Chronic limb ischaemia: case study and clinical literature review
This article will discuss chronic limb ischaemia as the result of peripheral artery disease (PAD) using a case study. The patient's concurrent diagnosis of metastases meant clinical decision making was complex and treatment options were limited. PAD is the third most common clinical presentation of atherosclerosis after coronary artery disease and stroke. Although advances in radiological technology and biochemical screening offer the potential for earlier intervention and improved survival rates for patients with PAD, a review of the evidence suggests that commitment to more conservative approaches, such as exercise therapy and health promotion, could have more sustainable, longer-term benefits for patients with chronic limb ischaemia. The therapeutic nature of the nurse–patient relationship makes nurses ideally placed for encouraging lifestyle changes and signposting to support services. Active participation from the patient is imperative for any potential modifications, which should be individualised as part of a holistic care plan, to ensure patient engagement and compliance. Therefore emphasis should remain on the management and prevention of modifiable risk factors, for which the nurse's role is an integral part to ensure success.
Chronic limb ischaemia is the result of peripheral artery disease (PAD). This article will discuss the epidemiology, aetiology and pathophysiology of the disease, as well as critically evaluating the methods of assessment and surgical treatment used. A case study will be presented. Patient details have been anonymised to protect confidentiality, in line with the Nursing and Midwifery Council Code (2018).
PAD affects more than 200 million people worldwide (Yang et al, 2017) and is the third most common clinical presentation of atherosclerosis after coronary artery disease (CAD) and stroke (Song et al, 2019). Previously an ailment of more affluent nations, the disease is now becoming more common in poorer countries (Coughlin, 2019a). The upward trend in international incidence has been attributed to a number of causative factors, with arguably the most important being a significant increase in life expectancy (Baubeta Fridh et al, 2017). This is a reasonable theory when considering there is a proven link between ageing and PAD presentation, with various studies identifying a sharp increase in prevalence from 3% to 10% among the general populace to 15% to 20% when focusing on those aged more than 70 years (Coughlin, 2019a).
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