CARDIOVASCULAR CASE STUDY Clinical Scenario You are the nurse working in the cardiac care unit. Ms. Franklin is a 54-yea

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Cardiovascular Case Study Clinical Scenario You Are The Nurse Working In The Cardiac Care Unit Ms Franklin Is A 54 Yea 1 (98.63 KiB) Viewed 134 times

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Cardiovascular Case Study Clinical Scenario You Are The Nurse Working In The Cardiac Care Unit Ms Franklin Is A 54 Yea 3 (69 KiB) Viewed 134 times

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Cardiovascular Case Study Clinical Scenario You Are The Nurse Working In The Cardiac Care Unit Ms Franklin Is A 54 Yea 5 (35.91 KiB) Viewed 134 times

CARDIOVASCULAR CASE STUDY Clinical Scenario You are the nurse working in the cardiac care unit. Ms. Franklin is a 54-year-old woman admitted to your unit with a myocardial infarction (MI) 3 days ago. She is alert, oriented, and gives a reliable history. She has been experiencing headaches and worsening burning chest pains which she interpreted as indigestion, along with left arm numbness and dyspnea on exertion. Her brother, age 66, who sustained an MI at age 45, encouraged her to go to the emergency room (ER) even though she could not believe her symptoms were cardiac. Ms. Franklin thought she was just exhausted from all the yard work she had been doing. She also has a history of cervical strain from a motor vehicle accident, which she thought was acting up and causing her arm numbness. She is divorced with a 25-year-old daughter who is on her own. Ms. Franklin is working as a high school teacher and sells cosmetics part-time to make ends meet. She admits to not eating well, having a lot of fast food and frozen dinners because she eats mostly alone between jobs. She is moderately obese and knows she has a high cholesterol level, but thought she could manage it by diet and fish oil capsules. She has not had a physical examination in 3 years because she is "too busy." She has hypertension with an admission blood pressure of 176/110. She has had problems with intermittent premature ventricular contractions (PVCs), although it has not gone into ventricular tachycardia. Her work-up also revealed a systolic murmur, so she is scheduled for an echocardiogram tomorrow. As her primary nurse, it is your job to help her understand coronary artery discase, hypertension, hyperlipidemia, and all the lifestyle changes she must now make. You start with some focused questions. Interview Select the appropriate questions to ask your potient. "Do you have a family history of heart disease, rheumatic fever, or high blood pressure?" "Have you had indigestion, galbladder disease, or irritable bowel syndrome?" "Did either of your parents or any siblings have a heart attack or die of a heart attack, and at what age?" "Have you had any unusual rashes or changes in moles?" What type of diet do you eat?" "Have you taken any medication for these symptoms?" "Do you exercise regularly? How often and how much?" Have you experienced any other chest pain or discomfort? If so, when and how was it relieved?" Do your legs, feet, and ankles get swollen? If so, what do you do to help these symptoms?" "Do you experience shortness of breath? If so, when, and what relieves it?" "Do you have any burning on urination?"
Focused Review of Systems Reports onset of mid-sternal chest burning symptoms about 7 days ago, intermittently, mostly when she was exerting herself with housework or walking. Average occurrence was twice a day, lasting about 10 to 15 minutes each time. Resting seemed to help. She also tried antacids, which gave a bit of relief because she thought she was experiencing indigestion due to an increased use of ibuprofen to partly relieve her frontal headaches. History of a heart murmur as a child, but was told it was "innocent and nothing to worry about. She has not had a mummur noted on examination again until this hospitalization. She denies any other known cardiac abnormalities. Reports a history of migraine headaches since teen years, but these current headaches are different, with sharp frontal head pains that exacerbate with exertion. Headaches started about 2 weeks ago with an average of three episodes per day Reports numbness without tingling or burning sensation in left arm from shoulder to fingertips. This symptom occurred whenever she had the chest burning. She has a history of cervical neck strain. Reports shortness of breath also with exertion, but only when it involves walking fast more than one block or with heavy yard work. Stopping to rest a few moments relieves the shortness of breath. Denies wheezing. cough, hemoptysis, discolored sputum, or history of