Group case study. Our CI corrected us that CVD is cerebrovascular disease and not cardiovascular, enjoy browsing.

1. A Case Study
on
Cardiovascular
Disease

2. Introduction:
A cardiovascular disease is one
of the greatest concerns on health
today. This disease is known as a
silent killer. It just comes with no
apparent signs and symptoms and
people are not warned with any
manifestation to signal they contain
this disease.

3. One way to detect its presence is to
trace your family history. You are at
risk of it if one or more family
members died because of it, more
so with an advanced age. Other
medical condition like Diabetes
Mellitus can predispose such
individual to having cardiovascular
diseases.

4. Aside from genetic predisposition,
diet has also been a great
contributory factor, if not indeed the
cause, to having such disease.

5. An excessive intake of salty and
sodium-rich foods and over
consumption of fats and cholesterol,
alcohol and substance abuse and
smoking are more often than not,
the predisposing factors of
cardiovascular diseases.

6. An excessive intake of salty and
sodium-rich foods and over
consumption of fats and cholesterol,
alcohol and substance abuse and
smoking are more often than not,
the predisposing factors of
cardiovascular diseases.

7. CVDs, as it is commonly known, are
diseases that involve merely the
heart and the blood vessels, which
should be detected at an earlier
time to possibly reduce its morbidity
more so, its mortality.

8. Many deaths were reported of this
disease. In fact, most countries face
greater risks of this over cancer.

9. For us, to better understand its
causes for we know once you are
affected with this disease you can't
find any way out and it could cause
you multiple organ failure.

10. More so, We'd like to impart health
teaching to our parents, relatives
and friends, now that we can
foresee its manifestations. As much
as possible, we want them to be
conscious of their health too.

11. We want them to be aware of this
disease and how morbid it is. We
want them to live longer as much as
we want me to stay longer too. This
case study is not just for us to learn
but also for them to know and
understand.

12. II.CLIENT'S PROFILE
Patient X is a 76-year old
female, widowed at age 75 and has
8 grown-up children. She used to
stay at one of her child’s house at
Adela, Camaman-an, Cagayan de
Oro where she helps in their
''ALACART” business as the 'puso'-
maker.

13. She wakes up at around 6 in the
morning and drinks her cup of
coffee. Taking care of her
grandchildren before they get to
school is what she usually does
during weekdays.

14. She then eats her breakfast, watch
TV afterwards and do some
household chores. In the afternoon,
after lunch, is her ample time to do
the 'puso' and prepare in making
barbecues. This is what she keeps
doing almost everyday.

15. History of Present Illness
Just few hours before
admission, Patient X was watching
TV with her child and grandchildren
when her child noticed she was no
longer answering her questions and
her lower jaw is slightly misplaced.

16. Her child tried to put on some cold
packs to somehow soften the
hardened jaw part but it didn't work
so they brought the patient for
check-up but the doctor ordered for
admission subsequently.

17. Patient X then was diagnosed with,
Cardiovascular Disease, probably
cardioembolic, CAD, atrial
fibrilation and in controlled
ventricular response. Few days on
admission, patient X was apparently
well but each day gets worse, until
she can hardly speak and open her
eyes.

18. She was also unable to swallow
foods even fluids so the doctor
ordered for Nasogastric Tube
insertion. Her doctor also orders for
oxygen administration regulated at 4
liters per minute.

19. Review of Systems
Upon assessment, the patient's
vital signs were: BP 130/90, PR 92
beats per minute of irregular and
bounding rhythm, RR 20 cycles per
minute and temperature of 37.8
degree Celsius

20. General Appearance
She looks generally weak and
stuporous, she does not respond to
questions and even to painful
stimuli.

21. Respiration/ Respiratory Status
She elicits rales and crackling
sounds during respiration noted
upon auscultation. She breathes 20
cycles per minute but of irregular
rhythm with frequent apneic
periods. Lung expansion is slightly
assymetrical due to prolonged bed
boundedness and immobility. Non-
productive cough was also noted.

22. SKIN
General Color Pallor
Texture smooth
Turgor firm
Temperature Cool
Moisture dry

23. Facial Movements Symmetrical
Fontanels Closed
Hair dry
Scalp With dandruff and
lice

24. Lids Symmetrical
Preorbital region Intact/Full
Conjunctiva Pallor
Sclera Anicteric
Reaction to light R-brisk
L-brisk
Reaction to
accomodation
Uniform
constriction/Convergence
Vicual Acuity Grossly Normal
Peripheral Vision Intact/Full

