Off-Label Drug Use In Pediatrics

The unapproved use of approved drugs, also called off-label use, with children is quite common. This is because pediatric dosage guidelines are typically unavailable since very few drugs have been specifically researched and tested with children.

When treating children, prescribers often adjust dosages approved for adults to accommodate a child’s weight. However, children are not just “smaller” adults. Adults and children process and respond to drugs differently in their absorption, distribution, metabolism, and excretion. Children even respond differently during stages from infancy to adolescence. This poses potential safety concerns when prescribing drugs to pediatric patients. As an advanced practice nurse, you have to be aware of safety implications of the off-label use of drugs with this patient group.

To prepare:

· Review the Bazzano et al. and Mayhew articles in the Learning Resources. Reflect on situations in which children should be prescribed drugs for off-label use.

· Think about strategies to make the off-label use and dosage of drugs safer for children from infancy to adolescence. Consider specific off-label drugs that you think require extra care and attention when used in pediatrics.

With these thoughts in mind:

Post an explanation of circumstances under which children should be prescribed drugs for off-label use. Then, describe strategies to make the off-label use and dosage of drugs safer for children from infancy to adolescence. Include descriptions and names of off-label drugs that require extra care and attention when used in pediatrics.

This work should have Introduction and conclusion

– This work should have at 3 to 5current references (Year 2012 and up)

– Use at least 2 references from class Learning Resources

The following Resources are not acceptable:

1. Wikipedia

2. Cdc.gov- nonhealthcare professionals section

3. Webmd.com

4. Mayoclinic.com

Required Readings

Arcangelo, V. P., Peterson, A. M., Wilbur, V., & Reinhold, J. A. (Eds.). (2017). Pharmacotherapeutics for advanced practice: A practical approach (4th ed.). Ambler, PA: Lippincott Williams & Wilkins.

  • Review Chapter 4, “Principles      of Pharmacotherapy in Pediatrics” (pp. 53-63)
    This chapter explores concepts relating to drug selection, administration,      and interaction for pediatric patients. It also compares age-related      pharmacokinetic differences in children and adults.
  • Chapter 17, “Ophthalmic      Disorders” (pp. 221-243)
    This chapter examines the causes, pathophysiology, diagnostic criteria,      and drug treatment for four ophthalmic disorders: blepharitis,      conjunctivitis, keratoconjunctivitis sicca, and glaucoma. It also explores      methods of monitoring patient response to treatment.
  • Chapter 43,      “Attention-Deficit/Hyperactivity Disorder” (pp. 743-756)
    This chapter explains the process of diagnosing      Attention-Deficit/Hyperactivity Disorder (ADHD). It also identifies drugs      for treating patients with ADHD, including proper dosages, selected      adverse events, and special considerations for each drug.
  • Chapter 51, “Immunizations”      (pp. 906-926)
    This chapter explores vaccines that are licensed for use in the United      States and provides a recommended vaccination schedule for pediatric      patients and adults.
  • Chapter 52, “Smoking Cessation”      (pp. 927-943)
    This chapter examines clinical implications of smoking. It also covers      various approaches for aiding patients who are dependent on nicotine but      want to stop smoking.
  • Chapter 54, “Weight Loss” (pp. 945-956)
    This chapter begins by reviewing patient factors that contribute to      obesity. It also examines drug therapy for initiating weight loss in      patients, as well as alternative non-drug treatments.

Bazzano, A. T, Mangione-Smith, R., Schonlau, M., Suttorp, M. J., & Brook, R. H. (2009). Off-label prescribing to children in the United States outpatient setting. Academic Pediatrics, 9(2), 81–88. 

This study examines the frequency of off-label prescribing to children and explores factors that impact off-label prescribing.

Mayhew, M. (2009). Off-label prescribing. The Journal for Nurse Practitioners, 5(2), 122–123. 

This article reviews the prevalence of off-label prescribing, including its benefits and risks. It also explores issues regarding the safety of off-label prescribing and when it is unavoidable.

Drugs.com. (2012). Retrieved from http://www.drugs.com/

This website presents a comprehensive review of prescription and over-the-counter drugs including information on common uses and potential side effects. It also provides updates relating to new drugs on the market, support from health professionals, and a drug-drug interactions checker.

Required Media

Laureate Education, Inc. (Executive Producer). (2012). Advanced pharmacology – Final course review. Baltimore, MD: Author. 

This media is an interactive final review covering course content.

