Case study Gary Turcell is a 66-year old male admitted to th
Case study Gary Turcell is a 66-year old male admitted to the… Case study Gary Turcell is a 66-year old male admitted to the hospital due to increasing shortness of breath over the past 3-4 weeks. He has noticed his feet and ankles are swollen by the end of the day over the past 6 days. He reports feeling tired most of the time and thinks it is because he has been waking up in the middle of the night with acute shortness of breath. He has a history of a transmural anterior wall myocardial infarction (MI) 7 years ago. At that time, he required a 3-vessel coronary artery bypass graft (CABG). He was diagnosed with hypertension (HTN) about 10 years ago and is on medication. Current medications: Atenolol 50 mg daily; Diltiazem CD 120 mg daily; ASA one daily; Lipitor 10 mg daily in the evening. He is employed full time as a janitor at a local elementary school. He is married with 3 adult children. He was a 2-pack/day smoker since his 20-30s, but quit following his MI and CABG. He currently drinks 2-3 glasses of wine per month. He reports occasionally smoking marijuana as a teen, but denies any other illicit drug use. He has a family history of MI, stroke, and HTN. He has no known allergies. Physical examination and diagnostic test results General, neuromuscular: Mildly obese, alert, oriented, cooperative. Extremities with full range of motion and strength 4/5. Slow, but steady gait. Vital signs: Temperature = 98.6 degrees Fahrenheit (oral); heart rate = 104 beats/min, sinus tachycardia; respiratory rate = 30 breaths/min, slightly labored, more labored with talking and transferring to the bed); blood pressure = 110/60 mmHg; oxygen saturation = 90% on 2 liters of oxygen via nasal cannula; pain = 0/0. Head and neck: Pupils equal, round, reactive to light and accommodation. Nasopharyngeal mucous membranes pink and moist. Bilateral jugular vein distention noted. Cardiopulmonary: Bilateral chest expansion symmetrical. Bibasilar crackles to auscultation. S1, S2, and S3 auscultated. Grade II/VI blowing holo-systolic murmur auscultated at apex radiating to the axilla. Point of maximal impulse displaced laterally. Bilateral 2+ pitting pedal edema with pedal pulses 1+. Upper extremity pulses 2+. Extremities cool with capillary refill of 2 seconds. Abdomen: Soft, non-tender, and bowel sounds in all quadrants. No abdominal bruits. Serum test results: Complete blood count results within normal ranges. Chemistry results within normal ranges except creatinine = 1.5 mg/dl (normal 0.6-1.2 mg/dl) and blood urea nitrogen = 30 mg/dl (normal 7.0-22.0 mg/dl). B-type natriuetic peptide = 506 pg/mL (normal < 100pg/mL). Cardiac troponins levels not significant. Other results: Chest x-ray with cardiomegaly and small bilateral pleural effusions (left> right). Electrocardiogram shows sinus tachycardia with 1-2 premature monomorphic ventricular contractions per minute, but no other acute ischemic changes. Echocardiogram with decreased left ventricle motion and decreased ejection fraction. To answer s 1-3, use the scenario above 1. Identify the likely disorder, the underlying pathophysiology (i.e., cellular and tissue changes), and relate the changes to abnormal findings to support your interpretation. 2. Identify all nursing diagnoses labels (just the label!) that apply to this patient (e.g., impaired swallowing). Identify the priority (#1) nursing diagnosis label; and for the (#1) nursing diagnosis label, explain the nursing interventions to address the identified problem. Provide evidence-based rationale to explain the need and/or benefit of each intervention. For interventions, include what the nurse should “monitor/assess”, “do”, and “teach” to the client. 3. Describe 2 medical therapies used to treat the disorder and explain their specific mechanism of action and intended impact at the cellular and/or tissue level. Health Science Science Nursing NUR 3125
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