Case Study
\nHenry Brusca is a 68-year-old, married father of 7 who was in relatively good health until 3 weeks ago. At that time, he visited the emergency room with the complaint of \u201cjust not feeling right.\u201d His BP on admission was 170\/118, so he was admitted to the coronary care unit with the diagnosis of uncontrolled HTN. His BP was controlled with medication, and he was discharged several days later. He is now being seen for follow-up care and management of HTN. Because Mr. Brusca is newly diagnosed with HTN, you will need to complete a history and thorough cardiovascular examination.
\nCase Study Findings
\nBiographical data:
\n\u25a0 68-year-old white male.
\n\u25a0 Married, father of seven grown children.
\n\u25a0 Self-employed entrepreneur; BS degree in engineering.
\n\u25a0 Born and raised in the United States, Italian descent, Catholic religion.
\n\u25a0 Blue Cross\/Blue Shield medical insurance plan.
\n\u25a0 Referral: Follow-up by primary care physician.
\n\u25a0 Source: Self, reliable.
\nCurrent health status:
\n\u25a0 No chest pain, dyspnea, palpitations, or edema.
\n\u25a0 Complains of fatigue, loss of energy, and occasional dizzy spells.
\nPast health history:
\n\u25a0 No rheumatic fever or heart murmurs.
\n\u25a0 No history of injuries.
\n\u25a0 Inguinal hernia repair.
\n\u25a0 Left ventricular hypertrophy revealed by electrocardiogram (ECG).
\n\u25a0 Hospitalized 3 weeks ago for HTN.
\n\u25a0 No known food, drug, or environmental allergies.
\n\u25a0 No other previous medical problems.
\n\u25a0 Immunizations up to date.
\n\u25a0 No prescribed medications except Vasotec 5 mg bid and weekly use of antacid for indigestion.
\nFamily history:
\n\u25a0 Positive family history of HTN and stroke.
\n\u25a0 Mother had HTN and died at age 78 of a stroke.
\n\u25a0 Paternal uncle died at age 79 of MI.
\nReview of systems:
\n\u25a0 General Health Survey: Fatigue, weight gain of 60 lb over past 3 years.
\n\u25a0 Integumentary: Feet cold, thick nails, tight shoes.
\n\u25a0 Head, Eyes, Ears, Nose, and Throat (HEENT): Two dizzy spells over past 6 months.
\n\u25a0 Eyes: Wears glasses, no visual complaints, yearly eye examination.
\n\u25a0 Respiratory: \u201cShort winded\u201d with activity.
\n\u25a0 Gastrointestinal: Indigestion on weekly basis.
\n\u25a0 Genitourinary: Awakens at least once a night to go to bathroom.
\n\u25a0 Musculoskeletal\/Neurological: General weakness, cramps in legs with walking.
\n\u25a0 Lymphatic: No reported problems.
\n\u25a0 Endocrine: No reported problems.
\nPsychosocial pro\ufb01le:
\n\u25a0 States that he does not have time for routine checkups. \u201cI only go to the doctor\u2019s when I\u2019m sick. \u201cTypical day consists of arising at 7 A.M., showering, having breakfast, and then going to work. Returns home by 6 P.M., eats dinner, watches TV till 11:30 P.M., but usually falls asleep before news is over. Usually in bed by 12 midnight.
\n\u25a0 24-hour recall reveals a diet high in carbohydrates and fats and lacking in fruits and vegetables. Heavy-handed with salt shaker; salts everything. Admits that he has gained weight over the years and is 60 lb overweight.
\n\u25a0 No regular exercise program. States: \u201cI\u2019m too busy running my business.\u201d
\n\u25a0 Hobbies include reading, crossword puzzles, and antique collecting.
\n\u25a0 Sleeps about 7 hours a night, but usually feels he is not getting enough sleep. Lately is more and more tired. Wife states that he snores.
\n\u25a0 Never smoked. Has a bottle of wine every night with dinner.
\n\u25a0 Works at sedentary job, usually 7 days a week. No environmental hazards in workplace.
\n\u25a0 Lives with wife of 45 years in a two-story, single home in the suburbs with ample living space.
\n\u25a0 Has a large, close, caring family.
\n\u25a0 Admits that running his own business is very stressful, but feels he can handle it alone and doesn\u2019t need anyone to help him.
\nGeneral Health Survey findings:
\n\u25a0 Well-developed, well-groomed 68-year-old white male, appears younger than stated age.
\n\u25a0 Sits upright and relaxed during interview, answers questions appropriately.
\n\u25a0 Alert and responsive without complaint, oriented x 4 (time, place, situation, and person).
\n\u25a0 Affect pleasant and appropriate.
\n\u25a0 Head-to-toe scan reveals positive arcus senilis, positive AV nicking and cotton wool, extremity changes including thin, shiny skin, thick nails, and edema.
