...Case Studies on Cardiac Function This is the first case study that is required for the class. Please submit a paper (doesn’t have to be long; you could even give me bullet-point answers to the questions listed below) that answers all of the questions posed after Case Study 1. I have included an easy second case study which, if you complete it, will be worth extra credit. Answers to the first Case Study are worth 25 points and responding to Case Study 1 is required work for the course. The extra credit, which is not required, will be worth a total of 10 points. Case 1 A.O. is an 89-year-old woman with a long history of systolic heart failure secondary to a large left ventricular infarct when she was in her 70s. She had poor activity tolerance and required assistance with activities of daily living. Even minimal activity was associated with moderately severe dyspnea and exertional chest pain, which was relieved by rest. A.O. also exhibited marked pedal edema bilaterally. She is being treated with digitalis, furosemide (Lasix), KCl, and sublingual nitroglycerin. Discussion Questions 1. Which type of heart failure (left or right sided) is usually associated with dyspnea? Left-sided heart failure is usually associated with dyspnea. What other clinical findings are likely to be present with left-sided heart failure? Other clinical findings that are likely to be present with left-sided heart failure include radiographic cardiomegaly, abnormal apical pulse and...
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...two articles to analyze for assignments in Weeks Three and Four. One article is a qualitative research study, and the other is a quantitative research study. Identify which article is which, and then complete the table where applicable. Write no more than three sentences in each cell of the table. | Qualitative | Quantitative | Articles | Living with unexplained chest pain | Predictors of vascular complications post diagnostic Cardiac Catheterization and Percutaneous Coronary interventions | Research question | How patients experience unexplained chest pain and how it affects their everyday life? | How to identify risk factors associated with cardiac catheterization and percutaneous coronary interventions to prevent complications? | Problem | Often there is no clear explanation for heart disease it makes it difficult to know what nursing interventions to provide for the patient. | There are increased risks for vascular complications found in patients 70 years or older | Purpose | To determine the type of heart disease the patient has so nursing can know what type of signs and symptoms to look out for. | For nurses to identify early signs/symptoms and risk factors to prevent complications. Also to develop safe protocols to care for these type of patients. | Hypothesis | Patients physical and mental status has a direct effect on their perception of chest pain especially if there is no cardiac issue is present | A patient’s age, sex, health status and comorbidities...
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...Case study This paper will use a case study approach to explore the registered adult nurse’s role in the holistic care, in the first 24 hours, given to patient presenting with chest pain, caused by a myocardial infarction (MI). Using clinical guidance and evidence based research. The case study will use the ABCDE assessment framework. The resuscitation council (2006) recommends that nurses should follow the ABCDE method when assessing acutely and critically ill patients as it ensures nurses quickly and accurately identify acute illness and promptly begin management of the condition/ illness (Jevon, 2010). The aim of the assessment is to determine the cause of the chest pain efficiently and prioritise care needed. The main priorities were; pain control, informing appropriate medical staff and the nurse in charge, reperfusion of myocardial tissue, managing anxiety and monitoring for complications of MI and the effects of the treatment given. A MI occurs when a coronary artery becomes occluded, most commonly by a thrombus due to the rupture of an atherosclerotic artery which results in the necrosis of myocardial tissue because of the ischemia the thrombus causes (O’Neil, 1996). For the purpose of this case study and in order to protect confidentiality and anonymity the patient used will be fictitious and given a pseudonym. However the events the case study follows are very much a reality (Edwards, 2002). Case scenario Brian, a 64 year old male, was recovering...
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...assigned two articles to analyze for assignments in Weeks Three and Four. One article is a qualitative research study, and the other is a quantitative research study. Identify which article is which, and then complete the table where applicable. Write no more than three sentences in each cell of the table. | Qualitative | Quantitative | Articles | Living with unexplained chest pain | Predictors of vascular complications post diagnostic Cardiac Catheterization and Percutaneous Coronary interventions | Research question | How patients experience unexplained chest pain and how it affects their everyday life? | How to identify risk factors associated with cardiac catheterization and percutaneous coronary interventions to prevent complications? | Problem | Often there is no clear explanation for heart disease it makes it difficult to know what nursing interventions to provide for the patient. | There are increased risks for vascular complications found in patients 70 years or older | Purpose | To determine the type of heart disease the patient has so nursing can know what type of signs and symptoms to look out for. | For nurses to identify early signs/symptoms and risk factors to prevent complications. Also to develop safe protocols to care for these type of patients. | Hypothesis | Patients physical and mental status has a direct effect on their perception of chest pain especially if there is no cardiac issue is present | A patient’s age, sex, health status and comorbidities...
