Introduction.Robert Is A Ninety-Year-Old Man, Who Has Been

Mr. XXXX is a 44 years old Caucasian male, a general construction worker who works on a nearby highway for the bridge project, and checked in this urgent care center for complaining of chest pain and shortness of breath (SOB). The chest pain is constant dull and pressure like pain, and started 3 hours ago. The pain is located on the center of chest. He rates the pain 4 out of 10 on a pain scale 0 to 10 while resting. The pain gets worse and increases after eating. He experienced increased chest pain and SOB with simple walking from the parking lot to this office. The pain was not resolved with taking PO 365mg of Aspirin 2 hours ago and resting. He was diagnosed with hyperlipedemia 10 years ago. He is taking medication to manage his high cholesterol level. He denies past history of chest pain, hypertension, and coronary artery disease. He denies any history of heart surgery or cardio artery bypass surgery. He is anxious and fearful for his first chest and SOB. He smokes a half pack a day for past 20 years. He drinks one bottle of bear every evening with meals. He denies taking any herbal medication or illicit drugs. He has been a good appetite. He reported 20 lbs weight gain since his retirement from military. He has an irregular meal time and does not exercise as much as he used to do in the military.

Situation: Two patients in their 70s present to the office at different times today, each with documented heart failure: one diastolic and the other systolic, and both are hypertensive. First, discuss the difference between systolic and diastolic heart failure, providing appropriate pathophysiology. ACEI/ARBs are the only medications prescribed for CHF that have been found to prolong life and improve the quality of that life. EXPLAIN the mechanism of action of ACEI/ARBs and how they affect morbidity and mortality in CHF. Be specific. Diuretics must be used very carefully in diastolic ventricular dysfunction. EXPLAIN this statement using appropriate physiology. Now considering all of the above, describe an appropriate comprehensive plan of

tells you that he began feeling changes in his heart rhythm about 10 days ago. He has hypertension

Jonathan is a 63-year-old man, born on August 23rd, 1956 and lives with his eldest son. He was married two times and has three children, two children from his first marriage and one from his second. He lives in northern Ontario but originally was from southern Ontario, he moved here shortly following his second divorce. He is of Italian decent and is a practicing Catholic. The patient’s weight is 95 kilograms; he is 178 centimeters tall and has a body mass index (BMI) of 28.3. Jonathan says he smokes around one pack of cigarettes a day, does not exercise enough and eats fast food a few times a week. The patient now has congestive heart failure as a consequence of his myocardial infarction (MI) or heart attack. He was transferred from another hospital in the beginning of November and was waiting for more tests to be completed before he could be discharged. Jonathan has some known comorbidities that can exacerbate his CHF, this includes smoking, obesity, and noncompliance with medications.

Pulse rate is at 72. The blood pressure was 140 / 95,which is suggestive of high blood pressure and related to his medical history. No heart murmur was noted, and no other abnormalities were noted.

Review of the medical record indicates that he had a MVA in 1977 with C4-5 injury that resulted in him been a Quadriplegic. Due to his bedbound and immobility status he has had multiple pressure ulcers over the years that have resulted in hospital admission and rehab stays. Other medical history include, HTN, hyperlipidemia, Sacral pressure ulcer, Right hip pressure ulcer, Constipation, depression. Bilateral arm contractures, bladder cancer, prostate cancer, urostomy and colostomy, aspiration pneumonia, neuropathy and MRSA.

Heart failure affects nearly 6 million Americans. It is the leading cause of hospitalization in people older than 65. Roughly 550,000 people are diagnosed with heart failure each year (Emory Healthcare, 2014). Heart failure is a pathologic state where the heart cannot pump enough blood to meet the demand of the body’s metabolic needs or when the ventricle’s ability to fill is impaired. It is not a disease, but rather a complex clinical syndrome. The symptoms of heart failure come from pulmonary vascular congestion and inadequate perfusion of the systemic circulation. Individuals experience orthopnea,

Patient states he is “in very good shape overall,” he has had some concerns in the past with his blood pressure which was too high, but it's been a long time since

