Case Study, Cardiovascular Disorders Gloria Gonzales is a 56-year-old Hispanic female with a history of type 2 diabetes mellitus, obesity, and hypertension. She was admitted to the medical unit 2 days ago with chest pain that was unrelieved with three nitroglycerin sublingual. She has had the following lab work: CK, LDH, AST, troponin, lipid levels, and an ECG stress test. She is scheduled to have a cardiac catheterization in the morning 3. According to Mrs. Gonzales’ medical history, what has contributed to her myocardial infarction? 4. What should the nurse anticipate doing to prepare Mrs. Gonzales to be discharged?
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Case Study, Cardiovascular Disorders
Gloria Gonzales is a 56-year-old Hispanic female with a history of type 2 diabetes mellitus, obesity, and hypertension. She was admitted to the medical unit 2 days ago with chest pain that was unrelieved with three nitroglycerin sublingual. She has had the following lab work: CK, LDH, AST, troponin, lipid levels, and an ECG stress test. She is scheduled to have a cardiac catheterization in the morning
3. According to Mrs. Gonzales’ medical history, what has contributed to her myocardial infarction?
4. What should the nurse anticipate doing to prepare Mrs. Gonzales to be discharged?
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- Case Study, Cardiovascular Disorders Gloria Gonzales is a 56-year-old Hispanic female with a history of type 2 diabetes mellitus, obesity, and hypertension. She was admitted to the medical unit 2 days ago with chest pain that was unrelieved with three nitroglycerin sublingual. She has had the following lab work: CK, LDH, AST, troponin, lipid levels, and an ECG stress test. She is scheduled to have a cardiac catheterization in the morning 1.Explain the rationales for the laboratory tests and ECG stress test. 2. What should the nurse do to prepare for the cardiac catheterization that is scheduled?Patient M., 36 y/o, was found in the street unconscious. The patient has a medical history of diabetes. There is a smell of alcohol from the mouth. The skin is moist, warm, arterial pressure -145/90 mm column of mercury, convulsive twitching of muscles. Breathing is shallow, eye ball tone is retained, pupils are dilated, hyperflexion. How would you treat this patients?A. Intravenous introduction of 40-80-100 ml 40% glucose solution B. Injecting 20 units of insulin subcutaneouslyC. Injecting 20 units of insulin intravenouslyD. Injecting 500 ml 5% glucose solution intravenouslyE. Injecting 500 ml 0.9% sodium chloride intravenouslyHeart Failure Case Study James is a 70-year-old male brought to the emergency department (ED) by ambulance with complaints of shortness of breath. The patient's medical record shows a past history of hypertension, diabetes, MI X 2, congestive heart failure (CHF), and chronic renal insufficiency. Upon assessment, James has labored breathing at 36 breaths/min and tachycardia at 112 beats/min. His pulse oximetry is 90% on 40% oxygen via a face mask. Crackles are heard throughout his lungs. 1. List potential causes and risk factors for his condition. 2. Identify the typical symptoms of left-sided heart failure vs. right-sided heart failure with an "L" or an "R" or "B" for both. Cough Blood-tinged sputum Tachycardia Fatigue Nocturnal polyuria Exertional dyspnea Peripheral edema Crackles or wheezes Jugular venous distension Ascites and GI distress Orthopnea Cyanosis Paroxysmal nocturnal dyspnea The physician orders a chest x-ray, ECG, arterial blood gases (ABGS), and lab work to be done.…
- Case study: Mr. James McDougal, age 68 years old was admitted on July 1st, 2020 with a diagnosis of congestive heart failure, diabetes type 2, hyperlipidemia, hypertension, and cellulitis of his left calf. A central line was placed based on Mr. McDougal’s poor vascular status. Current Medications: Allergies: Aspirin 325 mg po daily Penicillin & Sulfa Digoxin (Lanoxin®) 0.125 mg po daily Carvedilol (Coreg®) 25 mg bid Furosemide (Lasix®) 40 mg bid Lisinopril (Zestril®) 5 mg po bid Simvastatin (Zocor®) 40 mg qhs Glyburide (Micronase®) 2.5 mg daily The physician orders are as follows: Admit patient to service of Dr. Monka and cardiac telemetry floor for cardiac monitoring. Out of bed with assistance Oxygen via nasal canula @ 2 L 2000-gram ADA diet Central line dressing as per hospital protocol Lactated Ringers 1000 cc to run over 8 hours via central…Case #2Mr. H is a 52-year-old male who presents to the emergency department. His left leg is in a cast, and he states that 1 week ago he was in an automobile crash and broke his upper leg. Since that time he has had difficulty “getting around” and has mostly been lying on the couch watching television. On the evening of admission he noticed a sudden onset of dyspnea and chest pain. He denies having orthopnea, cough, hemoptysis, or wheezing. He smoked two packs of cigarettes a day for 19 years, but quit 3 years ago. Mr. H suggests hypoxemia and respiratory alkalosis which might be an indication of serious illness such as pulmonary embolism. Part 1: His arterial-venous oxygen content (Ca-vO2) difference is 5.73 mL/dL Part 2: His extraction ratio (ER) 0.276 or 27.6% What is clinically happening to the patient? Please explain.Case #2Mr. H is a 52-year-old male who presents to the emergency department. His left leg is in a cast, and he states that 1 week ago he was in an automobile crash and broke his upper leg. Since that time he has had difficulty “getting around” and has mostly been lying on the couch watching television. On the evening of admission he noticed a sudden onset of dyspnea and chest pain. He denies having orthopnea, cough, hemoptysis, or wheezing. He smoked two packs of cigarettes a day for 19 years, but quit 3 years ago. Part 1: What is his arterial-venous oxygen content (Ca-vO2) difference? Part 2: Calculate his extraction ratio please.