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...Case study By Kevin Whelan Axia College of University of Phoenix PSY 210 Dean Marzofka January 11, 2011 Final Project: Case Study What are the causes of stress in Michael’s or Jennifer’s life? How is stress affecting Michael’s or Jennifer’s health? I chose to analyze the second case study, Michael the airline pilot, as I am in the same line of work, (aviation), I hope to be able to relate to the subjects symptoms, behaviors and anxieties and be able to relate positive and practical analysis and possible recommendations for coping with the anxieties of life in the profession of aviation. The primary stressors in Michael’s life are most likely a combination of the following: Chest pain, divorce and all the legal technicalities like paper work and the emotional implications, the end of a long marriage and loss of a close friend due to the commitment termination, (his wife), the difficult custody battle for his two children, ages 10 and 12, a heavy work schedule that keeps him away from his family two weeks a month, work concerns of possible lay offs in the future, the burden of a new town house in uncertain financial times, and finally, (if that all isn’t enough for one to deal with), unknown physical medical condition as a result of the increasing regularity of the chest pains. How are these stressors affecting Michael’s or Jennifer’s self-concept and self-esteem? In Michael’s case, self esteem has not been directly reflected in the case study, for instance...
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...with unexplained chest pain Margaretha Jerlock MSc, RN, RNT Lecturer, Faculty of Health and Caring Science, Institute of Nursing, The Sahlgrenska Academy at Goteborg University, ¨ Goteborg, Sweden ¨ Fannie Gaston-Johansson PhD, RN Professor, Faculty of Health and Caring Science, Institute of Nursing, The Sahlgrenska Academy at Goteborg University, ¨ Goteborg, Sweden, and Johns Hopkins University, School of Nursing, Baltimore, MD, USA ¨ Ella Danielson PhD, RN Associate Professor, Faculty of Health and Caring Science, Institute of Nursing, The Sahlgrenska Academy at Goteborg ¨ University, Goteborg, Sweden ¨ Submitted for publication: 19 July 2004 Accepted for publication: 1 February 2005 Correspondence: Margaretha Jerlock Institute of Nursing The Sahlgrenska Academy Goteborg University ¨ Box 457, SE-40530 Goteborg ¨ Sweden Telephone: þ46 31 773 60 39 E-mail: margaretha.jerlock@fhs.gu.se 956 J E R L O C K M , G A S T O N - J O H A N S S O N F & D A N I E L S O N E ( 2 0 0 5 ) Journal of Clinical Nursing 14, 956–964 Living with unexplained chest pain Aim. The aim was to describe patients’ experience of unexplained chest pain, and how the pain affected their everyday life. Background. Chest pain is one of the most common reasons for patients to consult the emergency department. Often no clear ischaemic heart disease or any other somatic explanation is found. Exploring the pain experience and how the pain affects everyday...
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...Case Studies on Cardiac Function Case 1 A.O. is an 89-year-old woman with a long history of systolic heart failure secondary to a large left ventricular infarct when she was in her 70s. She had poor activity tolerance and required assistance with activities of daily living. Even minimal activity was associated with moderately severe dyspnea and exertional chest pain, which was relieved by rest. A.O. also exhibited marked pedal edema bilaterally. She is being treated with digitalis, furosemide (Lasix), KCl, and sublingual nitroglycerin. Discussion Questions 1. Which type of heart failure (left or right sided) is usually associated with dyspnea? Left-sided What other clinical findings are likely to be present with left-sided heart failure? Signs of pulmonary congestion are orthopnea or basilar crackles. Possible cough. Increased heart rate and S3 heart sound with auscultation. 2. What compensatory mechanisms are likely to be operative in A.O. to enhance cardiac output? Baroreceptors will detect a low blood pressure and carbon monoxide levels, which would excite the sympathetic system resulting in an increased heart rate. During this mechanism the beta receptors will down regulate leaving this mechanism less effective. Prolonged stretch on the myocardium will result in myocardial hypertrophy. 3. What is the most likely cause of A.O.’s pedal edema? Right sided failure causes pedal edema. 4. What is the cause of A.O.’s exertional...
