Discussion: Cardiovascular Alterations

At least once a year, the media report on a seemingly healthy teenage athlete collapsing during a sports game and dying of heart complications. These incidents continue to outline the importance of physical exams and health screenings for teenagers, especially those who play sports. During these health screenings, examiners check for cardiovascular alterations such as heart murmurs because they can be a sign of an underlying heart disorder. Since many heart alterations rarely have symptoms, they are easy to miss if health professionals are not specifically looking for them. Once cardiovascular alterations are identified in patients, it is important to refer them to specialists who can further investigate the cause.

Consider the following scenario:

A 16-year-old male presents for a sports participation examination. He has no significant medical history and no family history suggestive of risk for premature cardiac death. The patient is examined while sitting slightly recumbent on the exam table and the advanced practice nurse appreciates a grade II/VI systolic murmur heard loudest at the apex of the heart. Other physical findings are within normal limits, the patient denies any cardiovascular symptoms, and a neuromuscular examination is within normal limits. He is cleared with no activity restriction. Later in the season he collapses on the field and dies.

To Prepare

· Review the scenario provided, as well as Chapter 25 in the Huether and McCance text. Consider how you would diagnose and prescribe treatment for the patient.

· Select one of the following patient factors: genetics, ethnicity, or behavior. Reflect on how the factor you selected might impact diagnosis and prescription of treatment for the patient in the scenario.

·  

Post a description of how you would diagnose and prescribe treatment for the patient in the scenario. Then explain how the factor you selected might impact the diagnosis and prescription of treatment for that patient.

Use resource below for reference

Huether, S. E., & McCance, K. L. (2017). Understanding pathophysiology (6th ed.). St. Louis, MO: Mosby.

• Chapter 23, “Structure and      Function of the Cardiovascular and Lymphatic Systems”

This chapter examines the circulatory system, heart, systemic circulation, and lymphatic system to establish a foundation for normal cardiovascular function. It focuses on the structure and function of various parts of the circulatory system to illustrate normal blood flow.

• Chapter 24, “Alterations of      Cardiovascular Function”

This chapter presents the pathophysiology, clinical manifestations, evaluation, and treatment of various cardiovascular disorders. It focuses on diseases of the veins and arteries, disorders of the heart wall, heart disease, and shock.

• Chapter 25, “Alterations of      Cardiovascular Function in Children”

This chapter examines cardiovascular disorders that affect children. It distinguishes congenital heart diseases from acquired cardiovascular disorders.

Hammer, G. D., & McPhee, S. J. (2019). Pathophysiology of disease: An introduction to clinical medicine (8th ed.). New York, NY: McGraw-Hill Education.

• Chapter 10, “Cardiovascular      Disorders: Heart Disease”

This chapter begins by exploring the normal structure and function of the heart. It then examines the etiology, pathophysiology, and clinical manifestations of five heart disorders: arrhythmias, congestive heart failure, valvular heart disease, coronary artery disease, and pericardial disease.

Jacobsen, R. C., & Gratton, M. C. (2011). A case of unrecognized prehospital anaphylactic shock.Prehospital Emergency Care, 15(1), 61–66.

Retrieved from the Walden Library databases.

 
 

This article provides information relating to the diagnosis and management of anaphylactic shock. It also explores difficulties encountered when diagnosing uncommon clinical presentations of anaphylactic shock.

  

A 39-year-old homeless man presents to the emergency department for cough and fever. He says that his illness has been worsening over the past 2 weeks. He originally had dyspnea on exertion and now is short of breath at rest. On questioning, he tells you that he lives in a homeless shelter when he can, but he frequently sleeps on the streets. He has used IV drugs (primarily heroin) “on and off” for many years. He denies medical history but the only time he gets medical attention is when he comes to the emergency department for an illness or injury. On review of systems, he complains of fatigue, weight loss, and diarrhea. On examination, he is a thin, disheveled man appearing much older than his stated age. His temperature is 100.5°F (38.0°C), his blood pressure is 100/50 mm Hg, his pulse is 105 beats/min, and his respiratory rate is 24 breaths/min. His initial oxygen saturation is 89% on room air, which comes up to 94% on 4 L of oxygen by nasal cannula. Significant findings on examination include dry mucous membranes, a tachycardic but regular cardiac rhythm, a benign abdomen, and generally wastedappearing extremities. His pulmonary examination is significant for tachypnea and fine crackles bilaterally, but no visible signs of cyanosis. His chest x-ray is read by the radiologist as having diffuse, bilateral,

interstitial infiltrates that look like “ground glass.”

