Answered: 1. Describe the pathophysiology of…

Phlebotomy Essentials

6th Edition

ISBN:9781451194524

Author:Ruth McCall, Cathee M. Tankersley MT(ASCP)

Publisher:Ruth McCall, Cathee M. Tankersley MT(ASCP)

Chapter1: Phlebotomy: Past And Present And The Healthcare Setting

Section: Chapter Questions

Problem 1SRQ

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The patient is a 44-year-old, overweight female who presented to her primary healthcare provider yesterday with complaints of recent episodes of shortness of breath that occur with minimal activity such as walking a flight of stairs or with increased stress. Her symptoms are relieved with rest. She denied any chest, arm or jaw pain but did have some diaphoresis with one or two episodes. - She attributed her symptoms to her smoking one pack per day for the past 20 years and obesity. - She has gastroesophageal reflux controlled with ranitidine and has a history of elevated cholesterol (252), HDL of 46, and LDL of 180. Her triglycerides were 140. - She drinks three to four caffeinated beverages per day and denies alcohol use. -In addition, she has a history of situational anxiety since her mother's death and hypertension controlled with atenolol. - Her surgical history includes total abdominal hysterectomy six years ago and right carpal tunnel surgery two years ago. The patient's mother had a myocardial infarction (MI) at age 56 and died at age 66, secondary to complications of a coronary artery bypass graft. - Her oldest sister died at age 54 from sudden cardiac death. - Her father is alive with a recent stroke and two younger brothers are alive and well. The patient and her husband have three healthy children, ages 14-18, all living at home. - She is employed full-time as a paralegal. - The patient failed an exercise tolerance test today with ST depression, shortness of breath and a drop in BP. - She was admitted to the cardiac unit and an MI was ruled out with normal Troponin, CPK and Iso-Enzymes and ECG. She was then sent to the cardiac catheterization lab for possible angioplasty and stent placement. - She was unable to have stent placement or angioplasty secondary to findings of three vessel disease and poor coronary anatomy. - Thus, she was scheduled to have a coronary artery bypass graft (CABG) the following day. The time is 1600 hours and the nurses are working the PM shift. -The cardiac catheterization RN has just reported to you that the patient was medicated with alprazolam 2mg at 1430 hours. - She tolerated the procedure with no complications. - Her vital signs have been stable with a clean, dry, and intact left groin dressing. A sandbag is over the site and the head of the bed is flat. - The left lower extremity neurovascular status is intact and pulses are 2/4. - She is scheduled to have a CABG tomorrow and she is aware of this. 1. Describe the pathophysiology of coronary artery disease. 2. Discuss risk factors for coronary artery disease and health promotion measures. 3. What are the classic and non-classic symptoms of chest pain? How are they different in men and women? 4. Discuss the following medications: nitroglycerin, morphine sulfate, aspirin, atenolol, aluminum hydroxide/magnesium hydroxide, alprazolam, atorvastatin calcium. Include indications, actions, contraindications, side effects, normal dosage and nursing implications. 5. Discuss the nursing and medical management of the patient post cardiac angiogram. 6. Describe how to intervene and care for the patient with chest pain and anxiety. 7. Outline and discuss the preoperative education plan for a patient and family for coronary artery bypass graft surgery. This should include preoperative education, instruction on the surgical procedure, postoperative course, and avoidance of complications. 8. Discuss the basic components of cardiac rehabilitation.

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