NGN Case Study with Compete Solutions Rated A
Assessment findings:
Cardiovascular: Sinus tachycardia with occasional prema-
ture ventricular contractions (PVCs). No murmur noted
Respiratory: Tachypnea, inspiratory crackles auscultated
Cardiac - Patient 1 throughout bilateral lung fields, dyspnea with mild exer-
tion, orthopnea, nonproductive chronic cough
Client was brought to the emergency department by his Gastrointestinal: Positive bowel sounds
son with reports of diflculty breathing and inability to Genitourinary: Clear yellow urine, urinary frequency, and
walk short distances without becoming extremely short of nocturia
breath. Client is a 72-year-old African American man with Peripheral: +4 pitting edema in bilateral lower extremities
a history of obesity, hypertension, coronary artery disease, Vital signs:
and diabetes mellitus. Temperature: 98.6°F (37°C)Heart rate: 120 beats/min-
Client reports fatigue related to diflculty sleeping at night Respiratory rate: 26 breaths/minBlood pressure: 152/90
as a result of a nonproductive cough that is unresolved mm HgPulse oximetry reading of 93%
with cough drops.
Client reports a weight gain of 10 pounds in the past week, Imaging Studies
despite his decreased appetite. Electrocardiogram (ECG) reveals ventricular hypertrophy
The son reports that his father has been unable to care for Chest x-ray reveals cardiomegaly
himself as a result of the fatigue and increasing shortness Echocardiogram results pending
of breath. He states "he has not showered in over a week."
Potential Conditions
HF
The nurse is preparing a plan of care for the client. Based
Anticipated Meds
on the information provided, choose the potential condi-
furosemide
nitroglycerin
, NGN Case Study with Compete Solutions Rated A
SEs to monitor
hypokalemia
hypotension
tion with anticipated medication and side ettect from the
list of options provided. Rationale:
Heart failure is a chronic condition when the heart does
Potential Conditions not ettectively work as a pump. This condition is evident
gastroparesis by tachycardia, orthopnea, fatigue, edema, fluid overload,
acute renal failure and elevated BNP levels. Furosemide is a loop diuretic
HF prescribed to treat heart failure. It is potassium wasting so
hypothyroidism the nurse should monitor for hypokalemia. Nitroglycerin is
a vasodilator prescribed to decrease the volume of blood
Anticipated Meds
return to the heart. Because it causes a decrease in blood
finasteride
pressure, the nurse should monitor for hypotension. Gas-
furosemide
troparesis is a complication caused by decreased stimula-
docusate sodium
tion and peristalsis in the stomach. Acute renal failure is a
nitroglycerin
temporary decrease in renal function that causes elevated
levothyroxine
serum waste products. Hypothyroidism is a decrease in
SEs to monitor the thyroid hormone production causing weight gain and
hypokalemia muscle weakness. Levothyroxine is a medication that can
hypoglycemia treat hypothyroidism. Finasteride is a medication given
stomatitis to decrease an enlarged prostate, not treat heart fail-
hypotension ure. Docusate sodium is a stool softener prescribed for
nausea constipation, not for heart failure. Stomatitis are sores in
the mouth often caused by chemotherapy treatment, not
heart failure. Nausea is not a common side ettect of either
furosemide of nitroglycerin.
Cardiac - Patient 2 He reports sleeping on two pillows and waking at night
one to two times per week, gasping with diflculty breath-
A 64-year-old male client has arrived for an appointment ing and having to get up during the night to urinate. He
at the outpatient clinic because of diflculty breathing and has noticed increased irritability and anxiety. Client reports
, NGN Case Study with Compete Solutions Rated A
joint and back pain in the evenings. He has increasing
a rash.
shortness of breath when he walks more than 30 feet and
History: is concerned about a red scaly rash on his left lower leg.
Hypertension
His body mass index (BMI) is 32 kg/m2. He works as the
Hypothyroidism
manager in a retail clothing store. He is divorced and has
Depression
two adult children and a grandchild who lives in another
Erectile dysfunction
state. He lives in an apartment on the second floor.
Chronic back pain
Hyperlipidemia
Current vital signs:
Anterior wall myocardial infarction (MI) at age 44. Up until
Temperature: 99.3° F (37.3° C)
the MI, he smoked two packs of cigarettes per day for
Heart rate: (HR) 118 beats/min
25 years. After the MI, he completed a cardiac rehabilita-
Blood pressure (BP): 142/90 mm Hg
tion program. His only current physical activity is walking
Respiratory rate (RR): 30 breaths/min
around at work.
Oxygen saturation: 92% on room air
The nurse reviews the patient history and physical in the
EHR to identify relevant cues requiring follow-up.
nocturia
Choose the most likely options for the information missing paroxusmal nocturnal dyspnea
from the statement by selecting from the lists of options
provided.The nurse identifies symptoms related to a pos- Rationale:
sible cardio-respiratory concern including Signs of cardiac dysfunction may include nocturia (urinat-
and . ing during the night) and paroxysmal nocturnal dyspnea
(waking up gasping with dyspnea). Erectile dysfunction
Options for 1 is often caused by a low testosterone level, not a cardiac
erectile dysfunction condition. Joint pain may be related to inactivity or arthritis,
joint pain not a cardiac condition. Depression and the leg rash are
nocturia unlikely to be related to a cardiac condition. A BMI of 32
depression kg/m2 indicates obesity but is not a symptom of a cardiac
leg rash condition.