Answer the following questions

What is the most likely cause of this patient’s current pulmonary

complaints?

➤ What underlying illness does this patient most likely have?

➤ What testing and treatment should be started now?

Note: 

I need the work to have at least two updated bibliography of the last 5 years, thanks

1-Discuss  and provide 2 specific ways Early Conceptualization About Nursing Theory can be applied to advanced practice nursing. Identify one MSN Essential that most relates to this particular topic. 

 

*Under the Class Resources tab, students will find the MSN Essentials which help to guide and shape graduate nursing education. Select 1 of these essentials that most closely reflect the concepts of this theory.**

note:  All discussion posts must be minimum 250 words, references must be cited in APA format, and must include minimum of 2 scholarly resources published within the past 5-7 years.  Please be sure to cite your reference(s) in APA format, at the end of your posting.

  

SOAP NOTE SAMPLE FORMAT FOR MRC

  

Name:  LP

Date: 

Time: 1315

 

Age: 30

Sex: F

 

SUBJECTIVE

 

CC:  

“I am having vaginal itching and pain in   my lower abdomen.”

 

HPI:  

Pt is a   30y/o AA female, who is a new patient that has recently moved to Miami. She seeks treatment today after   unsuccessful self-treatment of vaginal itching, burning upon urination, and   lower abdominal pain. She is concerned   for the presence of a vaginal or bladder infection, or an STD. Pt denies fever. She reports the itching and burning with   urination has been present for 3 weeks, and the abdominal pain has been   intermittent since months ago. Pt has   tried OTC products for the itching, including Monistat and Vagisil. She denies any other urinary symptoms,   including urgency or frequency. She   describes the abdominal pain as either sharp or dull. The pain level goes as high as 8 out of 10   at times. 200mg of PO Advil PRN   reduces the pain to a 7/10. Pt denies   any aggravating factors for the pain. Pt reports that she did start her menstrual cycle this morning, but   denies any other discharge other that light bleeding beginning today. Pt denies douching or the use of any   vaginal irritants. She reports that   she is in a stable sexual relationship, and denies any new sexual partners in   the last 90 days. She denies any   recent or historic known exposure to STDs. She reports the use of condoms with every coital experience, as well   as this being her only form of contraceptive. She reports normal monthly menstrual cycles that last 3-4 days. She reports dysmenorrhea, which she also   takes Advil for. She reports her last   PAP smear was in 7/2016, was normal, and reports never having an abnormal PAP   smear result. Pt denies any hx of   pregnancies. Other medical hx includes   GERD. She reports that she has an Rx   for Protonix, but she does not take it every day. Her family hx includes the presence of DM   and HTN. 

 

Current Medications: 

Protonix   40mg PO Daily for GERD

MTV OTC   PO Daily

Advil   200mg OTC PO PRN for pain

 

PMHx:

Allergies:  

NKA & NKDA

Medication Intolerances: 

Denies

Chronic Illnesses/Major traumas

GERD

Hospitalizations/Surgeries

Denies

 

Family History

Father-   DM & HTN; Mother- HTN; Older sister- DM & HTN; Maternal and paternal   grandparents without known medical issues; 1 brother and 3 other sisters   without known medical issues; No children.

 

Social History

Lives   alone. Currently in a stable sexual   relationship with one man. Works for   DEFACS. Reports occasional alcohol   use, but denies tobacco or illicit drug use.

