Download Case Study

Case Study: Assessment of the Cardiovascular System
Your client is a 72-year-old man who had an extensive left ventricular myocardial
infarction (MI) at 36 years of age. At the time of his MI, he was overweight by 50 pounds
and smoked two packs of unfiltered cigarettes per day. He had smoked for 20 years.
Alcohol consumption was part of his ethnic background; it was customary for him to
drink one or two beers per day and several mixed drinks per week. His father had also
suffered an MI, at the age of 48, and was a chain smoker. Your client slowly recovered
from his MI, gave up smoking, and lost weight. His weight stabilized within 15 pounds of
the upper limit of his ideal weight. His wife became an active participant in his recovery
by changing her style of cooking and virtually eliminating saturated fats from their diets.
He no longer drank beer, but he continued to consume an average of two mixed drinks
per day. He began a moderate exercise program that included walking several miles a day
at least three times a week. He has had stable angina for many years and has annual
physical checkups and ECGs at the cardiologist’s office. He took up the hobby of
downhill skiing at the age of 66, with his cardiologist’s approval. He is a retired
accountant with a type A personality. Over the past 6 months, he has experienced
infrequent periods of lightheadedness. He has “blacked out” on at least one occasion and
was unable to remember any details of what happened. A second episode of loss of
consciousness occurred on a clear, cold winter day while he was skiing. He revived
spontaneously. The next day, he scheduled an appointment with his physician.
1. Which lifestyle changes decreased his risk status after his MI? Which habits
increased his risk status?
Decreased
 Gave up smoking
 Lost weight
 No longer drinks beer
 Exercises moderately
 Changed dietary habits, with a significant reduction in saturated fats
 Began downhill skiing at age 66
Increased
 Two mixed drinks a day
 Type A personality
2. Compare and contrast the risk factors of the CV disease for a 36-year-old man and a
72-year-old man.
Copyright © 2006, 2002 by Elsevier Inc.
Answer Guidelines – Study Guide Case Studies
2
See Chart 36-1, “Nursing Focus on the Older Adult: Changes in the Cardiovascular
System Related to Aging.”
3. The cardiologist performs an ECG and orders blood work drawn for AST, CK and
CK-MB, LDH and isoenzymes, and serum potassium. What is the purpose for these
tests?
See Chart 36-4, “Laboratory Profile: Cardiovascular Assessment.”
4. The ECG and blood work are inconclusive, but the physician is concerned about his
symptoms. Discuss why there is reason for concern.
Syncope is caused by any condition that suddenly reduces cardiac output, resulting in
decreased blood flow. However, with the older adult, there actually may not be a reason
for concern. See the section on "Considerations for Older Adults" on textbook p. 688.
5. He is scheduled for an inpatient cardiac catheterization. The physician tells him that,
based on the findings at the time of the catheterization, he may go ahead and perform
an angioplasty. Develop a teaching-learning plan for this client.
Client preparation includes the following:
 Reviewing the purpose of the procedure, explaining the length of time for the
procedure, answering any questions the client may have, allaying any fears that the
client or family may have, monitoring vital signs, auscultating the heart and lungs,
and evaluating the client's peripheral pulses
 Explaining which areas of the heart will be explored, the physical preparation for the
procedure, how the client may feel during and after the procedure, and any
medications that may be used
 Explaining that follow-up care will consist of vigilant observation of the insertion
site, bedrest for a period of hours as determined by the physician (usually 4 to 6
hours), observation for complications of cardiac catheterization, monitoring of vital
signs, and management of pain or discomfort
 Informing the client about preparation for the procedure, the procedure itself, and
follow-up care to encourage more cooperation and trust during the procedure.
6. The cardiac catheterization is completed, and a 95% blockage of the left anterior
descending (LAD) artery is seen along with an 80% blockage of the circumflex
artery. A balloon angioplasty is performed in the catheterization laboratory. After the
procedure, the LAD has a 40% blockage, and the circumflex has a 25% blockage.
The physician counsels the client to resume activity gradually. A stress test will be
scheduled in several weeks for further evaluation of his exercise tolerance and
cardiac status. Develop a teaching-learning plan for this client to prepare him for the
upcoming tests.
Copyright © 2006, 2002 by Elsevier Inc.
Answer Guidelines – Study Guide Case Studies
3
With a stress test being planned for the client, the following information should be
included:
 The reason for the test (to determine the functional capacity of the heart)
 The need to screen for asymptomatic coronary disease
 The need for physical assessment before the stress test, possibly including a 12-lead
ECG
 Clarification about the procedure (after the cardiologist obtains the informed consent)
or referral to the cardiologist for further explanation
 What the client can expect before, during, and after the test
Copyright © 2006, 2002 by Elsevier Inc.