GENERAL SURVEY:
- Alert, pleasant, in no acute distress.
- Dress appropriate for the season.
- Hygiene and grooming normal for age and gender.
- Calm, body relaxed, no grimacing, appears to be resting comfortably.

NEUROLOGICAL:
- Alert & oriented to person, place, time, and situation (x4).
- Muscle strength 5/5 in both upper and lower extremities bilaterally.

HEENT:
- Head normocephalic with symmetry of all facial features.
- PERRLA, sclera white bilaterally, conjunctival sac pink bilaterally.
- Lips, tongue, and oral mucosa pink and moist.

RESPIRATORY:
- Breath sounds clear with equal aeration on inspiration and expiration in all lobes anteriorly, posteriorly, and laterally.
- Nonlabored respiratory effort on room air.

CARDIAC:
- Skin pink, warm & dry.
- Left foot has a moderate amount of nonpitting edema.
- Heart sounds irregular with no abnormal beats.
- Pulses right leg anterior pedal and posterior post-tibial 2+ and brisk cap refill.
- Left leg popliteal pulse thready 1+ and lower left leg has sluggish cap refill of 1-2 seconds.

ABDOMEN:
- Abdomen round, soft, and nontender.
- BS + in all four quadrants.

GU:
- Voiding without difficulty, urine clear/yellow.

INTEGUMENTARY:
- Left great toe is black with an open stage III ulcer 1x1 cm on the top of his left foot with no odor or drainage.
- Surrounding tissue is warm, bright red, tender to gentle palpation, extending from his left foot to his lower left leg.
- Skin turgor elastic, no tenting present.

What assessment findings are abnormal? What is the reason (pathophysiology) for these findings?

Abnormal findings include cardiac irregularities, signs of poor peripheral circulation, sensory deficits, and integumentary concerns such as a black toe with a stage III ulcer. These may indicate cardiovascular disease, peripheral neuropathy, or peripheral artery disease.

The abnormal findings from the assessment include cardiac irregularities manifesting as an irregular heart rhythm with no abnormal beats, and evidence of poor peripheral circulation indicated by the presence of nonpitting edema in the left foot, a thready left leg popliteal pulse, and sluggish capillary refill in the lower left leg. The neurological exam suggests sensory deficits suggested by the pins and needles sensation and difficulty in detecting the pen on the left arm and leg. Additionally, there are integumentary system concerns, including a black great toe with a stage III ulcer and surrounding tissue inflammation on the left foot.

The pathophysiology behind these findings could point to several possible medical conditions. The cardiac irregularities and peripheral circulation issues could be indicative of cardiovascular disease, which may be caused by atherosclerosis or thromboembolic events, restricting blood flow and leading to ischemia in the extremities. The neurological symptoms might suggest peripheral neuropathy or a central nervous system condition such as a stroke. The integumentary abnormality is consistent with severe peripheral artery disease, leading to tissue necrosis and ulceration.