two years ago, S.P. could walk two city blocks before having to stop because of
leg pain. Today, he can barely walk across the yard. S.P. has smoked two to three packs of cigarettes per
day (PPD) for the past 45 years. He has a history of coronary artery disease (CAD), hypertension (HTN),
peripheral vascular disease (PVD), and osteoarthritis. Surgical history includes quadruple coronary artery
bypass graft (CABG × 4) 3 years ago. He has had no further symptoms of cardiopulmonary disease since
that time, even though he has not been compliant with the exercise regimen his cardiologist prescribed,
he continues to eat anything he wants, and continues to smoke two to three PPD. Other surgical history
includes open reduction internal fixation of the right femoral fracture 20 years ago.
S.P. is in the clinic today for a routine semiannual follow-up appointment with his primary care
provider. As you take his vital signs, he tells you that, besides the calf pain, he is experiencing right hip
pain that gets worse with exercise, the pain doesn't go away promptly with rest, some days are worse
than others, and his condition is not affected by a resting position.
� Chart View
General Assessment
Weight 261 lb
Height 5 ft, 10 in.
Blood pressure 163/91 mm Hg
Pulse 82 beats/min
Respiratory rate 16 breaths/min
Temperature 98.4° F (36.9° C)
Laboratory Testing (Fasting)
Cholesterol 239 mg/dL
Triglycerides 150 mg/dL
HDL 28 mg/dL
LDL 181 mg/dL
Current Medications
Lisinopril (Zestril) 20 mg/day
Metoprolol (Lopressor) 25 mg twice a day
Aspirin 325 mg/day
Simvastatin (Zocor) 20 mg/day
Case Study 4
Name Class/Group Date ____________________
Group Members
INSTRUCTIONS All questions apply to this case study. Your responses should be brief and to the point. When
asked to provide several”
― Mariann M. Harding, Winningham's Critical Thinking Cases in Nursing - E-Book: Medical-Surgical, Pediatric, Maternity, and Psychiatric