14 Jan Respond on or before Day

Week 4 discussion

Discussion Part I: Assessment and Care of Patients With Cardiovascular Conditions

Many cardiac disorders such as myocardial infarctions are a common problem in the acute care setting. Thus it is essential for you, as the advanced practice nurse caring for acute patients, to identify potential signs and symptoms of complications. Although some cardiac disorders require outpatient treatment and management, other procedures such as CABGs or valve replacements are more common and frequently require major interventions. In your role with acute cardiac patients, you must evaluate symptoms and determine how to treat patients. For this Discussion, consider potential diagnoses, treatment, and/or referral options for the patients in the following 3 case studies.

Case Study 1: Tom is 56-year-old African American male who presented to the ED with chest pain radiating to his back. The pain has been continuous for 1 hour. The patient complains of shortness of breath. The pain has not been relieved with rest. The patient’s vitals are: 99.1-98-18-198/110. The patient’s cardiac enzymes are negative. Labs results are as follows:

Na 134

K 4.1

Cr 1.8

BUN 42

Glucose 248

WBC 13.1

Hbg 14.1

Hct 44.2

Plt 236

EKG sinus rhythm no ekg changes

Case Study 2: Liz is a 79-year-old female with a history of aortic stenosis and hypertension. The patient underwent elective aortic valve replacement yesterday. This AM during rounds, the patient is sitting up in the chair. Vital signs: 99.4-54-20-85/50. Pa 29/13, CVP10. Urine output 20 ml/hr for the last 3 hours. Cardiac output 3.9, cardiac index 1.8. Patient’s preop ef was 50%. Labs are as follows:

K 4.0

Cr 1.5

BUN 42

Hgb 9.8

Hct 29.1

Plt 138

Postoperative chest X-ray normal

Case Study 3: Arvid is a 69-year-old male you are seeing in CCU 1 hour after he had a CABG × 4. The patient is intubated. VS: 97.1-78-14-90/50. PA 30/13, CVP 12. ABG 7.21-49-98-19.6-99%- -6 base deficit. Mixed venous O2 sat 68. Hgb 10.2, Hct 32.1. The patient is sedated. Vent settings FiO2 50%, IMV 12, PEEP 5, tidal volume 550.

To prepare:

Review and select 1 of the 3 case studies provided. Analyze the patient information.

Consider a differential diagnosis for the patient in the case study you selected. Think about the most likely diagnosis for the patient.

Think about a treatment and management plan for the patient. Be sure to consider appropriate dosages for any recommended pharmacologic and/or nonpharmacologic treatments.

Consider strategies for educating patients and families on the treatment and management of the cardiac disorder.

Post on or before Day 3 an explanation of the differential diagnosis for the patient in the case study you selected. Explain which is the most likely diagnosis for the patient and why. Include an explanation of unique characteristics of the disorder you identified as the primary diagnosis. Then, explain a treatment and management plan for the patient, including appropriate dosages for any recommended treatments. Finally, explain strategies for educating patients and families on the treatment and management of the cardiac disorder.

Read a selection of your colleagues’ responses.

Respond on or before Day 6 to at least two of your colleagues on 2 different days in both of the ways listed below. Respond to colleagues who selected different case studies from yours.

Describe how a patient factor such as age, gender, ethnicity or culture might affect the diagnosis, management, and follow-up care of patients with the cardiac disorders your colleagues discussed.

Based on your personal and/or professional experiences, expand on your collea