Assignment 1

Select  an article from a magazine or newspaper that has something in it that  pertains to biology. This will serve as the “target article” for this  assignment. For instance, you can select an article about medicine,  invasive species, nature, conservation, genetic technology, ecology, or  any other topic that is related to biology. One purpose of this  assignment is to help you become aware of how biology is related to your  everyday life.

Write a one to four (1-4) page paper in which you:

  1. Summarize the article in one (1) or more paragraphs, using your own words. Be  sure to identify the article using an in-text citation in the body of  the paper, as well as a reference in the reference section.
  2. Explain  how the article relates to this course. Identify which biological  concepts from the course and / or text are relevant to the topic covered  in the article. Citing the course text, discuss the ways in which this  course does (or doesn’t) provide background information to help you  understand the article and the larger issues surrounding it.
  3. Explain  why the article caught your attention. Relate the article to your life  and to issues that are important to you. Discuss how or if the  scientific knowledge about the topic covered in the article affects you  directly or indirectly.
  4. Discuss  your opinion on how research on this topic should be funded. State  whether you think taxpayer monies should support research on this topic  or whether such research in this area should be funded by the private  sector. Rate the importance of research on this topic, relative to other  areas of research.

Psychosocial Development Case Study Assessment Overview

The purpose of this assignment is to use what you have learned about lifespan theories, models of resilience, and psychosocial development to assess how well individuals and families are functioning in relation to all three of these areas. To address realistic situations without violating personal rights to privacy, you will view the movie The Butler, or one of the other approved films for this assignment, in order to provide a case scenario.

If you have not yet viewed the movie, you need to do so to complete this assignment. Each movie represents characters in multiple life stages. Identify three characters moving through a different life stage and focus on details that will make your analysis applicable to your specialization.

Directions

For this assignment, imagine you are a counselor working with each of these three characters. Now, conduct the following analysis for each character:

  • Identify the life stage he or she is in, along with the psychological crisis each is experiencing.
  • Identify social or environmental factors that may have influenced the character’s behavior. Examine the connection between these factors and theories of learning.
  • Apply psychosocial developmental theory to the situation presented, from the perspective of a counselor:
    • Conceptualize your ideas for the developmental tasks of each character selected, grounding your conceptualization in your own area of specialization.
    • Include a discussion of the character’s life and factors that might affect behaviors, including cultural and other influences related to the stage of development assessed. To the extent that it is relevant for each character, include an analysis of interrelationships among work, family, and other life roles. Include an analysis of the impact of cultural influences, as well. Refer to specific actions and words of the characters in the movie as evidence for your analysis.
    • Support your ideas with specific lifespan theories discussed in this course, citing and referencing your sources.

From a clinical perspective, assess how these three characters function as a family unit:

  • Examine their functioning in relation to a model of resilience appropriate to your specialization, and evaluate their challenges and strengths related to wellness and resilience. As each character transitions to his or her next developmental stage, how will the transition impact the functioning of the family unit?
  • Support your ideas with appropriate sources on the model of resilience you chose.

Use the document Unit 8 Assignment Template (given in the resources) to prepare and submit your report. Do not include a synopsis of the movie in your paper. Instead, follow the template. Focus on the three selected characters, and the realities of their functioning as a family unit and transitioning within the family unit, as described in the template. Then, provide your assessment of how well they are functioning in relation to your choice of a model of wellness and resilience, as described in the template. Your summary, at the end of the template, should provide a brief, focused review of the key insights in your assessment.

Review the scoring guide given in the resources to make sure you understand how this assignment will be graded.

Other Requirements

Your paper must meet the following requirements:

  • Resources: Cite and reference at least three resources from the professional literature that you use as the basis of your ideas related to life span theory and resilience models.
  • APA formatting: Resources and citations must be formatted according to current APA style.
  • Font and Font size: Times New Roman, 12 point.
  • Length of Paper: Doing a thorough job on this assignment is likely to require approximately 7–10 typed, double-spaced pages.
  • Turnitin: You are required to submit your final version of this paper to Turnitin to generate a final report prior to submitting the assignment for grading. From the Turnitin tool, first submit to the draft link to check your work for any necessary edits. Once the paper is finalized and all edits have been made, submit your final paper to the Final report option for the assignment. Please be advised it can take up to a day to obtain the percentage from Turnitin. When your paper is downloaded and viewable in Turnitin, save the originality report. Refer to the Turnitin Tutorial: Viewing an Originality Report (linked in the Resources) for guidance.
    1. Submit your assignment using the following file naming format: Your Name_AssignmentNumber_Assignment Title (example: Ima_Learner_u08a1_CaseStudyAssessment).
    2. In the comment section, provide the percentage from the final Turnitin report (example: Final Turnitin percentage = 4%). Please be prepared to provide your faculty member with a copy of the Turnitin report should this be requested of you.

