Question

Patient S is a white woman, 43 years of age, and mother of three small children. She has a long-standing history of significant obesity with little success in dieting over the years. At 5'3", she is obese, weighing 220 pounds. Her fat distribution is "apple-shaped" and consequently, her waist-hip ratio is more than the 0.8 normal range. In addition, Patient S lives a fairly sedentary lifestyle and does not have a regular exercise program. Her dietary habits do not take into account basic recommendations for cardiac nutrition.

Patient S has a previous history of MI 1 year ago. Today she presents to the ER with complaints of chest pain and nausea. Her ECG is unremarkable, she has an elevated troponin with ongoing intermittent left side chest pain that she describes as "sharp and intermittent".

She reports that she did not comply to the cardiac rehab program post cardiac event 1 year ago stating, "I have been lethargic and unmotivated since then". The patient goes on to tell you that she has been unable to return to work due to ongoing symptoms of depression. Patient S is not seeing a psychiatrist in the community. She is not taking any medication currently. She reports her symptoms of depression that surfaced following her MI have been persistent but have not worsened over time.

What is the priority nursing intervention at this point?

	1.	Using interview or standardized measurement tools identify psychological distress
	2.	Call Mrs. M's daughters and demand they stay with Mrs M at all times despite her declining their offer
	3.	Refer Mrs M. to a psychiatrist for further assessment
	4.	Assess Mrs. M's return to work capacity

Answer 1

Answer

Since she has been unable to return to work due to ongoing symptoms of depression she has to be

3. Refer to a psychiatrist for further assessment.

{Counseling recommendations for Patient S would primarily focus on cardiac nutrition aspects and developing an exercise program for cardiovascular fitness. Because she is more than 30% overweight, she is at a tremendously increased risk of coronary heart disease due to the added stress on her heart and the changes that occur in lipid metabolism when fat is distributed in the abdominal versus gluteal region. Therefore, patient teaching should emphasize good nutrition and reading nutrition labels to manage caloric intake, as well as limiting intake of fat and cholesterol. In addition to changes in diet, Patient S should be counseled on incorporating some form of aerobic exercise, such as walking, three to five times a week to achieve cardiovascular fitness. The exercise will also have the added benefit of helping her modify her weight level.}

(pls note instead of Mrs.S ,wrongly mentioned as Mrs.M in answering options)