Coronary Observation Report

Mr. Heart, a 72-year-old male admitted for an elective open heart procedure has the following medical and surgical history: coronary heart disease; arthritis; hypothyroidism; diet controlled diabetes; underwent appendectomy; arthroscopic right knee surgery; and two cardiac stents. No history of smoking and weights 160 lbs. at 5’ 11”.

shortness of breath. Pain improved with sublingual Nitroglycerine and Aspirin given by EMS. On arrival to ED his blood pressure was 154/94, HR 70 bpm, RR 19 and SpO2 98% in room air. Heart, lung, abdominal and neurological examinations were unremarkable.

My day in the E.R. was slow for the first hour and a half. We got our first patient at 7:57 am, and it went at a brisk pace for the rest of the day. The first patient came in with sinus tachycardia. She received one liter of NS 0.9% at a rate of 1L/hr. and two doses of IV diltiazem 10 mg each to cardiovert her, and it was successful. She was released home with instructions to follow up with her cardiologist. There were two patients with chest pain one patient received Nitro Sublingual tablets x3, and the other received Nitro Paste one inch on the left side of his chest. Troponin labs CMP, and CBC on both patients were within normal range. The urine culture on the patient who received the Nitro tabs had WBC in it. When I left the nurse was waiting for blood cultures and lactic acid labs to come back to try and pinpoint a reason for WBC in the urine the physician wanted to admit this patient to the

With attention to her heart issues, I checked her capillary refill on both fingers and toes for perfusion, her pulse (62 bpm) and her blood pressure (120/58). Additionally, when she was getting up I had her sit for a minute before standing to decrease the likelihood of orthostatic hypotension.

Mr. Smith has a history of coronary artery disease. Records indicate he has had seven stents in the past, though I do not have primary records for all of these stents. The most recent catheterization I can find in the system is from 2014. At that point in time, he had a 50% in-stent restenosis in the right coronary artery and minimal disease in the left system. His most recent echocardiogram was done in 04/2017 and showed normal left ventricular size and function. He had an EKG in 03/2017, which was consistent with an old inferior infarction but no ischemic changes. No ST or T-waves. His most recent lipid panel was from 05/2017 showing an LDL of 51. He has been maintained on a good cardiac regimen including aspirin, moderate dose of atorvastatin, carvedilol, hydralazine, hydrochlorothiazide, and isosorbide mononitrate.

I have chosen to do case study #1 about Coronary Artery Disease. In this case study, Eric is a 47-year-old male who has just been diagnosed with Coronary Artery Disease. He is a construction worker and spends a great deal of time away from his wife and three children. Eric smokes approximately 1 1⁄2 packs of cigarettes a day and enjoys drinking a 6-pack after a long day at work. In Eric’s case, smoking clearly causes CAD and he smokes quite a bit. Also, high blood pressure can cause CAD and if he is stressed from all of his hard work, it could contribute to the disease as well (Beaumont, n.d.) Coronary artery disease is when plaque builds up in the coronary arteries. The coronary arteries supply blood to the heart. Plaque buildup in the arteries is called atherosclerosis. The plaque makes the arteries smaller and makes it harder for the arteries to supply oxygen to the heart. This atherosclerosis can cause heart attacks and angina (chest pain). Coronary artery disease can also cause arrhythmias, or irregular heart rhythm (Loeffler & Hart, 2014).

The purpose of this lab was to allow students to understand how to conduct/examine a questionnaire and, from the information, infer if they are at high, medium, or low risk for coronary heart disease. Also, to use the information gathered from the questionnaire to suggest ways to improve ones health through lifestyle changes such as diet, exercise, or quit smoking. Knowing how to conduct this questionnaire will allow a physician to obtain as much information about the patient for them to maximize the patient’s safety and to prevent them from coronary heart disease.

