2023-24 Cardiovascular case study

       Cardiovascular case study                                         !"  "#!   "            $#!!%            #   ##!&    !!&       !   '               '!%"             !#"#                           "!    '#(&    )*+*                   * !       !""""!         "       "+,-!"!                ./.0-                      "!      "!                          !11""% &"!                          """! ! %       '++2#"'!)   #                                3#"  %#        3#4            3/#  ""#"!     #5        #  6 7 1. What is the most likely diagnosis for this patient?    ""!    #!         '!   "#"4#     "                        -       ""#"         #    ""66""#                     8"#              9-              "#       #       #4 4    ":  ""!"-!#      "              -!48-; 498%09 2. What are the most common causes of this disease? Which is the most likely in this patient?        "#""               !"  "    "           #  """      ! # ##         "    """      #""    :"     "        '++2#  "  " "               !#4   ""#                         "            "                 ""  """#        "      "             "         #             !      "#       !"#":                                %8/*<%!9  "             ":                 ""-     !             This study source was downloaded by from CourseH on :41:37 GMT -06:00 Zaina Aoun Madonna University Saturday September 21, 2019 causes excess strain that results in damage that causes the arteries to slowly become narrow and further reduce blood flow to the heart (Honan, 422). 3. What are this patient’s risk factors for coronary artery disease? a. Risk factors are further categorized as modifiable and nonmodifiable. Nonmodifiable risk factors include age (men over 45 years old) and Mr. M is a 59-year-old male. Gender as well, men are at greater risk and in his case this increases his risk. Family history of first-degree relative with premature diagnosis of heart disease which is another nonmodifiable risk factor, both of his parents passed away in their early 60s from coronary artery disease. Modifiable risk factors include a history of smoking, hypertension, hyperlipidemia, and a sedentary lifestyle (physical inactivity). Mr. M presents with all the modifiable risk factors and nonmodifiable risk factors which have put him at a greater risk for coronary artery disease. Modifiable risk factors are measures that can be taken to change/lower his risk of developing the disease or managing this event from reoccurring (Honan, 422). 4. What laboratory tests would you as the nurse expect to be ordered? a. Laboratory tests that would be ordered are known as cardiac biomarkers which are used to diagnose an MI. Troponin analysis produces faster results and earlier diagnosis. Also, another order put into place would be an ECG which could be done as soon as the patient reports symptoms of pain. The location, resolution and evolution of an MI can be identified with an ECG and also this can help identify the type of MI it is. In this case the presence of an ST-segment elevation is a significant finding. An echocardiogram is used to evaluate ventricular function and may be used to assist in diagnosing an MI, especially when the ECG is nondiagnostic. This can detect hypokinetic and akinetic wall motion, determine ejection fraction and also assess valvular function (Honan, 425). 5. As the nurse caring for this patient the family is asking what the treatment plan is for Mr. M. Provide an explanation of what you would tell the family regarding the procedure used during a myocardial infarction? a. The goal of treatment during the management of a myocardial infarction is to lessen myocardial damage, save myocardial function, and prevent further complications associated with the disease. Therefore, the family needs to be involved in the course of action that will be taken, the diagnostics studies used and the results of the diagnostic studies and also the medications that will be involved in the treatment process and furthermore education process that should be put in place to manage the disease. First measures that need to implemented is to get an ECG started within the 10 minutes of onset of when the patient is admitted to the hospital. The family should understand the importance of this procedure and how it will help us identify further treatment measures. Lab blood specimen of cardiac biomarkers (specifically troponin) should be assessed as well as this is crucial. The family will be informed on the importance of this cardiacThis study source was downloaded by from CourseH on :41:37 GMT -06:00 Zaina Aoun Madonna University Saturday September 21, 2019 biomarker in the identification of an MI. Medication regimen that will most likely be implemented are nitroglycerin which is first-line treatment for acute MI, morphine which is used to decrease the pain and anxiety associated with a myocardial event, aspirin (162 mg or 325 mg) or clopidegrel which will prevent platelet aggregation and help prevent a recurrent MI by slowing/ decreasing blood clot formation. Beta-blockers are given as initial treatment during hospitalization which reduce the incidence of recurrent angina, infarction and cardiac mortality. The patient and the family as well will be educated on the importance of being compliant with the medication regimen as this is crucial in managing this event. Supplemental oxygen which will assist in reperfusion, this is essential for the patient and family to be involved in the treatment plan, so it can decrease anxiety and concerns regarding this disease (Honan, 429-430). 