...Cardiac Case Study Pharmacology 291 Larry Goldie, a 63-year-old Caucasian male, visits the healthcare clinic complaining of increasing fatigue and difficulty breathing. Physical assessment findings include a rapid, irregular heart rate of 138 beats per minute, BP of 140/86, and a respiratory rate of 28. His breath sounds are clear with fine crackles in the bases bilaterally. He has positive jugular vein distention (JDV) bilaterally and 1+ pitting edema of his ankles bilaterally. His initial medical diagnosis is heart failure (HF). His past medical history includes: CHD, MI, and HTN. Larry is admitted to the acute care facility. 1. The nurse considers Larry’s symptoms that differentiate right and left-sided failure. (10 points) Left-...
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...Case Studies on Cardiac Function This is the first case study that is required for the class. Please submit a paper (doesn’t have to be long; you could even give me bullet-point answers to the questions listed below) that answers all of the questions posed after Case Study 1. I have included an easy second case study which, if you complete it, will be worth extra credit. Answers to the first Case Study are worth 25 points and responding to Case Study 1 is required work for the course. The extra credit, which is not required, will be worth a total of 10 points. Case 1 A.O. is an 89-year-old woman with a long history of systolic heart failure secondary to a large left ventricular infarct when she was in her 70s. She had poor activity tolerance and required assistance with activities of daily living. Even minimal activity was associated with moderately severe dyspnea and exertional chest pain, which was relieved by rest. A.O. also exhibited marked pedal edema bilaterally. She is being treated with digitalis, furosemide (Lasix), KCl, and sublingual nitroglycerin. Discussion Questions 1. Which type of heart failure (left or right sided) is usually associated with dyspnea? Left-sided heart failure is usually associated with dyspnea. What other clinical findings are likely to be present with left-sided heart failure? Other clinical findings that are likely to be present with left-sided heart failure include radiographic cardiomegaly, abnormal apical pulse and...
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...to explore the applications of stem cells while avoiding the ethical problems associated with embryonic stem cell research (Seki & Fekuda, 2015). One intriguing area in stem cell research is the potential applications for them in the treatment of cardiac diseases. Studies have explored the potential uses for stem cells for the treatment of heart disease (Yamakawa & Ieda, 2015). Additionally, stem cells have been explored for the treatment of heart failure and myocardial infarction (Rasmussen, et al., 2013). Stem cells and how they may be used for the treatment of various cardiac diseases is an exciting topic and has the potential to change future approaches to the treatment. This paper will examine the applications and significance of stem cells in relation to these common cardiac pathologies. Heart disease is one of the leading causes of death in developed countries and currently there are few effective treatment options available (Yamakawa & Ieda, 2015). This it is important to research and make state of the art treatments available to address this issue. The use of stem cells may become an option for treatment of coronary artery disease (CAD). One approach has involved the use of endothelial progenitor cells (EPCs). In one study, EPCs were introduced into areas affected by ischemia and have been able to generate proliferation of new...
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...Consistent Daily Weighing Important of Cardiac Patients Student’s Name Institution Consistent Daily Weighing Important of Cardiac Patients In almost all parts of the world, cardiac-related problems are one of the most leading causes of death (Windale, 2010). The term cardiac problems often connote a deadly disease, silent killer and/or a type of illness related to diabetes, stroke and coronary heart disease. Studies conducted reveal that chronic heart failure and other forms of cardiac disorders account for high hospitalization and high mortality rate (Bushnell, 1992). According to Windale (2010), the three most prevalent types of cardiac problems, which are based from the World Health Organization statistics, are in the form of diabetes, heart failure and coronary artery diseases. People from various countries suffer from this threatening problem, and it often manifests in the form of angina or chest pains. Windale pointed out that such disorder is associated with cultural lifestyle of various nations (2010). Patients with cardiac problems often seem to have lowered functional and physical impairment, decreased quality of life (QoL), increased caregiver responsibilities, especially during hospitalizations (Remme & Swedberg, 2001). Increased hospitalizations for cardiac patients are one of the results of the problem. However, compliance to intervention strategies often poses a greater problem for the healthcare community. Such intervention...
