INSTRUCTION:

BASED ON THE FOLLOWING CASES, ANSWER THE CORRESPONDING

QUESTIONS.

CASE I: MYOCARDIAL INFARCTION

CASE II: CONGESTIVE HEART FAILURE

Submit answers to each question in long bond paper, handwritten. This case is due on
Saturday 8am November 28, 2009 . No time extension. Non-compliance will be given a
grade of 0 for said requirement.

Everybody is expected to have a book for reference. Answers to the questions can be found
in Brunner & Suddarth Medical Surgical Nursing.

CASE I:
B.R., a 41-year-old male with a history of arthritis, right hip replacement, nephrolithiasis,
and hyperlipidemia, experienced a right-sided headache while doing light yard work. He then
experienced severe chest pain radiating to both shoulders with associated diaphoresis. B.R. went
to the emergency room to seek health care. Physical examination revealed: BP = 140/98 mm Hg
and HR in the 50s and 60s. An ECG was taken and revealed normal sinus rhythm, normal axis,
and ST segment elevation in lead III, and aVF.
The patient was diagnosed with an acute inferior wall myocardial infarction . He was
initially treated with aspirin, nitroglycerin, IV heparin, and tissue plasminogen activator (tPA) 50
minutes after presentation to the emergency department. Despite treatment, B.R. continued to
have chest pain but it finally subsided within approximately 6 hours and he was transferred to a
tertiary care center.
Myocardial infarction was confirmed by serial CPK: peak CPK = 1967 IU/L (normal =
20-232 IU/L); peak CPK-MB = 172.6 ng/ml (normal = 0.0-90.0 ng/ml). His other laboratory test
results were within normal limits. The following morning after arrival at the new care center,
B.R. again complained of chest pain.
The patient then underwent percutaneous transluminal coronary angiography (PTCA) of
the Left circumflex artery. B.R. was discharged 6 days after admission with no complaints of
chest pain and with the following medications: metoprolol, aspirin, and nitroglycerin
(sublingual) prn. B.R. was recommended for cardiic rehabilitation.

1. What is Myocardial Infarction?

2. Based on the above case what diagnostic exams confirms that this is a case of Myocardial
Infarction?
3. What is the significance of these diagnostic exams in relation to Myocardial Infarction?
4. What are these medications? aspirin, nitroglycerin, IV heparin, and tissue plasminogen
activator (tPA) & Why were they given to the patient?
5. What is PTCA? & Why was this done to the patient?
6. Discharge medications include: metoprolol, aspirin, and nitroglycerin (sublingual) prn.
What are these medications & Why was this given to the patient?
 7. What is Cardiac Rehabilitation? Describe briefly the phase of Cardiac Rehabilitation in
relation to the nurses role in instituting the plan of care for this client.
CASE II

B.A., a 67-year-old Caucasian male, was diagnosed with congestive heart failure (CHF)
approximately 1 year ago, after an acute myocardial infarction. His CHF was considered to be
New York Heart association Class II. Over the past year, he consistently adhered to his low-salt
diet and weighed himself daily. B.A. now presents with complaints of fatigue and quickly
“losing my breath” with any type of activity. He states that he occasionally awakens during the
night with what he describes as a “coughing spell.” His daily weight diary indicates he has
gained 0.5 to 1 pound per week over the last 6 weeks.
A chest x-ray and blood work is ordered for B.A. Chest x-ray findings include mild
cardiomegaly as well as pulmonary venous congestion. Laboratory data is as follows:
Client is maintained on 1tab. Captopril 50 mg/tab OD, Digoxin 0.25 mg/tab OD,
furosemide 1 tab OD.

1. What is Congestive Heart Failure?

2. What type of Heart Failure does the patient have? Right or Left? Pulmonary Venous
Congestion is seen in what type of heart failure? Explain why.
3. What is the purpose of adhering to a Low Salt Low Fat Diet?
4. Is there a significance in the weight gain of the client? Explain Why.
Client is maintained on the following medications: Captopril 50 mg/tab OD, Digoxin 0.25
mg/tab OD, Spironolactone 1 tab OD. What are these medications for & why are they given to
the client.
5. As the nurse caring for this client. What instructions should you provide when weighing
client?
6. What is digitalis toxicity? Is there a risk for this client? What precautionary measures
should the nurse take to prevent this occurrence?