Case Study 1: Alterations of Cardiovascular Function
Mr. W.G. is a 53-year-old white man who began to experience chest discomfort while playing tennis with a friend. At first, he attributed his discomfort to the heat and having had a large breakfast. Gradually, however, discomfort intensified to a crushing sensation in the sternal area and the pain seemed to spread upward into his neck and lower jaw. The nature of the pain did not seem to change with deep breathing. When Mr. G. complained of feeling nauseated and began rubbing his chest, his tennis partner was concerned that his friend was having a heart attack and called 911 on his cell phone. The patient was transported to the ED of the nearest hospital and arrived within 30 minutes of the onset of chest pain. In route to the hospital, the patient was placed on nasal cannula and an IV D5W was started. Mr. G. received aspirin (325 mg po) and 2 mg/IV morphine. He is allergic to meperidine (rash). His pain has eased slightly in the last 15 minutes but is still significant; was 9/10 in severity; now7/10. In the ED, chest pain was not relieved by 3 SL NTG tablets. He denies chills.
Case Study Questions
1. Cite four risk factors that predisposed this patient to acute myocardial infarction.
2. Cite four clinical signs that suggest that acute myocardial infarction has occurred in the left ventricle and not in the right ventricle.
3. Which single laboratory test provides the clearest evidence that the patient has suffered acute myocardial infarction?
4. What is the pathophysiologic mechanism for elevated temperature that occurred several days after the onset of acute myocardial infarction?
Case Study 2: Alterations of the Pulmonary Function
D.R. is a 27-year-old man, who presents to the nurse practitioner at the Family Care Clinic complaining of increasing SOB, wheezing, fatigue, cough, stuffy nose, watery eyes, and postnasal drainage—all of which began four days ago. Three days ago, he began monitoring his peak flow rates several times a day. His peak flow rates have ranged from 200 to 240 L/minute (baseline, 340 L/minute) and often have been at the lower limit of that range in the morning. Three days ago, he also began to self-treat with frequent albuterol nebulizer therapy. He reports that usually his albuterol inhaler provides him with relief from his asthma symptoms, but this is no longer sufficient treatment for this asthmatic episode.
Case Study Questions
1. Based on the available clinical evidence, is this patient’s asthmatic attack considered mild, moderate, or bordering on respiratory failure?
2. What is the most likely trigger of this patient’s asthma attack?
3. Identify three major factors that have likely contributed to the development of asthma in this patient.