Scenario
You are directly admitting a 30-year-old woman, J.L., to your telemetry unit with the diagnosis
of status post–cardiac transplantation and fever of unknown origin. She was healthy until the
birth of her only child at 27 years of age. She developed idiopathic cardiomyopathy after
childbirth and underwent cardiac transplantation
. 10 months ago. All of her endomyocardial
biopsies have been negative for signs of rejection; her last one was 3 weeks ago. She is currently
maintained on a regimen of baby aspirin, multivitamins, tacrolimus (Prograf), nifedipine
(Procardia), and metolazone (Zaroxolyn). The UAP reports her vital signs (VS) as 130/78, 104,
20, 101.7° F (38.7° C).
1. Discuss the disease process related to the care of this patient.
Cardiomyopathy is a disease of the heart muscle that makes it harder for the heart to deliver
blood to the rest of the body and maintain a normal electrical rhythm leading to arrhythmias and
even heart failure. Cardiomyopathy is divided into four categories: Dilated Cardiomyopathy,
Hypertrophic Cardiomyopathy, Restrictive Cardiomyopathy, and Arrythmogenic Right
Ventricular Cardiomyopathy. Dilated Cardiomyopathy is the most common form of
Cardiomyopathy and it usually starts in the left ventricle, which is the heart’s main pumping
chamber. The heart muscle dilates and causes the left ventricle to enlarge and then the right
ventricle as well. The enlargement spreads to the atria and this impairs the heart muscle from
contracting and pumping blood normally. Hypertrophic cardiomyopathy is caused by abnormal
genes in the heart muscle that cause the wall of the left ventricle to become thicker and to
contract harder. These thick walls then become thick decreasing the amount of blood that is taken
in and pumped out of the body. The rarest of the cardiomyopathies, Restrictive cardiomyopathy,
occurs when the heart’s ventricles become rigid and fill with blood. This causes the atria to
enlarge and blood flow in the heart reduces over time. Arrhythmogenic Right Ventricular
Cardiomyopathy most often affects young adults, and it occurs when the muscle tissue in the
right ventricle is replaced with scar tissue. This disrupts the hearts electrical signals and causes
arrhythmias.
Ignatavicius, Workman & Rebar. “Care of Patients with cardiac Problems.” Medical-Surgical Nursing: Concepts for the
Interprofessional Collaborative Care, Elsevier, 9th Edition, pp 714-716.
1
, 2. Describe and clarify the clinical data in the initial presentation and how you will use it to set
up your initial plan of care or focused assessment.
J.L’s vital signs show that she has a heart rate of 104, which is indicative of tachycardia, and a
temperature of 101.7 degrees, which is indicative of a fever. Fever is a sign of Sepsis and Organ
Rejection, which are two major complications of organ transplantation. Since J.L has a low-grade fever,
she may be experiencing either sepsis or transplant rejection. Additionally, her tachycardia is a symptom
of either sepsis or organ rejection to that will be my primary concern when it comes to her care. However,
J.L has been taking the medication tacrolimus which is an immunosuppressive medication that helps
prevent organ rejection in patients that have undergone organ transplants. One of the side effects of
Prograf is that it can cause a fever.
3. Admitting has assigned J.L. to a semiprivate room. Her roommate is on day 4 of IV antibiotic
treatment for pneumonia and now has a near normal white blood cell (WBC) count. Is this
assignment appropriate?
This assignment if not appropriate. Although her roommate has been on IV antibiotic
treatment for four days, J.L. is immunosuppressed because she just underwent cardiac
transplantation 10 months ago. Patients that are immunosuppressed should be kept in a
private room and every precaution should be taken to prevent any type of infections.
Since J.L requires a private room due to her condition, the admitting department should
be called immediately so that they could make proper arrangements.
Ignatavicius, Workman & Rebar. “Care of Patients with cardiac Problems.” Medical-Surgical Nursing: Concepts for the
Interprofessional Collaborative Care, Elsevier, 9th Edition, pp 714-718.
4. Fever is a sign of two major complications of organ transplantation. What are they?
Fever is a sign of Sepsis and Organ Rejection, which are two major complications of
organ transplantation. Since J.L has a low-grade fever, she may be experiencing either
sepsis or transplant rejection. Sepsis is life threatening and it occurs when an infection
triggers an immune response. Since J.L has been taking immunosuppressive medications,
she is prone to contracting infections which can have led to her contracting sepsis.
