12.10 Clinical Judgment: Case Study

A 74-year-old white client was admitted to the hospital. The client has a history of heart failure, hypertension, peripheral vascular disease (PVD), and arthritis. The client stated they have a “heavy, dull, achy feeling” in their legs. Skin on the lower legs has a brownish yellow discoloration. No visible veins. Client has +2 pitting edema bilaterally in the lower legs and feet, pulses difficult to palpate due to edema. Legs warm to touch down to toes. Open sore on the lateral malleoli is irregular in shape and shallow, no discharge or smell. Client smokes 3–5 cigarettes a day. Client has been smoking for 40 years and stated they have slowly been decreasing the amount each day for the past year. Client moved to a new community 6 months ago and has not been going out as much because they do not know anyone and has been more sedentary than usual. Client stated their legs usually feel worse at the end of the day and when making dinner if standing too long. Vital signs: R20, P90, BP 140/90, O2 saturation 97%, T 36.1 °C / 96.9 °F, BMI 34.5.