Olga Brenheim is a 65-year old female

Olga Brenheim is a 65-year old female presenting with “heaviness” and pain in her lower thighs and calves during walking. She has a history of coronary artery disease, myocardial infarction, heart failure, carotid stenosis, hypertension, hyperlipidemia, type 1 diabetes mellitus, and asthma. General, neuromuscular: Obese, alert, oriented, cooperative. Pupils equal, round, reactive to light and accommodation. Nasopharyngeal mucous membranes pink and moist. Slow, but steady gait. Vital signs: Temperature = 98.6 degrees Fahrenheit (oral); heart rate = 84 beats/min, sinus rhythm with 1-2 monomorphic, premature ventricular complexes per min; respiratory rate = 18 breaths/min, slightly labored with exertion; blood pressure = 140/80 mmHg; oxygen saturation = 90% on room air; pain = 0/0 when resting, but increases to 4/10 with prolonged walking. Cardiopulmonary: Bilateral chest expansion symmetrical. Lung sounds clear. S1, S2, and S3 auscultated, but no murmur. Bilateral jugular vein distention noted. Extremities: Full ROM in all extremities. Strength 4/5 in upper extremities and 3/5 in lower extremities. Lower extremities cool and pale. Diminished sensation and prolonged capillary refill in both feet. Bilateral 2+ pedal edema. Doppler pedal pulses difficult to find and weak. Abdomen: Large, soft, non-tender, and bowel sounds in all quadrants. Serum test results: Complete blood count results, chemistry panel, and troponin levels within normal ranges. Other results: Chest x-ray shows clear lungs and cardiomegaly. Electrocardiogram shows no acute ischemic changes. Echocardiogram with decreased left ventricle motion and decreased ejection fraction consistent with her baseline; no new changes. Abdominal aortogram with arteriogram of the lower extremities showed aortoiliac disease with multiple stenoses of varying degrees and affecting both legs. The resting ankle-brachial index was 0.50 and 0.70 at the right and left dorsalis pedis, respectively (normal = 0.90-1.30). 1. Identify the likely disorder, the underlying pathophysiology (i.e., cellular and tissue changes), and relate the changes to abnormal findings to support your interpretation. 2. Identify all nursing diagnoses labels (just the label!) that apply to this patient (e.g., impaired swallowing). Identify the priority (#1) nursing diagnosis label; and for the (#1) nursing diagnosis label, explain the nursing interventions to address the identified problem. Provide evidence-based rationale to explain the need and/or benefit of each intervention. For interventions, include what the nurse should “monitor/assess”, “do”, and “teach” to the client. 3. Describe 2 medical therapies used to treat the disorder and explain their specific mechanism of action and intended impact at the cellular and/or tissue level. SCIENCE

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