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...Case Study 1 Heart Failure M.G., a “frequent flier,” is admitted to the emergency department (ED) with a diagnosis of heart failure (HF). She was discharged from the hospital 10 days ago and comes in today stating, “I just had to come to the hospital today because I can't catch my breath and my legs are as big as tree trunks.” After further questioning, you learn she is strictly following the fluid and salt restriction ordered during her last hospital admission. She reports gaining 1 to 2 pounds every day since her discharge. 1. What error in teaching most likely occurred when M.G. was discharged 10 days ago? If M.G. is currently following her fluid and salt restriction strictly but is still exhibiting the symptoms of fluid overload in heart failure, there was most likely an error in regards to medication teaching. She would have been prescribed a diuretic to eliminate the fluid that what giving her shortness of breath, edema and weight gain but if not taken correctly or at all this would explain why M.G. is still having these manifestations. CASE STUDY PROGRESS During the admission interview, the nurse makes a list of the medications M.G. took at home. * Chart View Nursing Assessment: Medications Taken at Home Enalapril (Vasotec) 5 mg po bid Pioglitazone (Actos) 45 mg po every morning Furosemide (Lasix) 40mg/day po Potassium Chloride 20meq/day po 2. Which of these medications may have contributed to M.G.’s heart failure? Explain. ...
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...Aldosterone: Role in Edematous Disorders, Hypertension, Chronic Renal Failure, and Metabolic Syndrome. Schrier RW, Masoumi A, Elhassan E. University of Colorado Denver, Aurora, Colorado. Abstract The role of aldosterone has expanded from the hormone's genomic effects that involve renal sodium transport to nongenomic effects that are independent of the effect of aldosterone on sodium transport. The nongenomic effects of aldosterone to increase fibrosis, collagen deposition, inflammation, and remodeling of the heart and blood vessels, however, are markedly increased in the presence of high sodium intake. The genomic effect of aldosterone increases renal sodium transport, but the administration of large doses of aldosterone to normal individuals does not cause edema, relating to the phenomenon of "aldosterone escape"; however, in edematous disorders including cardiac failure, cirrhosis, and nephrotic syndrome, impaired aldosterone escape leads to renal sodium retention and edema formation. There is now considerable evidence for the nongenomic effects of aldosterone in several important diseases. Thus, low dosages of mineralocorticoid antagonists, with little or no effect on urinary sodium excretion, have been shown to afford a beneficial effect on morbidity and mortality in patients with advanced cardiac failure and after acute myocardial infarction. Three-drug-resistant hypertension has also been found to respond to spironolactone in modest dosages. The combination of an...
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...Case Study 1 Heart Failure M.G., a “frequent flier,” is admitted to the emergency department (ED) with a diagnosis of heart failure (HF). She was discharged from the hospital 10 days ago and comes in today stating, “I just had to come to the hospital today because I can't catch my breath and my legs are as big as tree trunks.” After further questioning, you learn she is strictly following the fluid and salt restriction ordered during her last hospital admission. She reports gaining 1 to 2 pounds every day since her discharge. 1. What error in teaching most likely occurred when M.G. was discharged 10 days ago? The patient most likely failed to adequately apply the fluid and sodium restrction diet properly. Upon discharge teaching, she probably did not have an appropriate understanding of how much soidum to restrict in her diet, as well as what foods may be high in sodium. She also may not have an adequate understanding of what a "fluid" restriction diet entails. CASE STUDY PROGRESS During the admission interview, the nurse makes a list of the medications M.G. took at home. * Chart View Nursing Assessment: Medications Taken at Home Enalapril (Vasotec) 5 mg po bid Pioglitazone (Actos) 45 mg po every morning Furosemide (Lasix) 40mg/day po Potassium Chloride 20meq/day po 2. Which of these medications may have contributed to M.G.’s heart failure? Explain. a. Pioglitazone: Side effects:Severe weight gain and water retention (edema) are...
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...Case Study 2 A.O. is an 89-year-old woman with a long history of systolic heart failure secondary to a large left ventricular infarct when she was in her 70s. She had poor activity tolerance and required assistance with activities of daily living. Even minimal activity was associated with moderately severe dyspnea and exertional chest pain, which was relieved by rest. A.O. also exhibited marked pedal edema bilaterally. She is being treated with digitalis, furosemide (Lasix), KCl, and sublingual nitroglycerin. Discussion Questions: 1. Which type of heart failure (left or right sided) is usually associated with dyspnea? What other clinical findings are likely to be present with left-sided heart failure? The type of heart failure usually associated with dyspnea is left-sided. Other clinical findings likely to be present with left-sided heart failure are cardiomegaly and pulmonary congestion such as orthopnea or basilar crackles. There would also be an increased heart rate and S3 heart sound while listening with a stethoscope. 2. What compensatory mechanisms are likely to be operative in A.O. to enhance cardiac output? The following compensatory mechanisms are likely to be operative to enhance cardiac output: myocardial hypertrophy due to prolonged stretch on the myocardium; baroreceptors will detect a low blood pressure and carbon monoxide levels, which would excite the sympathetic system due to an increased heart rate. During this mechanism the beta receptors will downregulate;...
