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.

Submission Instructions:

• You must complete both case studies
• Your initial post should be at least 500 words per case study, formatted and cited in current APA style with support from at least 2 academic sources. Your initial post is worth 8 points.
• Grading Rubric

  ---

  Your assignment will be graded according to the grading rubric.

  Discussion Rubric
  Criteria	Ratings	Points
  Identification of Main Issues, Problems, and Concepts	5 points DistinguishedIdentify and demonstrate a sophisticated understanding of the issues, problems, and concepts.	4 points ExcellentIdentifies and demonstrate an accomplished understanding of most of issues, problems, and concepts.	2 points FairIdentifies and demonstrate an acceptable understanding of most of issues, problems, and concepts.	1 points PoorIdentifies and demonstrate an unacceptable understanding of most of issues, problems, and concepts.	5 points
  Use of Citations, Writing Mechanics and APA Formatting Guidelines	3 points DistinguishedEffectively uses the literature and other resources to inform their work. Exceptional use of citations and extended referencing. High level of APA precision and free of grammar and spelling errors.	2 points ExcellentEffectively uses the literature and other resources to inform their work. Moderate use of citations and extended referencing. Moderate level of APA precision and free of grammar and spelling errors.	1 point FairIneffectively uses the literature and other resources to inform their work. Moderate use of citations and extended referencing. APA style and writing mechanics need more precision and attention to detail.	0 point PoorIneffectively uses the literature and other resources to inform their work. An unacceptable use of citations and extended referencing. APA style and writing mechanics need serious attention.	3 points
  Response to Posts of Peers	2 points DistinguishedStudent constructively responded to two other posts and either extended, expanded or provided a rebuttal to each.	1 points FairStudent constructively responded to one other post and either extended, expanded or provided a rebuttal.	0 point PoorStudent provided no response to a peer’s post.	2 points