Case Study Exam III
Probably has a lot of stress due to work because he owns his own store,
higher level of stress than someone that works a regular job. Also works with
wife who works in score, and might not eat the healthiest.
PMH is positive for hypertension, dyslipidemia, and a MI three years ago
followed by four-vessel coronary artery bypass surgery. The patient has been
asymptomatic since surgery with no complaints for chest pain
o No chest pain good because he is perfusing, when oxygen doesn’t get
to the cells the lactic acid builds up and they have pain. If he has had
no chest pain then his supply has met his demand.
o Thinking about in terms of a cardiac patient
Over the last three months PTA, Mr. Simon notes onset of SOB while
unloading groceries stairs, and other strenuous ADLs
o SOB on exertion- possible HF because his left ventricle is not pumping
as well anymore, and fluid backing up into lungs
Two weeks ago, he was unable to complete his daily one-mile walk at the
high school track. He noted swelling in his feet ankles
o Swelling- a lot of extra fluid in the system
Four days PTA he woke at 2 am SOB and had to sleep in his recliner the rest
of the night. He has been unable to lay felt in the bed at night then and has
slept on 3 pillows
o Gravity pulls on all the fluid to the bases of the lungs, so it’s at the
bottom, causes gas exchange at those aveoli
o Gravity big factor
o When laying down all the fluid equalizes out in the whole lung field,
and then all the alveoli are effected
Yesterday, he became breathless walking from one room to another. He
presents today to the ED with extreme shortness of breath. He denies chest
pain.
Patient reports good appetite; often stopping at the Omega restraint after
work for the dinner special
NKDA, walking one mile until weeks PTA. smoked 1 ppd until 2012. 30
pack/year history. ETOH- none. Works 8-12 hours/day in grocery store.
Father died at 60-sudden death of unknonwn causes, no CAD. Sister died MI.
Current meds:
o Atorvastatin (Lipitor)- 40 mg daily
Dyslipidemia- risk factor for heart disease, keep plaque away
form vessel wall
o ASA 325 mg daily
To prevent clotting
If plaque ruptures the platelets won’t aggregate
o Metoprolol (Lopressor) 50 mg daily
Beta- blocker, beta 1- heart rate, contractility
Decreases heart rate & contractility- dropping CO, lower BP
Probably has a lot of stress due to work because he owns his own store,
higher level of stress than someone that works a regular job. Also works with
wife who works in score, and might not eat the healthiest.
PMH is positive for hypertension, dyslipidemia, and a MI three years ago
followed by four-vessel coronary artery bypass surgery. The patient has been
asymptomatic since surgery with no complaints for chest pain
o No chest pain good because he is perfusing, when oxygen doesn’t get
to the cells the lactic acid builds up and they have pain. If he has had
no chest pain then his supply has met his demand.
o Thinking about in terms of a cardiac patient
Over the last three months PTA, Mr. Simon notes onset of SOB while
unloading groceries stairs, and other strenuous ADLs
o SOB on exertion- possible HF because his left ventricle is not pumping
as well anymore, and fluid backing up into lungs
Two weeks ago, he was unable to complete his daily one-mile walk at the
high school track. He noted swelling in his feet ankles
o Swelling- a lot of extra fluid in the system
Four days PTA he woke at 2 am SOB and had to sleep in his recliner the rest
of the night. He has been unable to lay felt in the bed at night then and has
slept on 3 pillows
o Gravity pulls on all the fluid to the bases of the lungs, so it’s at the
bottom, causes gas exchange at those aveoli
o Gravity big factor
o When laying down all the fluid equalizes out in the whole lung field,
and then all the alveoli are effected
Yesterday, he became breathless walking from one room to another. He
presents today to the ED with extreme shortness of breath. He denies chest
pain.
Patient reports good appetite; often stopping at the Omega restraint after
work for the dinner special
NKDA, walking one mile until weeks PTA. smoked 1 ppd until 2012. 30
pack/year history. ETOH- none. Works 8-12 hours/day in grocery store.
Father died at 60-sudden death of unknonwn causes, no CAD. Sister died MI.
Current meds:
o Atorvastatin (Lipitor)- 40 mg daily
Dyslipidemia- risk factor for heart disease, keep plaque away
form vessel wall
o ASA 325 mg daily
To prevent clotting
If plaque ruptures the platelets won’t aggregate
o Metoprolol (Lopressor) 50 mg daily
Beta- blocker, beta 1- heart rate, contractility
Decreases heart rate & contractility- dropping CO, lower BP
