Republic of the Philippines CAMARINES SUR POLYTECHNIC COLLEGES Nabua, Camarines Sur COLLEGE OF HEALTH CARE TECHNOLOGY PROJECT

IN NCM 103-OXYGENATION Instructor: NOREVEE D. DE LA VEGA, RN

INSTRUCTION: Read the following questions carefully and be able to explain each of your answers. Write or type your answers in a short bond paper and place it in a short brown envelope on October 12, 2010 (Tuesday) not later than 9:00 am. Do not copy from your classmates output. Individual answers are required for this project.

QUESTIONS: Case Study #1: These are questions pertaining to patients with structural, infectious, and inflammatory cardiac disorders. 1. Your patient is a 55-year-old man who was diagnosed last year with systolic HF (due to coronary artery disease) and was stabilized with lisinopril, Lasix and metoprolol. He follows a low-sodium diet, with only an occasional indiscretion. He is complaining of a nagging cough. What are some of the possible causes for the cough? What would be the key assessment factors that would help identify the cause? What medical treatments and nursing interventions would be appropriate for each of the possible causes? ANSWERS: Some of the possible causes for the cough are due to the large amount of fluid are trapped in the pulmonary tree, irritating the lung mucosa. Also, pulmonary artery pressures are elevated. - Since cough is a common manifestation of LVF, this is the result from increased left ventricular and left atrial pressures, which causes excessive amount of fluid in interstitial and alveolar spaces. Thats why the lung mucosa was irritated that results to nagging cough. - Vasodilators and ACE inhibitors to decrease the afterload. Intubation also provides a route for removing secretions from the bronchi. Deep breathing technique will also help to lessen breathing difficulty and back clapping will help to drain secretions. 2. You are caring for a man with pericarditis. His systolic blood pressure begins to fall, and heart sounds cannot be heard. Describe the actions you would take and why? ANSWERS: The actions would be, first, there should be critical monitoring for signs and symptoms like muffled heart sounds and hypotension. Then, report it to the attending physician so the attending physician will do an emergency procedure to the patient. I need to focus and be calm and attend to the patients need as possible.

Case Study #2: These are questions pertaining to patients with complications from heart disease. 3. A 77-year-old female patient was readmitted for HF for the third time in 2 months. Identify the factors that possibly contribute to her readmission and that would need to be assessed. What interventions could be

implemented to prevent another readmission? Describe the interaction (ie, behaviors, words, and communication techniques) that would demonstrate the concept of partnering with patient. ANSWERS: The factors that possibly contribute to her readmission and that would need to be assessed are: dysrhytmias, especially tachycardia, systemic infections (sepsis), anemia, thyroid disorders, pulmonary embolism, thiamine deficiency, chronic pulmonary disease, medication dose changes, physical or emotional changes, endocarditis, myocarditis or pericarditis, fluid retention from medication or salt intake or a new cardiac condition. - Interventions must be tailored to the patient and taught to improve adherence. The instructions should be well said and with consideration to the feeling of the patient. Encouraging the patient more to adhere to the instructions. The explanation must be according to the patients intellectual preference. Consider also the clients psychosocial and financial assistance. One must fully understand the care of clients to improve the outcomes and quality of life and to reduce morbidity and mortality. 4. One of your neighbors has been diagnosed with mitral regurgitation and does not understand why antibiotics need to be taken before undergoing any dental work, including routine checkups. How would you explain the rationale for these instructions? ANSWERS: Antibiotics are needed to be taken before undergoing any dental work, including routine checkups because dental work is an invasive procedure. Antibiotic serves as prophylaxis to prevent infective endocarditis.

Case study #3: These are questions pertaining to patients with vascular disorders and problems of peripheral circulation. 5. Your patient has been diagnosed with an enlarging abdominal aortic aneurysm (AAA). The physician gives the patient two surgical options: repair of the AAA using an endovascular graft or open surgical repair. What factors would you include in discussing the surgical options, post-operative care? If the patient is taking warfarin (Coumadin) for atrial fibrillation and insulin for diabetes, how would you incorporate these factors into the plan of care? ANSWERS: The usual postoperative care is provided. Assessing the surgical sites for swelling and pain and bleeding. To monitor peripheral perfusion closely, comparing findings to baseline. That ambulation is allowed after surgery. That the hook connected will not be able to be felt since the aorta cannot sense the hooks. - If the patient is taking warfarin, the patient should be stopped taking it for 3 days before any invasive procedure because warfarin is an anticoagulant drug. The risk for bleeding at the graft site is so high that client is at risk for hemorrhage. And since the client is taking insulin for diabetes, the healing of the surgical wound immediately will be difficult to attain, so wound care is really necessary. 6. Your 96-year old patient presents with a 1-year history of experiencing symptoms of claudication after walking four or five blocks the patients live alone, six blocks from the local shopping area, and no longer drives a vehicle. The patient does not wish to undergo surgery at this time and wants to continue living at his current location. What options would you discuss with the patient? If this patient also had a nonhealing foot wound and had smoked two packs of cigarettes each day for the past 80 years, how would your plan of care change?

ANSWERS: Other options I would discuss with patient are to have moderate program of exercise and rest. The program exercise should begin slowly with the client sopping at the onset of pain and progress gradually until the client has substantially lengthened walking distances. - Clients are advised and counseled to reduce sugar intake by following low sugar diet. As for the wound the client must know through health teaching the proper wound care. Smoking cessation is difficult to achieved, social support, especially of family and friends, is an important factor in assisting to quit the habit. Educating the client about the dangers of cigarette smoke, encouraging them to stop smoking, act as a role model for nonsmoking. 7. Your patient has been diagnosed with deep vein thrombosis of a calf. The physician gives the patient two treatment options: hospitalization with intravenous sodium heparin therapy or home treatment with LMWH (low-molecular-weight heparin). What factors would you include in discussing with the patient? ANSWERS: When the client has marked PTT levels, frequent assessment of bleeding or bruising is important. Bleeding precautions include avoidance of injections, brushing teeth with a soft sponge device, supervision with ambulation to prevent falls, increasing intake of fiber and fluids to prevent straining and constipation. Prescribed drugs and over-the-counter drugs must be reviewed for potential drug-drug interactions.

Republic of the Philippines CAMARINES SUR POLYTECHNIC COLLEGES Nabua, Camarines Sur COLLEGE OF HEALTH CARE TECHNOLOGY

SUBMITTED BY:

Nikki Marie P. Casi BSN III-C

SUBMITTED TO:

Norevee D. De la Vega, RN INSTRUCTOR