Cardiovascular Disease: Family Nursing Case Study and Treatment Plan

This case study presents a 63-year-old man, Mr. Solomon, with a history of multiple health issues including myocardial infarctions, hypertension, diabetes, and recent heart surgery, who presents with new onset breathing problems. The case details his symptoms, vital signs, physical examination findings, and laboratory results, revealing signs of heart failure and other complications. The assignment requires the student to provide a family nursing perspective, including a focused history and physical exam, discussion of the disease process, health risks, and relevant guidelines. It also addresses home care issues that may impact the patient. The solution incorporates patient and family teaching, diagnostic procedures, and treatment plans, with references to supporting literature. The case emphasizes the importance of early diagnosis, comprehensive assessment, and the role of family in patient care and management of cardiovascular diseases. The provided solution focuses on the medical history, physical examination, laboratory data, and the development of a care plan, including patient education and pharmacological interventions for the patient's condition. The ultimate goal is to provide appropriate medication and create awareness among the family to carry out proper interventions or taking the right call at the time of need by understanding the patient situation.

Running head: FAMILY NURSING
Case Study
Name of the Student:
Name of the University:
Author Note:

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Case Study
Mr. Solomon is a gentle man of 63 years old who in the past 5 years has been taking
care of a wide range of health issues. He was treated for two myocardial infarctions, high
blood pressure, non-insulin-dependent diabetes, and left leg stasis dermatitis. One year ago,
he had an aorto-coronary invasive heart surgery to treat his cardiac blockage.
He is now showing breathing problems in the workplace, which over the last five days
has been positive. Nevertheless, in the last four months, particularly as exercising, he has had
shortness of breath episodes. He quickly fails and has expended "all of my strength in doing
anything." Immediately he waked from sleep last night because he had developed a dry cough
and because of "I could not catch my air." As he sat on the edge of his bed for an hour, the
coughing issue changed. He normally has two to three pillows for his nap. He had no chest
pain, pain in his legs to fainting spells.
A study in the office shows an undernourished man who looks depressed and older than the
age he is indicated. He is ruthless. His shoes are torn apart. His breathing is labored with blue
tinges on his lips.
Vital Signs: Blood Pressure 98/82mmHg in the right arm; Heart Rate 110/min; Respiratory
Rate 26/min; Temperature 98 degree Fahrenheit. Examination of the lungs reveals dullness
to percussion in both bases with decreased excursion of the diaphragms. Course rhonchi and
moist, inspiratory crackles are heard bilaterally in the lower lung fields.
Cardiovascular examination: the neck vein becomes conspicuous when the patient becomes
sitting upright, leading to the mandible. In the 5ICS on the left of the MCL the apical pulse is
palpated. S3 at the peak is visible. Diminished are S1 and S2. The peak is reacting to S3. The
apex is best heard with a 3/6 grade holosytolic murmur; it radiated to the left axilla. Abdomen
examination: round and soft anterior wall. The edge of the liver is tender and palpable. The

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spleen can't be felt. Examination of limbs showed decreased peripheral pulses. An irregular
pulse is present. Both lower extremities have pitting edema. The patient is admitted to
hospital.
ADMISSION LABORATORY TEST
CBC:
Leukocyte count = 8,4000/mm3 with normal differential count
Hemoglobin 14.6g/dL, Hematocrit 40%
Platelet count 290,000/mm3
Chemistries:
Glucose 112mg/dL (non-fasting); BUN 33mg/dL; Creatinine 1.6mg/dL; Total Bilirubin
1.9gm/dL, Direct Bilirubin 0.3mg/dL; Total Protein 5.8g/dL, Albumin 3.1g/dL; Electrolytes:
Sodium 132mEq/L, Chloride 93mEq/L, Potassium 4.0mEq/L, Bicarbonate 23mEq/L; Urine:
Specific Gravity 1.032, 1 plus protein, hyaline casts.
Chest X-ray:
"Marked prominence of the pulmonary vascular shadows (bilateral), bilateral pleural
effusions, increased haziness and decreased radiolucency of the lung parachyma (bilateral),
increased transverse diameter of the heart."
Patient and Family Teachings
Persons with a stroke are at elevated risk for another stroke, especially within the first
year of the initial stroke (Magwood, White & Ellis, 2017). Older age, high blood pressure
(hypertension), high cholesterol, diabetes, obesity, transient ischemia attack (TIA), cardiac