Transplant rejection occurs when the patient’s immune system recognizes the
2
You are directly admitting a 30-year-old woman, J.L., to your telemetry unit with the diagnosis
of status post–cardiac transplantation and fever of unknown origin. She was healthy until the
birth of her only child at 27 years of age. She developed idiopathic cardiomyopathy after
childbirth and underwent cardiac transplantation
. 10 months ago. All of her endomyocardial
biopsies have been negative for signs of rejection; her last one was 3 weeks ago. She is currently
maintained on a regimen of baby aspirin, multivitamins, tacrolimus (Prograf), nifedipine
(Procardia), and metolazone (Zaroxolyn). The UAP reports her vital signs (VS) as 130/78, 104,
20, 101.7° F (38.7° C).
1. Discuss the disease process related to the care of this patient.
Cardiomyopathy is a disease of the heart muscle that makes it harder for the heart to deliver
blood to the rest of the body and maintain a normal electrical rhythm leading to arrhythmias and
even heart failure. Cardiomyopathy is divided into four categories: Dilated Cardiomyopathy,
Hypertrophic Cardiomyopathy, Restrictive Cardiomyopathy, and Arrythmogenic Right
Ventricular Cardiomyopathy. Dilated Cardiomyopathy is the most common form of
Cardiomyopathy and it usually starts in the left ventricle, which is the heart’s main pumping
chamber. The heart muscle dilates and causes the left ventricle to enlarge and then the right
ventricle as well. The enlargement spreads to the atria and this impairs the heart muscle from
contracting and pumping blood normally. Hypertrophic cardiomyopathy is caused by abnormal
genes in the heart muscle that cause the wall of the left ventricle to become thicker and to
contract harder. These thick walls then become thick decreasing the amount of blood that is taken
in and pumped out of the body. The rarest of the cardiomyopathies, Restrictive cardiomyopathy,
occurs when the heart’s ventricles become rigid and fill with blood. This causes the atria to
enlarge and blood flow in the heart reduces over time. Arrhythmogenic Right Ventricular
Cardiomyopathy most often affects young adults, and it occurs when the muscle tissue in the
right ventricle is replaced with scar tissue. This disrupts the hearts electrical signals and causes
arrhythmias.
Ignatavicius, Workman & Rebar. “Care of Patients with cardiac Problems.” Medical-Surgical Nursing: Concepts for the
Interprofessional Collaborative Care, Elsevier, 9th Edition, pp 714-716.
1
, 2. Describe and clarify the clinical data in the initial presentation and how you will use it to set
up your initial plan of care or focused assessment.
J.L’s vital signs show that she has a heart rate of 104, which is indicative of tachycardia, and a
temperature of 101.7 degrees, which is indicative of a fever. Fever is a sign of Sepsis and Organ
Rejection, which are two major complications of organ transplantation. Since J.L has a low-grade fever,
she may be experiencing either sepsis or transplant rejection. Additionally, her tachycardia is a symptom
of either sepsis or organ rejection to that will be my primary concern when it comes to her care. However,
J.L has been taking the medication tacrolimus which is an immunosuppressive medication that helps
prevent organ rejection in patients that have undergone organ transplants. One of the side effects of
Prograf is that it can cause a fever.
3. Admitting has assigned J.L. to a semiprivate room. Her roommate is on day 4 of IV antibiotic
treatment for pneumonia and now has a near normal white blood cell (WBC) count. Is this
assignment appropriate?
This assignment if not appropriate. Although her roommate has been on IV antibiotic
treatment for four days, J.L. is immunosuppressed because she just underwent cardiac
transplantation 10 months ago. Patients that are immunosuppressed should be kept in a
private room and every precaution should be taken to prevent any type of infections.
Since J.L requires a private room due to her condition, the admitting department should
be called immediately so that they could make proper arrangements.
Ignatavicius, Workman & Rebar. “Care of Patients with cardiac Problems.” Medical-Surgical Nursing: Concepts for the
Interprofessional Collaborative Care, Elsevier, 9th Edition, pp 714-718.
4. Fever is a sign of two major complications of organ transplantation. What are they?
Fever is a sign of Sepsis and Organ Rejection, which are two major complications of
organ transplantation. Since J.L has a low-grade fever, she may be experiencing either
sepsis or transplant rejection. Sepsis is life threatening and it occurs when an infection
triggers an immune response. Since J.L has been taking immunosuppressive medications,
she is prone to contracting infections which can have led to her contracting sepsis.
Transplant rejection occurs when the patient’s immune system recognizes the
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