NIU NURS 308 Heart Failure Case Study

Mr. Pepper is 74 y/o who presented to the ED with shortness of breath, fatigue, and “swollen legs and stomach”. In assessing his health history, you found out that he smokes a pack a day. His wife reported that he has been sleeping with two pillows propped behind him.

Part I

What other pertinent information might the nurse need in assessing this patient?

Upon further evaluation Mr. Pepper reported that he had not been taking his fluid pill because he ran out. In obtaining his assessment, you noted bilateral crackles, bilateral lower edema of +3 and distended abdomen. His V.S. are: BP 92/48, P 88, R 30, T 98.9, SPO2 of 88% on room air. You decide to supplement him with 2 L of O2.

Part II

What other interventions might the nurse consider? What

procedures, medications and labs do you anticipate? Be brief!

Mr. Pepper was admitted to 6 South for Heart Failure exacerbation and for diuresis. He was administered Lasix with Potassium supplements. He stated relief from his fatigue and shortness of breath. During hospital stay you noted that his wife was bringing him Chinese food. The patient also requested multiple times to go outside and smoke.

ORDER NOW FOR A CUSTOM-WRITTEN, PLAGIARISM-FREE PAPER

Part III

What teaching strategies will you implement in Mr. Pepper’s care? What resources will you consult or utilize? Where do you obtain your resources? Be brief!

Upon discharge, Mr. Pepper was in good spirits and ready to go home. He was educated about his heart failure and disease process and management throughout his hospital stay.

Part IV

List the discharge instruction topics that you would go ove

with Mr. Pepper. What resources will you give him?

Mr. Pepper verbalized understanding from his discharge instructions. He has decided to quit smoking and live a healthier lifestyle. He was sad to leave the excellent nursing staff, but was ready to go home.

The nurse documented that discharge instructions and educational materials were given to Mr. Pepper.

NIU NURS 308 Quiz 3

Question 1

Antibodies are produced by:

B cells.

memory cells.

T cells.

helper cells.

plasma cells.

Question 2

Mast cell degranulation decreases:

histamine, neutrophil chemotactic factor, and leukotrienes.

histamine and prostaglandins.

histamine and platelet-activating factor.

histamine, IL-4, and eosinophil chemotactic factor of anaphylaxis.

Question 3

Antibody is effective against:

expression of MHC molecules.

virus-infected cells.

viral protein synthesis.

extracellular viruses.

Question 4

CD4 markers are associated with:

cytotoxic T cells.

suppressor T cells.

helper T cells.

APCs.

Question 5

The sequence of inflammatory events within the vasculature is:

slower blood flow, arteriolar vasoconstriction, increased capillary permeabilty, edema.

blood becoming more viscous, vasodilation, increased capillary permeability, edema.

vasodilation, vasoconstriction, decreased local blood flow to injured site, edema.

arteriolar vasoconstriction, vasodilation, increased capillary permeability, plasma leakage, edema

Question 6

The inflammatory response:

minimizes injury and promotes healing.

elevates body temperature to prevent spread of infection.

prevents the formation of abscesses.

prevents blood from entering the injured tissue.

Question 7

Cytotoxic T cells:

inhibit virus-infected cells.

inhibit viral protein synthesis.

inhibit intracellular viruses.

decrease expression of MHC molecules.

Question 8

Characteristic systemic manifestations of acute inflammation include:

leukopenia.

fever caused by the release of IL-1 by neutrophils and macrophages.

reduced host susceptibility to the effects of endotoxins.

a “right shift” in the ratio of immature to mature neutrophils.

Question 9

Innate resistance or immunity

Involves “memory”

Is a development of an individual’s later yearsc.

Is a relatively slow and specific process

Depends on physical, mechanical, and biochemical barriers

Question 10

Cytokines and their receptors function:

as negative regulators of acquired immune responses.

as intracellular chemical signals.

aschemical signals between cells.

to decrease the production of proteins.

NIU NURS 308 Cystic Fibrosis Case Study

Part I – The Meeting

Sarah stared blankly at the blue paisley wallpaper. Her husband Mike sat by her side, bending and unbending a small paper clip. “Sarah and Michael, it’s good to meet you,” welcomed the genetic counselor, as she entered the room. “I apologize for being late, but I was just meeting with another couple. Let’s see, you’d like to have a child, but you’re concerned because of your family history of cystic fibrosis.”

“Yes,” Sarah replied softly. “Mike and I met at a CF support group meeting a few years ago. He had a younger brother who died of cystic fibrosis, and I had a younger sister. We saw the painful lives they had—difficulty breathing, the constant respiratory infections. Although the treatments for CF are better now, we just don’t know if we can…” she trailed off.

“I can certainly understand your concern,” the genetic counselor responded sympathetically. “That’s where I hope to help, by providing as much information and advice as I can. I’m glad that you came to see me before you became pregnant so I can fully advise you of all options beforehand.”

“To start, let’s go over what we know about your case so far,” continued the genetic counselor. She pulled out a pad of paper, which she placed on the table in front of Sarah and Michael, and began to draw a series of circles and squares connected by lines.

“As I recall, both sets of parents did not display any of the symptoms of cystic fibrosis, right?” “Yes,” said Sarah and Michael in unison. The genetic counselor replied, “Ok, well that means….”

Questions

Consult your textbook and trustworthy Internet sites to answer the following questions:

See H & M pp. 718-720

University of Utah Health Sciences. (201_). Cystic fibrosis. Learn.Genetics—Genetic Science Learning Center. Retrieved from http://learn.genetics.utah.edu/content/disorders/singlegene/cf/

US National Library of Medicine. (2012). Cystic fibrosis. Genetics home reference—your guide to understanding genetic conditions. Retrieved from https://ghr.nlm.nih.gov/condition/cystic-fibrosis

1. Which organs are affected by cystic fibrosis?

2. What are the disease symptoms?

Part II

“So, what’s next?” asked Mike. “First, we’ll collect DNA samples from both of you. We’ll then analyze your CF genes for the most common mutations to see if you are carriers for this recessive genetic disease” the genetic counselor replied.

A few weeks later, the genetic counselor welcomed back Sarah and Mike. “We’ve received the results of your genetic tests for common CF mutations. Michael, you’re a carrier of the most common disease allele, delta-F508, and Sarah, you tested negative for the most common CF mutations.” “Thank goodness,” Sarah replied with relief. “That means it’s safe for us to have a child, right?” “Not exactly,” cautioned the genetic counselor. “Since Sarah tested negative for CF, it seems we don’t have much to worry about, right?” said Michael, pointing to the pedigree in which Sarah is not a carrier. “So, what did you mean when you said not exactly?”

The genetic counselor grabbed her laptop computer and positioned it in front of the three of them. Her fingers quickly typed out a web address and the words “OMIM – Online Mendelian Inheritance of Man” stretched across the browser window. “We can learn a lot more about this disease from this site. It will begin to explain why I said not exactly when Sarah asked if it was safe to conceive a child.”

Questions

The Online Mendelian Inheritance of Man (OMIM) is a catalog of known human genetic diseases. Go to OMIM at http://www.ncbi.nlm.nih.gov/omim and search with the keyword “cystic fibrosis.” Examine the OMIM record entitled “602421 cystic fibrosis transmembrane conductance regulator.”

5. Scroll down the webpage and look closely at the section on “Allelic Variants.” Is the delta-F508 mutation the only known alteration of the CFTR gene or are there additional variants associated with cystic fibrosis?

NIU NURS 308 Heart Failure Case Study