Question

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Case study:

64-year-old patient, admitted to the emergency room, due to throbbing chest pain after walking with shortness of breath for several days, his employee is a bank, with no known allergies, he has been an active smoker of a pack a day for 40 years with a history of Alternate Hypertension (HTN), with uncontrolled BP, for 5 years with pharmacological treatment, In his history he mentions that he is type-2 diabetic, for which he takes oral hypoglycemic drugs. He does not refer other antecedents of interest and denies Family history of heart disease. His treatment is Amlodipine 5 mg, Sinvastatin 40 mg and Metformin 850mg PO

On his physical examination he shows;

1- A BP 195 \ 110, Cardiac frequency 109

2-L Ascultation Cardiac Reveal, a soft tip puff.

3-Both hemitorax expand normally and there are no noises added to the respiratory ascultation

4-The abdomen is palpable globular and soft to the touch, with no signs of venous congestion in its physical examination.

5-The pulses are palpated normally and are symmetrical, except that the pulses in both feet are weak, it has a good capillary return.

Develop the following information

1-Mentions subjective and objective data of the patient,

2-Describe each diagnosis mentioned, define, signs and symptoms, nursing intervention

3-Mention each drug, mentioned here, trade name, generic name, use, dosage, adverse reactions

4-Write a nursing note where you develop nursing interventions.

5-Carry out a care plan with each problem presented here (problem, short and long-range objectives, nursing interventions, and evaluation for each intervention.

Answer 1

1. Subjective data :

Chest pain and shortness of breath

Hypertension history

Diabetes history

Smocking history

Objective data:

Blood pressure

Cardiac auscultation findings

Respiratory auscultation findings

Abdomen palpation findings

Pulse

Capillary refills

2. Chest pain

Angina is pain or discomfort in the chest that occurs when the heart does not get enough blood. People with angina may feel tension, pressure, or a squeezing sensation in the chest.

Symptoms includes:

• Pressure, fullness, burning or tightness in your chest.
• Crushing or searing pain that radiates to your back, neck, jaw, shoulders, and one or both arms.
• Pain that lasts more than a few minutes, gets worse with activity.
• Shortness of breath.

stop all activities and sit or rest in bed in a semi-Fowler's position .

Administer nitroglycerin sublingually.

Hypertension

A condition in which the force of blood exerting it's arterial walls are too high.

Symptoms can be headach, shortness of breath, nosebleeds, flushing, dizziness, chest pain .

Management includes regular physical exercise, stress reduction, antihypertensive medications, lifestyle modifications, dietry modifications.

Type 2 diabetes

Condition in which body doesn't produce enough insulin or it resist insulin and results in high blood glucose levels.

Symptoms include increased thirst, frequent urination, hunger, fatigue and blurred vision.

Management include diet, exercise, antidiabetic medication and insulin therapy.

3. Amlodipine

Genetic name is norvasc .

Indication is hypertension, Angina, coronary artery diseases.

Available dose is 2.5 mg, 5 mg, 10 mg

Side effects includes swellingof your legs or ankles.tiredness or extreme sleepiness, stomach pain,nausea, dizziness, hot or warm feeling in your face ,irregular heart rate, palpitations.

Simvastatin

Simvastatin oral tablet is used to help lower cholesterol and triglyceride levels. It can also reduce the risk of heart disease.

Genetic name is zocor

Sideeffects includes headache, nausea, stomach pain, constipation, muscle pain or weakness, joint pain, upper respiratory infections etc.

Metformin

Brand names: Glucophage,Glucophage XR, Fortamet, and Glumetza.

Generic name metformin.

Available doses includes immediate release 500mg, 850mg, 1000mg. Extended release tablets 500mg, 750mg , 1000mg and oral solution 500mg, 750mg and 1000mg.

Side effects includes physical weakness, diarrhea,gas (flatulence),symptoms of weakness, muscle pain (myalgia),upper respiratory tract infection,low blood sugar ,abdominal pain (GI complaints.

4 Nursing interventions includes rest, anxiety reduction, dietry modifications, lifestyle modifications, medical management, exercise, control of diabetes and hypertension etc.