Nursing help

NSG6001 Advanced Practice Nursing I

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Week 1: Cardiology Clinical Case

HPI A 52-year-old Irish American male is discharged from the hospital. He was hospitalized for four

days after a stent placement, following admission from the emergency room with angina

symptoms. This patient presented to the emergency room with four hours of crushing chest pain.

He was short of breath with exertion and diaphoretic. The patient thought he was having a heart

attack and was afraid to come to the hospital. The symptoms lasted for four days before the

patient sought help. The patient had been suffering from similar symptoms for the past six months

but thought that he just out of shape. It was worse upon admission to the hospital. Prior to this,

the symptoms disappeared with rest.

His symptoms were relieved in the emergency department with medication and he was

transferred to the cardiac floor for catheterization.

The patient’s symptoms were highly debilitating upon his admission to the emergency

department.

Prior to his admission to the hospital for this event, the patient was not very active because of his

angina symptoms. The pain that he had was substernal and crushing and radiated to his neck

and jaw. His symptoms resolve with rest only. He has not sought any therapeutic maneuvers.

He is currently asymptomatic and is here for a follow-up visit from his hospitalization to discuss

his risk factors. The patient is still concerned that he may have other episodes of angina, even

after the stent placement.

PMH The patient has not sought care for his problems in the past. He had been treated for

hypertension and high cholesterol in the past but stopped medication on his own. Besides that,

he has had no other significant illnesses.

He was hospitalized for a cholecysectomy ten years ago.

NSG6001 Advanced Practice Nursing I

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This patient had a baseline EKG at his doctor’s office when he was first prescribed his blood

pressure medication. Otherwise he’s had no other investigations for heart disease besides his

cholesterol levels checks.

Results of Laboratory Investigations Following Hospitalization

Total cholesterol - 210

LDL- 200

HDL- 25

Triglycerides – 250

Fasting blood sugar – 140

HgbA1c – 7.5

CXR – hyperinflation of the lungs – no infiltrate

EKG – no change from baseline.

Risk Factors:

• High blood pressure

• Hypercholesterolemia

• Type 2 diabetes

• Android obesity

• Cigarette smoker

• Positive family history

Past surgical history of Cholecysectomy, almost 10 years age without any complications.

ROS

Review of systems is otherwise negative

DISCHARGE MEDICATIONS

Tenormin XL 50 mg QD

Lipitor 10 mg QD

Glucophage – 500mg BID

Baby ASA QD

Patient is now compliant with the prescribed regimen, but wasn’t in the past. The medicines were

prescribed by the physician who discharged him from the coronary care unit.

NSG6001 Advanced Practice Nursing I

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ALLERGIES/REACTIONS

Patient has no known drug allergies

SOCIAL HISTORY

The patient is a high school graduate and a licensed carpenter and is anxious to get back to work

because of finances. His income is around $50,000.00 per year. His wife is currently disabled

with uncontrolled type 2 diabetes. The patient has disrupted self-efficacy because he is not sure

whether he can care for his wife, who needs his help, now that he is sick. They live paycheck to

paycheck and cannot afford a vacation. They have three grown-up children who have left home

and do not live in the area. The patient has lived in the same city all his life. He does not

participate in sports or any other physical activity. The streets of his neighborhood are not safe for

exercising; the crime rate is high. There is little community socialization and most people are at

the poverty level.

He is the sole bread winner in the family. His stress level is very high because of the impending

bills that he needs to pay while he is not able to work. He believes that a man should be able to

care for his family and be strong enough not to suffer from any illnesses himself.

The patient and his wife live in a one-bedroom apartment in an inner city, quite isolated from their

community. They do not have any relatives living in the area nor do they socialize with neighbors.

He has little emotional or social support. He is stressed most of the time and is now suffering from

depressive symptoms such as sleeping excessively and over eating.

This patient has health insurance through the union to which he belongs, but it does not offer

complete coverage of all his prescription medications. Though he goes to a clinic that is

associated with the hospital, he does not always see the same primary care provider.

HABITS

• Diet Habits

The patient usually eats one large meal a day after work. He skips breakfast most of the times

and eats fast food for lunch. He eats few fruits and vegetables; mostly pasta and meat at home.

He feels that he got all the exercise he needed when he was a young man, and the exercise he

gets as a carpenter now is sufficient to keep him healthy.

Smoking: He smokes 1 pack per day from the past 30 years

NSG6001 Advanced Practice Nursing I

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Alcohol: Does not drink

Substance Use: Denies street drug use

• WORK HABITS

He’s always been a carpenter; has no hobbies and reads at home.

• FAMILY HISTORY

He has two older brothers who are being treated for high blood pressure and type 2 diabetes.

Both brothers were diagnosed with these disorders in their early forties.

Both parents are deceased; father from heart disease, and mother from breast cancer.

7. PHYSICAL EXAMINTAION

Vital Signs: BP: 160/92 left are sitting; P:60 ; R: 16; T: 98; Wt: 220#; Ht:– 70”

HEENT: WNL

Lymph Nodes: None

Lungs: Decreased breath sounds throughout, no adventitious sounds

Heart: RRR without murmur

Carotids: Right bruit

Abdomen: Android obesity, WC = 44 inches

Rectum: Not examined

Genital/Pelvic: NA

NSG6001 Advanced Practice Nursing I

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Extremities, Including Pulses:

Decreased pedal pulses BL with lower leg edema from ankle to mid calf.

Neurologic: Not examined

EKG: No change from baseline