 

ROS

 

General 

Denies   weight change, fatigue, fever, night sweats

Cardiovascular

Denies   chest pain and edema. Reports rare palpitations that are relieved by drinking   water

 

Skin

Denies   any wounds, rashes, bruising, bleeding or skin discolorations, any changes in   lesions

Respiratory

Denies   cough. Reports dyspnea that accompanies the rare palpitations and is also   relieved by drinking water

 

Eyes

Denies corrective   lenses, blurring, visual changes of any kind

Gastrointestinal

Abdominal   pain (see HPI) and Hx of GERD. Denies   N/V/D, constipation, appetite changes

 

Ears

Denies   Ear pain, hearing loss, ringing in ears

Genitourinary/Gynecological

Reports   burning with urination, but denies frequency or urgency. Contraceptive and STD prevention includes   condoms with every coital event. Current stable sexual relationship with one man. Denies known historic or recent STD   exposure. Last PAP was 7/2016 and normal. Regular monthly menstrual cycle   lasting 3-4 days. 

 

Nose/Mouth/Throat

Denies   sinus problems, dysphagia, nose bleeds or discharge

Musculoskeletal

Denies   back pain, joint swelling, stiffness or pain

 

Breast

Denies   SBE

Neurological

Denies   syncope, seizures, paralysis, weakness

 

Heme/Lymph/Endo

Denies   bruising, night sweats, swollen glands

Psychiatric

Denies   depression, anxiety, sleeping difficulties

 

OBJECTIVE

 

Weight   140lb 

Temp -97.7

BP 123/82

 

Height 5’4”

Pulse 74

Respiration 18

 

General Appearance

Healthy   appearing adult female in no acute distress. Alert and oriented; answers   questions appropriately. 

 

Skin

Skin is   normal color for ethnicity, warm, dry, clean and intact. No rashes or lesions   noted.

 

HEENT

Head is   norm cephalic, hair evenly distributed. Neck: Supple. Full ROM. Teeth are in   good repair.

 

Cardiovascular

S1, S2   with regular rate and rhythm. No extra heart sounds. 

 

Respiratory

Symmetric   chest walls. Respirations regular and easy; lungs clear to auscultation   bilaterally.

 

Gastrointestinal

Abdomen   flat; BS active in all 4 quadrants. Abdomen soft, suprapubic   tender. No hepatosplenomegaly.  

    

Genitourinary

Suprapubic   tenderness noted. Skin color normal   for ethnicity. Irritation noted at   labia majora, minora, and perineum. No ulcerated lesions noted. Lymph nodes   not palpable. Vagina pink and moist   without lesions. Discharge minimal,   thick, dark red, no odor. Cervix pink   without lesions. No CMT. Uterus normal size, shape, and consistency.  

 

Musculoskeletal

Full   ROM seen in all 4 extremities as patient moved about the exam room.

 

Neurological 

Speech   clear. Good tone. Posture erect. Balance stable; gait normal.

 

Psychiatric

Alert   and oriented. Dressed in clean clothes. Maintains eye contact. Answers   questions appropriately.

 

Lab Tests

Urinalysis   – blood noted (pt. on menstrual period), but results negative for infection

Urine   culture testing unavailable

Wet   prep – inconclusive 

STD   testing pending for gonorrhea, chlamydia, syphilis, HIV, HSV 1 & 2, Hep B   & C 

 

Special Tests- No ordered at this   time.

 

Diagnosis 

 

Differential Diagnoses

• 1-Bacterial Vaginosis (N76.0)
• 2- Malignant neoplasm of female genital organ,         unspecified. (C57.9)
• 3-Gonococcal infection, unspecified. (A54.9)

Diagnosis

o Urinary   tract infection, site not specified. (N39.0) Candidiasis of vulva and vagina.   (B37.3) secondary to presenting symptoms (Colgan & Williams, 2011) &   (Hainer & Gibson, 2011). 

 

Plan/Therapeutics

 

• Plan:  
  • Medication – 

§ Terconazole cream 1 vaginal application QHS for 7 days for   Vulvovaginal Candidiasis; 

§ Sulfamethoxazole/TMP DS 1 tablet PO twice daily for 3 days   for UTI (Woo & Wynne, 2012)

• Education – 

§ Medications prescribed. 