pneumonia. Denies shortness of breath at night and uses only one pillow to sleep. Never wakens with short of breath at night. Denies cyanosis of lips or extremities. Denies ankle and foot edema. Gets up once a night to void. Reports palpitatiofis experienced as irregular beats that feel like a flipping or fluttering of her heart since she was admitted with the ML Admits that anxiety seems to increase these palpitations. Denies prior cardiac symptoms, prior palpitations, and use of diet pills or other stimulants such as decongestants. Denies syncope or pre-syncope, although admits to slight dizziness when she gets several of these palpitations close together. FAMILY CARDIAC HISTORY Father died at age 62 with his third MI and ventricular tachycardia Sustained first MI at age 42. Also history of diabetes mellitus type 2 poorly controlled. Mother alive at age 88, with history of hypertension, congestive heart failure, and chronic obstructive pulmonary disease (COPD), Brother age 66 with history of MI at age 45 and hypertension and hyperlipidemia in control. Sister age 52 with hyperlipidemia. SOCIAL HISTORY Divorced mother of one adult daughter, who does not live with her. Nonsmoker, although tried cigarettes as a teen for about a week. Alcohol is social, average of one glass wine or one beer per weekend. Denies use of illegal drugs ever. College graduate; works as teacher full-time with second part-time job. Financial concerns with single income cause stress and tend to give her difficulty falling asleep some nights. Diet consists of many prepared and frozen high-sodium and high-caloric foods or fast food. She has no time to exercise beyond short walks with her dog in the yard.
Name: Documentation: Review of Systems Fill in the circle next to reported symptoms. O No murmur O Palpitations Innocent murmur Syncope O Dizziness Heart fluttering History of arrhythmia before admission COMMENT: Chest pain: 0 No cardiac pain o Chest burning pain Location: Right sternal pain Midsternal sternal pain Onset: 0 3 days ago 0 7 days ago o Duration 10-15 minutes Rellef: O Antacid relieves fully Rest relieves COMMENT Headache: None Temporal Frontal O Band-like O Sharp o With exertion with anxiety o Onset 3 days ago Onset 2 weeks ago COMMENT ; Arm numbness: O Teft o Tingling Neck pain o Weakness Chest numbness COMMENT: Respiratory: 0 Normal O Pain o Shortness of breath Cough O Wheeze O Associated with exertion Occurs at night O Ankle edema COMMENT: Family history: 0 No risks Early coronary artery disease Hypertension Hyperlipidemia O Diabetes mellitus O Myocardial infarction COMMENT: Social history: 0 No risks Smoker O No tobacco use O Alcoholic O Social alcohol Excellent diet O High sodium diet High fat diet Adequate exercise Depression Ariety Married Divorced Childless COMMENT O Right
Assessment GENERAL APPEARANCE Looks anxious. No diaphoresis; no acute pain; no cyanosis evident. VITAL SIGNS Pulse: radial and carotid 84, irregular, +2 amplitude; blood pressure left arm sitting 154/100; respirations 16, quiet, regular, temperature 97° F (tympanic) Pulse ox of 97% RA. CARDIAC Chest symmetric. Heart rate 84 beats per minute with two ectopic beats (possible premature ventricular beats per EKG) per minute noted. S S: normal. Physiologic, normal split S: in pulmonic area. No Ss, no Se grade TI/VI systolic ejection murmur, soft, musical, heard along left sternal border. Murmur louder supine. No change in sounds with left lateral recumbent position or leaning forward sitting. No click or gallop, heaves, lifts, thrills, or abnormal pulsations. Apical impulse palpated left 5th intercostal space. Apical pulse equals radial pulse. No pulse deficit. CAROTID ARTERY No bruits; no radiation of murmur. Documentation: Assessment Fill in your assessment findings, Vital Signs Temperature: Oral O Tympanic O Temporal Pulse: Rate O Regular O Irregular Amplitude: Blood Pressure: Right arm Left arm o Standing o Sitting O Lying Respirations: O Regular O Irregular COMMENT INSPECTION o lift or heave O Pulsation O Normal O Symmetric o Cyanosis Surgical scar Diaphoresis COMMENT PALPATION No vibrations o Change in skin texture Positive pulsations O Right sternal border vibration Apical pulse palpable at 84 Point of maximal impulse not palpable No thrills No pulse deficit COMMENT
Name: Documentation: Assessment (cont'd) AUSCULTATION O Normal Murmur grade: 1/10 11/1 O III/MI OVI OVNI O VI/VI O Systolic murmur O Diastolic murmur O Harsh murmur O Murmur softer supine O Murmur same bending forward OSSZ abnormal O Physiologic split 52/S2 O Murmur right and left sternal border Murmur left sternal border O Murmur right sternal border OS, heart sound O Sa heart sound O No gallop o Positive ejection click O No carotid bruit COMMENT: