NURS 313 Post-Sim Case Study
Name Abby Carrick Class/Group Adult
Health 1 Date November 8th, 2020
Scenario
Your patient, 58-year-old K.Z., has a significant cardiac history. He has long-standing coronary
artery disease (CAD) with occasional episodes of heart failure (HF). One year ago, he had an
apicalmyocardial infarction (MI). In addition, he has chronic anemia, hypertension, chronic
renal insufficiency, and a recently diagnosed 4-cm suprarenal abdominal aortic aneurysm.
Because of his severe CAD, he had to retire from his job as a railroad engineer about 6 months
ago. This morning, he is being admitted to your telemetry unit for a same- day cardiac
catheterization. As you take his health history, you note that his wife died a year ago (at about
the same time he had his MI) and he does not have any children. He is a current cigarette
smoker with a 50- pack-year smoking history. His vital signs are 158/94, 88, 20, and 97.2°F
(36.2 ° C). As you talk with him, you realize he has only a minimal understanding of the
catheterization procedure.
1. Before he leaves for the cath lab, you briefly teach him the important things he needs to
know before having the procedure. List 5 priority topics you will address.
1. The patient should be informed how the procedure is performed. The location it is going to be done.
2. The patient should be told that after the procedure, the limb will need to be kept straight for
4-6 hours after surgery.
3. The patient should be told that the catheter will administer blood easier to the heart
4. The patient should be told the complications that could arise from the procedure.
5. The patient should be told if they are going to shower, then the dressing from the
surgery should be covered.
2. Look at his past history. What other factors are present that could contribute to his risk for
cardiac ischemia?
1. Hypertension
2. Stress from his wife passing and having to retire due to
health issues 3.Smoking- 50 pack-year history
4. Aneurysm
CASE STUDY PROGRESS
Several hours later, K.Z. returns from his catheterization. The catheterization report shows
90% occlusion of the proximal left anterior descending (LAD) coronary artery, 90% occlusion of
the distal LAD, 70% to 80% occlusion of the distal right coronary artery (RCA), an old apical
infarct, and an ejection fraction (EF) of 37%. About an hour after the procedure is finished, you
perform a brief physical assessment and note a grade III/VI systolic ejection murmur at the
cardiac apex, crackles bilaterally in the lung bases, and trace pitting edema of his feet and
ankles. Except for the soft systolic murmur, these findings were not present before the
, catheterization.
Name Abby Carrick Class/Group Adult
Health 1 Date November 8th, 2020
Scenario
Your patient, 58-year-old K.Z., has a significant cardiac history. He has long-standing coronary
artery disease (CAD) with occasional episodes of heart failure (HF). One year ago, he had an
apicalmyocardial infarction (MI). In addition, he has chronic anemia, hypertension, chronic
renal insufficiency, and a recently diagnosed 4-cm suprarenal abdominal aortic aneurysm.
Because of his severe CAD, he had to retire from his job as a railroad engineer about 6 months
ago. This morning, he is being admitted to your telemetry unit for a same- day cardiac
catheterization. As you take his health history, you note that his wife died a year ago (at about
the same time he had his MI) and he does not have any children. He is a current cigarette
smoker with a 50- pack-year smoking history. His vital signs are 158/94, 88, 20, and 97.2°F
(36.2 ° C). As you talk with him, you realize he has only a minimal understanding of the
catheterization procedure.
1. Before he leaves for the cath lab, you briefly teach him the important things he needs to
know before having the procedure. List 5 priority topics you will address.
1. The patient should be informed how the procedure is performed. The location it is going to be done.
2. The patient should be told that after the procedure, the limb will need to be kept straight for
4-6 hours after surgery.
3. The patient should be told that the catheter will administer blood easier to the heart
4. The patient should be told the complications that could arise from the procedure.
5. The patient should be told if they are going to shower, then the dressing from the
surgery should be covered.
2. Look at his past history. What other factors are present that could contribute to his risk for
cardiac ischemia?
1. Hypertension
2. Stress from his wife passing and having to retire due to
health issues 3.Smoking- 50 pack-year history
4. Aneurysm
CASE STUDY PROGRESS
Several hours later, K.Z. returns from his catheterization. The catheterization report shows
90% occlusion of the proximal left anterior descending (LAD) coronary artery, 90% occlusion of
the distal LAD, 70% to 80% occlusion of the distal right coronary artery (RCA), an old apical
infarct, and an ejection fraction (EF) of 37%. About an hour after the procedure is finished, you
perform a brief physical assessment and note a grade III/VI systolic ejection murmur at the
cardiac apex, crackles bilaterally in the lung bases, and trace pitting edema of his feet and
ankles. Except for the soft systolic murmur, these findings were not present before the
, catheterization.
