Question

1Normal 1 No Spacing Heading 1 Heading 2 Title Subitle Sut Styles Paragraph G. E., a 52-year-old Mexican migrant farm worker, has been discharged from the hospital for a deep vein thrombosis two days ago. You are the home health nurse assigned to visit G.E. When you arrive, you see that he is apprehensive, restless, diaphoretic, and extremely anxious. His SaO2is 82% (previously had been 97% on room air), his heart rate is 116 beats per minute, and his blood pressure is 100/56 mm Hg. He is complaining of a sharp chest pain that gets worse when he breathes in, and he has shortness of breath. G. E. and his eight-month pregnant wife do not speak English well. Their 11-year-old son is interpreting and tells you his dad has a past medical history of congestive heart failure (CHF), hypertension, and diabetes. Interview reveals a change in his condition with the following symptoms: increase in number of pillows from two to four: decrease in activity tolerance; a dry, hacking cough: and a decrease in appetite. Address all of the following: . Develop a problems list from the objective and subjective data. DVT 2 days ago Sa02-8200 HR- 116 BP- 100/56 apprehensive restless diaphoretic anxious chest pain shortness of breath PMH: Congestive Heart Failure, hypertension, diabetes . From the readings, discuss the most probable causes of the symptoms . Articulate what cardiac changes can be attributed to the aging process and separately to culture and genetics.

Answer 1

List of problems:

• Deep vein thrombosis
• Dyspnea relieved by head elevation and rest
• Tachycardia
• Hypotension and Diaphoresis
• Fall in Oxygen saturation (SaO₂)
• Anxiety and Restlessness
• Known case of CHF, Hypertension and Diabetes

From the above mentioned symptoms, two important differentials that can be derived.

• Congestive Heart Failure (CHF).
• Pulmonary embolism secondary to Deep Vein Thrombosis.

Features of CHF:

• Shortness of breath (Dyspnea) and difficulty in breathing in supine position (Orthopnea)
• Fatigue, weakness and sweating
• Tachycardia (rapid or irregular heartbeat)
• Reduced tolerance to exercise
• Persistent cough or wheezing with white or pink blood-tinged sputum.
• Increased need to urinate at night (nocturia)
• Pulmonary edema and drop in SaO2
• Pedal edema
• Chest pain if (secondary to myocardial infarction)

Features of Pulmonary Embolism:

• Tachycardia and Arrhythmia
• Chest pain especially with coughing or deep inspiration
• Sudden shortness of breath (dyspnea)
• Hypotension and sweating
• Dizziness or fainting
• Blood tinged cough
• Further cardiac evaluation is needed to make a conclusive diagnosis.

Age related Cardiac Changes: Structural changes with aging involve the myocardium, the cardiac conduction system, and the endocardium. There is a progressive degeneration of the cardiac structures with aging, including a loss of elasticity, fibrotic changes in the valves of the heart, and infiltration with amyloid. The important structural and physiological changes are as follows:

• Valvular stenosis and Regurgitation (aortic, mitral, tricuspid).
• Hypertrophy of cardiac chambers.
• Calcification and Atherosclerosis of vessels resulting in reduced elasticity.
• Compromised coronary blood flow and blockage
• Reduction in cardiac output and aerobic capacity
• Slight increase in stroke volume
• Decrease in maximum achievable heart rate
• Increase in blood pressure
• Left shift of the QRS axis in ECG (reflecting a variable degree of fibrosis in the anterior fascicle of the left bundle branch as well as mild left ventricular hypertrophy).
• Flat S-T segment, diminished amplitude of the T wave.