You counsel S.P. on risk factor modification. What would you ...

[karlynnae]

You counsel S.P. on risk factor modification.
 
  What would you address, and why?

Question 2

S.P.'s ABI results showed 0.43 right (R) leg and 0.59 left (L) leg. His primary care provider discusses these results with him and decides to wait 2 months to see whether his symptoms improve with medication changes
 
  and risk factor modification before deciding about surgical intervention. S.P. receives a prescription
  for clopidogrel (Plavix) 75 mg daily and is told to discontinue the daily aspirin. In addition, S.P. receives
  a consultation for physical therapy.
 
  What do these ABI results indicate?

[maya.nigrin17@yahoo.com]

Answer to Question 1

Quit smoking: Smoking cessation reduces the progression of the disease. Among other things,
smoking can cause repetitive endothelial damage that leads to increased risk of atherosclerosis
and related damage.
Exercise: Exercise decreases vascular resistance and enhances blood flow to the exercised extremity.
It is important to encourage the patient to walk through some of the pain before resting; this
stimulates the growth of new blood vessels to supply the oxygen- and nutrient-deprived muscles.
Claudication symptoms will decrease as collateral circulation is formed.
Control BP: Patients who have PAD almost certainly have concomitant cardiovascular and
cerebrovascular disease. Reducing BP helps reduce the risk of morbidity from all vascular
problems.
Comply with medication regimen: Patients need to be educated about the importance of taking
their medication as prescribed. It might be helpful to explain how each medication will help with
the treatment of PAD. For example, lipid-lowering agents, antihypertensives, and antiplatelet
agents, such as aspirin or clopidogrel, all help decrease the patient's risk for cardiovascular and
cerebrovascular disease.

Answer to Question 2

The ABI is a ratio that is derived by dividing the ankle BP by the brachial BP. An ABI of less than 0.9 in
either leg is diagnostic of PAD. S.P.'s right leg shows a lower ABI, which means the disease is worse in
his right leg. His results indicate moderate PAD.

[karlynnae]

TYSM

[Alyson.hiatt@yahoo.com]

Thanks for the timely response, appreciate it