A 52-year-old man complained of pain and cramping in his right calf caused by walking two
blocks. The pain was relieved with cessation of activity. The pain had been increasing in
frequency and intensity. Physical examination findings were essentially normal except for
decreased hair on the right leg. The patient’s popliteal, dorsalis pedis, and posterior tibial
pulses were markedly decreased compared with those of his left leg.
Routine laboratory work Within normal limits (WNL)
Doppler ultrasound systolic pressures Femoral: 130 mm Hg; popliteal: 90 mm Hg;
posterior tibial: 88 mm Hg; dorsalis pedis: 88
mm Hg (normal: same as brachial systolic
Arterial plethysmography Decreased amplitude of distal femoral, popliteal,
dorsalis pedis, and posterior tibial pulse waves
Femoral arteriography of right leg Obstruction of the femoral artery at the midthigh
Arterial duplex scan Apparent arterial obstruction in the superficial
With the clinical picture of classic intermittent claudication, the noninvasive Doppler and
plethysmographic arterial vascular study merely documented the presence and location of the
arterial occlusion in the proximal femoral artery. Most vascular surgeons prefer arteriography
to document the location of the vascular occlusion. The patient underwent a bypass from the
proximal femoral artery to the popliteal artery. After surgery he was asymptomatic.
Critical Thinking Questions
- What was the cause of this patient’s pain and cramping?
- Why was there decreased hair on the patient’s right leg?
- What would be the strategic physical assessments after surgery to determine the
adequacy of the patient’s circulation?
- What would be the treatment of intermittent Claudication for non-occlusion?
various backgrounds should have been used to get a more accurate and generalised result. Piaget’s theory received a number of critic’s however his work had a major influence in the education sector. He disliked the idea of children being taught sat at desks, listening and transmitting information the teacher gives. Piaget believed that children learn through discovery, the task should be set by the teacher and children should be left to discover, any mistakes the children make should provide useful information on the child’s cognitive development. Also for the correct answers, the process of how the child worked out the correct answer should be investigated (Smith et al, 2003, p.388). The curriculum is set out in a sequence, particularly in the core subjects such as mathematics and science. This is influenced by Piaget’s theory. The choice of learning objectives, curriculum sequencing, grade placements of topics, the assessment of children’s intellectual functioning and teaching methodology (Murray, 1985, p.291) It is important that the class teacher knows at what stage of cognitive development each child is at as it is an important aspect in Piaget’s theory. This also has an impact on pedagogy as teachers have to change their teaching style to enhance the child’s development. The second theorist i will be critically analysing is Lev Vygotsky (1896-1934). He was born in Russia in the same year as Piaget. He studied law and graduated at Moscow University. He then went on the study a Ph.D in Literature and Linguistics. Vygotsky’s began to work in psychology after the Russian revolution where the Marxism replaced the rule of the czar. The new Marxist philosophy emphasised socialism and collectivism. Individuals were expected to give up their personal goals and achievements to improve the society as a whole by sharing and co operation. The success of an individual was seen as reflecting the success of the culture. Heavy emphasis was placed on history, believing that any culture can only be understood through the ideas and events that have made it occur. (Vasta, R., Haith, M.M., Miller, S.A., 1995). Vygotsky used these elements in his model of human development; this is known as a sociocultural approach. The development of an individual is a result of culture. The theory primarily applies to mental development such as the thought and reasoning process which were believed to develop through social interaction with others mainly parents. He states: Every function in the child’s cultural development appears twice: first, between people (interpsychological) and then inside the child (intrapsychological). This applies equally to voluntary attention, to logical memory, and to the formation of ideas. All the higher functions originate as actual relationships between individuals (Vygotsky, 1978, p.57). Vygotsky looked at mental abilities and processes in historical terms using the events that led to them whereas Piaget believed that the child’s development process follows a similar pattern of stages. Vygotsky saw intellectual abilities as being much more specific to the culture in which the child was reared (Vasta, R., Haith, M.M., Miller, S.A., 1995). Culture contributes to a child’s intellectual development in two ways: firstly children obtain knowledge from it and seco>GET ANSWER