Navigating the unique cultural and religious needs of your patients can be unnerving. You could accidentally offend your patient or their family by not knowing about a crucial cultural practice or you could witness something that goes against your personal beliefs or convictions. The trend of today`s healthcare leans toward being more inclusive of personal and cultural preferences. This demands a knowledgeable and open response from caregivers. What can we, as nurses, do to facilitate this trend toward honoring individual choices and beliefs, even when we are not fully aware of them? by incorporating three practices – awareness, acceptance, and asking – we can make these interactions both easier and more successful.
s(sepsis, septic shock) and noninfectious conditions(SIRS). MODS can be broken further into primary or secondary. Primary MODS is when organ dysfunction occurs early and can be attributable to itself. Secondary MODS is organ failure that is not in direct response to itself, but is a consequence of the host’s response.
(Baird, 2016 p1009; Neviere, 2017)
Risk factors
• Family or personal hx of tobacco abuse, hyperlipidemia, hypertension, diabetes, obesity, stress, sedentary living, cardiovascular disease, renal insufficiency, clotting disorders, foot ulcers, or noncomplicance with medical management Pt has history of smoking, hyperlipidemia, hypertension, diabetes, obesity, cardiovascular disease, renal insufficiency, and foot ulcer!
• Age <50 years, w/ diabetes and one other atherosclerosis risk factor (smoking, dyslipidemia, HTN, or hyperhomocysteeinemia)
• Age 50-69 years with hx of smoking or diabetes
• Age >70 Pt is 78 y/o
• Leg symptoms w/ exertion(suggestive of claudication) or ischemic rest pain Pt states LLE claudication
• Abnormal lower extremity pulse examination Absent pedal pulses
• Known atherosclerotic coronary, carotid, or renal artery disease
• Male, Black ethnicity Pt is male and African American
(Baird, 2016 p592)
Clinical manifestations
• Intermittent claudication (cramping with exertion, relieved at rest) Pt reports bilateral LE claudication, worse in left leg.
• Nocturnal rest pain
• Fatigue/numbness in an extremity Pt came in to ED for generalized weakness
• Pain – Patient reports LLE pain constant and hurting
• Pallor
• Pulselessness Pt has absent pedal pulses
• Poikilothermia (coldness)
• Paralysis
• Poor hair growth
• Parethesia(abnormal physical sensation-prickling, tingling, numbness)
• Poor healing of sores or ulcers Pt has nonhealing wound on L foot, led to amputation of 2nd and 3rd toe
• Bruits – indicate disturbance in flow (plaque formation)
• Edema – Pt has bilateral LE w/ 2+ pitting edema from knee down
(Baird, 2016 p595, Osborn, 2014 p1069)
Common lab & diagnostic tests
