Case study

Learning Goal: I’m working on a nursing case study and need an explanation and answer to help me learn.

NU606 Week 7 Case Study

Part 1

Ms. X, age 55 years, has been complaining of severe fatigue and indigestion on and off, but it seems to be getting worse over the past several hours. Her son is quite concerned and decides to take her to the emergency department. On arrival, she appears very anxious, and her facial skin is cool and clammy; her blood pressure is 90/60, and her pulse is around 90, weak and irregular. She is given oxygen, an intravenous line is opened, and leads for ECG are attached. Blood is taken for determination of serum enzymes and electrolytes. Tentative diagnosis is myocardial infarction involving the left ventricle. Her son provides information indicating that Ms. X is a long-time smoker, has a stressful job as a high school teacher, is recently separated after 20 years of marriage, and is fearful of losing the family home. Ms. X says that she seems to be more fatigued, and she stopped going to the gym about 18 months ago. She has begun to rely on fast foods like pizza and fried chicken, and she cooks infrequently. Her father died of a heart attack at age 50. She hasalso noticed more fatigue and intermittent leg pain when walking or climbing stairs at work. Generalized atherosclerosis is suspected.

1. List the high-risk factors for atherosclerosis in this patient’s history. For each risk factor, identify whether it would be measured/reported subjectively, objectively, or both.

2. Assuming that Ms. X does, indeed, have atherosclerosis, how would this lead to the condition she is experiencing today?

3. What do you suspect Ms. X was experiencing when she reported indigestion? Was this true indigestion or related to her cardiac condition? Explain the pathophysiology behind this pain.

Part 2

Because Ms. X is now stable and you are waiting on labs, you review some of her medical records. At her last several office visits with her PCP, her blood pressure was noted to be 145/90, 138/96, 150/94, and 142/96. She is not taking any medications for blood pressure at this time.

4. Do you think Ms. X has essential hypertension? Evaluate her blood pressure readings and use them to support your position.

5. Describe the pathophysiology of essential hypertension.

6. Identify two possible problems associated with prolongedhigh diastolic pressure and describe how they occur.

Part 3

After some diagnostics, it is determined that Ms. X has a large infarct in the anterior left ventricle; she continues to be monitored on telemetry.

7. What ECG changes would you expect to support left ventricular involvement and infarction?

8. Ms. X is showing increasing PVCs on the ECG. What is causing these, and what can happen if these continue to increase in frequency?

Part 4

Unfortunately, Ms. X’s condition becomes less stable, and she is unable to go home. Several days later, she is found unconscious on the floor of her hospital room bathroom. Her pulse is weak and elevated, and her skin is moist with pallor evident. Her BP is 50 systolic. A diagnosis of cardiogenic shock is made, and resuscitation efforts are started.

9. What signs and symptoms is Ms. X exhibiting that support cardiogenic shock? Label each as subjective (symptom) or objective (sign).

10. Describe the pathophysiology of cardiogenic shock and the effects of cardiogenic shock on the organs of the body.