DNP- POPULATION MANAGEMENT

Please! No Plagiarized Work.

Topic: Case Report: Application of Public Health Concepts for the Uninsured

In this assignment, learners are required to write a case report addressing the personal knowledge and skills gained in this course and potentially solving an identified practice problem.

General Guidelines:

Use the following information to ensure successful completion of the assignment:

  • Doctoral learners are required to use APA style for      their writing assignments.
  • This assignment requires that at least two additional      scholarly research sources related to this topic, and at least one in-text      citation from each source be included.
  • You are required to submit this assignment to      LopesWrite.

Directions:

Construct a 2,500-3,000 word (approximately 10-12 pages) case report that includes a problem or situation consistent with a DNP area of practice.

  1. Review the IOM and Kaiser Commission Report on the      uninsured to develop the case report.
  2. Apply public health concepts to describe understanding      of the problem or situation of focus.
  3. Apply one or more public health concepts to the recommended      intervention or solution being proposed.
  4. Develop the case report across the entire scenario from      the identification of the clinical or health care problem through the      proposal for an intervention, implementation, and evaluation using an      appropriate research instrument.
  5. Describe the evaluation of the selected research      instrument in the case report.
  6. Lastly, explain in full the tenets, rationale for      selection (empirical evidence), and clear application using the language      of public health concepts within the case report.

Case Report Requirements:

In addition, your case report must include the following:

  1. Introduction with a problem statement.
  2. Brief literature review.
  3. Description of the case/situation/conditions explained      from a theoretical perspective.
  4. Discussion that includes a detailed explanation of the      synthesized literature findings.
  5. Summary of the case.
  6. Proposed solutions to remedy gaps, inefficiencies, or      other issues from a theoretical approach.
  7. Identification of a research instrument to evaluate the      proposed solution along with a description of how the instrument could be      evaluated.
  8. Conclusion.

You are required to complete your assignment using real-world application. Real-world application requires the use of evidence-based data, contemporary theories, and concepts presented in the course. The culmination of your assignment must present a viable application in a current practice setting.

Study Materials

Review Chapter 7 and read Chapter 8.

URL: http://www.gcumedia.com/digital-resources/springer-publishing-company/2015/population-based-nursing_concepts-and-competencies-for-advanced-practice_ebook_2e.php

Bunnell, R., O’neil, D., Soler, R., Payne, R., Giles, W., Collins, J., & Bauer, U. (2012). Fifty communities putting prevention to work: Accelerating chronic disease prevention through policy, systems and environmental change. Journal of Community Health37(5), 1081-1090.

URL:https://lopes.idm.oclc.org/login?url=http://search.ebscohost.com.lopes.idm.oclc.org/login.aspx?direct=true&db=ccm&AN=2011673066&site=ehost-live&scope=site

Larkin, H. (2014). Population health: embracing RISK. H&HN: Hospitals & Health Networks88(10), 30-45.

URL:https://lopes.idm.oclc.org/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=107834961&site=ehost-live&scope=site

Hamar, G., Rula, E. Y., Wells, A., Coberley, C., Pope, J. E., & Larkin, S. (2013). Impact of a chronic disease management program on hospital admissions and readmissions in an Australian population with heart disease or diabetes. Population Health Management16(2), 125-131.

URL:https://lopes.idm.oclc.org/login?url=http://search.ebscohost.com.lopes.idm.oclc.org/login.aspx?direct=true&db=ccm&AN=2012070001&site=ehost-live&scope=site

Play The Expert

Prior to beginning work on this discussion, please read the following required articles:

  • “Relations Between Inductive Reasoning and Deductive Reasoning”
  • “The Effect of the Environment (Real and Virtual) and The Personality on the Speed of Decision Making”
  • “Decision-Making Theories and Models: A Discussion of Rational and Psychological Decision-Making Theories and Models: The Search for a Cultural-Ethical Decision-Making Model”
  • “Seven Basic Steps to Solving Ethical Dilemmas in Special Education: A Decision-Making Framework”
  • “Looking for a Psychology for the Inner Rational Agent”

Play the expert in the following scenario and apply ethical principles and professional standards of decision-making to your rationale and actions:

  • You are a counseling psychologist in a state prison. You have been counseling a new inmate, and he confided in you that one of the other inmates has indicated he is considering suicide. He does not divulge the name of the other inmate and refuses to talk any further about the issue. Consider the following steps in your decision-making process:
    • Define the problem.
    • Explore the alternatives.
    • Consider the consequences.
    • Identify ethical considerations.
    • Determine how you would reduce bias in your decision-making process.
    • Explain your decision.

