CV Case Study (Refer to Cardiac and Comm-Interview Lecture)

CV Case Study (Refer to Cardiac and Comm-Interview Lecture) CV Case… CV Case Study (Refer to Cardiac and Comm-Interview Lecture)CV Case Study Instructions:  Read the case study and answer the following s.  You will receive full credit for completing the case study.  If any are not correct, I will provide feedback, as this is a formative learning exercise to augment critical thinking.  I have given information on the labs and medications, as you are not expected to know what these are in this class.Labs:CBC-evaluate red blood/white blood cells and platelets circulating in the blood (check anemia/infection)BMP-evaluate electrolytes (check body’s fluid balance and kidney function)BNP-checks a protein that is typically elevated in cases of congestive heart failureCPK-checks enzymes that elevate when there is muscle damage in the bodyCKMB-checks enzymes that elevate more specifically when there is cardiac muscle damageAlbumin-checks for malnutrition, liver disease, or inflammation in the bodyMedications:Aspirin-helps prevent blood clots from forming in arteries, to help reduce stroke/heart attackClopidogrel-antiplatelet that is used to reduce blood clot formationLisinopril-ace-inhibitor to reduce blood pressureCarvedilol-alpha-beta blocker used to reduce blood pressure/can also reduce preload in heart failureCase Study ScenarioGeraldine Yates is a 70-year-old woman originally from Alabama.  She lives alone and is unable to manage herself independently.  She is active in her community and church.  Mrs. Yates was admitted to the hospital two months ago for heart failure.  Since her discharge, a visiting nurse visits every other week to assess for symptoms of heart failure and see that Mrs. Yates is continuing to manage well on her own. The visiting nurse stops in to see Mrs. Yates today.  The nurse immediately notices that Mrs. Yates’s legs are very swollen.  Mrs. Yates states, “I noticed they were getting a bit bigger.  They are achy, too.”  The nurse asks Mrs. Yates if she has been weighing herself daily to which Mrs. Yates replies, “I got on that scale last time you were here, remember?”  The nurse weighs Mrs. Yates and she has gained 10 pounds. Additional assessment findings indicate that Mrs. Yates gets short of breath when ambulating from on room to the other (approximately 20 feet) and must sit down to catch her breath.   Her oxygen saturation is 95% on room air. Bibasilar (both bases) crackles are heard when auscultating her lung sounds.  The nurse asks Mrs. Yates if she is currently or has in the past few days experienced any chest, arm, or jaw pain or become nauseous or sweaty.  Mrs. Yates states, “No, I didn’t have any of that. I would know another heart attack. I didn’t have one of those.”  The nurse asks about any back pain, stomach pain, confusion, dizziness, or a feeling that Mrs. Yates might faint. Mrs. Yates denies these symptoms stating, “No.  None of that. Just a little more tired than usual lately.”  Her vital signs are temperature 97.6 F (36.4 C), blood pressure 140/70, pulse 93, and respirations 22.  The nurse reviews Mrs. Yates’s list of current medications.  Mrs. Yates is taking aspirin, clopidogrel bisulfate, lisinopril, and carvedilol.  The nurse calls the health care provider who asks the nurse to draw blood for a complete blood count (CBC), basic metabolic panel (BMP), brain natriuretic peptide (BNP), troponin, creatinine kinase (CPK), creatinine kinase-MB (CKMB), and albumin. The health care provider also prescribes oral (PO) furosemide and asks the nurse to arrange an outpatient electrocardiogram (EKG) to check heart rhythm and signs of cardiac ischemia, chest x-ray to check lungs, and echocardiogram to check heart function. s to AnswerWhat are potential environmental concerns the nurse should address with Mrs. Yates? What are current health-related safety concerns that the nurse should address with Mrs. Yates2. What are some therapeutic communication techniques that would be appropriate for the nurse to communicate with Mrs. Yates?  List communication traps to avoid. 3.  Which assessment findings during the nurse’s visit are consistent with heart failure Legs are swollen, oedema, very short of breath, lung crackles4. Discuss anything else the nurse should assess during her visit with Mrs. Yates. Do you smoke or drink? How you feel and is there any anaphylaxisWhat is your diet…? Do you take your medicine in the time?5. Based on what you know about signs/symptoms of heart failure, which type or types of heart failure does Mrs. Yates appear to have?6. Discuss Mrs. Yates’s predisposing risk factors for heart failure.7. Why has Mrs. Yates been prescribed furosemide (Lasix)?  Look up the medication if you are unfamiliar with it. 8. As Mrs. Yates will be taking furosemide, a new medication.  What is the nurse’s top priority9. When speaking to the doctor, the nurse asks if he/she will prescribe potassium tablets for Mrs. Yates.  Why does the nurse ask for this?10.  What are key patient education topics that the nurse should discuss with Mrs. Yates?  What teaching methods could be useful?  How will the nurse know that Mrs. Yates understands the content being taught?Case Study Scenario ContinuesThe visiting nurse returns the next day.  Mrs. Yates does not seem to be diuresing as well as the nurse anticipated.  Mrs. Yates is not worse, but the swelling in her legs and her weight has not changed.  The nurse asks about frequency of urinating, and Mrs. Yates says she has not noticed any difference.  The nurse begins to reach for her stethoscope to check lung sounds when Mrs. Yates says, “I was just going to make myself a ham sandwich.  Would you like one?”  The nurse declines and becomes concerned. 11. Why is the nurse concerned?  What is should the nurse do at this point?  What are key patient education topics the nurse should discuss with Mrs. Yates at this time?Case Study Scenario ContinuesSince changing her diet, Mrs. Yates is responding well to her treatments.  The nurse wants to make sure Mrs. Yates understands the importance of monitoring her weight.  In addition, if Mrs. Yates gains more than three pounds in one week, what she should do.12.  How often should the nurse instruct Mrs. Yates to check her weight?  What should the nurse instruct Mrs. Yates to do if she gains more than three pounds in one week?13.  Prioritize three nursing diagnoses that the visiting nurse should consider for the recent events regarding Mrs. Yates’s care.Health Science Science Nursing NURSING N125

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