Question Case Study 1 Julie, age 35, was a computer programmer, but… Case Study 1Julie, age 35, was a computer programmer, but beginning last year, she started taking more and more days off work, as she couldn’t seem to get out of bed. Her software company let her go, and she has been depressed lately. Julie’s husband, Jim, keeps telling her to “snap out of it” and reminds her that they really need two paychecks. They have two young teenagers who are pretty much on their own, as Julie can barely manage to put dinner on the table, let alone do the cleaning and laundry. She has seen a number of physicians about her vague complaints, and other than ordering a selective serotonin uptake inhibitor (SSRI) and recommending counseling, they have been no help. CC: “I feel like I’m going crazy, because no one thinks I’m sick. I’m tired of feeling this way. Can you help? I’m always tired; I can’t sleep; I ache all over; and I’m losing my memory.”Physical Examination:Tired looking woman looking older than her stated agePale skin, shoddy, tender cervical lymph nodesMMSE WNLOtherwise, normal examination except for vague muscle painQuestion 1Do you need to do any diagnostic examinations to rule out your initial diagnosis?Question 2What differentials are you considering and why?Question 3What nonpharmacological interventions will you suggest Julie try?Question 4What pharmacological prescriptions will you order?  Health Science Science Nursing NURS 685 Share QuestionEmailCopy link Comments (0)

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Question Case Study 1 Julie, age 35, was a computer programmer, but… Case Study 1Julie, age 35, was a computer programmer, but beginning last year, she started taking more and more days off work, as she couldn’t seem to get out of bed. Her software company let her go, and she has been depressed lately. Julie’s husband, Jim, keeps telling her to “snap out of it” and reminds her that they really need two paychecks. They have two young teenagers who are pretty much on their own, as Julie can barely manage to put dinner on the table, let alone do the cleaning and laundry. She has seen a number of physicians about her vague complaints, and other than ordering a selective serotonin uptake inhibitor (SSRI) and recommending counseling, they have been no help. CC: “I feel like I’m going crazy, because no one thinks I’m sick. I’m tired of feeling this way. Can you help? I’m always tired; I can’t sleep; I ache all over; and I’m losing my memory.”Physical Examination:Tired looking woman looking older than her stated agePale skin, shoddy, tender cervical lymph nodesMMSE WNLOtherwise, normal examination except for vague muscle painQuestion 1Do you need to do any diagnostic examinations to rule out your initial diagnosis?Question 2What differentials are you considering and why?Question 3What nonpharmacological interventions will you suggest Julie try?Question 4What pharmacological prescriptions will you order?  Health Science Science Nursing NURS 685 Share QuestionEmailCopy link Comments (0)

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Question Answered step-by-step Question 1 Scenario: Chester is a 63 year old man of African...  Question 1Scenario:Chester is a 63 year old man of African descent who is an accountant.  He arrives to the emergency department for evaluation of chest pain that was a sudden onset while getting out of his vehicle. It was associated with dizziness and difficulty breathing. Chester tells you that he knows what it is as his father died of a heart attack when he was 59 years of age and now it's my turn.What is the first diagnostic test that you will perform? 1.Cardiac stress test 2.ECG 3.Echocardiogram  4.TroponinQ.2. His wife takes you aside and tells you that he had been treated for hypertension, high cholesterol levels, and diet controlled diabetes but that he has refused medication for the past year.  He eats what he wants and does not get much exercise during the school year.  According to his wife, Helen he is 23 kg overweight.  She also tells you the he quit smoking couple of months ago.  Based on the information about Chester that has been provided above, and the previous question identify six potential cardiac risk factors. (0.5 each -3 marks) Question.3. When obtaining your subjective assessment for pain, you will be using the PQRST mnemonic to gather as much data as possible. Identify at least one to two assessment data for each of the PQRST and what should the nurse consider? (10 marks) Question.4. When assessing pain in chest pain presentation for Chester, what are descriptor words of concern used for describing chest pain/discomfort? What would the differential diagnoses that you would be most concerned with? (4marks) Question.5.Upon your objective assessment you note the following:Heart rate = 104Respiratory rate = 22BP = 172/102SPO2 = 95% on room airNo visible pulsations, heaves, or lifts evident with the precordiumPain = 10/10No cyanosis is observed, and an apical impulse is palpable at the 5th intercostal spaceHis skin is cool and moist, and his clothes are damp from perspirationHe feels nauseated but had not vomitedShortness of breath noted with tachypneaDescribes the pain he experienced as intenseCurrently he is unable to find a position of comfort due to pain When you auscultate his chest you note that S1 and S2 are present.  Describe the difference between the two sounds, and the best location to hear them. (2.5 marks each portion = 5 marks) Question.6.Select the differences in cardiac chest pain symptoms for women. Select all that apply. 1.stomach discomfort 2.chest pain described as pressure/squeezing 3.dizzy or lightheaded 4.unexplained fatigue, tiredness 5.SOB, N& V 6.nausea 7.chest pain described as "elephant on chest" 8.sleep difficultyQuestion.7. From the list below choose the diagnostic tests applicable to Chester's  condition. Select all that apply.  1.cardiac protein  2.ABG 3.liver function studies 4.cardiac enzyme  5.lipid studies  6.outpatient stress testQuestion.8. What are some ethnic considerations to keep in mind in Chester's case? 1 mark Question 9There are different cardiac tests that may be ordered for a cardiac patient. Match the diagnostic test to the description. 1.ECG 2.ABG 3.VBG 4.echocardiogram 5.stress test 6.CRPa.Primarily lacking in O2 & relatively high in carbon dioxide b.Assess cardiovascular capacity, heart rate, blood flow within the heart, severity of existing heart conditionc.Used to detect heart disease, assess if heart problems cause of SOB, or chest pain and/or shows pumping strength, damage to heart muscle, heart sized.Blood marker of inflammation in arteries of heart e.Test that measures the electrical activity of the heartbeatf.Evaluate lung function & detect acid-base imbalance that could indicate respiratory, metabolic or kidney disorder        Question 10Chester is exhibiting shortness of breath with some crackles in the lower bases. What additional blood test would be ordered for Chester to differentiate between a non-cardiac cause and cardiac cause such as ventricular dysfunction? 1MARKQuestion.11.As a nurse completing the cardiovascular assessment, it is important to obtain data that helps to differentiate between ACS and aortic dissection. This will guide the nurse with the care plan, the frequency of monitoring, when to become concerned and notify the physician.Match the data to ACS and aortic dissection(10marks) 1. ACS 2.ACS 3.ACS 4.ACS 5.AAA 6.AAA 7.AAA 8.AAA 9.ACS 10.AAAA.May have pallor, diaphoresis, possible cyanosis or mottling coloringB.may have pallor, diaphoresis or peripheral cyanosisC.Hypertension is a major predisposing factorD.Region of pain that is substernal and can radiate to the neck, throat, jaw, and face, interscapular back, abdomenE.resulting from a continuum of cardiac ischemic processesF.sudden, excruciating, severe painG.Region of pain in the chest, substernal area, epigastrium, neck, jaw, or ulnar aspect of the left arm or elbowH.will have ECG changesI.Tachycardia or bradycardia, hypotension or hypertension, bilateral arm BP may have slight variation, tachypneaJ.may have significant right and left arm BP variation, may have tachycardia, dimished peripheral pulses  Health Science Science Nursing CNC 110 Share QuestionEmailCopy link Comments (0)