This Assessment is part of the Homework category, worth 10% of your grade. Deadl

This Assessment is part of the Homework category, worth 10% of your grade.
Deadline
See Tracking Calendar for due dates.
Completing this Assessment will help you to meet the following:
Course Outcomes
• Illustrate how changes in one body system affect the functioning of other body systems.
• Examine diagnosis, treatment, and prevention options for disease states.
Directions
Read the following case study on congestive heart failure. Answer the 10 questions, listed throughout the assignment, on a word document using complete sentences.
History of Present Illness
Julie presented to the emergency department late one evening complaining of a “racing heartbeat.” She is an overweight, 69-year-old white female who has been experiencing increased shortness of breath during the past two months and increased swelling of the feet and ankles during the last three weeks. She feels very weak and tired most of the time and has begun waking up during the middle of the night with severe breathing problems. She has been sleeping with several pillows to keep herself propped up at night. Five years ago, she suffered an anterior wall myocardial infarction. She received a two-vessel coronary artery bypass graft surgery 4.5 years ago for obstructions in the left anterior descending and left circumflex coronary artery. Her family history is positive for atherosclerosis, coronary artery disease, and cerebral vascular accidents. She had been a three-pack per day smoker for the previous 30 years but quit after her heart attack. She uses alcohol infrequently. She has a 9-year history of high cholesterol, gout, and arthritis. She is allergic to nuts, shellfish, strawberries, hydralazine. Her medications include celecoxib, allopurinol, atorvastatin, clopidogrel, and daily aspirin.
Questions 1-3:
1. Based on the limited amount of information given above, explain the type of CHF and justify your selection. Describe the potential cause of this patients’ heart failure.
2. Based on the information given above, identify three risk factors contributing to the patient’s heart attack five years ago.
3. Discuss the reasons why the patient currently taking the medications listed above.
Vital signs
BP is 125/80; the pulse is 125 and regular; the respiratory rate is 28 and labored; temperature is 98.5 degrees Fahrenheit. Weight is 215 pounds; height is 5 foot 8 inches, the patient appears to be anxious.
Review of systems
• Head, Ears, Eyes, Nose, Throat
o The fundoscopic exam is normal, pharynx and nares are clear, the tympanic membrane is intact
• Skin
o Pale with cool extremities, slightly diaphoretic.
• Neck
o The neck is supple with no bruits over the carotid arteries—no thyromegaly or adenopathy. Positive jugular venous distention and hepatojugular reflex is positive.
• Lungs
o Bibasilar rales with auscultation, percussion was resonant throughout.
• Heart
o Normal rate and rhythm, S1-S2, no murmurs, rubs, or gallops
• Abdomen
o The abdomen is soft and non-tender to palpation. No bruits or masses. Significant hepatomegaly with tenderness was observed with deep palpation.
• Extremities
o 2+ pitting edema in feet and ankles bilaterally extending to mid-calf region. Skin is cool and diaphoretic. Distal pulses are present and moderate in intensity.
• Neurological
o The patient is alert and oriented to person, place, time. Cranial nerves II-XII are intact. Deep tendon reflexes are 2+ and symmetric. Strength is 3/5 throughout.
Questions 4 – 7:
4. Evaluate this patient blood pressure. Is it normal or abnormal?
5. Propose why might this patient be tachycardic and tachypneic.
6. Propose a reason why the patient has positive jugular venous distention and 2+ pitting edema.
7. Identify if the new information above indicates left-heart failure, right heart failure, or total heart failure. Explain your reasoning.
Testing
• Chest X-ray
o Prominent cardiomegaly, perihilar shadows consistent with pulmonary edema.
• ECG
o Sinus tachycardia with waveform abnormalities consistent with left ventricular hypertrophy. Pronounced Q waves consistent with previous myocardial infarction.
• ECHO
o Cardiomegaly with poor left ventricular wall movement. The ejection fraction is 39%.
Laboratory blood tests
Na= 153mEq/L
Albumin= 3.5g/dL
K= 3.1mEq/L
PaO2=65mmHg (room air)
BUN= 52mg/dL
PaCO2= 56mmHg
Creatinine= 2.4mg/dL
BNP=13,000pg/mL
Glucose (fasting)= 131mg/dL
Hemoglobin= 13.8g/dL
Hematocrit=41%
Platelets= 220K/mm3
Questions 8 – 10:
8. Identify which cardiac exam and chest x-ray findings complement each other.
9. Determine which cardiac exam and ECG findings complement each other.
10. Propose three (3) treatment options for this patient.
BIOL205 – Congestive Heart Failure Homework4
BIOL205 – M4 Homework Grading Rubric
Criteria
Exceeds Expectations
Meets Expectations
Needs Improvement
Points
Content
80 points
72-80 points
Thoroughly answered all assigned questions correctly. Thorough use of information from the case study and/or references is evident. Excellent depth to at least 90% of all talking points.
56–71 points
Adequately answered at least 70% of assigned questions, with several errors. Adequate use of information from the case study and/or references is evident. Adequate depth to at least 70% of talking points.
0-55 points
Answered less than 50% of assigned questions, with a multitude of errors. Less than adequate use of information from the case study and/or references. Adequate depth to less than 70% of assigned questions.
Grammar/Mechanics
10 points
9-10 points
The assignment demonstrates the student’s ability to use standard English grammar. There are no significant errors in use of pronouns, verb tenses; and sentence structure is consistently correct.
7-8 points
This assignment exhibits strong grammar skills; there may be occasional lapses, but these do not detract from the overall impression or understanding. Very few, if any, sentence structure errors (fragments, run-ons, comma splices, fused sentences) occur.
0-6 points
The assignment is characterized by frequent grammatical errors. The assignment would profit from careful proofreading and the application of the rules of standard English grammar for agreement, use of pronouns, verb tenses, and sentence structure.