\n\u25a0 Vital Signs
\n\u25a0 Temperature, 36.6 \u00b0C.
\n\u25a0 Pulse, 86 BPM, strong and regular.
\n\u25a0 Respirations, 18\/min, unlabored.
\n\u25a0 BP: 150\/90 mmHg.
\n\u25a0 Height: 180 CM.
\n\u25a0 Weight: 124 KG.
\nCardiovascular assessment \ufb01ndings include:
\n\u25a0 Neck Vessels
\n\u25a0 Positive large carotid pulsation, +3, symmetrical with smooth, sharp upstroke and rapid descent, artery stiff, negative for thrills and bruits.
\n\u25a0 JVP at 30 degrees <3 cm, negative abdominojugular re\ufb02ux.\n\u25a0 Precordium\n\u25a0 Positive sustained pulsations displaced lateral to apex, PMI 3 cm with increased amplitude.\n\u25a0 Slight pulsations also appreciated at LLSB and base, but not as pronounced.\n\u25a0 Negative thrills; cardiac borders percussed third, fourth, and \ufb01fth intercostal spaces to the left of the midclavicular line.\n\u25a0 Heart sounds appreciated with regular rate and rhythm at apex S1 > S2 and +S4,at LLSB S1 > S2.
\n\u25a0 S2 negative split, at base left S1 < 2 negative split, at base right S1 < 2 with an accentuated\nS2, negative for murmurs and rubs.\nQuestions:\n1) What questions might be useful to elicit further details surrounding the Chest pain, using one of the common acronyms in this regard? (5 Marks)\n2) From the subjective information you have obtained from Mr. Brusca\u2019s history, what are his identi\ufb01able risk factors for heart disease? Which risk factors are modi\ufb01able and which are unmodi\ufb01able? (5 Marks)\n3) List three priority nursing diagnosis for Mr. Brusca\u2019s case, and cluster subjective and objective data that support each diagnosis. (3 Marks)\n4) From the previous data, discuss the main issues of health promotion and disease prevention should the nurse discussed during health history and physical examination? (4 Marks).\n5) Considering the relationship of the cardiovascular system to the respiratory system, what respiratory problems might Mr. Brusca have as a result of his cardiovascular disease? (3 Marks)\n\n_______________________\nAnswer Guide;\n\n1) Exploring Chest Pain Further Using the PQRST Acronym:\n\nTo delve deeper into the details of Henry Brusca's chest pain, the PQRST acronym can be employed to comprehensively assess his symptoms:\n\nP - Provocation\/Palliation: Ask if any specific activities or positions provoke or alleviate the chest pain. Inquire about any associated symptoms like shortness of breath or sweating during these episodes.\n\nQ - Quality: Determine the character of the chest pain. Does it feel sharp, dull, crushing, burning, or stabbing? This can provide insights into potential causes.\n\nR - Region\/Radiation: Ask where the pain is located and if it radiates to other areas like the arms, neck, or jaw. This can help differentiate between cardiac and non-cardiac causes.\n\nS - Severity: Quantify the intensity of the pain on a scale from 0 to 10. This helps assess the severity of the symptom and its impact on the patient's daily life.\n\nT - Timing: Inquire about when the pain started, how long it lasts, and its frequency. This can aid in understanding the pattern of the symptoms.\n\nBy using the PQRST approach, clinicians can gather a more comprehensive picture of Henry's chest pain, which is crucial for accurate diagnosis and treatment planning.\n\n2) Identifiable Risk Factors for Heart Disease:\n\nIdentifiable risk factors for heart disease based on Mr. Brusca's history include:\n\nModifiable Risk Factors:\n\nHypertension (HTN): Mr. Brusca was recently diagnosed with uncontrolled high blood pressure, a significant modifiable risk factor for heart disease.\nObesity: He has gained 60 pounds over three years and is 60 pounds overweight, contributing to cardiovascular risk.\nSedentary Lifestyle: Lack of regular exercise increases the risk of heart disease.\nDiet: A high-carbohydrate and high-fat diet, along with excessive salt intake, can exacerbate cardiovascular risk.\nStress: The stress from managing his own business might contribute to heart disease risk.\nUnmodifiable Risk Factors:\n\nAge: Being 68 years old increases his risk.\nGender: Being male is associated with a higher risk.\nFamily History: Positive family history of hypertension and stroke elevates his risk.\nEthnicity: Italian descent might have genetic implications for cardiovascular risk.\n3) Priority Nursing Diagnoses and Supporting Data:\n\n1. Ineffective Coping Related to High Stress Levels and Sedentary Lifestyle:\n\nSubjective: Mr. Brusca's busy, stressful routine, and lack of exercise.\nObjective: Lack of stress management activities, sedentary job, and indulging in high-calorie meals.\n2. Risk for Imbalanced Nutrition: More than Body Requirements:\n\nSubjective: Excessive weight gain, high-carb, high-fat diet, excessive salt use.