Reflect on the care of this patient

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Reference no: EM133510807

CASE STUDY

Mr. Smith is a 68-year old African American male. He presents to the ER with c/o substernal chest pain radiating down his left arm, nausea, & shortness of breath.

PMH: Mr. Smith states that he has a 4 year history of CAD and an Anterior MI 2 years ago. He has a history of asthma, Type II diabetes, and hyperlipidemia.

Social/Personal History: He reports being under a lot of stress, He was divorced 2 years ago and since then been eating out a lot. He has gained a lot of weight and is unable to exercise because of his work schedule. Work has become very stressful and busy. He recently moved from outside the state and has not been able to find a religious community to join.
Family History: His father died at age 55 of a heart attack, a brother with HTN, mother died of breast cancer, and sister has no medical history.

QUESTION#1

He does well at home with minimal heart failure exacerbations for the next few months. Over the course of a year, he notes that it is harder for him to manage his daily activities, be independent, and complains of consistent fatigue, general pain, and decreased appetite. He expresses his concerns to his cardiologist and after further workup it is determined that Mr. Smith's heart failure has progressed further. The healthcare team suggests a possible heart transplant for Mr. Smith. He expresses that this is against his religious beliefs and does not desire to pursue transplantation or mechanical device support. The healthcare team consults the Palliative Care team to become involved in Mr. Smith's care. Explain to Mr. Smith the purpose of palliative care services in his healthcare team.

QUESTION#2

Mr. Smith is stabilized and discharged to home. However due to his continued oxygen needs he is discharged with home O2. What education points and precautions would the nurse provide for Mr. Smith ?

QUESTION#3

After being home a few days, Mr. Smith returns to the ED with SOB and inspiratory & expiratory wheezes bilaterally and a dry hacking cough. He denies chest pain, but states he is having trouble catching his breath. On assessment, the RN notes a prolonged expiratory phase with diminished breath sounds. Oxygen saturations are 88% on RA and RR is 28. What possible cause will the nurse be aware of? What interventions will be anticipated for this?

Question#4

After a few day stay in the Cardiac Intensive Care Unit, Mr. Smith is stabilized and diagnosed with stage C heart failure. He is prescribed 20 mg lisinopril and carvedilol 25 mg.

What medication education will the nurse provide?

What education for home management of HF will the nurse provide?

QUESTION#5

Mr. Smith has been admitted to Cardiac Care unit. The HCP has prescribed a Dobutamine drip at 5 µg/kg/min and Furosemide 20 mg IVP now for acute decompensating Heart failure. Describe 2 ways the nurse will evaluate the effectiveness of each treatment. State at least 1 assessments for each medication that would be concerning to the nurse.

QUESTION#6

Mr. Smith begins to complain of heart palpitations and the nurse notices the rhythm below on the monitor. The client is is very SOB with a RR 28 and O2 sats of 92%.

What is the rhythm Mr. Smith is experiencing? Describe 2 nursing interventions and 2 collaborative interventions the nurse should anticipate for Mr. Smith.

Mr. Smith has been home from the hospital for many months. He begins to experience breathlessness when walking upstairs, pillows to prop when sleeping, and shortness of breath. He has noticed a weight gain and his shoes are fitting tighter.

QUESTION#7

Mr. Smith has completed the cardiac cath and was diagnosed with multi vessel coronary artery disease. He was prepped for a CABG surgery to best provide blood flow to the heart. Mr. Smith had a CABG time four vessels. He has two substernal chest tubes draining 30 mls serous sanguineous fluid per hour. He has a mid-sternal incision that is dry and intact. He has left leg graft sites that are stapled and with a dry dressing. He is on 2L 02 via NC with RR of 20 BPM. HR is 78 BPM and BP 134/67. He is afebrile.

Describe day 2 post op care for this client. List appropriate nursing interventions to anticipate for this patient.

QUESTION#8

Identify at least 4 risk factors Mr. Smith has for CAD. Describe if risk factor is modifiable or non modifiable.

Question#9

Mr. Smith has been experiencing chest pain with exertion. He has now continuous substernal chest pain associated with diaphoresis and SOB.
He has admitted to the ED and placed on 2L O2 via NC and EKG was completed. His vital signs are HR98 BPM RR20 BP 145/84. EKG shows nonstemi changes and goes to the cath lab for diagnostic cath.

State medications the nurse would anticipate giving in the ED.

Question#10

Upon waking in the morning, Mr. Smith is profoundly SOB and has crackles in the lungs throughout. He returns to the hospital via the ED. He has been placed on 50% face mask and and the following ABG.

PH: 7.32 - PCO2: 48 -HCO3 ; 24 - PaO2: 55 Sat: 76%

Analyze these ABGs and give 3 Interventions the nurse might anticipate for this client?

QUESTION#11

Reflect on the care of this patient. How did this course prepare you to care for a patient like Mr. Smith?

Reference no: EM133510807

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