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Q1.

Assessment Description

Select three of the following questions for your discussion response. Indicate which questions you have chosen using the format displayed in the “Discussion Forum Sample.”

Scenario

C.H. presented to your office with the complaint of a “racing heartbeat.” She is an overweight, 66-year-old African American female, who has been experiencing increasing shortness of breath during the past 4 months and marked swelling of the ankles and feet during the past 3 weeks. She feels very weak and tired most of the time and has recently been waking up in the middle of the night with severe breathing problems. She has been sleeping with several pillows to keep herself propped up. Five years ago, she suffered a transmural (i.e., through the entire thickness of the ventricular wall) anterior wall (i.e., left ventricle) myocardial infarction. She received two-vessel coronary artery bypass surgery 4.5 years ago for obstructions in the left anterior descending and left circumflex coronary arteries. Her family history is positive for atherosclerosis as her father died from a heart attack and her mother had several CVAs. She had been a three-pack-per-day smoker for 30 years but quit smoking after her heart attack. She uses alcohol infrequently. She has a 9-year history of hypercholesterolemia. She is allergic to nuts, shellfish, strawberries, and hydralazine. Her medical history also includes diagnoses of osteoarthritis and gout. Her current medications include celecoxib, allopurinol, atorvastatin, and daily aspirin and clopidogrel.

Questions

Based on the limited amount of information provided above, do you suspect that this patient has developed heart failure based on the most recent guidelines? Explain your answer.

What are the most common causes of CHF in an adult? Given the information in this case, which causes seems to be the most likely?

From the information given above, identify three risk factors that probably contributed to the patient’s heart attack five years ago.

You are curious as to the usefulness of the S3 in making a diagnosis of CHF. You go to the literature and find two studies. The first study started with 100 patients with echocardiographically proven LV systolic dysfunction and an ejection fraction estimated at less than 35%. Of that group, 80 patients had an S3. The other study took 100 normal volunteers and performed auscultation and echocardiography. Of that group, 10 patients with normal echocardiograms had an S3. You then see a patient in your office with a history of exertional dyspnea. You estimate before examining her that she has a “50-50 chance” of having congestive heart failure. If you hear an S3, what do you then think are her chances of having CHF?

What diagnostic tests would you consider in this case.

Q2.

Assessment Description

Select two of the following questions for your discussion response. Indicate which questions you have chosen using the format displayed in the “Discussion Forum Sample.”

Scenario

Mr. K.P. is a 71-year-old female, who presents to your office with a 3-day history of more than 103F with chills. The patient reports, “I don’t feel well, and I think that I may have the flu.” He also complains of “some painful bumps on my fingers and toes that came on last night.” He denies IVDA. When asked about recent medical or dental procedures, he responds: “I had an infected tooth removed about 2 weeks ago.” He does not recall receiving any antibiotics either prior to or after the procedure.

PMH:

Asthma since childhood

Rheumatic fever as a child x 2 with mitral valve replacement 2 years ago

HTN x 20 years

DM type 2, x 9 years

COPD x 4 years

H/O tobacco abuse

Alcoholic liver disease

Urinalysis: The urine was pale yellow, clear, and negative for proteinuria and hematuria. A urine toxicology screen was also negative.

ECG: Normal

Transthoracic ECHO: A 3-cm vegetation on the aortic valve was observed. No signs of ventricular hypertrophy or dilation were seen.

Blood Cultures: 3 of 3 sets (+) for

Streptococcus viridans

(collection times 1030 Tuesday, 1230 Tuesday, 1345 Tuesday)

Laboratory Blood Test Results

Na 135 meq/L

K 3.7 meq/L

Cl 100 meq/L

HCO3 22 meq/L

BUN 17 mg/dL

Cr 1.0 mg/dL

Glu, random 145 mg/dL

Hb 14.1 g/dL

Hct 40%

Plt 213,000/mm3

WBC 19,500/mm3

Neutros 80%

Bands 7%

Lymphs 12%

Monos 1%

Alb 4.0 g/dL

ESR 30 mm/hr

Ca 8.9 mg/dL

Questions

Which type of infective endocarditis is suggested by the patient’s clinical manifestations—acute or subacute? Explain your answer.

Which three of the illnesses in this patient’s medical history may be contributing to the onset of infective endocarditis and why are these diseases considered risk factors? Explain each of the factors.

What are the six diagnostic modified Duke University criteria that favor a diagnosis of infective endocarditis in this patient? Explain your answer.

Explain the pathophysiology of proteinuria and hematuria in a patient with infective endocarditis.

Identify four elevated laboratory test results that are consistent with a diagnosis of bacterial endocarditis. And explain the pathophysiology of the elevated values

Q3.

Assessment Description

Answer both of the following questions for your discussion response using the “Discussion Forum Sample.”

Explain the underlying pathophysiology associated with hypertensive conditions. What are the associated pathological complications?

Detail a common congenital defect associated with the cardiovascular system of a pediatric patient

Revised: 9/22/2020
AGACNP & FNP
Acceptable References
Rationale: As future providers, one wants to follow the evidenced-based practice that is
accepted by regulatory authorities. The authorities and peer-reviewed journals have the input of
many professionals and not just one provider’s opinion. As a provider, you want your care
substantiated with best practices and published treatment plans and protocols to withstand your
defense with other providers and a lawsuit.
Examples of these authorities include, but not limited to:
ACOG, AADE, ADA, American College of Surgeons, etc.
Acceptable Resources
• Textbooks used in your courses
• Peer-reviewed journal articles:
o New England Journal of
Medicine
o Diabetes Educator
o Journal of the American
Association of Nurse
Practitioners
o UpToDate with an author
o Epocrates – Drug information
only
Unacceptable resources
• WebMD
• Emedicine.com
• Dynamed
• Stat pearls
• Medscape
• No blogs
• Educational tools for patients
• Mayo and Cleveland Clinic –
opinions, not evidence,
• Materials aimed at the “lay” person
How to locate adequate resources that are peer-reviewed:
•
•
https://scholar.google.com/
Link your computer to the GCU library
Library resources/education links:
•
•
•
•
Library Walkthrough Tutorial:
o https://lc.gcumedia.com/mediaElements/library-walk-through-tutorial/v2.1/
Nursing & Health Sciences Research Guide:
o https://libguides.gcu.edu/Nursing
Nursing Webinar:
o https://libguides.gcu.edu/webinars
Appointments with a librarian:
o Phone Local 602.639.6641
o Email: https://library.gcu.edu/AskALibrarian
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