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Karl is a 45 year old obese ( 250 lbs 5ft 6 inches tall man). He entered the nurse’s office
complaining of pain and tenderness in his right calf by three days. He said that he is
experiencing pain and difficulty walking. Karl is self-employ is as an accounting software
developer for small business; his office is located at his house. He sits at his computer for
upwards of 10 hours a day. He is unmarried and eats out more than six times a week, usually
at the fast food palace which is just about a ten minute walk from his office. Karl usually
chooses to drive to the outlets and he says walking cause pain, burning and fatigue in his legs.
On evenings Karl usually eats dinner in front of a big screen computer in his bedroom and
sometimes falls asleep in his chair there. His medical history includes a coronary artery
bypass graft (CABG) five years ago for angina, complicated postoperatively by a pulmonary
embolus. However, he has not had any problems since then. The nurse’s physical assessment
reveals his right calf is swollen, slightly flushed, red warm and tender on palpation. His right
calf measures 42cm at 20am above the ankles. His left calf is 34.5cm at the same location.
Homan’s sign is positive for pain in the right calf only. He denies numbness, tingling or loss
of mobility in either extremity.
OBJECTIVES
Homan’s test was then performed: Karl’s knee was in an extended position and
the examiner forcefully dorsiflexed his ankle. A positive sign is indicated when
pain is experienced in the popliteal region and the calf is elicited as the foot is
dorsiflexed.
SEX: Male
URINALYSIS: NAD
MEDICATIONS: NIL
Client lives in an owner-occupied, high rise building with four bedrooms and one occupant.
All amenities (pipe borne water, flushing toiler and electricity). Garbage disposal is by truck
twice a week.
PAST ILLNESSES: Coronary artery bypass graft for angina five years ago complicated
postoperatively by a pulmonary embolus.
SYSTEMS REVIEW
HEARING: No difficulty
RESPIRATORY: No difficulty
MOBILITY: No difficulty
NEUROLOGICAL: No difficulty
SKIN: No abnormality
REPRODUCTIVE: No abnormality
OBJECTIVE DATA
Upon assessment of Karl’s right calf, it was observed to be swollen, slightly flushed, red,
warm and tender on palpation. The right calf was measured to be 42cm at 20 cm above the
ankles while the left calf measured to be 34.5cm at the same location. Homan’s sign was
positive for pain in the right calf only. Full range of motion of all joints, with no pain,
tenderness, clicking or crepitus in the left leg. Nil lesions, scars, rashes were observed on
upper or lower extremities. Full smooth ROM against gravity and resistance.
Weight 250lbs
Right calf swollen, slightly flushed, red, warm and tender on palpation
Right calf = 42cm as compared to Left calf = 34.5cm
Homan’s sign positive in right calf only
Facial grimacing
SUBJECTIVE DATA
Mr. Karl Smith complained of pain and tenderness in his right calf for three days. Has
difficulty in walking which causes severe pain, burning and fatigue in his leg. On a pain scale
of 1-10 the pain is an 8. He is not physically active, sits at the computer for ten hours a day as
an accounting software developer. Eats out more than six times a week and drives to the fast
food outlet that’s ten minutes away. He had a history of a coronary bypass graft 5 years ago
complicated postoperatively by a pulmonary embolus. No history of smoking or alcohol use.
Client voiced no complaints of numbness, tingling or loss of mobility in either extremity.
Verbalized by Karl….
Nursing Interventions
Nursing Diagnosis: Risk for situational low self- esteem related to lack of socialization
Nursing Interventions
vs
Readiness to Modify Health
1. Recommend that Mr Karl use a massage chair to promote circulation and elevate his
foot while he sits for his long work hours.
2. Encourage Mr Karl to walk to the fast food outlet since it is 10minutes away.
3. Discuss/educate with Mr Karl the importance of incorporating simple daily exercise
into his schedule.
4. Recommend a Personal Trainer for enhance daily exercise routine
5. Recommend body massages at least once a month.
INTERVENTIONS:
1. Discuss current eating patterns by having Mr Karl state what, when and where he eats.
2. Discuss/educate Mr Karl about the importance of a proper well balanced diet/meal.
3. Develop a meal plan with a well-balanced diet, reduced calories and reduced fat,
therefore encouraging him to make healthy choices while purchasing food.
4. Suggest hired (chef/ healthy delivery lunches)
5. Encourage him to attend weight control programs held at the community health
centre.
INTERVENTIONS:
1. Assess Mr Karl’s current health status (restrictions, problems, personal habits etc.)
2. Assess/discuss his lifestyle and choices by discussion.
3. Discuss with him his potential for developing chronic diseases (diabetes,
hypertension), due to his current health status.
4. Introduce him to online soft copies books about chronic diseases
5. Converse his risk for having Deep Vein Thrombosis due to his complaint.
6. Discuss his familiarity with technology, so that it can be a source of learning.
INTERVENTIONS:
1. Encourage Karl to join age appropriate programs where interaction is included eg.
Programmes or activities at the health centre.
2. Encourage Karl to go out and socialize after work.
3. Introduce Karl to online dating and chatting
4. Suggest community charity and mentoring youths
Mission Accomplish!