- Case #2Mr. H is a 52-year-old male who presents to the emergency department. His left leg is in a cast, and he states that 1 week ago he was in an automobile crash and broke his upper leg. Since that time he has had difficulty “getting around” and has mostly been lying on the couch watching television. On the evening of admission he noticed a sudden onset of dyspnea and chest pain. He denies having orthopnea, cough,hemoptysis, or wheezing. He smoked two packs of cigarettes a day for 19 years, but quit 3 years ago.Blood work values on room air:Blood Gas Blood Gas Arterial Venous pH 7.51 7.40 PaCO2 30 mmHg 45 mmHg PaO2 60 mmHg 30 mmHg HCO3 24 mEq/l 21 mEq/l BE - 1 - 4 SaO2 90% 60% Hb 15 g/dl 15 g/dl Part 1: Interpret the ABGPart 2: What is the arterial- venous oxygen content (Ca-vO2) difference for this patient?Patient C., 32 y/o, complains of excessive weight, shortness of breath, defective memory, performance decrement, feeling cold, emotional retardation. It is known from the case history that the patient is suffering from primary hypothyroidism. Objectively: the skin is dry, waxlike, swollen, periosteal reflexes are lowered, body mass index: 33.5 kg/cubic meter, TSH (thyroid-stimulating hormone) – 25 µU/dL (norm 0.5 -5.0). Obesity is homogenous. Arterial pressure: 150/100 mm column ob mercury. What type of obesity can be suspected?A. Endocrine hypothyroidB. Endocrine accompanying dysfunctions of hypothalamopituitary systemC. Alimentary constitutionalD. HypothalamicE. Androidal with the developed symptoms of metabolic syndromePatient C, has stomach cancer using corticosteroids and currently on his 4th week of radiation therapy. Patient is alcoholic and loves to eat highly seasoned food. Medications include aluminum hydroxide, Medical Diagnosis Gastritis. Medications given: Ranitidine, Omeprazole, Sucralfate, Misoprostol (Cytotec)Identify the etiology, trends and issues regarding the disease
- Patient's Profile: A 22-year-old woman in her 2 pregnancy has arrived in the labor ward at 38 weeks 3 days She had a normal delivery 18 months ago. This pregnancy has been complicated by persistent vomiting until 20 weeks and more recently by anemia. She reports contractions commencing approximately 4 hours ago. She took paracetamol at home and tried to relieve the pain with a bath, but now she feels she cannot cope with the pain She had a show 2 days ago but has had no bleeding since then and has not noticed any vaginal leak. She has felt the baby moving normally all day. Physical Examination: BP is 110/58 mmHg, heart rate is 98/min. The presentation is cephalic with 2/5 palpable abdominally, Uterine contractions are palpable and the uterus is non-irritable. On vaginal examination the cervix is 5 cm dilated and the head is 1 cm above the ischial spines. The fetus is right occipitotransverse with mild caput and molding. The membranes are intact but rupture spontaneously during…Case Study 1 -Acute Coronary Syndrome – Had a heart attack last year. June is a 70-year old female who will be entering your Phase II Cardiac Rehab. class today. Her medical history is as follows: Cardiac History: Anterior MI (heart attack) with PTCA & stent placement to the left circumflex artery on 8/18/21. Other medical history: Hyperlipidemia, smoker- quit 5 years ago. Medications- Lipitor- cholesterol medication, Coumadin- a blood thinner, Enteric coated aspirin- also prevents clotting, Toprol – Betablocker med for Blood Pressure control, Nitroglycerin as needed for chest pain Graded Exercise Test: Not available 1. Do a google search to look up the medications June takes, and notice their effects. Which of these drug side effects may affect June’s exercise prescription from what you can find? 2. Write an exercise prescription for June. Use your FITT principle to help you but make sure you state any precautions or considerations you for June, since she is an ACS…Description A-45-year-old woman presents complaining of fatigue, 30 pounds of weight gain despite dieting, constipation, and menorrhagia. On physical examination, the thyroid is not palpable: the skin is cool, dry, and rough: the heart sounds are quiet; and the pulse rate is 50 bpm. The rectal and pelvic examinations show no abnormalities, and the stool is negative for occult blood. The clinical findings suggest hypothyroidism. Questions A. What other features of the history should be elicited? What other findings should be sought on physical examination? B. What is the pathogenesis of this patient's symptoms? C. What laboratory tests should be ordered, and what results should be anticipated? D. What are the possible causes of this patient's condition? Which is most likely? E. What other conditions may be associated with this disorder?