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...Case Studies on Cardiac Function Case 1 A.O. is an 89-year-old woman with a long history of systolic heart failure secondary to a large left ventricular infarct when she was in her 70s. She had poor activity tolerance and required assistance with activities of daily living. Even minimal activity was associated with moderately severe dyspnea and exertional chest pain, which was relieved by rest. A.O. also exhibited marked pedal edema bilaterally. She is being treated with digitalis, furosemide (Lasix), KCl, and sublingual nitroglycerin. Discussion Questions 1. Which type of heart failure (left or right sided) is usually associated with dyspnea? Left-sided What other clinical findings are likely to be present with left-sided heart failure? Signs of pulmonary congestion are orthopnea or basilar crackles. Possible cough. Increased heart rate and S3 heart sound with auscultation. 2. What compensatory mechanisms are likely to be operative in A.O. to enhance cardiac output? Baroreceptors will detect a low blood pressure and carbon monoxide levels, which would excite the sympathetic system resulting in an increased heart rate. During this mechanism the beta receptors will down regulate leaving this mechanism less effective. Prolonged stretch on the myocardium will result in myocardial hypertrophy. 3. What is the most likely cause of A.O.’s pedal edema? Right sided failure causes pedal edema. 4. What is the cause of A.O.’s exertional...
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...diomyopathy Topic presentation on Cardiomyopathy Topic presentation on Cardiomyopathy INDEX S.N | CONTENT | PG.NO | 1 | Introduction | 5 | 2 | Definition Cardiomyopathy | 5 | 3 | Classification | 6 | 4 | Risk Factors | 7 | 5 | Clinical Manifestations | 7 | 6 | Diagnostic Evaluation | 7-9 | 7 | Dilated CardiomyopathyDefinition,Charecteristics,Types , Causes,Diagnostic Evaluation,Pathophysiology,Clinical Manifestations,Medical Management | 10-17 | 8 | Hypertrophic CardiomyopathyIncidence,Causes,Charecteristics,Clinical Manifestations,Medical And Nursing Management | 18-21 | 9 | Restrictive Cardiomyopathy-Other Names,Causes,Pathophysiology,Clinical Manifestations,Diagnostic Evaluation,Medical Management | 23-26 | 10 | Surgical management | 27-32 | 11 | Prevention | | 12 | Nursing Management,Home Care Management | 32-40 | 13 | Complications | 40-42 | 14 | Conclusion | 42 | 15 | Research Abstract | 42-43 | 16 | References | 44 | GENERAL OBJECTIVE: On completion of the course the students aquires indepth knowledge regarding cardiomyopathy and able to apply this knowledge with a positive attitude. SPECIFIC OBJECTIVE: On completion of the course the students are able to ...
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...Prevention of Hospital Readmissions Related to Symptoms of Congestive Heart Failure NRS 441V Professional Capstone March 1, 2014 Abstract Providing patients diagnosed with Congestive Heart Failure effective teaching can eliminate reoccurring hospitalizations. Patients are discharged with CHF and readmitted within 30 days. The information provided will examine the process of enhancing patient knowledge and provide additional resources essential for effective health care management. Research evidence provides data that proves patients who are diagnosed with CHF needs a variety of health care needs during admission and after discharge. The proposal will display an evaluation plan, implementation plan and a dissemination of the evidence. Provide at least 1 evidence based literature; for at least 1 evidence based solution. Keywords: congestive heart failure, therapy, education, patient outcomes Description of the Problem Prevention of Hospital Readmissions Related to Symptoms of Congestive Heart Failure Health care providers must ensure skills, knowledge and teaching is effective when providing care to their patients and families about symptoms of CHF. The length of stay for an average hospital visit can be two days however, for more chronic issues warrant an even longer stay. To avoid readmission of the disease processes of CHF warrants additional care and resources during and after discharge. . Some patients cannot follow up with their primary care physician because...
