Discussion: Cardiovascular Alterations

At least once a year, the media report on a seemingly healthy teenage athlete collapsing during a sports game and dying of heart complications. These incidents continue to outline the importance of physical exams and health screenings for teenagers, especially those who play sports. During these health screenings, examiners check for cardiovascular alterations such as heart murmurs because they can be a sign of an underlying heart disorder. Since many heart alterations rarely have symptoms, they are easy to miss if health professionals are not specifically looking for them. Once cardiovascular alterations are identified in patients, it is important to refer them to specialists who can further investigate the cause.

Consider the following scenario:

A 16-year-old male presents for a sports participation examination. He has no significant medical history and no family history suggestive of risk for premature cardiac death. The patient is examined while sitting slightly recumbent on the exam table and the advanced practice nurse appreciates a grade II/VI systolic murmur heard loudest at the apex of the heart. Other physical findings are within normal limits, the patient denies any cardiovascular symptoms, and a neuromuscular examination is within normal limits. He is cleared with no activity restriction. Later in the season he collapses on the field and dies.

To Prepare

· Review the scenario provided, as well as Chapter 25 in the Huether and McCance text. Consider how you would diagnose and prescribe treatment for the patient.

· Select one of the following patient factors: genetics, ethnicity, or behavior. Reflect on how the factor you selected might impact diagnosis and prescription of treatment for the patient in the scenario.

·  

Post a description of how you would diagnose and prescribe treatment for the patient in the scenario. Then explain how the factor you selected might impact the diagnosis and prescription of treatment for that patient.

Use resource below for reference

Huether, S. E., & McCance, K. L. (2017). Understanding pathophysiology (6th ed.). St. Louis, MO: Mosby.

• Chapter 23, “Structure and      Function of the Cardiovascular and Lymphatic Systems”

This chapter examines the circulatory system, heart, systemic circulation, and lymphatic system to establish a foundation for normal cardiovascular function. It focuses on the structure and function of various parts of the circulatory system to illustrate normal blood flow.

• Chapter 24, “Alterations of      Cardiovascular Function”

This chapter presents the pathophysiology, clinical manifestations, evaluation, and treatment of various cardiovascular disorders. It focuses on diseases of the veins and arteries, disorders of the heart wall, heart disease, and shock.

• Chapter 25, “Alterations of      Cardiovascular Function in Children”

This chapter examines cardiovascular disorders that affect children. It distinguishes congenital heart diseases from acquired cardiovascular disorders.

Hammer, G. D., & McPhee, S. J. (2019). Pathophysiology of disease: An introduction to clinical medicine (8th ed.). New York, NY: McGraw-Hill Education.

• Chapter 10, “Cardiovascular      Disorders: Heart Disease”

This chapter begins by exploring the normal structure and function of the heart. It then examines the etiology, pathophysiology, and clinical manifestations of five heart disorders: arrhythmias, congestive heart failure, valvular heart disease, coronary artery disease, and pericardial disease.

Jacobsen, R. C., & Gratton, M. C. (2011). A case of unrecognized prehospital anaphylactic shock.Prehospital Emergency Care, 15(1), 61–66.

Retrieved from the Walden Library databases.

This article provides information relating to the diagnosis and management of anaphylactic shock. It also explores difficulties encountered when diagnosing uncommon clinical presentations of anaphylactic shock.

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 Does staffing contain, as opposed to elevate, costs? Is there a point where the care delivery model and staffing become a detriment to cost control? That is, where does the law of diminishing returns kick in, both cost-wise and care-wise? 1 page, 2 sources, APA.

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 How might health care leaders determine appropriate nursing and care delivery models to address rapidly changing populations? 1 page, APA, 2 sources.

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Please provide a brief description of your career and educational goals.

Minimum length: 150 words.

Maximum length: 300 words.