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...Case Study Pleural effusion NSG/340 Sandra Gilderson, MSN/Ed, RN Case Study Diagnosis and admission A.B. admitting diagnosis pleural effusion, pulmonary infiltrates possible pneumonia based on the result of chest x-ray. Also the presenting signs and symptom provided information that can link to pleural effusion evidenced of his signs and symptoms Pleural effusion Is an abnormal collection of fluid in the pleural space, it is not a disease but an indication of a disease (Lavie et al, 2014). Difference between transudate and exudate “A transudate effusion occurs primarily in noninflammatory conditions and is an accumulation of protein-poor, cell-poor fluid” (Lavie et al, 2014, p. 549). The fluid is leaking into the pleural space, the hydrostatic pressure is increased in the blood vessels, and the protein is low. “An exudate effusion results from increased capillary permeability characteristic of inflammatory reaction. It is most commonly associated with infections and malignancies” (Lavie et al., 2014, p. 549). The blood vessel is blocked or the inflammation result from fluid escaping into the tissues and cavities. Three common causes of pleural effusion “Pleural effusions can arise from a variety of disease states or medications including heart failure, bacterial pneumonia, and pulmonary embolism” (Saguil et al., 2014 p. 2). The reduction in lung volume, depression of the diaphragm and reduced chest wall compliance cause dyspnea, and occasionally pain or cough (Myatt...
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...the hospital with symptoms. In this paper we will address the acronym of M.O.N.A. As the protocol stands right now there are parameters for the administration of three out of the four treatments, these are morphine, nitroglycerin and aspirin. For example, the policy states we are not able to give nitroglycerin if the systolic blood pressure is below 90mm/mg or if the patient has taken any phosphodiesterase medications within 12 hours. However, there are no parameters for the administration of oxygen. Coronary heart disease is the leading cause of death within the US. Oxygen has long been advocated as standard treatment in the management of chest pain and myocardial ischemia, although, for over 60 years the scientific background for this has been questioned (Ripley, Riley, Shome, Awan, McCloskey, Murphy & DeBelder, 2012). Recent studies have shown possible negative reactions with the administration of pure oxygen with patients that were not presenting with hypoxia. The possibility for oxygen toxicity to those with ACS could cause more cardiac tissue injury due to vasoconstriction and decreased cardiac output (Williams, Gandy, & Grayson, 2013). The result of this could be poorer patient outcomes. The American Heart Association (AHA) has also been...
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...experiencing a heart attack is more likely to die from it than a man (Shirato & Swan 2010). Is there a difference between the way women and men experience an Acute Coronary Syndrome (ACS) whether it is Unstable Angina or a true Acute Myocardial Infarction (AMI)? Numerous studies have identified the symptoms females experience when they are suffering from a cardiac event and compared them to males resulting in noteworthy trends identified in the female symptoms. It is also noted that the perception of female cardiac symptoms by the lay community, the health care community and the patients themselves, contribute to the increased death rate in women with AMI. With improved public health education focused on what we’ve learned about the prevalence and seriousness of women experiencing an ischemic cardiac event and their unique symptoms, along with improved training for health care providers that promotes early recognition and aggressive medical treatment for all patients with cardiovascular disease, we can improve these deadly outcomes for women. The typical, hallmark sign of an ACS or Acute Myocardial Infarction (AMI) is widely known to be chest pain and pressure felt over the patient’s left chest. While this is still true for most white middle aged men, what we know today is that not all AMI’s present with this initial complaint...
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...CASE STUDY 1 Acute coronary syndrome Patrick Gallagher Case outline Peter Brown is a 58-year-old gentleman who has experienced an episode of crushing central chest pain while at work. Peter works as a taxi driver and a colleague has taken him to the Accident and Emergency Department. On admission, Peter is sweaty, clammy, nauseated and short of breath. He is complaining of chest pain radiating to his left arm. This is Peter’s first presentation to hospital and he has no relevant past medical history. Peter smokes approximately 20–30 cigarettes per day and takes alcohol at weekends only. Peter is anxious and is concerned that his wife and children are informed. He also states his father died suddenly following a heart attack a number of years ago. Peter is immediately triaged and taken to the resuscitation room. You are the receiving nurse. Observations on admission include: Respiratory rate: 18 breaths per minute Oxygen saturations: 95% Blood pressure: 150/90 mmHg Pulse: 94 beats per minute Temperature: 37ºC. On admission to hospital an electrocardiograph (ECG) has been undertaken. Peter has been diagnosed with an anterior ST segment elevation myocardial infarction (anterior STEMI). Blood samples have also been drawn for urea and electrolytes (U&E), full blood picture (FBP) and highly sensitive troponin T. 1 Discuss Peter’s immediate problems and explain these using your knowledge of pathophysiology. A On admission to Accident and Emergency...
