Case Study
\nHenry Brusca is a 68-year-old, married father of 7 who was in relatively good health until 3 weeks ago. At that time, he visited the emergency room with the complaint of \u201cjust not feeling right.\u201d His BP on admission was 170\/118, so he was admitted to the coronary care unit with the diagnosis of uncontrolled HTN. His BP was controlled with medication, and he was discharged several days later. He is now being seen for follow-up care and management of HTN. Because Mr. Brusca is newly diagnosed with HTN, you will need to complete a history and thorough cardiovascular examination.
\nCase Study Findings
\nBiographical data:
\n\u25a0 68-year-old white male.
\n\u25a0 Married, father of seven grown children.
\n\u25a0 Self-employed entrepreneur; BS degree in engineering.
\n\u25a0 Born and raised in the United States, Italian descent, Catholic religion.
\n\u25a0 Blue Cross\/Blue Shield medical insurance plan.
\n\u25a0 Referral: Follow-up by primary care physician.
\n\u25a0 Source: Self, reliable.
\nCurrent health status:
\n\u25a0 No chest pain, dyspnea, palpitations, or edema.
\n\u25a0 Complains of fatigue, loss of energy, and occasional dizzy spells.
\nPast health history:
\n\u25a0 No rheumatic fever or heart murmurs.
\n\u25a0 No history of injuries.
\n\u25a0 Inguinal hernia repair.
\n\u25a0 Left ventricular hypertrophy revealed by electrocardiogram (ECG).
\n\u25a0 Hospitalized 3 weeks ago for HTN.
\n\u25a0 No known food, drug, or environmental allergies.
\n\u25a0 No other previous medical problems.
\n\u25a0 Immunizations up to date.
\n\u25a0 No prescribed medications except Vasotec 5 mg bid and weekly use of antacid for indigestion.
\nFamily history:
\n\u25a0 Positive family history of HTN and stroke.
\n\u25a0 Mother had HTN and died at age 78 of a stroke.
\n\u25a0 Paternal uncle died at age 79 of MI.
\nReview of systems:
\n\u25a0 General Health Survey: Fatigue, weight gain of 60 lb over past 3 years.
\n\u25a0 Integumentary: Feet cold, thick nails, tight shoes.
\n\u25a0 Head, Eyes, Ears, Nose, and Throat (HEENT): Two dizzy spells over past 6 months.
\n\u25a0 Eyes: Wears glasses, no visual complaints, yearly eye examination.
\n\u25a0 Respiratory: \u201cShort winded\u201d with activity.
\n\u25a0 Gastrointestinal: Indigestion on weekly basis.
\n\u25a0 Genitourinary: Awakens at least once a night to go to bathroom.
\n\u25a0 Musculoskeletal\/Neurological: General weakness, cramps in legs with walking.
\n\u25a0 Lymphatic: No reported problems.
\n\u25a0 Endocrine: No reported problems.
\nPsychosocial pro\ufb01le:
\n\u25a0 States that he does not have time for routine checkups. \u201cI only go to the doctor\u2019s when I\u2019m sick. \u201cTypical day consists of arising at 7 A.M., showering, having breakfast, and then going to work. Returns home by 6 P.M., eats dinner, watches TV till 11:30 P.M., but usually falls asleep before news is over. Usually in bed by 12 midnight.
\n\u25a0 24-hour recall reveals a diet high in carbohydrates and fats and lacking in fruits and vegetables. Heavy-handed with salt shaker; salts everything. Admits that he has gained weight over the years and is 60 lb overweight.
\n\u25a0 No regular exercise program. States: \u201cI\u2019m too busy running my business.\u201d
\n\u25a0 Hobbies include reading, crossword puzzles, and antique collecting.
\n\u25a0 Sleeps about 7 hours a night, but usually feels he is not getting enough sleep. Lately is more and more tired. Wife states that he snores.
\n\u25a0 Never smoked. Has a bottle of wine every night with dinner.
\n\u25a0 Works at sedentary job, usually 7 days a week. No environmental hazards in workplace.
\n\u25a0 Lives with wife of 45 years in a two-story, single home in the suburbs with ample living space.
\n\u25a0 Has a large, close, caring family.
\n\u25a0 Admits that running his own business is very stressful, but feels he can handle it alone and doesn\u2019t need anyone to help him.
\nGeneral Health Survey findings:
\n\u25a0 Well-developed, well-groomed 68-year-old white male, appears younger than stated age.
\n\u25a0 Sits upright and relaxed during interview, answers questions appropriately.
\n\u25a0 Alert and responsive without complaint, oriented x 4 (time, place, situation, and person).
\n\u25a0 Affect pleasant and appropriate.
\n\u25a0 Head-to-toe scan reveals positive arcus senilis, positive AV nicking and cotton wool, extremity changes including thin, shiny skin, thick nails, and edema.
\n\u25a0 Vital Signs
\n\u25a0 Temperature, 36.6 \u00b0C.
\n\u25a0 Pulse, 86 BPM, strong and regular.
\n\u25a0 Respirations, 18\/min, unlabored.
\n\u25a0 BP: 150\/90 mmHg.
\n\u25a0 Height: 180 CM.
\n\u25a0 Weight: 124 KG.
\nCardiovascular assessment \ufb01ndings include:
\n\u25a0 Neck Vessels
\n\u25a0 Positive large carotid pulsation, +3, symmetrical with smooth, sharp upstroke and rapid descent, artery stiff, negative for thrills and bruits.
\n\u25a0 JVP at 30 degrees <3 cm, negative abdominojugular re\ufb02ux.
\n\u25a0 Precordium
\n\u25a0 Positive sustained pulsations displaced lateral to apex, PMI 3 cm with increased amplitude.
\n\u25a0 Slight pulsations also appreciated at LLSB and base, but not as pronounced.
\n\u25a0 Negative thrills; cardiac borders percussed third, fourth, and \ufb01fth intercostal spaces to the left of the midclavicular line.
\n\u25a0 Heart sounds appreciated with regular rate and rhythm at apex S1 > S2 and +S4,at LLSB S1 > S2.
\n\u25a0 S2 negative split, at base left S1 < 2 negative split, at base right S1 < 2 with an accentuated
\nS2, negative for murmurs and rubs.
\nQuestions:
\n1) What questions might be useful to elicit further details surrounding the Chest pain, using one of the common acronyms in this regard? (5 Marks)
\n2) From the subjective information you have obtained from Mr. Brusca\u2019s history, what are his identi\ufb01able risk factors for heart disease? Which risk factors are modi\ufb01able and which are unmodi\ufb01able? (5 Marks)
\n3) List three priority nursing diagnosis for Mr. Brusca\u2019s case, and cluster subjective and objective data that support each diagnosis. (3 Marks)
\n4) From the previous data, discuss the main issues of health promotion and disease prevention should the nurse discussed during health history and physical examination? (4 Marks).
\n5) Considering the relationship of the cardiovascular system to the respiratory system, what respiratory problems might Mr. Brusca have as a result of his cardiovascular disease? (3 Marks)<\/p>\n","protected":false},"excerpt":{"rendered":"
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