Question

G. E., a 52-year-old Mexican migrant farm worker, has been discharged from the hospital for a deep vein thrombosis two days ago. You are the home health nurse assigned to visit G.E. When you arrive, you see that he is apprehensive, restless, diaphoretic, and extremely anxious. His SaO2 is 82% (previously had been 97% on room air), his heart rate is 116 beats per minute, and his blood pressure is 100/56 mm Hg. He is complaining of a sharp chest pain that gets worse when he breathes in, and he has shortness of breath. G. E. and his eight-months pregnant wife do not speak English well. Their 11-year-old son is interpreting and tells you his dad has a past medical history of congestive heart failure (CHF), hypertension, and diabetes. Interview reveals a change in his condition with the following symptoms: increase in number of pillows from two to four; decrease in activity tolerance; a dry, hacking cough; and a decrease in appetite.

Address all of the following: Develop a problems list from the objective and subjective data. From the readings, discuss the most probable causes of the symptoms. Articulate what cardiac changes can be attributed to the aging process and separately to culture and genetics.

Answer 1

ANSWER:

Subjective data are:

• Patient's complain of chest pain
• shortness of breadth
• Use of increased mumber of pillows
• Hacking cough
• Decreased appetite.

Objective data are:

• Saturation of 82%.
• Pulse rate of 116 beats per minute
• Blood pressure of 100/56 mmHg
• Restless
• Diaphoretic
• Anxious

The probable cause of the symptoms can be

• Remission of congestive cardiac failure.
• Pulmonary embolism
• Angina
• Myocardial infaraction.

Cardiac changes attributed to aging process are often seen in heart and blood vessels. Some of it occurs with aging while some occurs in aging due to modifiable factors.

• Changes that occur in heart:

1. With the advancing age, the pathways in the conduction system develop fibrous or fat deposits. Thus some of cells of the natural pacemaker is lost so it results in slower heart rate.
2. The cardiac muscles especially in the left ventricle thickens which increases the size of the heart and decreases the amount of blood that the chamber holds. This causes slow filling of heart.
3. ECG pattern of the aged and young people have different pattern. Aged people may have arryhthmias which is due to heart diseases.
4. The heart muscle cells degenerates slowly with aging, thus the valves that control the blood flow becomes thick and stiffer.

• Changes in blood vessels:

1. The baroreceptors present in the blood vessel that helps to regulate blood by identifying the changes to maintain a constant blood pressure, becomes less sensitive with aging.
2. The capillary wall thickens which results in reduced exchange of nutrients.
3. The aorta becomes thick with aging as there are changes in the connective tissue of the blood vessel wall. Thus a moderate increase in blood pressure is always seen among aged.

Not only this aging affects the consistency of the blood itself. Normal aging causes reduction in total body water, that causes decrease in the blood volume too. The production of red blood cells in response to stress and illness is reduced, so the body's response to anemia and blood loss is also slow. With aging certain white blood cells decreases in number and their ability to fight bacteria. Therefore the defense mechanism (immunity) of the aged people is often weak.

The cultural practices that determines the persons dietary pattern, activity levels and the health behaviours are the once that may result in cardiac changes and promote to risk people towards development of cardiovascular diseases. Genetics also plays significant role in occurence of cardiac changes. These cardiac changes may be functional or may be structural defects that disturbs the normal functioning of the heart and blood vessels like congenital heart diseases, cardiomyopathy, stroke, hypercholesetremia, CAD.They run in families indicating inherited genetic risk factors.