Your text here 1
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 anterior wall myocardial 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 (about the same time that he had his MI) and that he does not have any
children.
He is a current cigarette smoker with a 50-pack-year smoking history. His vital signs (VS) are 158/94, 88, 20, and 97.2° F
(36.2° C). As you talk with him, you realize that he has only minimal understanding of the catheterization procedure.
1. Before he leaves for the catheterization laboratory, you briefly teach him the important things he needs to know
before having the procedure. List five priority topics you will address.
a. He needs to know how the procedure will go. Such as where it will go: Internal jugular
(IJ), Subclavian (SVC), Femoral, Peripheral
b. That he will need to keep whichever limb it goes in straight and still for prescribed time
(usually 4-6 hours).
c. That the catheter will administer blood easier to the heart.
d. He needs to know complications that could happen such as: phlebitis, occlusion, and
mechanical complications.
e. Teach client how to take care of catheter right after surgery for example: not submerging
it in water. To shower, cover dressing site to avoid water ans when showering, cover
dressing site to avoid water exposure.
2. Look at his past history. What other factors are present that could contribute to his risk for cardiac ischemia?
a. His high blood pressure
b. Smoking
c. The aneurysm
d. The stress of his wife passing away
e. The stress of retiring from his job due to health issues
f. Being alone could elevate his emotions as well (since he has no children)
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 was
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.
4. What is your evaluation of the catheterization results?
The patient has a 90% occlusion to the left anterior descending (LAD) coronary artery and the
distal LAD. He also has 70% to 80% occlusion of the distal RCA. The RCA is the source of blood
flow to the posterior descending coronary artery. The LAD supplies blood flow to the thirds of
the ventricular septum, the anterior left ventricle, the apex, and must of the bundle branches.
This patient has 90% occlusion to the LAD, so all of these areas of the heart will have
diminished blood supply. The left coronary artery occlusion interferes with the amount blood
supply received by certain cardiac muscles and conducting tissues. These muscles and tissues
require adequate blood supply to prevent complications. The cardiac muscles that receive
blood supply from the LAD include: the anterior ventricular septum, anterior left ventricle, and
the apex. The conducting tissues that receive blood supply from the LAD are the bundle
This study source was downloaded by 100000838928381 from CourseHero.com on 06-16-2022 13:30:55 GMT -05:00
https://www.coursehero.com/file/37290025/Case-Study-week-3-1docx/
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 anterior wall myocardial 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 (about the same time that he had his MI) and that he does not have any
children.
He is a current cigarette smoker with a 50-pack-year smoking history. His vital signs (VS) are 158/94, 88, 20, and 97.2° F
(36.2° C). As you talk with him, you realize that he has only minimal understanding of the catheterization procedure.
1. Before he leaves for the catheterization laboratory, you briefly teach him the important things he needs to know
before having the procedure. List five priority topics you will address.
a. He needs to know how the procedure will go. Such as where it will go: Internal jugular
(IJ), Subclavian (SVC), Femoral, Peripheral
b. That he will need to keep whichever limb it goes in straight and still for prescribed time
(usually 4-6 hours).
c. That the catheter will administer blood easier to the heart.
d. He needs to know complications that could happen such as: phlebitis, occlusion, and
mechanical complications.
e. Teach client how to take care of catheter right after surgery for example: not submerging
it in water. To shower, cover dressing site to avoid water ans when showering, cover
dressing site to avoid water exposure.
2. Look at his past history. What other factors are present that could contribute to his risk for cardiac ischemia?
a. His high blood pressure
b. Smoking
c. The aneurysm
d. The stress of his wife passing away
e. The stress of retiring from his job due to health issues
f. Being alone could elevate his emotions as well (since he has no children)
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 was
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.
4. What is your evaluation of the catheterization results?
The patient has a 90% occlusion to the left anterior descending (LAD) coronary artery and the
distal LAD. He also has 70% to 80% occlusion of the distal RCA. The RCA is the source of blood
flow to the posterior descending coronary artery. The LAD supplies blood flow to the thirds of
the ventricular septum, the anterior left ventricle, the apex, and must of the bundle branches.
This patient has 90% occlusion to the LAD, so all of these areas of the heart will have
diminished blood supply. The left coronary artery occlusion interferes with the amount blood
supply received by certain cardiac muscles and conducting tissues. These muscles and tissues
require adequate blood supply to prevent complications. The cardiac muscles that receive
blood supply from the LAD include: the anterior ventricular septum, anterior left ventricle, and
the apex. The conducting tissues that receive blood supply from the LAD are the bundle
This study source was downloaded by 100000838928381 from CourseHero.com on 06-16-2022 13:30:55 GMT -05:00
https://www.coursehero.com/file/37290025/Case-Study-week-3-1docx/