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disease, smoking of cigarettes, excessive alcohol consumption, and drug abuse are at
increased risk of another stroke (Emdin, et al., 2016).
Although some stroke risk factors (such as age) cannot be altered, the risk factors for
others may decrease with the use of medications or lifestyle changes (Niewada & Michel,
2016). Patients and families should ask their doctor or nurse for advice on prevention. You
must collaborate to make healthy lifestyle changes in the patient. The warning indications of
a TIA should also be learned from patients and families, such as body shortcoming and
slurred speech, and if this occurs, see the doctor as soon as possible (Khare, 2016).
Treatment Plan
Consume additional salts. Experts normally recommend that you reduce the dietary
salt, as sodium sometimes dramatically increases blood pressure. This can be a good thing for
people with low blood pressure (Garfinkle, 2017). However, because excess sodium, in
especially in older adults, can contribute to heart failure (Butler et al., 2017), it is essential to
check with your doctor before salt increases in your diet. Drink more water. Drink more
fluids raise the blood volume, which is important for the treatment of hypotension, and help
to prevent dehydration. Wear volume compression. The elastic supply widely used for
varicose vein pain and swelling can help decrease blood pooling in your legs.
Diagnostic Procedure and treatment among Articles
The concerns associated with significant morbidity and mortality of elderly patients
are the orthostatic hypotension. While orthostatic hypotension is often related to treatment,
blood pressure, fluid depletion or inadequate surrender but persistent orthostatic hypotension
is often attributed to altered processes of the management and autonomic dysfunction of the
blood pressure or heart rate (Ricci, De Caterina & Fedorowski, 2015). The medical
evaluation includes a comprehensive background, including signs of autonomic Nervous

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System impairment, diligent monitoring of blood pressure at different times of the day and
during meals or medicines, and laboratory tests.
About 50 to 1,000 ml of blood in healthy people is transferred under the diaphragm
when an erect posture is assumed. It increases venous heart retour, decreases ventricular
swelling and reduces cardiac output and blood pressure.
In brief, a geriatrician referral should be pursued in cases involving frail older
patients, individuals with several comorbid factors, like cognitive loss, absence of normal
treatment, any problem of signs or lack of social help. Referral to a geriatrist may often prove
beneficial for older patients who are in need of counseling and improving when time
constraints limit the efficacy of the primary care doctor (Wang & Bajorek, 2016). For the
patients with severe supine hypertension, cardiological assessments are recommended,
considering standard treatments, elevated coronary artery symptoms, significant cardiac
insufficiency and for those with a new diagnosis of Tachy- or bradyarrhythmias. In the case
of individuals with an ambiguous condition of worsening autonomic dysfunction, the referral
to a neurologist is recommended specifically.
The diagnosis of an orthostatic hypotension in the older people is often a problem due
to the presence of numerous comorbid ities and unspecific signs and symptoms (Chou et al.,
2015). Instead, orthostaic hypotension should be treatment directed at enhancing the
symptoms, correcting any underlying cause, improving the functionality of the patient, and
reducing the risk of complications, rather than at achieving arbitrary blood pressure targets.
Interventions may usually be classified between non-pharmacological and pharmacological
strategies.
Several therapeutic chemicals occur if, given the aforementioned measures, the
individual stays symptomatic. Fludrocortisone, a synthetic oxygen, has a major mode of

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action to reduce salt loss and expand blood volume (Zhao, Zhang & Fent, 2016). It is one of
the most powerful chemicals. The initial dose is 0.1 mg daily with 0.1 mg intervals monthly
until the trace pedal edema is produced or a limit of 1 mg daily is reached.
Medications
Various medications (orthostatic hypotension) can be used to treat low blood pressure
that happens when you get up. This form of low blood pressure is usually treated with
fludrocortisone, for instance, that boosts blood volume. Doctors often use midodrine in
patients with chronic orthostatic hypotension to increase standing blood pressure level
(Okamoto et al., 2016). It works by limiting your blood vessel's ability to expand, which
increases blood pressure.
Conclusion
Therefore, the analyzed article concludes that cardiovascular diseases are common
among the elderly people and requires immediate interventions to treat them. Moreover, the
article stands to seek the validity and viability of the diagnosis and treatment plans regarding
the systolic fall in the blood pressure as described in the case. The case shows an elderly
individual with systolic fall has been admitted to a hospital who was already having a
medical past of invasive heart surgery.
The ultimate goal was to provide appropriate medication and create awareness among
the family to carry out proper interventions or taking the right call at the time of need by
understanding the patient situation.

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