Name: ___________________________
Module 4 Case Study Option 2
Please refer to the Case Study Sample on eclass for formatting and structure for the paper. You will need to include page numbers in the top right corner of page. You do not need a title page. You will write your answers below the questions.
Case Study A
Albert, an apartment superintendent, grabbed a quick cup of coffee and then put on his coat to shovel snow off the front sidewalk. He is 56 years old and has experienced two episodes of angina over the past 3 years. This time when he was shoveling the snow, he felt palpitations in his chest. It was as though his heart had stopped and then began to beat rapidly as if to catch up. Afraid of what he was feeling, he went inside and called for an ambulance. When the paramedics arrived, they took an ECG and told Albert he was going to be fine. He was taken to hospital to be seen by an emergency physician and was released later that afternoon.
1. The ECG taken by the paramedics showed Albert was experiencing premature ventricular contractions. In general terms, how do PVCs appear on an ECG? What factors contributed to the onset of PVCs in Albert’s situation?
2. Describe the physiologic events in PVC. How is cardiac output disrupted with the presence of PVCs?
3. Because of Albert’s history, his PVCs leave him at risk for events such as ventricular tachycardia or ventricular fibrillation. Compare and contrast these two arrhythmias. Why are they particularly dangerous?
Case Study B
Kelly had just finished dinner with her husband, and they had just sat down to watch television. She is 72 years old and has had a history of angina. Shortly after they sat down, Kelly said she had indigestion and went to take some antacid tablets. An hour later, she began to feel warm, restless, and anxious. Her husband noticed she was looking pale and said he would take her to a nearby walk-in clinic. By the time they arrived, Kelly said her left arm and shoulder were sore. Suspecting Kelly was having a heart attack, her husband turned the car around and rushed her to the hospital. Three hours after the onset of her symptoms, Kelly was receiving oxygen, fibrinolytic therapy, and nitroglycerin in the emergency ward. Afterward, she was moved to the cardiac unit for STEMI.
1. An ECG of Kelly’s heart demonstrated an elevated ST segment. What are the physiologic effects of myocardial ischemia that produce this finding? What variables affect the ECG tracing of a patient with ACS?
2. What are the benefits of administering fibrinolytic therapy, nitroglycerin, and oxygen in the early management of STEMI?
3. What is the inflammatory response in the postinfarction recovery period? Why will Kelly’s heart function be compromised after her STEMI?
4. When planning her discharge what important key points do you want to mention to this patient?
Case Study C
Karen was called at work by a woman at the local day care center. She told Karen to come and pick up her son because he was not feeling well. Her son, 3½-year-old Billy, had been feeling tired and achy when he woke up. While at day care, his cheeks had become red, and he was warm to touch. He did not want to play with his friends, and by the time Karen arrived, he was crying. Later that afternoon, Billy’s condition worsened. He had fever, chills, a sore throat, runny nose, and a dry hacking cough. Suspecting Billy had influenza, Karen wrapped him up and took him to the community health care clinic.
1. Why did Billy’s presentation lead Karen to think he had influenza and not a cold? Why is it important to medically evaluate and diagnose a potential influenza infection?
2. Describe the pathophysiology of the influenza virus. Outline the properties of influenza A antigens that allow them to exert their effects in the host.
3. Billy may be at risk at contracting secondary bacterial pneumonia. Why is this so? Explain why cyanosis may be a feature associated with pneumonia.