Nr 304 Case Study

The time is 1900 hours. You are working in a small, rural hospital. It has been snowing heavily all day, and the medical helicopters at the large regional medical center, 4 hours away by car (in good weather), have been grounded by the weather until morning. The roads are barely passable. WR., a 48 year old construction worker with a 36 pack year smoking history, is admitted to your floor with a diagnosis of rule out myocardial infarction (R/O MI). He has significant male pattern obesity (beer belly, large waist circumference) and a barrel chest, and he reports a dietary history of high fat food. His wife brought him to the ED after he complained of unrelieved indigestion. His

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

The patient has no family history of heart disease or diabetes, however both her parents are on medication for high blood pressure. Her paternal grandmother died of breast cancer at age 47. Her maternal grandmother

Patient complained she was short of breath and experiencing severe pain between her shoulder blades. She stated that she has been feeling nasuseated for the past 3 hours. She states she has a history of stable angina and is currently taking medication as needed. She states she did not take the nitroglycerin because she was not experiencing chest pain, just back pain. She states that her last check-up with the Pulmonologist showed that her EKG did not show any changes since her last visit. She denies episodes of syncope. The patient does report that she tripped over something on the floor, which resulted in her falling and hitting her back on a large table. In addition, she states that her heart rate has been ranging from 130/ 90 to 140/92. Patient states her Primary care physician placed her on blood pressure medication 2 months ago due to the increase.

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.

In transport, patient received O2 at 4 liters via nasal cannula, baseline EKG, Normal Saline IV started in left hand, 325 mg aspirin by mouth (po). Patient complained she was short of breath and experiencing severe pain between her shoulder blades. She stated that she has been feeling nasuseated for the past 3 hours. She states she has a history of stable angina and is currently taking medication as needed. She states she did not take the nitroglycerin because she was not experiencing chest pain, just back pain. She states that her last check-up with the Pulmonologist showed that her EKG did not show any changes since her last visit. She denies episodes of syncope. The patient does report that she tripped over something on the floor, which resulted in her falling and hitting her back on a large table. In addition, she states that her heart rate has been ranging from 130/ 90 to 140/92. Patient states her Primary care physician placed her on blood pressure medication 2 months ago due to the increase.

Such lifestyle changes include weight loss, if he is overweight or obese, reduce or eliminate alcohol and drug use as well as smoking, and changing his diet so that it is more ‘heart healthy’. A heart healthy diet will include the following characteristics: 20-35% fat, 10-25% protein, 45-65% carbs, emphasizes healthy fats such as DHA, EPA, mono and polyunsaturated fats, limits unhealthy fats including saturated and trans fat, is high in fiber (25-35 grams per day), contains whole grains and nuts, limits added sugars, moderates alcohol consumption and includes plant stanols or sterols (Brown,

Larry has a lot of challenges that he faces due to controlling his high blood pressure. The stress of his position at work along with supporting his parents has been an added stressor in his life. Larry is going to have to find a way to decrease the stress in both of these situations. Decreasing his work load by delegating more responsibilities to others can be of some much needed relief. He has to support his parents financially along with financially supporting his household can be a major challenge. Larry has two teenagers at home that he has to assist in leading and guiding in the right direction. The patient has to deal with his weight as well and is unable to do an exercise program due to his demands at work. Changing his dietary intake can also be challenging since he is

In viewing Mr. Laurane’s personal health issues as well as his family history, it appears clear that his overall well-being could benefit significantly from a weight-loss regimen that includes health education in terms of nutrition, exercise initiatives, supplements that may be taken to encourage the speeding up of a slow metabolism, etc. Mr. Laurane can only benefit from weight loss, which will reduce his hypertension, congestive heart failure, and high cholesterol, all of which pose serious threats to the patient’s long-term health if not addressed in any way possible.

During our interview G.F. stated that his blood pressure was “170/40”. I feel that it is important for G.F. to become more educated on blood pressure screenings due to his lack of knowledge on his baseline BP and his family history of cardiovascular disease. “Among patients with HTN, having an elevated SBP carries the highest risk for cardiovascular events” (Rodriguez, Swett, Agarwal, 2014, 1252-61).

Food: The father has a reported condition of high blood pressure and when taken at the assessment it was 190/102. He is on medications but will receive education regarding nutritional importance. He will consume fresh foods and remove as many pre-packaged foods as possible from his daily regime.

First, I would recommend decreasing the amount of sodium and saturated fat in his diet. The client should be conscious of what is in his food and educate himself on portion sizes. The U.S Department of Health and Human Services (2005) explains how important it is to reduce the amount of added sugars, saturated fat, and sodium to prevent weight gain or health problems such as hypertension, heart failure, high cholesterol or diabetes (HHS, 2005, para. 3-12).

I was born to a father with the history of Diabetic mellitus and on my mother’s side; there is a history of High Blood Pressure. Although my father is not diabetic, my mother has been diagnosed with blood pressure. Blood pressure has been a steady disease in my household which has affected four out my five uncles. In 2010, after a seven year long battle with infertility, I was diagnosed with High Blood Pressure which I was given medication for and shortly thereafter, I had a son after my aggressive treatment. Ever since, I have always link most diseases with food intake and I strongly believe that my nutrition and my health work hand in hand. According to Grodner, Roth &Walkingshaw (2012),

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.

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