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...Heart Failure Prevention Daniel Ruiz Grand Canyon University: NRS-429V March 16, 2014 Heart Failure Prevention There has begun a shift from acute care in the hospital setting to a more preventative approach, taking place in the community. With this shift, nurses will be taking a more involved role in preventing disease and promoting health. As healthcare evolves and changes over time, so has the role of the nurse. They will be seeing an increase in their responsibilities in implementing health promotion and disease prevention that can be approached in three different levels, primary, secondary and tertiary health promotion prevention. Health promotion is the process of helping people improve their lifestyle and taking steps towards more optimal health. The purpose of health promotion in nursing practice is just that, to help those they care for increase their health and quality of life. The nurse implements this improvement in several different areas. The nurse collaborates with those around them, other nurses, physicians, social workers and other interdisciplinary staff. The nurse advocates for individuals to ensure they are receiving the care they deserve and to help the individual learn to advocate for themself. The nurse is a case manager, collecting information and passing it along. They are a consultant and educator, teaching and providing information to help promote the health of the individual, family and community. The nurse provides direct...
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...Congestive Heart Failure FC IV Valvular Heart Disease Secondary to Rheumatic Heart Disease A case Presentation A Presented to: The Faculty College of Nursing Adventist University of the Philippines In Partial fulfillment Of the Course N303 Curative and Rehabilitative Nursing Care 1st Semester By: Tha Hnem Section F Presentation Date: September, 4, 2007 I. Introduction Heart failure, also called congestive heart failure (CHF), is a life-threatening condition in which the heart can no longer pump enough blood to the rest of the body. Heart failure is almost always a chronic, long-term condition, although it can sometimes develop suddenly. Rheumatic fever and Valvular Heart Disease also contributed to Heart Failure. This condition may affect the right side, the left side, or both sides of the heart. Rheumatic heart disease refers to the cardiac manifestations of rheumatic fever, including pancarditis (myocarditis, pericarditis, and endocarditis) during the early acute phase and chronic valvular disease later. Long-term antibiotic therapy can minimize recurrence of rheumatic fever, reducing the risk of permanent cardiac damage and eventual valvular deformity. In valvular heart disease, three types of mechanical disruption can occur; stenosis, or narrowing, of the valve opening: incomplete closure of the valve; or prolepses of the valve. They can result from such disorders as endocarditis (most common), congenital defects, and inflammation, and they...
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...Heart Failure is a progressive heart disease when the muscle of the heart is weakened that cannot pump blood as it should be, the blood backs up into the blood vessels around the lungs and the other part of the body (NHS Choice, 2015). In heart failure, the heart is not able to maintain a normal range cardiac output to meet metabolic need of the body (Kemp and Conte, 2012). Heart failure is a major worldwide public health problem, is the end stage of heart disease and it could lead to high mortality. At present, the heart failure was thought it is associated with older age, given the dramatic increase in the population of older people (ACCF/AHA, 2013).In the USA, there have about 5.7 million adults have heart failure, about half of the people...
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...Preventing Heart Failure Readmissions Henry D. Santos Purdue University Calumet I. Introduction High morbidity, mortality, and healthcare spending have been connected with heart failure management. As per Gheorghiade et al., every year, there are almost a million cases of hospitalization for heart failure, responsible for 6.5 million hospital days, and estimated expenditures of $37.2 billion here in the United States alone (2013). The incident of heart failure readmissions has increased over the last decades, distinctly related to the aging population and surpassed recovery after a myocardial infarction. Based on the Centers for Medicare and Medicaid Services (CMS) 2005 data, heart failure is the most frequent diagnosis among Medicare beneficiaries and the third highest reimbursement for hospitals (AHRQ, 2013). In 2009, CMS started the public reporting of readmission rates after being discharge for heart failure, and, the year after, the Patient Protection and Affordable Act inaugurated financial penalties for healthcare establishments with most rates of readmission within the 30 days after discharge. The elevated concern relating the want to decrease readmissions has been the biggest focused of national researchers and hospitals with the efforts of identifying and predicting which patients with heart failure are likely to be readmitted. Formulated designs and preventive strategies have been established, in order to avoid unnecessary readmissions. Heart failures risk factors...
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