A nurse is assessing a client who has valvular dysfunction. Which of the following manifestations should the nurse anticipate? (Select all that apply)

Choice A reason:

“Blood flow is altered due to restricted stretching of the ventricles, impairing the heart’s ability to contract” is not accurate in the context of peripheral arterial disease (PAD). PAD primarily affects the arteries outside the heart, particularly those supplying the legs and feet. It is caused by atherosclerosis, which leads to the narrowing and hardening of the arteries, reducing blood flow to the extremities. The statement about restricted stretching of the ventricles and impaired heart contraction is more relevant to conditions like heart failure or cardiomyopathy.

Choice B reason:

“Blood flow is altered due to increased pressure in the arteries” is a more accurate description of PAD. In PAD, the buildup of fatty deposits (plaques) in the arterial walls leads to increased resistance and pressure within the arteries. This condition reduces the flow of oxygenated blood to the limbs, causing symptoms such as pain, cramping, and fatigue, especially during physical activity. Managing PAD involves lifestyle changes, medications, and sometimes surgical interventions to improve blood flow and reduce symptoms.

Choice A reason: Lower Extremities Edematous with Decreased Pulses and Cool to the Touch

Lower extremities that are edematous with decreased pulses and cool to the touch can indicate severe peripheral artery disease (PAD) and poor blood circulation1. While this is a serious condition that requires medical attention, it is not necessarily an immediate emergency unless there are signs of acute limb ischemia, such as sudden pain or loss of function. Chronic symptoms like these often require ongoing management and monitoring rather than immediate intervention.

Choice B reason: Pain, Pallor, and Paresthesia in the Foot

Pain, pallor, and paresthesia (the three Ps) in the foot are classic signs of acute limb ischemia, a medical emergency that requires immediate intervention. Acute limb ischemia occurs when there is a sudden decrease in blood flow to a limb, leading to tissue damage and potential loss of the limb if not treated promptly4. The presence of these symptoms indicates that the limb is not receiving adequate blood supply, necessitating urgent medical attention to restore circulation and prevent permanent damage.

Choice C reason: Presence of an Open Wound Near the Ankle with Serous Drainage and Pruritus

An open wound near the ankle with serous drainage and pruritus (itching) suggests a chronic wound or ulcer, which is common in patients with PAD5. While this condition requires medical treatment to prevent infection and promote healing, it does not typically constitute an immediate emergency unless there are signs of severe infection, such as increased redness, warmth, or purulent drainage. Chronic wounds need regular care and monitoring but are not usually life-threatening.

Choice D reason: Murmur Auscultated at the Left Sternal Border, Slight Dyspnea, and Lower Extremity Edema

A murmur auscultated at the left sternal border, slight dyspnea (shortness of breath), and lower extremity edema can indicate heart valve disease or heart failure. These symptoms are concerning and require medical evaluation, but they do not typically represent an immediate emergency unless the patient is experiencing severe symptoms such as acute heart failure or cardiogenic shock. These conditions require prompt but not necessarily emergent intervention.