A patient 75 years old who attended to a podiatry clinic complaining pain in the left foot he was treated for his Onychomadesis & Onychomychosis nails problem and was giving advice to come back after 6 months. The patient is at high risk and has a peripheral arterial disease. Include medical history, types of medicament he is taking, what assessment has to do for him?
Patient is suffering from peripheral arterial disease or also called peripheral vascular disease in which the peripheral arteries become narrow. Peripheral arteries are artery other than those which supplies blood to heart and brain.
Medical history of patient:
Patient is suffering from peripheral arterial disease which specially affects the legs of the sufferer. Due to these legs start paining a lot when walking or standing which gets better on rest (1). Other symptoms which arose are ulcers in skin, poor nail and may be growth of hair in the leg region. The patient here is suffering from Onychomadesis & Onychomychosis in which he is experiencing poor nail condition and completely loss of nail called onychomadesis and infection of fungus on nail called onychomychosis. This condition of patient may be due to intake of cigarette smoking which is main reason for peripheral artery disease; other reason may be diabetes, high blood pressure, hypertension or high blood cholesterol.
Types of medication
Medication as given to this patient includes statins, some cilostazol and ACE inhibitors. Aspirin do not help patients with mild illness but is very effective on patients with severe disease. Some changes in routine may help by stopping cigarette smoking at all, control blood sugar levels and cholesterol with doing regular exercises like brisk walking, treadmill etc.
Assessment for patient
Patient suffering from such condition is assessed by test called ankle brachial pressure index called ABPI/ABI (2). This test is measured to know blood pressure difference between foot and other body part, when the blood pressure of the ankle is found less or lower than the blood pressure in the hands; than it indicates that there is a blockage in the artery which provides blood from heart to ankle. Normal range is 1.00 to 1.4. If patient gets reading less than 0.90 than he is suspected with this disease. If reading comes to be 0.40 or less than to it than condition is found very severe.
1. Diagnosis and Treatment of Peripheral Artery Diseases, European Society of Cardiology (2011)
2. Peach G, Griffin M, Jones KG, et al; Diagnosis and management of peripheral arterial disease. BMJ. 2012 Aug 14;3