Question

John Doe entered ABC Hospital ER with c/o chest pain, SOB, and nausea. The doctor on call

Ordered an EKG, blood work, began a regimen of O2, and prescribed salicylic acid. The initial blood

work had the following findings: WBC 8300; RBC 5.3; normal levels of troponin; HDL 43; LDL 220;

BUN25.

John has a hx of CHF and CKD. John’s VS were as follows: BP 163/88; HR 93; RR 24. John takes medicine

for HTN and Nitro for angina pectoris. John is independent with ADL’s, lives alone, and amb with a WW.

The ER doctor ordered anxiety medication b.i.d. and continued with oxygen at 2mL. After further

Assessment, MI was ruled out.

John’s condition improved and he was sent home to f/u with his GP. He was ordered to begin cardiac rehabilitation and wear a heart monitor. The heart monitor was to assess his heart for a-fib.

Questions

1. Identify which blood tests were abnormal?
2. What did the doctor prescribe in the ER? How does this help?
3. What condition was ruled out? How did they rule this condition out?
4. What did John have prior to his visit to the ER?
5. What does John take medicine for?
6. Why is he wearing the heart monitor? What happens with this condition?
7. How often does he take anxiety medication?
8. What does ADL mean?
9. What do you know about his ability to walk?

Answer 1

IN THIS TEST LDL IS HIGH ( BAD CHOLESTROL)-THE NORMAL VALUE OF LDL=LESS THAN 100mg/dl

HDL IS LOW (GOOD CHOLESTROL) -HDL SHOULD BE 50 mg/dl OR HIGHER

HIGH LDL(LOW DENSITY LIPOPROTEIN0 MEANS HAVE TOO MUCH LDL CHOLESTROL IN THE BLOOD .THIS EXTRA LDL,ALONG WITH OTHER SUBSTANCES ,FORMS PLAQUE.THE PLAQUE BUILDS UP IN THE ARTERIES ,THIS CONDITION CALLED ATHEROSCLEROSIS.

HDL(HIGH DENSITY LIPOPROTEIN) GOAL FOR MEN IS 40 OR HIGHER AND  REACHING THIS IS CONSIDERED TO BE GOOD .MR.JHON HDL IS BORDERLINE

BUN-IS HIGH -IN GENERAL ,AROUND 7 TO 20 mg/dl IS CONSIDERED NORMAL

MR.JHONS REPORT

WBC-NORMAL

RBC-NORMAL

HDL -BORDER LINE

LDL-HIGH

BUN-HIGH

2.DOCTOR PRESCRIBED SALICYLIC ACID

MR.JHON CAME FOR CHEST PAIN ,SOB AND NAUSEA .SO THE DOCTOR GIVE SALICYLIC ACID TO REDUCE CHEST PAIN

IN SALICYLIC ACID IS A SIMPLE PHENOLIC COMPOUND SYNTHESIZED IN A WIDE RANGE OF PROKARYOTIC AND EUKARYOTIC ORGANISMSBIT BELONGS TO THE SAME CLASS OF DRUG AS ASPIRIN (SALICYLATES)

SALICYLATES AND RELATED SUBSTANCES ASPIRIN IS ACETYLSALICYLIC ACID AND IS SYNTHETIC SALICYLATE.THIS REDUCE PAIN,FEVER AND INFLAMMATION AND AS A TREATMENT FOR HEART DYSFUNCTION.

I SALICYLIC ACID ,THE ASPIRIN HELP TO REDUCE THE PAIN ,AND OXYGEN REDUCE SOB BOTH OF THIS CONTROL, NAUSEA WILL REDUCE .

3.THE DOCTOR RULED OUT MYOCARDIAL INFARCTION

NORMALY MI RULED OUT BY THE TROPONIN VALUE-IT IS GREATER THAN 1ng/ml indicates MI , BUT HERE THE DOCTOR RULED OUT THE MI FROM EKG

TROPONIN IS NORMAL BUT THE ECG CHANGES OF ST DEPRESSION OR ELEVATION INDICATES MI .IT IS USUALLY CORONARY PLAQUE DISRUPTION AND PARTIAL CORONARY OCCLUSION.