§ UTI and Candidiasis symptoms, causes, risks, treatment,   prevention. Reasons to seek emergent care, including N/V, fever, or back   pain. 

§ STD risks and preventions. 

§ Ulcer prevention, including taking Protonix as prescribed,   not exceeding the recommended dose limit of NSAIDs, and not taking NSAIDs on   an empty stomach. 

• Follow-up         – 

§ Pt will be contacted with results of STD studies. 

§ Return to clinic when finished the period for perform   pap-smear or if symptoms do not resolve with prescribed TX.

            

THIS IS A RESPONSE TO DISCUSSION BELOW, PLEASE USE APA & IN-TEXT CITATIONS. NO MORE THAN 200 WORDS.

  I was always taught in nursing school that pain is what the patient says that it is. We cannot feel what the patient is feeling, so we have to believe the patient and what they are telling us. “McCaffery defined pain as ‘whatever the experiencing person says it is, existing whenever he says it does’” (Huether &McCance, 2017, p.336). Pain effects each and every person differently. There are many different types of pain caused by many different diagnoses and issues. “Acute pain is transient, usually lasting seconds to days, sometimes up to 3 months. It begins suddenly and is relieved after the chemical mediators that stimulate pain receptors are removed” (Huether & McCance, 2017, p.340). When I think of acute pain, I think of getting a shot. A shot hurts while we are receiving the shot but is quickly relieved once the shot is over. “Visceral pain often radiates (spreads away from the actual site of the pain) or is referred. Referred pain is felt in an area removed or distant from its point of origin- the area of referred pain is supplied by the same spinal segment as the actual site of pain” (Huether & McCance, 2017, p.340). An example of referred pain would be left arm pain during a heart attack. Pain that is radiating away from the actual site of where the hurt is. “Chronic or persistent pain has been defined as lasting for more than 3 to 6 months and is pain lasting well beyond the expected healing time”(Huether & McCance, 2017, p.340). We hear of a lot of people struggling with chronic back pain. 

Pain can feel throbbing, stabbing, aching, burning, cramping, squeezing, etc. There are different factors that affect pain as well. “There are important age and sex differences in the clinical presentations of chronic pain patients. Some older patients present with unique clinical profiles that may reflect cohort differences, and/or physiological or psychological adjustment processes. There appears to be a greater number of distinct chronic pain presentations among females” (Cook & Chastain, 2001, para.5). Age and gender are just 2 factors that can affect pain and the way it is perceived. “In general, the prevalence of chronic pain has been found to be 50% or more among people aged 65 years or older” (Karjalainen, Saltevo, Tiihonen, Haanpää, Kautiainen, & Mäntyselkä, 2018, p.6). Different diseases that patients have can cause patients to have pain. Ethnicity can also be a factor of pain. If we think about sickle cell patients, it occurs more in African Americans and can cause pain during a sickle cell crisis. Age does not affect who can get sickle cell but can affect pain. Sickle cell presents at birth but usually patients do not have any issues until the age of 5 or 6. Another example would be having a tonsillectomy. Everyone states that the pain and recovery is so much easier on young children than in adults. These examples just go to show that everyone perceives pain differently depending on different factors like age, gender, ethnicity, and diseases. 

References

Cook, A. J., & Chastain, D. C. (2001). The Classification of Patients with Chronic Pain: Age and 

Sex Differences. Pain Research and Management, (3), 142. https://doi-org.ezp.waldenulibrary.org/10.1155/2001/376352

Huether, S. E., & McCance, K. L. (2017). Understanding pathophysiology (6th ed.). St. Louis, 

MO: Mosby.

Karjalainen, M., Saltevo, J., Tiihonen, M., Haanpää, M., Kautiainen, H., & Mäntyselkä, P. 

(2018). Frequent pain in older people with and without diabetes – Finnish community-based study. BMC Geriatrics, 18(1), 73. https://doi-org.ezp.waldenulibrary.org/10.1186/s12877-018-0762-y