This seems to be a new practice that not only George Washington has implemented but has been the subject of multiple studies. In one study they monitored CLABSI rates after implementing mandatory patient handwashing with CHG wipes three times a day. All of the ICU patients were included within this study unless they had an allergy to CHG or had skin breakdown or open wounds on their hands. During this study there was only one case of CLABSI that occurred only two weeks prior to the end of the six month trial period. The ending result of was that the “mean monthly CLABSI rate decreased from 1.1 to 0.5 per 1000 central catheter days.” (Fox, 2015) An earlier study monitored ICU patients as well. However, instead of only using the CHG during handwashing they replaced soap and water basin baths with a 2% CHG lotion (not to include bathing the patients face and genitals). The study indicated that this reduced the amount of bacteria in the normal flora of the patient’s skin. The conclusion of the study was that “intervention of daily 2% CHG baths significantly reduced CLABSIs rates in the ICU. The monthly rates after initiation of the project dropped immediately to an average of 0 to 2.45.” (Dove, 2012) from a previous rate of 5.98 per 1000 central catheter

Every day there are news stories that pop up about new deadly diseases that ravish the world. But who knew that one of the deadliest diseases is also one of the most common. This disease is called Coronary Artery Disease (CAD), which is a form of heart disease. Affecting more than 15 million Americans, this is also the leading cause of death in the United States (Texas Heart Institute). Several things can attribute to this. Some of the main factors are pre-existing illness, lifestyle choices, and hereditary factors.

The authors commented that complications after surgery increases hospitals cost and lengthens the patient’s stay in the institution. Spiraling cost for healthcare is not advantageous for the hospitals or the patients. Patients who stay in hospitals longer than expected because of infections are likely to prefer law suits against the institution. Compounding the problem are cases that results in serious morbidity or mortality resulting from infected surgical sites. In addition, the rate of readmission into hospitals and further surgery contributes to the concerns for reducing postoperative infections (Webster & Osborne). The research is relevant and poses a nursing challenge that includes other healthcare professionals such as administrators, surgeons, practitioners, patients, and the public.

In this paper this author will discuss about the origin of coronary artery disease, its signs and symptoms, diagnostic procedures and treatment, prognosis and prevention, and how it affects lifestyle. The reason that this author chooses coronary artery disease as a topic for this paper is, she wants to know more about the coronary artery disease since it runs on her father’s side of the family. In fact, she lost both her great grandfather and one of her uncles due to coronary artery disease. Additionally, her father had coronary angioplasty surgery and inserted two stents into his arteries. The coronary artery disease requires one to change his lifestyle; therefore, the conclusion of this paper will focus on what individuals need to do to improve the condition of the disease and how they can prevent it.

Running head: SHORT TITLE OF PAPER (t occur until it becomes sever and target-organ disease has occurred. Moreover, a person in hypertensive crisis (systolic/top number higher than 180 OR diastolic/bottom number higher than 110) may experience severe headaches, severe anxiety, shortness of breath, and/or nosebleeds (Singh et al., 2010). However, unless BP is high or low; it is difficult to differentiate population with HTN and without HTN on the bases of frequency of symptoms.

While observing a physical therapist on the cardiac floor in the ICU, I was able to gather a detailed history on a patient who had a coronary artery bypass grafting (CABG) surgery. The patient was a 69-year-old Hispanic male who was admitted to the hospital for chest pain. The patient had complaints of jaw discomfort, low back pain, and shortness of breath. Furthermore, the patient had the

The goal of medical management is to minimized myocardial damage, preserve myocardial function, and prevent complications. These goals are achieved by reperfusing the area by emergency use of Percutaneous Transluminal Coronary Angioplasty (PTCA) or thrombolytic medication. Minimizing myocardial damage is also accomplished by reducing myocardial oxygen demand and increasing oxygen supply with medications, oxygen administration, and bed rest.

On April 18, 2016, I attended my assigned clinical site at Maimonides hospital. My assignment consisted of taking care of a 95-year-old female, who I will name as Ms. Lily due to confidentiality. Ms. Lily was admitted on April 9, 2016 for shortness of breath. She is alert and orientated to person, place, and time. She also has a history of atrial fibrillation, diabetes, HTN, and high cholesterol. Ms. Lily was also scheduled to have coronary angioplasty on April 18th.