Cardiovascular case study

Case study

• Wesley Mannon is a 48-year old, Cambodian-American, male admitted to the emergency department with a 3-day history of substernal chest pain radiating to his back. He first noted the pain while mowing the lawn and thought it was due to overexertion. Initially, the pain severity was 8/10 (0-10 pain scale), but now it is a 4/10. He reports mild shortness of breath and nausea, but has not vomited. He denies fever, cough, headache, or change in the quality or nature of the pain with deep breathing or position change.
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• He reports overall good health prior to this incident. He walks 3 miles per day. He denies any recent weight changes. His last total cholesterol was 232 mg/dL, and he admits to eating fast foods daily. He smokes half a pack of cigarettes per day and has done so for the past 15 years.
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• He reports his blood pressure has been a “little elevated” for the past few years, but does not recall if he was diagnosed with hypertension. He denies any history of diabetes or chronic lung disease. He reports a family history of myocardial infarction. He is not taking any medications and has no allergies. He is employed as a corporate manager and states his job is “very stressful”.Physical examination and diagnostic test results
• General, neuromuscular: Alert, oriented, cooperative, and moderately anxious. Full range of motion in all extremities with strength 5/5.
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• Vital signs: Temperature = 98.6° Fahrenheit; heart rate = 122 beats/min, sinus tachycardia; respiratory rate = 26 breaths/min, slightly labored; blood pressure = 158/98 mmHg; oxygen saturation = 95% on 2L nasal cannula; pain = 4/10 (substernal chest, radiates to back).
• Skin, nails: Skin pink, but slightly cool and diaphoretic. Capillary refill <2 seconds in all extremities. No clubbing.
• Head, neck: Pupils equal, round, reactive to light and accommodation. Nasopharyngeal membranes pink and moist. Cervical lymph nodes and thyroid non-palpable. Bilateral jugular vein distension present.
• Cardiopulmonary: Tachypnea with mild use of accessory muscles with inspiration. Chest wall non- tender to palpation. Bilateral inspiratory crackles at both lung bases. Apical pulse located at the 5th intercostal space just lateral to the mid-clavicular line. S1, S2, and a soft S3 heard. No murmurs heard. Peripheral pulses 2+ in all extremities and 1+ pedal edema noted.
• Abdomen: Abdomen soft, non-tender with normoactive bowel sounds throughout. Voided 300 mL clear, yellow urine.
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• Serum results: Complete blood count results within normal ranges; troponin T = 2.9 ng/ml (normal < 0.2 ng/ml); creatine kinase (CK) = 141 units/L (normal 30-135 units/L); creatine kinase myofibrillary-bound isoenzyme (CK-MB) = 2% (normal 0% of total CK).
• Other results: 12-lead electrocardiogram shows sinus tachycardia at 122 beats/minute, 6-8 polymorphic premature ventricular contractions/minute, and ST segment elevation with T wave inversion in leads V3 and V4. Chest x-ray shows clear lungs and borderline cardiomegaly.

Fall

To answer questions 1-3, use the scenario above

1. 1—Identify the likely disorder, the underlying pathophysiology (i.e., cellular and tissue changes), and relate the changes to abnormal findings to support your interpretation. 
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3. 2—Identify all nursing diagnoses labels (just the label!) that apply to this patient (e.g., impaired swallowing). Identify the priority (#1) nursing diagnosis label; and for the (#1) nursing diagnosis label, explain the nursing interventions to address the identified problem. Provide evidence-based rationale to explain the need and/or benefit of each intervention. For interventions, include what the nurse should “monitor/assess”, “do”, and “teach” to the client. 
4. (USE THIS SITE PLEASE- ELSEVIER NURSING DIAGNOSIS HANDBOOK ELEVENTH EDITION)
5. http://repo.stikesperintis.ac.id/1034/1/77%20Nursing%20diagnosis%20handbook%20an%20evidence-based%20guide%20to%20planning%20care%20Ed%2011.pdf
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7. 3—Describe 2 medical therapies used to treat the disorder and explain their specific mechanism of action and intended impact at the cellular and/or tissue level. 

Answer questions 4-5 on Peripheral Artery Disease.

1. 4—For Peripheral Artery Disease, identify the disorder and describe the impact on the population in the United States including incidence, prevalence, costs, morbidity, mortality, and/or other appropriate issues. Be sure to identify the disorder, the population associated with the data, and the year(s) of data. 
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3. 5—For Peripheral Artery Disease, locate recommendations in a nursing journal article or professional nursing organization. Provide a brief summary of the information and specific recommendations for nursing actions to improve care for patients.