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..............................................3 Patient’s profile..............................................................................................................4 Pathophysiology...............................................................................................................................5 Clinical manifestations...................................................................................................................6 Short of breath and ‘light headed’...................................................................................................6 Nauseous and uncomfortable feeling...............................................................................................6 Crushing substernal chest pain .......................................................................................................6 Modifiable and Non-modifiable risk factors.................................................................7 Laboratory tests results and ECG findings................................................................................7 ECG (Electrocardiogram)................................................................................................................7 Troponin...........................................................................................................................................8 Cholesterol.............................................................................................................
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...blood supply to a portion of the heart stops, that area of the heart will no longer receive the oxygen or nutrients needed to carry out its function and will die. If it is a very small part of the heart involved, it will be able to work without it. If a large portion is damaged, irreversible damage will happen which can lead to death. Damage to the heart muscle may be so severe that it may cause abnormal heart rhythm, called arrhythmias. Most people who are of a myocardial infraction or a heart attack do so within a few hours due to a type of arrhythmia. The heart attack victim will complain of pressure, discomfort or a squeezing sensation in the center of the chest. There may be pain radiating to the arms or the neck. There may also be shortness of breath, weakness, fatigue, nausea, vomiting and or indigestion. The pain that occurs is the result of heart tissue ischemia (decreased blood supply). The area that is not receiving enough blood is literally crying out for help. When a person complains of any of the symptoms mentioned, they should be transported to the nearest hospital. The diagnosis of an M.I. is made for the patient's history, from special tests on E.C.G. and measurement of certain enzymes released into the bloodstream from damaged heart muscle. Once an M.I. has occurred and a portion of the heart muscle has died, something has to be done to prevent a piece of the obstruction from breaking off and blocking another artery somewhere...
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...not been described. DIAGNOSIS: Hypertension Obstructive sleep apnea on CPAP 12/17/15 Progress Report described that the patient has worsening sleep quality (2 hours a night). The patient states that his blood pressure is controlled with medication. He complains of occasional chest pain and abdominal pain. Vital signs: BP was 118/81 mmHg and HR was 85. Weight is 140 pounds. Cardiovascular exam revealed regular rate and rhythm, S1 and S2. There were no rubs or gallops appreciated. There is no clubbing or cyanosis or edema. Current medications include HCTZ, Sentra, Donnatal, Eszopiclone, Tramadol, Gabapentin, Hydrocodone, Omeprazole, Myrbetrig, Naproxen...
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...Case Study on Herpes Zoster Case Study on Herpes Zoster History of Present Illness: This is a case of a 27 year old Asian female who came to the clinic complaining of pain on her right hand. She states that it feels like “pins and needles going up to my arm” She denies fever but states that she feels body malaise. She claims to have slight loss of appetite because of the pain. Pain level is about 7-8/10, occurs continuously and is temporarily relieved by Tylenol 500 mg. She noted the appearance of tiny blisters on her hand and upper arm which started about a week ago. The pain according to the patient is described as throbbing and tingling sensation. Patient otherwise has no other complaints. Past Medical History: Patient denies prior hospitalizations, surgeries, accidents. Patient does not remember immunizations but she claims that she never had chickenpox Family History: Both parents are alive. Her father is hypertensive and has coronary arterial disease. Her mother is apparently healthy. She is the only child. Social History: She lives in an apartment with her parents. She works as an employee in the casino. She does not smoke and does not drink alcoholic beverages. Review of Systems: General: Well nourished female, not in acute respiratory distress HEENT: Denies headache. No blurring of vision, hearing not impaired, no sore throat Neck: No tenderness and lymphadenopathy Cardiovascular: No chest pains and palpitations Gastrointestinal: No change in bowel habits...
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