NSG 6001 /NSG6001 Case Study W1 A3 Week 1: Cardiology Clinical Case

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NSG6001 Advanced Practice Nursing I Page 1 of 5 © 2015 South University NSG 6001 S Week 1: Cardiology Clinical Case HPI A 52-year-old Irish American male is discharged from the hospital. He wa ... s 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 sym 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. 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: NACOURSE CODE: LGS-NSG6001 Advanced Nursing Practice I WEEK 1 5 Extremities, Including Pulses: Decreased pedal pulses BL with lower leg edema from ankle to mid calf. Neurologic: Not examined EKG: No change from baselinent. PMH The patient has not sought care for his problems in the past. He had been treated for hypertensi 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 daily Lipitor 10 mg daily Glucoph 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 \ 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. 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: NACOURSE CODE: LGS-NSG6001 Advanced Nursing Practice I WEEK 1 5 Extremities, Including Pulses: Decreased pedal pulses BL with lower leg edema from ankle to mid calf. Neurologic: Not examined EKG: No change from baseline [Show More]

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