6. Upon discharge what other medications do you anticipate Mr. M being prescribed and what discharge teaching would you include to the patient and family? a. The medication that Mr. M would most likely be discharged home with are Clopidogrel (Plavix) and Ticagrelor which are usually the recommended treatment for medical management of an MI this is given in combination with Aspirin. Beta-blockers are also recommended during hospitalization after an MI event they reduce the incidence of recurrent angina, infarction, and cardiac mortality. Beta- adrenergic blocking agents such as Metoprolol (Lopressor, Toprol) reduce myocardial oxygen consumption which results in a decreased heart rate, slowed conduction of impulses through the conduction system as well as decreased blood pressure which in Mr. M’s case will be very beneficial. The Clopidogrel is given to prevent platelet aggregation and subsequent thrombosis which impedes blood flow. This also applies to the use of Ticagrelor (Honan, 429). b. Discharge teaching for Mr. M will include education regarding the medication that has been prescribed to him. Regarding the beta-blockers Mr. M needs to be cautioned not to stop taking them abruptly because angina may worsen, and MI may further develop. Because he is always being discharged home with antiplatelet medications he needs to be cautious of any internal and external bleeding that can occur as well as to be alert for a low blood pressure and an increased heart rate that accompany bleeding. Since Mr. M is being discharged this indicates he is free of symptoms and in this case a cardiac rehabilitation program is initiated. This program targets risk reduction by means of education, individual and group support and physical activity. It is characterized into three phases, phase I begins with the diagnosis of atherosclerosis, which will occur when the patient was admitted to the hospital. This includes any post procedural activity that occurs during hospitalization, it consists of low-level activities and initial education for the patient and family. Phase II occurs after the patient has been discharged and usually lasts for 4-6 weeks but may extend to 6 months.This study source was downloaded by from CourseH on :41:37 GMT -06:00 Zaina Aoun Madonna University Saturday September 21, 2019 ECG-monitored, exercise training that is individulized based on the results of an exercise stress test. Lastly, phase III, focuses on maintaining cardiovascular stability, and long-term conditioning. The patient will be education on some lifestyle modifications such as, losing weight, if indicated, smoking cessation, developing heart-healthy eating patterns, adhering to medical regimen and following recommendations that ensure blood pressure and blood glucose are in control. The patient is educated about an activity program and also how to manage recurrent of symptoms (Honan, 449). 7. Females can present with different manifestations discuss some of these differences? a. Women often present with symptoms different from those seen in men; in fact, 50% of women with an MI do not complain of chest pain. Therefore, the nurse needs to be alert when women complain with vague manifestations such as fatigue, shoulder blade discomfort and/or shortness of breath (Honan, 444). Mr. M has been in the hospital for three days and is still short of breath with minimal exertion. A cardiac echo was order on the day of the myocardial infarct which revealed a 35% ejection fraction of the left ventricle. It has been three days and a repeat echo is ordered revealing a further decline in left ventricular function to 25%. A chest x-ray also reveals pulmonary edema and bilateral pulmonary effusions. Mr. M is having complications as a result of his MI. 8. What is the diagnosis for this complication given the information listed above? a. The echocardiogram that was done was to assess how effective the left ventricle was pumping. Therefore, a Left ventricle ejection fraction is a measurement of how much blood is being pumped out of the left ventricle of the heart with each contraction. A normal ejection fraction ranges from 50% to 70%, Mr. M’s ejection fraction continued to decline which meant that the pumping ability of the left ventricle was below normal. In this case, indicating moderate to severe left sided heart failure. 9. What are the clinical manifestations of left sided heart failure? (Mr. M likely HF) a. The left ventricle is responsible for getting oxygen-rich blood to the rest of your body, so when the left ventricle isn’t pumping effectively the blood backs up into the lungs which is the reason why these symptoms differ. The manifestations of left sided heart failure are as follow, dyspnea, orthopnea, cough, pulmonary crackles, S3 ventricular gallop, oliguria if kidney perfusion is diminished, decreased perfusion to other systemic organs (advanced failure), sluggish GI motility, dizziness, lightheadedness, confusion, restlessness, anxiety, skin cool and clammy, decrease in EF, tachycardia and/or weak thread pulse and fatigue or activity intolerance (Honan, 458).This study source was downloaded by from CourseH on :41:37 GMT -06:00 Zaina Aoun Madonna University Saturday September 21, 2019 10. What are the clinical manifestations you would likely see if this was right sided heart failure? a. Right sided heart failure differs in its manifestations because in right sided heart failure the blood backs up into the body’s veins or systemic circulation. These manifestations involved with right sided heart failure include, lower extremity dependent edema which is dependent edema where swelling occurs following the position of the body; which includes the legs and feet, may progress to thighs, external genitalia, lower trunk, abdomen, and sacral edema in a bed-bound patient. Pitting edema is also involved (indentations in the skin that remain even after slight compression with the fingertips, hepatomegaly (enlargement of the liver), ascites (accumulation of fluid in the peritoneal cavity), anorexia and nausea, weight gain due to fluid retention, weakness/fatigue from reduced cardiac output and impaired cognition, and also in advanced stages decreased perfusion to other systemic organs. ReferencesThis study source was downloaded by from CourseH on :41:37 GMT -06:00 Zaina Aoun Madonna University Saturday September 21, 2019 Honan, L. (n.d.). Focus on Adult Health Medical-Surgical Nursing (2nd ed.).This study source was downloaded by from CourseH on :41:37 GMT -06:00 Powered by TCPDF ()