Increasing fatigue, weakness, Chest pain

Case study • Orla Ramos is 43-year old female admitted to the hospital due to increasing fatigue, weakness, chest pain, dyspnea, and shortness of breath (SOB). The chest pain as substernal, sharp, and radiating to both shoulders. The chest pain had been present for 2 days, but became progressively worse and was associated with dyspnea which prompted her to seek care. She reported a viral upper respiratory infection starting 1 week before the current symptoms began.

• She reports a personal history of smoking half a pack per day since her teens. She has no known allergies and no significant health issues. The only time she was hospitalized was for delivery of two children with no complications. She has a family history of Hashimoto thyroiditis. Physical examination and diagnostic test results

• General, neuromuscular: Mild obesity. Alert, oriented, cooperative, and anxious. Full ROM and strength 5/5 in all extremities • Vital signs: Temperature = 100.8 degrees Fahrenheit (oral); heart rate = 126 beats/min, sinus tachycardia; respiratory rate = 30 breaths/min, labored; blood pressure = 100/60 mmHg; oxygen saturation = 92% on a venturi mask with a flow rate equal to 40% fraction of inspired oxygen; pain = 7/10. Pain is substernal, radiating, and constant; but slight relief when she is upright and leans forward. Pain is worse with coughing and deep inspiration. She is unable to recline due to significantly increased SOB, dyspnea, and pain.

• Ears, nose, throat: Left tympanic membrane red, but not bulging. Posterior pharynx red and edematous, but no exudate noted. Tonsils reddened and 2+. • Cardiopulmonary: Bilateral chest expansion symmetrical. Breath sounds clear, but diminished at bases. S1 and S2 muffled with grating friction rub auscultated. Pedal pulses 1+ and slight pedal edema noted. Bilateral jugular venous distention noted. Extremities slightly cool and pale with capillary refill 3 seconds.
• Abdomen: Soft, non-tender, no masses, and normoactive bowel sounds in all quadrants. Voided 200 cc of clear, yellow urine. • Serum results: Abnormal serum results include total white blood cell count = 17 cells/mcL; c-reactive protein = 15 mg/L; creatinine = 1.5 mg/dl; blood urea nitrogen = 25 mg/dL. Troponin and brain natriuretic peptide levels within normal ranges.

• Other results: Chest x-ray positive for cardiomegaly, but lungs clear. Echocardiogram showed moderate pericardial effusion, reduced right ventricle wall motion, and reduced ejection fraction. Electrocardiogram showed sinus tachycardia with non-specific ST segment changes. Summer To answer questions 1-3, use the scenario above

1. Identify the likely disorder, the underlying pathophysiology (i.e., cellular and tissue changes), and relate the changes to abnormal findings to support your interpretation. (20 points) Hint: We are in the cardiovascular system ☺ !

2. Identify all nursing diagnoses labels (just the label!) that apply to this patient (e.g., impaired swallowing). Identify the priority (#1) nursing diagnosis label; and for the (#1) nursing diagnosis label, explain the nursing interventions to address the identified problem. Provide evidence-based rationale to explain the need and/or benefit of each intervention. For interventions, include what the nurse should “monitor/assess”, “do”, and “teach” to the client. (20 points)

3. Describe 2 medical therapies used to treat the disorder and explain their specific mechanism of action and intended impact at the cellular and/or tissue level. (15 points)

To answer questions 4-5, choose ONE disorder from this week’s reading

4. For the chosen disorder, identify the disorder and describe the impact on the United States population including incidence, prevalence, costs, morbidity, mortality, and/or other appropriate issues. Be sure to identify the disorder, the population associated with the data, and the year(s) of data. (15 points)

5. For the chosen disorder, locate recommendations in a nursing journal article or professional nursing organization. Provide a brief summary of the information and specific recommendations for nursing actions to improve care for patients. (15 points) Hint: To increase the likelihood of locating a nursing journal or organization, look for some form of the word “nurse” in the journal or organizational name!

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