Patient HJ: History of Present Illness H.J. presented to the

Patient HJ: History of Present Illness H.J. presented to the ER… Patient HJ: History of Present IllnessH.J. presented to the ER late one evening complaining of a “racing heartbeat.” She is an over- weight, 69-year-old white female, who has been experiencing increasing shortness of breath during the past two months and marked swelling of the ankles and feet during the past three weeks. She feels very weak and tired most of the time and has recently been waking up in the middle of the night with severe breathing problems. She has been sleeping with several pillows to keep herself propped up. Five years ago, she suffered a transmural (i.e., through the entire thickness of the ventricular wall), anterior wall (i.e., left ventricle) myocardial infarction. She received two-vessel coronary artery bypass surgery 41/2 years ago for obstructions in the left anterior descending and left circumflex coronary arteries. Her family history is positive for atherosclerosis as her father died from a heart attack and her mother had several CVAs. She had been a three pack per day smoker for 30 years but quit smoking after her heart attack. She uses alcohol infrequently. She has a nine-year history of hypercholesterolemia. She is allergic to nuts, shellfish, strawberries, and hydralazine. Her medical history also includes diagnoses of osteoarthritis and gout. Her current medications include celecoxib, allopurinol, atorvastatin, and daily aspirin and clopidogrel. The patient is admitted to the hospital for a thorough examination.Physical Examination and Laboratory TestsVital SignsBP = 125/80 (left arm, sitting); P = 125 and regular; RR = 28 and labored; T = 98.5°F oral; Weight = 215 lb; Height = 5’8″; patient is appropriately anxious.Head, Eyes, Ears, Nose, and Throat•           Funduscopic examination normal•           Pharynx and nares clear•           Tympanic membranes intactSkin•           Pale with cool extremities•           Slightly diaphoreticNeck•           Neck supple with no bruits over carotid arteries•           No thyromegaly or adenopathy•           Positive JVD•           Positive HJRLungs•           Bibasilar rales with auscultation•           Percussion was resonant throughoutHeart•           PMI displaced laterally•           Normal S1 and S2 with distinct S3 at apex•           No friction rubs or murmursAbdomen•           Soft to palpation with no bruits or masses•           Significant hepatomegaly and tenderness observed with deep palpationExtremities•           2+ pitting edema in feet and ankles extending bilaterally to mid-calf region•           Cool, sweaty skin•           Radial, dorsal pedis and posterior tibial pulses present and moderate in intensityNeurological•           Alert and oriented X 3 (to place, person, and time)•           Cranial and sensory nerves intact•           DTRs 2+ and symmetric•           Strength is 3/5 throughoutChest X-Ray•           Prominent cardiomegaly•           Perihilar shadows consistent with pulmonary edemaECG•           Sinus tachycardia with waveform abnormalities consistent with LVH•           Pronounced Q waves consistent with previous myocardial infarctionECHOCardiomegaly with poor left ventricular wall movementRadionuclide ImagingEF = 39% Laboratory Blood Test Results          Na+     153 meq/L      PaCO2 53 mm Hg K+       3.2 meq/L       PaO2   65 mm Hg (room air)BUN    50 mg/dL        WBC   5,100/mm3Cr        2.3 mg/dL       Hct      41%Glu, fasting     131 mg/dL      Hb       13.7 g/dLCa+2   9.3 mg/dL       Plt       220,000/mm3Mg+2  1.9 mg/dL       Alb      3.5 g/dLAlk phos         81 IU/L           TSH     1.9 µU/mLAST     45 IU/L           T4        9.1 µg/dLpH       7.35       1. Explain the abnormal arterial blood gas findings. Which of the hematologic findings, if any, are abnormal? What do the TSH and T4 data suggest?  2 Identify four drugs that might be immediately helpful to this patient. Ejection fraction is an important cardiac function parameter that is used to determine the contractile status of the heart and is measured with specialized testing procedures. If a patient has an SV = 100 and an EDV = 200, is EF abnormally high, low, or normal?Health Science Science Nursing NURSING MEDSURG201

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