Question

Mrs. D. presents to the emergency department (ED) complaining of progressive dyspnea on exertion and lower leg edema over the past 3 days. She states that she cannot climb the stairs to her second-floor bedroom without gasping for air, which she had no problem doing last week. The ED nurse attaches Mrs. D. to a cardiac monitor and obtains vital signs. Mrs. D. has sinus tachycardia -04 beats per minute. Her blood pressure is 170/94 mm Hg and her respiratory rate is 28 breaths per minute and labored. Her oxygen saturation is 96% and on 2 liters oxygen by nasal cannula. The nurse inserts an intravenous catheter (saline lock) and obtains a brief history from the patient. The interview indicates Mrs. D. is a 68-year-old female with a history of hypertension, type 2 diabetes, and coronary artery disease. She had a myocardial infarction (MI) 3 years ago. She has never smoked, uses alcohol only socially, and has no allergies. Her height is 65 inches and she weigh 150 pounds. Her medications include carvedilol 25 mg twice daily, lisinopril 40 mg daily, simvastatin 20 mg daily at bedtime, and aspirin 81

mg daily. She states being compliant with taking her medications. 1. Identify the cardiovascular risk factors that this Patient has? (minimum of 5) 2. Identify the subjective and objective signs and symptoms that would be essential in the clinical presentation of a patient with congestive heart failure? (minimum of 8) Emergency laboratory tests ordered,- chemistry, complete blood count, brain natriuretic peptide (BNP), and cardiac enzymes. A 12-lead electrocardiogram -- reveals sinus tachycardia with an old inferior MI. . 3. What is a BNP? 4. What is the normal level? 5. Why is the BNP elevated in Congestive Heart Failure? 6. What does this patient BNP signify and how severe is it? Mrs. D. physical exam reveals crackles halfway up lung fields bilaterally. Normal S1 and S2 heart sounds with a positive S3 heart sound are heard. Lower extremities have 1+ pitting edema bilaterally up to her mid calves. 7. What is S1 and S2? 8. Why is S3 significant and why does it occur?

Answer 1

1, Cardiovascular risk factors:
-high blood pressure
-Diabetes
-Coronary heart disease
-History of MI
- Age
2, Subjective s/s:
-Progressive dyspnea on exertion
-Lower leg edema
-Difficult climb the stains
Objective S/s:
-Sinus tachycardia
-High blood pressure 170/94mmHg
-Labored breathing
-hypoxemia
Lab test:
total cholesterol should be 200mg/dl
LDL should be less than 130mg/dl
HDL should be over 50mg/dl
Triglycerides should be less than 150mg/dl
CRP above 2.0mg/l indicates a high risk of heart disease
BNP vary as per age and gender and weight
Troponin T, if it is high, indicates a high risk of heart disease
3, BNP is a Brain natriuretic peptide, it is a protein from heart and blood vessels, it helps the body to eliminate fluids, relaxes blood vessels and remove sodium from urine. when heart damages it secretes more in blood and tries to strain on the heart.
4, Normal level BNP is less than 125pg/ml from 0-74 years. less than 450pg/ml for aged 75-99 years.