According to the Heart Foundation (2010), “Best-practice management of chronic heart failure (CHF) involves multidisciplinary care” (p. 3). A care coordinated with his different physicians including cardiologist, pulmonologist, and referring physicians, as well as clinical nurses, and dieticians will be an important step in Mr. P’s CHF care. As they are concerned about the mobility outside of their home, a telephonic follow-up after discharge from the hospital, and door delivery of medicines could be beneficial. It is also very important to help him to overcome his polypharmacy. Since Mrs. & Mr. P seem emotionally weak, they need emotional support to cope up with the situation. They are worried about the heaping medical bills. Provide information about the possibility of getting qualified for Medicaid/Medicare as well as grants from organizations like Patient Access Network

Robert is the definition of overcoming adversity. Robert was able to make the best out of every situation he was placed in and come out on top. Although it was not in any means easy, his morale and perseverance helped him get to where he is now in life. All throughout Robert’s childhood his social life was met with verbal abuse from piers, attacking Robert’s self-worth and confidence. However these were not the main cause of Robert’s despair, his teachers were the brunt of the abuse that he took, and they caused him to fear attending school.

Mr. P care approach will depend on the extent of danger to the heart muscle, dependent edema, and physical activities. At 76 years old, Mr. P’s day-to-day operations is declining. Evidently, he depends on family members to help him in making decisions critical to his health. The physician will order some exams to determine the extent of cardiomyopathies, such as chest x-ray, electrocardiography (ECG), and echocardiogram. Laboratory tests such as CBC and comprehensive metabolic panel, fasting lipid panel, and liver function tests are completed to determine the level of the heart failure and if other organs in the body have been affected.

In the case study it discusses a patient, Mrs. Harris, who is a 72 year old and is complaining of fatigue and swelling in her feet. Mrs. Harris also expresses her concern on the swelling, as some days she is unable to put her shoes on despite proper elevation. She also states walking to her mailbox can be challenging because it causes her to feel more tired and to have shortness of breath, also known as dyspnea. Mrs. Harris is currently taking medication for high blood pressure, hypertension; and is also drinking approximately 8-12 glasses of wine a week. While examining Mrs. Harris it’s clear she is a little overweight and has swollen ankles. Upon listening to Mrs. Harris’s breathing, crackles are heard. Therefore, Mrs. Harris seems to have congestive heart failure.

The first test that would help to see Jonas’s heart behavior better would be a physical. The doctor could see his swollen abdomen, legs, ankles, and neck vein. The doctor would use a stethoscope to heart any abnormalities in his chest. He would also be able to tell that Jonas had a chronic bloody cough based on questions that he could ask him. All of Jonas’s genetic and health history would be covered by the basic questions that doctors ask all their patients during a physical. Due to his chronic hypertension, the probability that he has CHF is increased, but does not necessarily mean that he definitely has CHF. At this point, the doctor may have a general idea that Jonas has CHF. However, more extensive tests must be used to correctly diagnose Jonas (Figueroa 406-407).

Bill Albert, is a 49-year-old man, presents to your office for a yearly checkup. He is 5 foot 10 inches tall, weighs 250 pounds, smokes two packs of cigarettes a day, and drinks 12 ounces of whiskey a day. He is a truck driver and is on the road a lot. He frequently eats at “fast-food joints”. He has no history of chest pain or heart disease. He takes no medications. His family history is significant for coronary artery disease in his father, who died at age 60. He believes his father’s cause of death was sudden cardiac death and recalls being told that his father had an enlarged heart.

Jonathan is a 63 year old man, born on August 23rd, 1956 and lives with his eldest son. He was married two times and has three children, two children from his first marriage and one from his second. He lives in northern Ontario but originally was not born here, he moved here shortly following his second divorce. He is of Italian decent and is a practicing Catholic. The patients weight is 95 kilograms; he is 178 centimeters all and has a body mass index (BMI) of 28.3. Jonathan says he smokes around one pack of cigarettes a day, does not get a lot of exercise and eats fast food a few times a week. The patient now has congestive heart failure as a consequence of his MI. He was transferred from another hospital in the beginning of November and currently is waiting for more testing before he can be discharged from the hospital or moved to another facility. The patient has some known comorbidities that can exacerbate his CHF, this includes