Question

Group 4:          

Course Project Case Study: Mr. Lopez is an 85 year-old Hispanic man who was admitted to the hospital with complaints of fatigue, decreased appetite, and a 25 pound weight loss over the past six months. He also reports change in his short term memory. He used to be active with his local retired friends and walked 1.5 miles a day but now spends most of his time in his recliner watching television. He has a medical history of coronary artery disease and hypertension.

Orders include:

Regular diet, calorie count

Ensure shakes TID daily

Ambulate TID daily, stand by assist

Daily weights

Warfarin 2 mg PO daily

Digoxin 125 mcg PO daily

Atorvastatin 20 mg PO daily

Escitalopram 10 mg PO daily

Metoprolol 50 mg PO BID

Do not resuscitate

1. Medical history- Describe the pathophysiology of the medical diagnoses of your assigned patient. Include the admitting diagnosis as number one and then four other medical diagnoses (for a total of 5). The admitting diagnosis is reason for being in the facility. If post-surgical, include surgery and reason for surgery. The secondary diagnoses include a history of pre-existing medical diagnoses). You need to include 4 secondary diagnoses. If your patient does not have a total of five medical diagnoses put N/A - you must note that in your paper or you will lose points. For each diagnosis, provide at least a 5 sentence explanation of the pathophysiology of the condition/problem. MAKE SURE YOU CITE YOUR SOURCES.   

2. Nursing Care Plan- 4 nursing diagnoses, one short-term and one long-term goal PER NURSING DIAGNOSIS, and three interventions PER NURSING DIAGNOSIS (not per goal, unless you want to). Prioritize per Maslow with an explanation and an expected evaluation. Make sure to include a teaching plan in your care plan.  Upload the table below into your paper. Include the following in your paper: Which of your nursing diagnoses are priority using Maslow’s Hierarchy of Needs? If you were to implement this plan of care, would you expect any of your short-term expected outcomes met during your shift? Explain. How might you revise your care plan next time to achieve at least one outcome during your shift?

Answer 1

coronary artery disease.   

CAD is caused by build up of cholesterol rich deposit or plaques on the lining inside the artery.These plaques are also called atheromatous plaques or atheromas and cause a thickening of the arterial wall and narrowing of the arterial space through which blood flows to the heart.The amount of blood reaching and supplying the heart muscle with oxygen and nutrients therefore reduced in the presence of atheromas.

An atheroma usually starts or develop as a result of injury or damage to the inner lining of the artery called the endothelium.Once the endothelium is damaged, cholesterol,fats, lipoprotein and other debris starts to accumulate at the site of injury in the wall or intima of artery.

High concentration of LDL penetrate the damaged endothelium and undergo oxidation.LDL act as a beacon that attracts WBC to migrate towards the vessel wall.As macrophages appear,they engulfed the lipoproteins and become foam cells.This foam cells give rise to fatty streak.This fatty streak form to plaque.If plaque's size is large it cause more narrowing of vessels.

This may cause stroke,MI,heart attack.These are the secondary diagnosis.

stroke occur when there is a blood flow to the brain is interrupted, results in permanent neurological damage.Two major categories ischemic and hemorrhagic.

Heart attack occur when there is supply is blocked.The plaque ruptured and form clot and block the arteries.

nursing diagnosis

decreased blood flow to the heart related to plaque formation as evidenced by fatigue

check vitals

give proper rest

avoid strenuous activity

give medicine correctly

loss apetite related to disease as evidenced by loss of weight

proper psychological support

give interested food

explain about the importance of food

anxiety related to disease

councilling

psychological support

be friendly

explain about the disease