Using appropriate citations and references, explain how the empirical research and theoretical models presented in the assigned articles suggest the importance of applying decision-making strategies in one’s own practice. Support your argument with empirical research.

Engage your critical thinking skills.

Memory loss is frightening. The purpose of this assignment is to make you think of memory loss realistically. Complete the steps listed below:

  • Watch the video, Living Without a Memory (Links to an external site.), which provides an overview of memory and discusses actual cases of memory loss.
  • Select a movie that has featured a character with memory loss. Describe the main features of the impairment exhibited by the movie character.

Engage your critical thinking skills. How accurately is memory loss featured in the selected movie? Specifically, does the memory loss in the movie resemble actual cases? Is appropriate terminology used? Is the prognosis realistic?

  • Note that statements regarding the accuracy or inaccuracy of the memory loss illustrated in the movie are to be supported by evidence collected by cognitive psychologists and neuroscientists (i.e., experts). Thus, review the literature on memory loss and use at least two peer-reviewed articles that can answer the questions above. Although your opinion is valuable and always welcome, it needs to be supported by scientific evidence.
  • Express your thoughts about how the movie could have more realistically depicted memory loss, its cause(s), time-course, and prognosis.
  • Describe the memory loss featured in the selected movie as well as discussing its accuracy Keep in mind that accuracy refers to the description of symptoms, potential cause(s), prognosis and actual time-course.

Your paper must begin with an introduction to the selected topic in which you define all concepts that will be discussed in the paper. You must also include a conclusion expressing your thoughts about how the movie could have more realistically depicted memory loss, its causes, time-course, and prognosis.

The Understanding Memory Loss Paper:

  • Must be four to five double-spaced pages in length (not including title and references pages) and formatted according to APA style as outlined in the Ashford Writing Center (Links to an external site.).
  • Must include a separate title page with the following:
    • Title of paper
    • Student’s name
    • Course name and number
    • Instructor’s name
    • Date submitted
  • Must use at least two peer-reviewed source in addition to the course text.
    • The Scholarly, Peer Reviewed, and Other Credible SourcesPreview the document table offers additional guidance on appropriate source types. If you have questions about whether a specific source is appropriate for this assignment, please contact your instructor. Your instructor has the final say about the appropriateness of a specific source for a particular assignment.
  • Must document all sources in APA style as outlined in the Ashford Writing Center.
  • Must include a separate references page that is formatted according to APA style as outlined in the Ashford Writing Center.

Gene Technology

Genetically modified animals

 

Write a four to six (4 to 6) page paper on your chosen topic.  Organize your paper into sections corresponding to the following requirements:

  1. Biological basis. Describe the technology. Discuss what it accomplishes. Elaborate on the scientific principles that make this technology possible. Your goal in this section of the paper is to show the instructor that you understand the underlying science behind the technology. Describe how exactly the technology works. Discuss the biological principles that underlie this technology.
  2. Social and ethical implications. Without disclosing your personal view about this technology, provide an analysis of its social and ethical implications. State the ethical concerns apparent in the use of this technology. Discuss the benefits and risks. Your goal in this section is to look at all sides of the issue. In the next section, you will give your opinion.
  3. Personal viewpoint. In the previous section, your goal was to be as objective as possible, to look at all sides of the issues. In this section, your goals are to give a personal opinion about the technology and provide a justification of that opinion.
  4. Use at least three (3) quality resources in this assignment, in addition to the course text.

NUR3472 DEL 3/4

NUR3472CBE Section 01CBE Emerging Healthcare Technologies and Innovation (6 Months) – CBE – 2020 Winter Six Month 2

Deliverable 3 – Leveraging Quality and Safety Measures with Communication Technologies

Competency

Differentiate the impact of various communication technologies on safety and quality improvement

Scenario

You are a staff nurse voted as the nursing delegate to sit on the Emerging Innovations Steering Committee. In preparing for your first committee meeting you have read through the last year of meeting minutes and determined what the past nursing delegate had achieved and what future goals were set for this specific role. The meeting minutes from last month show the steering committee is currently looking at emerging communication technologies and how the hospital can leverage integration of cost effective healthcare technology. In preparation for the first meeting, you have created a list of best practices based on your scholarly research and create a list of action plans for leveraging these into practice. You have been tasked with creating a comparative analysis of two communication technologies and how they can be used to improve communication between healthcare teams and how it can influence patient outcomes. Before the next monthly committee meeting, they want you to send them a comparative analysis using a format of your choice (i.e. table) of two communication technologies that you feel best improve safety and quality healthcare.