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1. Students
2. This is your main assignment for this week.  Attached is a blank Care Plan template.  I will also included a case study that you will use to complete your Care Plan. Basically, a Care Plan is the Nursing Process, which we have studied over the past few week.  We will use the information that we learned to Assess the patient using subjective and objective data, formulate a nursing diagnosis, develop a plan of care for the patient, implement our plan, and then evaluate our plan.
3. We will discuss the CARE PLAN on the Webinar this week.  
4. The care plan details are as follows: Much of the information is given to you.  There is one diagnosis listed and you will need to develop a second diagnosis for this patient.    Make sure that you have three references in APA format.  If the information is included in the case study (example:  Nursing diagnosis, interventions, etc.) you can use them in your care plan.  This is your first care plan, so much of it is fill in the blanks.  Good luck and I will be glad to help you with this assignment. APA format.  If the information is included in the case study (example:  Nursing diagnosis, interventions, etc.) you can use them in your care plan.  This is your first care plan, so much of it is fill in the blanks.  Good luck and I will be glad to help you with this assignment. 
5. Attached is the care plan template.  Please submit to the drop box by the due date.

   A 48 year old male is admitted to the interventional holding area after having a cardiac cath. The patient received a cardiac stent in the right coronary artery (RCA) and the insertion site was angiosealed. The insertion site is soft, no bruising noted, or active bleeding. Pulses are palpable in bilateral lower extremities. A sandbag in on the site which has to stay for another 1.5 hours per md orders. The patient is complaining of discomfort in the groin area and rates his pain 8 on 1-10 scale. In addition, the patient and his wife have verbalized they desire (but feel they will not be able to) to manage the new medication regime and post-op care and are having difficulty understanding why it is so important to take these new medications and quit smoking since he already “has his problem fixed with the stent placement”. He states he is going to have problems integrating these new “rules” into his daily life because he works around people who smoke all the time and does not want these medications to interfere with his life.interventional holding area after having a cardiac cath. The patient received a cardiac stent in the right coronary artery (RCA) and the insertion site was angiosealed. The insertion site is soft, no bruising noted, or active bleeding. Pulses are palpable in bilateral lower extremities. A sandbag in on the site which has to stay for another 1.5 hours per md orders. The patient is complaining of discomfort in the groin area and rates his pain 8 on 1-10 scale. In addition, the patient and his wife have verbalized they desire (but feel they will not be able to) to manage the new medication regime and post-op care and are having difficulty understanding why it is so important to take these new medications and quit smoking since he already “has his problem fixed with the stent placement”. He states he is going to have problems integrating these new “rules” into his daily life because he works around people who smoke all the time and does not want these medications to interfere with his life.     

Nursing Diagnosis:

 -Acute Pain related to tissue trauma and prescribed post procedure immobilization as evidence by patient rating pain 8 on 1-10 scale.      Demographics:  White male, 48 years old.  Weight is 285 pounds, Height is 5’9″. Pt is married and his wife and 2 children are at the bedside.  Pt speaks fluent English.  He is Catholic.  He finished high school and 2 years of community college.  He is employed in an office with about 30 other employees.    Past medical history:  HTN, Hyperlipidemia, Smokes    

Current labs:  Glucose – 165, Sodium 140, Potassium 3.2, Chloride 98, BUN 15, Creatinine 0.8. 

Chest Xray – normal

Medications:  Select 3 medications for your care plan.  One should be for hypertenstion, 1 should be for pain while in the hospital, the 3rd one is of your choice (a medication that goes along with his diagnosis).    

Nursing Outcomes:

-The patient will rate his groin pain less than 5 on a 1-10 scale within in 2 hours from admission. 

-The patient and his wife will relate to the nurse that they feel like they can integrate the new medication and stop smoking regimen into their lifestyle before discharge.

-The patient and his wife will verbalize 4 benefits of quitting smoking for the heart by discharge.

-The patient and his wife will demonstrate and verbalize how to administer and take his new medications before discharge.

Nursing Interventions:

-The nurse will assist the patient with re-positioning techniques as needed to help alleviate pain.

-The nurse will educate the patient and his wife on 4 benefits of quitting smoking by discharge.

-The nurse will verbalized and demonstrate to the patient and his wife how the patient needs to take his new medications by discharge.  The patient and his wife will verbalize their understanding of the medications.

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