4;JOHN IS A HISTORY OF CHF AND CKD ,HE KNOWS WELL ABOUT THE COMPLICATIONS AND HE LIVES ALONE,HE IS DOING ALL DAILY ACTIVITIES INDEPENDENTLY.

CHF IS A MAJOR PUBLIC HEALTH PROBLEM CHARACTERISED BY PROGRESSIVE DETERIORATION WITH DISABLING SYMPTOMS.SO MR.JHON SEEK ER DEPARTMENT BECAUSE OF WORSENING SYMPTOMS AND SIGNS .

5.THE JHON TAKES MEDICINE FOR HTN AND NITROGLYCERIN FOR ANGINA PECTORIS. NITROGLYCERIN SUBLINGUAL TABLETS ARE USED TO TREAT EPISODES OF ANGINA (CHEST PAIN ).IT IMPROVE THE BLOOD FLOW TO THE HEART ,OPEN UP THE ARTERIES IN THE HEART,WHICH IMPROVES SYMPTOMS AND REDUCES HOW HARD THE HEART HAS TO WORK.

IT HELPS TO LOWER THE BLOOD PRESSURE AND HEART RATE . MR.JHON HAS HIGH BP AND HR RATE SO THE MEDICINE HELPS TO CONTROL CHEST PIN,BP AND HEART RATE.

6. HOLTER MONITOR IS USED TO DETERMINE HOW THE HEART RESPONDS TO NORMAL ACTIVITY.THE MONITOR ALSO BE USED AFTER A HEART ATTACK.TO DIAGNOSE THE HEART RHYTHM PROBLEMS ,THAT MAY CAUSING SYMPTOMS SUCH AS PALPITATIONS OR SYNCOPE.

MR.JHON IS A HEART ATTACK AND CHF PATIENT-THIS HOME MONITORING HELP CLINICIANS TO IDENTIFY EARLY WARNING SIGNS OF FLUID RETENSION AND INTERVENE AS NEEDED,EITHER BY REINSTATING ADHERENCE TO OPTIMAL DIET AND MEDICATIONS OR INCREAING DIURETIC DOSING TO AVOID WORSENING OF SYMPTOMS .

7.HE TOOK ANXIETY MEDICATION BID

ANXIETY IS HIGHLY PREVALENT AMONG PATIENTS WITH CHD ,AND THERE IS GROWING EVIDENCE THAT HIGH LEVELS  OF ANXIETY ARE ASSOCIATED WITH WORSE PROGNOSIS .

ANXIETY MEDICATION HELPS TO REDUCE SYMPTOMS AND IMPROVING CLINICAL OUTCOMES

8.ADLs (ACTIVITIES OF DAILY LIVING). THE THINGS WE NORMALLY DO IN DAILY LIVING INCLUDING ANY DAILY ACTIVITY WE PERFORM FOR SELF-CARE SUCH AS FEEDING OURSELVES,BATHING ,DRESSING,GROOMING,WORK,HOMEMAKING AND LEISURE.

SIMPLY THE TASKS OF EVERYDAY LIFE ,BASIC ADL INCLUDE0 EATING.DRESSING,TAKING SHOWER,AND USING THE TOILET.

9.CHF PATIENT CAN WALK .BEGIN BY WALKING FIVE MINUTES A DAY,THEN SLOWLY ADD TO THE AMOUNT OF TIME HOW MUCH YOU CAN.

WALKING IS AGOOD TYPE OF PHYSICAL ACTIVITY FOR CHD BECAUSE IT IS GENTLE ON YOUR BODY AS IT LOW IMPACT ACTIVITY.SO JHON CAN WALK,WALKING IS GOOD FOR JHONS CONDITION.WALKING HELPS TO GREATER INCREASES CONFER LARGER CARDIOVASCULAR HEALTH BENEFITS . SO MR.JHON MAY ACCTUE SHORT-TREMS GAINS SUCH AS IMPROVED FITNESS,BODY COMPOSITION ,BP AND LIPID PROFILE.