\nObjective: Overweight status, poor dietary choices, thick nails and other physical markers.\n3. Activity Intolerance Related to Cardiovascular Weakness:\n\nSubjective: Fatigue, shortness of breath, cramps with walking.\nObjective: Positive pulsations, PMI displacement, and cardiac changes detected in examination.\n4) Health Promotion and Disease Prevention:\n\nThe nurse should discuss the following during the health history and physical examination:\n\nHeart-Healthy Diet: Emphasize the importance of a balanced diet rich in fruits, vegetables, lean proteins, and whole grains. Educate about salt reduction.\n\nRegular Exercise: Stress the significance of regular physical activity to manage weight, improve cardiovascular health, and reduce stress.\n\nStress Management: Provide strategies like deep breathing, mindfulness, and relaxation techniques to cope with stress.\n\nWeight Management: Discuss setting achievable weight loss goals through diet and exercise modifications.\n\n5) Cardiovascular-Respiratory Relationship and Potential Respiratory Problems:\n\nCardiovascular and respiratory systems are closely intertwined. With cardiovascular disease, respiratory problems can arise:\n\nDyspnea: Cardiovascular issues can lead to fluid buildup in the lungs, causing shortness of breath.\n\nDecreased Tolerance for Physical Activity: Heart disease can impair oxygen delivery, leading to exercise intolerance and breathlessness.\n\nOrthopnea: Fluid accumulation in the lungs can worsen when lying down, causing orthopnea.\n\nThese respiratory issues are primarily consequences of heart-related challenges and can significantly impact Mr. Brusca's quality of life. Monitoring and managing his cardiovascular health are crucial to prevent these respiratory complications.\n\nReferences:\n\nWorld Health Organization. (2016). Cardiovascular Diseases (CVDs). Retrieved from https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/cardiovascular-diseases-(cvds)\n\nAmerican Heart Association. (2018). Understanding Blood Pressure Readings. Retrieved from https:\/\/www.heart.org\/en\/health-topics\/high-blood-pressure\/understanding-blood-pressure-readings\n\nMayo Clinic. (2020). Cardiovascular disease. Retrieved from https:\/\/www.mayoclinic.org\/diseases-conditions\/cardiovascular-disease\/symptoms-causes\/syc-20373124\n\nCenters for Disease Control and Prevention. (2019). Heart Disease Risk Factors. Retrieved from https:\/\/www.cdc.gov\/heartdisease\/risk_factors.htm\n<\/p>\n","protected":false},"excerpt":{"rendered":"
Case Study Henry Brusca is a 68-year-old, married father of 7 who was in relatively good health until 3 weeks ago. At that time, he visited the emergency…<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[37,35,41,34,38,40,42,39,33,32,36],"tags":[47,43,44,51,49,45,48,50,46],"class_list":["post-3040","post","type-post","status-publish","format-standard","hentry","category-apa-citation-format-assignment","category-assignment-writers-australia-college-student","category-buy-essay-usa","category-cheap-essay-writing-service-us","category-help-write-a-page-assignment","category-i-need-someone-to-do-my-assignment-within-hours","category-need-assistance-completing-the-assignment","category-need-to-write-an-essay","category-thesis-writing-service-sample","category-write-my-dissertation-usa","category-write-pages","tag-assignment-writers-canada-university-cost","tag-best-dissertation-writers-china","tag-doctoral-dissertation-writing-service","tag-free-ai-english-assignment-writers-china","tag-in-page-paper-write-an-essay","tag-need-help-completing-this-assignment","tag-professional-assignment-writers-usa","tag-uae-1-cheap-assignment-writing-service","tag-write-a-word-essay"],"_links":{"self":[{"href":"https:\/\/www.homeworkacetutors.com\/nursing\/wp-json\/wp\/v2\/posts\/3040","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.homeworkacetutors.com\/nursing\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.homeworkacetutors.com\/nursing\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.homeworkacetutors.com\/nursing\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.homeworkacetutors.com\/nursing\/wp-json\/wp\/v2\/comments?post=3040"}],"version-history":[{"count":0,"href":"https:\/\/www.homeworkacetutors.com\/nursing\/wp-json\/wp\/v2\/posts\/3040\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.homeworkacetutors.com\/nursing\/wp-json\/wp\/v2\/media?parent=3040"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.homeworkacetutors.com\/nursing\/wp-json\/wp\/v2\/categories?post=3040"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.homeworkacetutors.com\/nursing\/wp-json\/wp\/v2\/tags?post=3040"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}