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Development of Atherosclerosis Diseases

   

Added on  2019-09-25

9 Pages2275 Words261 Views
Workbook Case: Day 1John Smith is a 62 year old male. He lives on his own, and has two adult children, who have been telling him for some time that they think he needs to get healthier. He doesn’t exercise, and his weight gain has increased a lot since he retired several years ago. He has been a smoker for many years.Two weeks ago, he finally went to his doctor for a general check-up, as the death of one of his long-time mates only about 3 months ago had left him getting quite concerned about his own health. During the consultation, John’s height was 175cm, weight 160kg, blood pressure 150/90, and body temperature 37.6oC. The doctor asked John to have a blood test and return for a follow-up appointment.Today (Case Day 1), John has returned to his doctor to discuss results of his blood test. The findings were:LDL: 5.6HDL: 0.4TG: 5.7Total cholesterol: 9.41.Interpret John’s blood test results.2.Interpret all aspects about John that relate to the development of atherosclerosis.3.Discuss the steps involved in the development of atherosclerosis, ensuring that you relate this to John’s blood test.4.If John is currently developing atherosclerosis, discuss where this may be developing in his body, ensuring that you interpret the potential consequences in these locations. Based on this, discuss the prioritisation of monitoring these locations.

Clinical Case Report: Day 2John is usually tired during most days. Last night, he didn’t sleep well, waking several times during the night panicking and struggling to breathe. By mid-morning, John watching morning TV shows andis tired, but thinking constantly about his doctor’s appointment yesterday. The doctor had discussed lots of health concerns, and John’s been getting more worried. He was given prescriptions for medications, but didn’t feel like going to the chemist (pharmacy) yesterday as he felt he was too overwhelmed. The medications are:Lipid loweringACE inhibitorAs he gets up and starts getting ready to go to purchase his medications, he’s becoming increasingly anxious. He starts getting chest pain, so sits back down to watch TV and try to relax, hoping that will make the pain will go away. After about 20 minutes, he still has the pain, so calls an ambulance which arrives within about 8 minutes. The paramedics found his blood pressure to be 175/95, heart rate at 125 beats per minute, respiratory rate 28 breaths per minute, and body temperate 37.5oC. His immediate treatment includes glyceryl trinitrate and aspirin, and his pain quickly stops.Upon arrival at the hospital, the ECG is shown here, and blood tests reveal:No increase in cardiac troponin or cardiac lactate dehydrogenaseBlood glucose level: 14 mmol/LBecause he’s in the high risk group, he was scheduled as a priority for angiogram; during the angiogram, a 95% occlusion was found high in his left anterior descending coronary artery, near to the aorta, which was treated successfully using angioplasty. Results from blood tests later that evening show:Increased cardiac troponin and increased CKMBBlood glucose level: 9.4 mmol/LSince his angioplasty, he is now being treated with the following medications:AspirinGTNLipid loweringACE inhibitorNon-selective β-blocker

1.Discuss the clinical relevance of his stress in the morning in relation to his chest pain.2.Interpret his clinical presentation, including his chest pain, ECG and blood test results.3.Compare the purposes of his treatment with the medications glyceryl trinitrate and aspirin; discuss the potential benefit of both medications in relation to his case.4.What is the purpose for him being administered the ACE inhibitor and non-selective β-blocker since his angioplasty?5.Although the blockage in his coronary artery has been treated, discuss reasons why he remains on a lipid lowering medication.

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