Mesopotamia, mainly modern-day Iraq and Kuwait, in particular is often referred to as the cradle of civilization because some of the most influential early city-states and empires first emerged there, although it is not the only place. Its modern name comes from the Greek for middle – Mesos – and river – potamos – and literary means a “country between two rivers.” Those two rivers are the Tigris and Euphrates. Not only was Mesopotamia one of the first places to develop agriculture, it was also at the crossroads to the Egyptian and the Indus Valley civilizations. This made it a melting pot of languages and cultures that stimulated a lasting impact on writing, technology, language, trade, religion, and law.
lessness 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
• CBC ( to check for anemia r/t surgical blood loss or post op bleeding, platelet level for evaluating for increased clotting/bleeding propensity, increased WBCs indicating possible infection – High WBC(19.7,14.8, 12.9)-infection, Low RBC(3.22)infection, Low Hgb (32.9/25.9) anemia, renal disease – Low Hct (32.9, 25.9) – anemia, renal disease, acute blood loss
• BMP (fluid shift or volume changes w/ increased use of IV fluids, kidney disorders) – Elevated BUN(92/92/94) renal disease r/t HF , High Cr (3.71,3.3,3.96) – HTN,high K (6.5) lactic acidosis
• Coagulation studies(evaluate increased clotting/bleeding propensity)- Elevated PT (22.8, 20.5) & PTT(41.6)
• HgbA1C
• Liver enzymes, CPK (evaluating for reperfusion injuries) Elevated ALT, AST, Alk Phos, Osmo Calc, CPK r/t liver disease, CHF, acute MI
• Lactic acid (compensation for metabolic acidosis) (high ; 4.7 on admission – lactic acidosis r/t CHF & COPD)
• Ankle-brachial index ( detects PAD of LE by assessing pressure of foot and brachial)
• Doppler waveforms( Assess for LE stenosis)
• Duplex US (sound waves to identify areas of stenosis in arterial vessels and defines severity) Occluded left superficial femoral artery distal reconstitution of the popliteal artery through collateral vessels consistent w/ chronic occlusion. Two vessel runoff in the calf.
• Treadmill exercise arterial studies (decreased ABI following exercise indicates arterial insufficiency)
• Angiography(Visualizes anatomy, areas of stenosis and/or occlusion) Long segment occlusion of the distal superficial femoral/popliteal artery. Severe narrowing of the popliteal artery above the knee two – vessel run off through the posterior tibial and peroneal artery to the foot. Marked stenosis in the proximal portion of the posterior tibial artery.
• CT Scan (Visualizes anatomy, areas of stenosis and/or occlusion)
• MRI and MRA (Visualizes anatomy, areas of stenosis and/or occlusion)
(Baird, 2016 p596-597, Osborn, 2014 p1071)
Treatment
Patients with PVD should receive lifelong antiplatelet therapy with aspirin. Aspirin has antithrombotic effects and inhibits platelet aggregration. Other medications in this class include Ticlid, Plavix, and Pletal. Ticlid and Plavix are theinopyridine derivatives that inhibit adenosine diphosphate(ADP) –induced platelet aggregration.
Endovascular repair is the treatment of vascular disease from endoluminal(inside the blood vessel) and includes angioplasty, stenting, and radiation therapy. Percutaneous transluminal ang