Options for 2
Assessment findings:
Cardiovascular: Sinus tachycardia with occasional prema-
ture ventricular contractions (PVCs). No murmur noted
Respiratory: Tachypnea, inspiratory crackles auscultated
Cardiac - Patient 1 throughout bilateral lung fields, dyspnea with mild exer-
tion, orthopnea, nonproductive chronic cough
Client was brought to the emergency department by his Gastrointestinal: Positive bowel sounds
son with reports of diflculty breathing and inability to Genitourinary: Clear yellow urine, urinary frequency, and
walk short distances without becoming extremely short of nocturia
breath. Client is a 72-year-old African American man with Peripheral: +4 pitting edema in bilateral lower extremities
a history of obesity, hypertension, coronary artery disease, Vital signs:
and diabetes mellitus. Temperature: 98.6°F (37°C)Heart rate: 120 beats/min-
Client reports fatigue related to diflculty sleeping at night Respiratory rate: 26 breaths/minBlood pressure: 152/90
as a result of a nonproductive cough that is unresolved mm HgPulse oximetry reading of 93%
with cough drops.
Client reports a weight gain of 10 pounds in the past week, Imaging Studies
despite his decreased appetite. Electrocardiogram (ECG) reveals ventricular hypertrophy
The son reports that his father has been unable to care for Chest x-ray reveals cardiomegaly
himself as a result of the fatigue and increasing shortness Echocardiogram results pending
of breath. He states "he has not showered in over a week."
Potential Conditions
HF
The nurse is preparing a plan of care for the client. Based
Anticipated Meds
on the information provided, choose the potential condi-
furosemide
nitroglycerin
, NGN Case Study with Compete Solutions Rated A
SEs to monitor
hypokalemia
hypotension
tion with anticipated medication and side ettect from the
list of options provided. Rationale:
Heart failure is a chronic condition when the heart does
Potential Conditions not ettectively work as a pump. This condition is evident
gastroparesis by tachycardia, orthopnea, fatigue, edema, fluid overload,
acute renal failure and elevated BNP levels. Furosemide is a loop diuretic
HF prescribed to treat heart failure. It is potassium wasting so
hypothyroidism the nurse should monitor for hypokalemia. Nitroglycerin is
a vasodilator prescribed to decrease the volume of blood
Anticipated Meds
return to the heart. Because it causes a decrease in blood
finasteride
pressure, the nurse should monitor for hypotension. Gas-
furosemide
troparesis is a complication caused by decreased stimula-
docusate sodium
tion and peristalsis in the stomach. Acute renal failure is a
nitroglycerin
temporary decrease in renal function that causes elevated
levothyroxine
serum waste products. Hypothyroidism is a decrease in
SEs to monitor the thyroid hormone production causing weight gain and
hypokalemia muscle weakness. Levothyroxine is a medication that can
hypoglycemia treat hypothyroidism. Finasteride is a medication given
stomatitis to decrease an enlarged prostate, not treat heart fail-
hypotension ure. Docusate sodium is a stool softener prescribed for
nausea constipation, not for heart failure. Stomatitis are sores in
the mouth often caused by chemotherapy treatment, not
heart failure. Nausea is not a common side ettect of either
furosemide of nitroglycerin.
Cardiac - Patient 2 He reports sleeping on two pillows and waking at night
one to two times per week, gasping with diflculty breath-
A 64-year-old male client has arrived for an appointment ing and having to get up during the night to urinate. He
at the outpatient clinic because of diflculty breathing and has noticed increased irritability and anxiety. Client reports
, NGN Case Study with Compete Solutions Rated A
joint and back pain in the evenings. He has increasing
a rash.
shortness of breath when he walks more than 30 feet and
History: is concerned about a red scaly rash on his left lower leg.
Hypertension
His body mass index (BMI) is 32 kg/m2. He works as the
Hypothyroidism
manager in a retail clothing store. He is divorced and has
Depression
two adult children and a grandchild who lives in another
Erectile dysfunction
state. He lives in an apartment on the second floor.
Chronic back pain
Hyperlipidemia
Current vital signs:
Anterior wall myocardial infarction (MI) at age 44. Up until
Temperature: 99.3° F (37.3° C)
the MI, he smoked two packs of cigarettes per day for
Heart rate: (HR) 118 beats/min
25 years. After the MI, he completed a cardiac rehabilita-
Blood pressure (BP): 142/90 mm Hg
tion program. His only current physical activity is walking
Respiratory rate (RR): 30 breaths/min
around at work.
Oxygen saturation: 92% on room air
The nurse reviews the patient history and physical in the
EHR to identify relevant cues requiring follow-up.
nocturia
Choose the most likely options for the information missing paroxusmal nocturnal dyspnea
from the statement by selecting from the lists of options
provided.The nurse identifies symptoms related to a pos- Rationale:
sible cardio-respiratory concern including Signs of cardiac dysfunction may include nocturia (urinat-
and . ing during the night) and paroxysmal nocturnal dyspnea
(waking up gasping with dyspnea). Erectile dysfunction
Options for 1 is often caused by a low testosterone level, not a cardiac
erectile dysfunction condition. Joint pain may be related to inactivity or arthritis,
joint pain not a cardiac condition. Depression and the leg rash are
nocturia unlikely to be related to a cardiac condition. A BMI of 32
depression kg/m2 indicates obesity but is not a symptom of a cardiac
leg rash condition.
Options for 2