Instructions

Write a comparative analysis table including the following:

  • Discuss the two selected communication technologies you have chosen with support from scholarly research
    • Describe the function of each technology
    • Analyze how it is used in the healthcare setting
  • Examine how the two selected technologies can be used to improve communication among the healthcare team.
    • Provide a specific practice example from the literature to support how each technology has been shown to improve communication among the healthcare team.
  • Discuss how each type of communication technology has been shown to improve patient outcomes underneath the table.
    • Identify evidence from the literature to support how each technology has been shown to impact patient outcomes

Deliverable 4 – Merging Ethics and Information Technology

Competency

Analyze ethical and nursing informatics practice standards within the context of healthcare delivery.

Scenario

You are a nursing manager of the education and innovations department at a large nonprofit academic medical center. You work at the flagship hospital and there are three additional campuses and several affiliated facilities throughout three additional states. Therefore, technology is heavily relied upon for consistent and reliable communication for interdisciplinary care. Recently, the CNO sent you a patient satisfaction survey highlighting how impressed this patient was with their nurse’s timeliness of answering their questions. The patient continued to share that the nurse used their personal cell phone to reach out to the patient’s provider to get clarification of the patient’s discharge instructions. The patient loved their quick response and wanted to highlight this as a best practice for all healthcare professionals.

You have just completed a technology usage assessment of the healthcare staff across departments and it has come to your attention that several nurses occasionally communicate with medical providers through text on their personal cell phones, using their phone’s messaging service. The nurses found that they are able to meet their patient needs more quickly. Your assessment also discovered that a nurse used their personal cell phone to take a picture of a patient’s foot ulcer. The picture was posted on social media as a reminder to diabetics the importance of managing their blood sugars. As the nursing education manager, it is your responsibility to ensure staff are following the hospital polices and your technology assessment has highlighted that the staff is in urgent need of HIPAA training and Smart Phone use.

Instructions

Use the scenario above to create a mandatory training for all staff using PowerPoint with voice over including the following:

  • Examine personal Smart Phone use and its implications in Healthcare
    • Identify and explain a minimum of 3 unethical uses of Smartphones in healthcare (including text messaging and pictures)
    • Discuss potential benefits to appropriate Smartphone use in healthcare
  • Examine judicious use of Social Media and its implications in Healthcare
    • Potential benefits to appropriate use of Social Media in healthcare
    • Identify a minimum of 3 unethical uses of Social Media  (as reviewed by NCSBN)
  • Describe regulatory bodies and Ethical Frameworks used to protect Personal Health Information (PHI)
    • Investigate the role of HIPAA, HITECH, and Nursing Code of Ethics
    • Present possible legal consequences associated with unethical or illegal Smart Phone and Social Media u

NSG 6101

Please write at least 2 paragraph to support this post. APA, citation and reference..

Notably, the learning objectives for the term have been based on nursing research methods with a focus on the ways of carrying out research that is evidence-based and beneficial to the nursing profession. As such, it is vital to review and reflect on what has been covered because through this one can draw on their strengths and realize their weaknesses. Through reflection, any concepts that were not addressed appropriately can be given more emphasis by setting goals to achieve them shortly. My topic has been based on oncology, and all the learning outcomes were met through discussions centered on the subject.

Discussion

The learning objective of ethics in research was met by reviewing the article on protecting human research participants outlined in the National Institute of Health (NIH). I learned about the requirements for carrying out qualitative research and how participants in a study on oncology should be treated with dignity and respect. In an oncology unit, patients often suffer psychological problems just as much as physical pain is experienced as well. Treating the patient with utmost dignity while alleviating their suffering is critical in ensuring the nurse and patient build a trusting relationship (Ford, 2014). The learning outcome of the problem statement was met by developing a PICOT question with a focus on my population, which was patients with oncology needs. The patient characteristics were explained with two interventions being compared to determine which was best for the care of the patient. I came up with a statement of the problem for my topic on oncology with an emphasis on facts that depict the existence of a problem that needs to be addressed to ensure patients with cancer are cared for using standard practice. The research purpose was indicated by highlighting the vitality of the subject in the society because oncology is fast becoming an area that should be addressed by all, making awareness crucial.

