University : Australian Catholic University UniLearnO is not sponsored or endorsed by this college or university.
Subject Code : EXSC679
Country : Australia
Assignment Task

 

Subjective:
A 60-year-old male presented to the vascular clinic complaining of left leg calf pain. He is currently able to walk 100m before the onset of moderate left leg pain. He is able to push through the pain for another 100m or so. The pain only occurs during exercise not at rest. His femoral, popliteal, and pedal pulses were all palpable for both
extremities, but the left leg presented with a much weaker pulse. His left foot was cold to touch. Vascular studies were completed to examine the peripheral vasculature. The patients ABIs were 0.80 for the right leg and 0.6 for the left leg. Baseline CT angiography indicated stenosis of the distal superficial femoral artery in his left leg.
The patient has Type 2 diabetes which was diagnosed 4 months ago. He presented to his GP with a Hba1c of 13%, and his Hba1c is now 7%. He has managed this with Metformin (1g oral tablet), nightly Lantus and postprandial walking (lunchtime). He was a previous smoker for 35 years, but quit 2 years ago. He does have hyperlipidaemia and hypertension both of which are moderately controlled with medication Medications include: Aspirin 325 mg/day, Lantus 2-unit injection at bedtime, Lisinopril, 20 mg/day, Metformin 1g/day, and Zocor 40 mg/day.

Goals: Use exercise to reduce pain when walking, reduce the need for Lantus at night.
Barriers/enablers: Happy to come into the EP clinic 1x/week
Home equipment: Theraband and swiss ball
Availability: At lunch time

Objective:
Physical examination
• Blood pressure: 128/80mmHg,
• HR 86 bpm,
• Body weight:100 kg
• Height 180cm
• Waist circumference 90 cm
• Resting ECG – normal
• Exercise testing (Maximal CPET with ECG monitoring) – peak blood pressure was 140/90 and heart rate 110 bpm. Terminated due to leg pain.
• VO2peak = unable to be calculated

Laboratory information:
• Fasting blood glucose 6.5 mmol/L
• Total cholesterol 6.0 mmol/L
• LDL 3.1mmol/L
• HDL 0.6mmol/L.

Unexpected situation during intervention:
• The client's blood glucose is dropping very rapidly after exercise sessions in week 7, from 6.8 mmol/L to 4.0 mmol/L value. This isn’t causing any symptoms.
• The client becomes hostile in week 3, when the pain during exercise becomes too intense. He later apologises and says he was just having a bad day.
• By the end of the program the client thanks you kindly but doesn’t want to attend the EP clinic anymore now that he has achieved 8 weeks of an exercise program.

 

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  • Uploaded By : Brett
  • Posted on : September 01st, 2019
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