Case Study Coronary Artery Disease and Pacemakers<\/p>\n
It is midmorning on the cardiac unit where you work, and you are getting a new patient. G.P. is a 60-year- old retired businessman who is married and has three grown children. As you take his health history, he tells you that he began feeling changes in his chest about 10 days ago. He has hypertension (HTN) and a 5-year history of angina pectoris. During the past week, he has had frequent episodes of mid-chest discomfort. The chest pain responds to nitroglycerin (NTG), which he has taken sublingually about 8 to 10 times over the past week. During the week, he has also experienced increased fatigue. He states, \u201cI just feel crappy all the time.\u201d A cardiac catheterization done several years ago revealed 50% stenosis of the right coronary artery (RCA) and 50% stenosis of the left anterior descending (LAD) coronary artery. He tells you that both his mother and his father had coronary artery disease (CAD). He is currently taking amlodipine (Norvasc), metoprolol (Lopressor), atorvastatin (Lipitor), and aspirin 81 mg\/day. Several years ago, a cardiac catheterization revealed 50% stenosis of the right coronary artery (RCA) and 50% stenosis of the left anterior descending (LAD) coronary artery. He informs you that both his mother and father suffered from coronary artery disease (CAD). He is currently on amlodipine (Norvasc), metoprolol (Lopressor), atorvastatin (Lipitor), and 81 mg of aspirin per day.<\/p>\n
1.\tWhat other information are you going to obtain about his episodes of chest pain?<\/p>\n
2.\tWhat are common sites for radiation of ischemic cardiac pain?<\/p>\n
3.\tYou know that G.P. has atherosclerosis of the coronary arteries. You need to know his risk factors for CAD to plan teaching for lifestyle modifications. What will you ask him about?<\/p>\n
4.\tAlthough he has been taking sublingual nitroglycerin (SL NTG) for a long time, you want to be certain he is using it correctly. Which actions are correct when taking SL NTG for chest pain? (Select all that apply.)
\na.\tStop the activity and lie or sit down.
\nb.\tCall 911 immediately.
\nc.\tCall 911 if the pain is not relieved after taking one SL tablet.
\nd.\tCall 911 if the pain is not relieved after taking three SL tablets, 5 minutes apart.
\ne.\tChew the tablet slowly then swallow.
\nf.\tPlace the NTG tablet under the tongue.<\/p>\n
5.\tYou review the use and storage of SL NTG with G.P. Which statement by G.P. indicates a need for further education? Explain your answer.
\na.\t\u201cI will discard any open bottle of nitroglycerin after a year.\u201d
\nb.\t\u201cI will not store other pills in the nitroglycerin bottle.\u201d
\nc.\t\u201cI carry the tablets with me at all times.\u201d
\nd.\t\u201cI will keep the pills in their original brown bottle.\u201d<\/p>\n
CASE STUDY PROGRESS
\nWhen you first admit G.P., you place him on telemetry and observe his cardiac rhythm.<\/p>\n
6.\tIdentify the rhythm:<\/p>\n
7.\tExplain the primary complication that could occur if this heart rhythm were not treated.<\/p>\n
8.\tReview G.P.’s history. What conditions may have contributed to the development of this dysrhythmia?<\/p>\n
9.\tYou review G.P.’s laboratory test results and note that all of them are within normal range, including troponin and creatinine phosphokinase (CPK) levels. His potassium level is 4.7 mEq\/L. Given this and his current dysrhythmia, what is the likely cause of the symptoms he has been experiencing this past week?<\/p>\n
CASE STUDY PROGRESS
\nWithin the hour, G.P. converts with intravenous diltiazem (Cardizem) to sick sinus syndrome with long sinus pauses that cause lightheadedness and hypotension.<\/p>\n
10.\tWhat risks does the new rhythm pose for G.P.? Explain the reasons for your answers.<\/p>\n
CASE STUDY PROGRESS
\nBecause G.P.’s dysrhythmia is causing unacceptable symptoms, he is taken to surgery and a permanent DDDR pacemaker is placed and set at a rate of 70 beats\/min.
\n11.\tWhat does the code DDDR mean?<\/p>\n
12.\tThe pacemaker insertion surgery places G.P. at risk for several serious complications. List three potential problems that you will monitor for as you care for him.<\/p>\n
13.\tG.P. will need some education regarding his new pacemaker. What information will you give him before he leaves the hospital?<\/p>\n
14.\tG.P.’s wife approaches you and anxiously inquires, \u201cMy neighbor saw this science fiction movie about this guy who got a pacemaker and then he couldn’t die. Is that for real?\u201d How are you going to respond to her?<\/p>\n
15.\tG.P. and his wife tell you they have heard that people with pacemakers can have their hearts stop because of microwave ovens and cell phones. Where can you help them find more information?<\/p>\n
CASE STUDY PROGRESS
\nAfter discharge, G.P. is referred to a cardiac rehabilitation center to start an exercise program. He will be exercise tested, and an individualized exercise prescription will be developed for him, based on the results of the exercise test.<\/p>\n
16.\tWhat information will be obtained from a graded exercise (stress) test, and what is included in an exercise prescription?<\/p>\n","protected":false},"excerpt":{"rendered":"
Case Study Coronary Artery Disease and Pacemakers It is midmorning on the cardiac unit where you work, and you are getting a new patient. G.P.\u2026<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[479,537,172,478,6744],"tags":[7780,7779,687,7783,3504,8899,8900,7782,7785,7787,7784,7781,8901,7788,7786],"class_list":["post-95761","post","type-post","status-publish","format-standard","hentry","category-nursing-course-hero","category-nursing-essay-pro","category-nursing-study-bay","category-nursing-study-pool","category-nursing-studybay","tag-apps-to-help-with-writing-assignment","tag-assignment-help-in-australia","tag-assignment-help-website","tag-assignment-helpers-for-students","tag-essay-writing","tag-essy-help","tag-essy-pro","tag-help-students-with-assignment","tag-i-will-pay-someone-to-do-my-assignments","tag-looking-for-someone-to-do-my-assignments","tag-pay-someone-to-do-my-assignment","tag-paying-someone-to-do-assignment","tag-studbay","tag-studybay","tag-university-assignment-hacks"],"_links":{"self":[{"href":"https:\/\/www.studyproessays.com\/help\/wp-json\/wp\/v2\/posts\/95761","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.studyproessays.com\/help\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.studyproessays.com\/help\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.studyproessays.com\/help\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/www.studyproessays.com\/help\/wp-json\/wp\/v2\/comments?post=95761"}],"version-history":[{"count":0,"href":"https:\/\/www.studyproessays.com\/help\/wp-json\/wp\/v2\/posts\/95761\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.studyproessays.com\/help\/wp-json\/wp\/v2\/media?parent=95761"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.studyproessays.com\/help\/wp-json\/wp\/v2\/categories?post=95761"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.studyproessays.com\/help\/wp-json\/wp\/v2\/tags?post=95761"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}