A theoretical and conceptual framework based on the subject was achieved by reviewing previously documented theories on the subject of oncology. In the recent years, there has been a surge of information on cancers and their proposed forms of management because it has become a public health concern. Through the analysis of the theories cited by various authors, I was able to construct a conceptual map narrowing precisely on the subject. I learned many aspects of oncology since it is a widely researched topic with many angles of patient management and treatment options as well. Research design learning outcome was met by identifying a design that was most appropriate with chosen research questions. I was able to identify various strengths and weaknesses of the design and relate to my topic. A research outcome is dependent on the design was chosen because quantitative and qualitative research designs are different and often provide results that could be significantly different. Through reading on the research designs and selecting an appropriate one for my topic, I was able to identify the most suitable design to use on the subject of oncology.

Through the problem statement, I came up with a method to select the sample size and sample characteristics based on the topic. A sampling technique is crucial in determining if, at the end of the research process, the results will be generalized to the entire population. I came up with a research question to help in addressing the research topic with the information on the existing instrument that would be used to address the research question. All the learning outcomes were successfully met through a proper literature review on the topic of oncology and the research of the appropriate research design.

Case Study 1-2

Lyme Disease

Case Study

A 38-year-old male had a 3-week history of fatigue and lethargy with intermittent complaints of headache, fever, chills, myalgia, and arthralgia. According to the history, the patient’s symptoms began shortly after a camping vacation. He recalled a bug bite and rash on his thigh immediately after the trip. The following studies were ordered:

Studies

Results

Lyme disease test,

Elevated IgM antibody titers against Borrelia burgdorferi (normal: low)

Erythrocyte sedimentation rate (ESR),

30 mm/hour (normal: ≤15 mm/hour)

Aspartate aminotransferase (AST),

32 units/L (normal: 8-20 units/L)

Hemoglobin (Hgb),

12 g/dL (normal: 14-18 g/dL)

Hematocrit (Hct),

36% (normal: 42%-52%)

Rheumatoid factor (RF),

Negative (normal: negative)

Antinuclear antibodies (ANA),

Negative (normal: negative)

Diagnostic Analysis

Based on the patient’s history of camping in the woods and an insect bite and rash on the thigh, Lyme disease was suspected. Early in the course of this disease, testing for specific immunoglobulin (Ig) M antibodies against B. burgdorferi is the most helpful in diagnosing Lyme disease. An elevated ESR, increased AST levels, and mild anemia are frequently seen early in this disease. RF and ANA abnormalities are usually absent.

Critical Thinking Questions

1. What is the cardinal sign of Lyme disease? (always on the boards)

2. At what stages of Lyme disease are the IgG and IgM antibodies elevated?

3. Why was the ESR elevated?

4. What is the Therapeutic goal for Lyme Disease and what is the recommended treatment.

Peripheral Vascular Disease

Case Studies

A 52-year-old man complained of pain and cramping in his right calf caused by walking two blocks. The pain was relieved with cessation of activity. The pain had been increasing in frequency and intensity. Physical examination findings were essentially normal except for decreased hair on the right leg. The patient’s popliteal, dorsalis pedis, and posterior tibial pulses were markedly decreased compared with those of his left leg.

Studies

Results

Routine laboratory work

Within normal limits (WNL)

Doppler ultrasound systolic pressures

Femoral: 130 mm Hg; popliteal: 90 mm Hg; posterior tibial: 88 mm Hg; dorsalis pedis: 88 mm Hg (normal: same as brachial systolic blood pressure)

Arterial plethysmography

Decreased amplitude of distal femoral, popliteal, dorsalis pedis, and posterior tibial pulse waves

Femoral arteriography of right leg

Obstruction of the femoral artery at the midthigh level

Arterial duplex scan

Apparent arterial obstruction in the superficial femoral artery

Diagnostic Analysis

With the clinical picture of classic intermittent claudication, the noninvasive Doppler and plethysmographic arterial vascular study merely documented the presence and location of the arterial occlusion in the proximal femoral artery. Most vascular surgeons prefer arteriography to document the location of the vascular occlusion. The patient underwent a bypass from the proximal femoral artery to the popliteal artery. After surgery he was asymptomatic.

Critical Thinking Questions

1. What was the cause of this patient’s pain and cramping?

2. Why was there decreased hair on the patient’s right leg?

3. What would be the strategic physical assessments after surgery to determine the adequacy of the patient’s circulation?

4. What would be the treatment of intermittent Claudication for non-occlusion?

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