25. Septum Midline
Mucosa Pallor
Patency Both patent
Gross Smell Normal/Symmetrical
Sinuses Non-tender

26. External Pinnae Normoset;
Symmetrical
Tympnic
Membrane
Intact
Gross Hearing Normal

27. Lips Pallor
Mucosa Pallor
Tongue Midline
Teeth Dentures
Gums Pallor

28. Trachea Midline
Thyroids Non-palpable
Others Normal ROM

29. Uvula Midline
Tonsils Not inflamed
Posterior
Pharynx
Not inflame
Mucosa Pallor

30. General Normal
Configuration Symmetrical
Bowel Sounds Normoactive
Percussion Tympanic

31. Range of Motion Normal
Musle tone and
strength
Fair
Spine Midline
Gait Coordinated

32. Elimination Pattern
The patient use to defecate
once every morning in soft
consistency and in yellow to
brownish color. She has no problems
or any discomfort in defecation. Her
bowel sounds are hypoactive upon
auscultation. She was given Senna
Concentrate to manage
constipation.

33. ROM/ Exercise Pattern
Patient's inability to do range of
motion exercises by herself is
impaired. Her joints are flexed
through passive ROM except for the
head. Muscle tone and strength
were decreased and are possible for
atrophy.

34. The presence of rales and
crackles, apneic periods and cough
upon auscultation are signs and
symptoms of pulmonary edema.
Edema and ascites formation also
signal fluid movement from the
intravascular compartment to the
interstitial compartment indicative
of fluid overload.

35. III. ANATOMY and PHYSIOLOGY

36. The heart is the main organ
responsible for pumping blood all
through out the systems. It is
responsible for the delivery of oxygen
to the tissues for nourishment and
uses the circulating blood as the
medium for the removal and
excretion of the cell's metabolic
wastes through exhalation.

37. The heart is situated in the
anterior chest cavity. It has four
chambers, the upper ones are called
the atria and are divided into two,
the right and left. And the ones
situated below are the right and left
ventricles.

38. These chambers are divided by
valves the tricuspid and the bicuspid
valve, and still divided laterally by a
septum called atrioventricular
septum.

41. Blood from the systemic
circulation is already deoxygenated,
passes trough the superior and
inferior vena cavae. It then, enters
the right atrium, passing through
the tricuspid valve and moves to the
right ventricle, goes to the lungs via
the pulmonic artery.

42. Oxygenation and gas exchange
happens in the alveoli of the lungs
through the process of diffusion.
The oxygenated blood then gets
back to left atria passing through the
pulmonic vein. It moves to the left
ventricles through the bicuspid valve
then it passes the aorta for systemic
nourishment.

43. The pumping action starts with
the simultaneous contraction of the
two atria. This contraction serves to
give an added push to get the blood
into the ventricles at the end of the
slow-filling portion of the pumping
cycle called "diastole.

44. " Shortly after that, the
ventricles contract, marking the
beginning of "systole." The aortic
and pulmonary valves open and
blood is forcibly ejected from the
ventricles, while the mitral and
tricuspid valves close to prevent
backflow. At the same time, the
atria start to fill with blood again.

45. After a while, the ventricles
relax, the aortic and pulmonary
valves close, and the mitral and
tricuspid valves open and the
ventricles start to fill with blood
again, marking the end of systole
and the beginning of diastole.

46. It should be noted that even
though equal volumes are ejected
from the right and the left heart, the
left ventricle generates a much
higher pressure than does the right
ventricle.

47. IV. PATHOPHYSIOLOGY

48. V. DIAGNOSTIC PROCEDURES and LABORATORY
RESULTS
The diagnostic procedures patient X has
undergone were Electrocardiogram (ECG),
complete blood count CBC and urinalysis. The ECG
reads a lightly depressed P wave, widened QRS
waves and peak T wave. This means that the atria
(P wave) are contracting less and atrial filling is
decreased. QRS or the time for the ventricles to
contract and depolarize takes greater time. And
the time for the ventricles to relax for ventricular
filling T wave, is prolonged.

49. BLOOD CHEMISTRY
Result Unit Reference
WBC 9.8 10^3/uL 5.0-10.0
RBC 3.9 10^6/uL 4.2-5.4
Hgb 7.9 g/dL 12.0-16
Hct 23.6 % 37-47
Differential Count
Lymphocytes 8.1 % 17.4-48.2
Neutrophils 73.2 % 43.4-76.2
Monocytes 7.2 % 4.5-10.5
Eosinophils 3.6 % 1.0-3.0
Basophils 0.4 % 1.0-3.0
Platelet 170 10^3/uL 150-400

50. Diagnostic/Laboratory Procedures Indication/purposes Result Analysis and Interpretation
1. Urinalysis
Ordered: last July 1, 2010
To diagnose and monitor renal or urinary tract
disease
Color: yellow
Clarity: hazy
pH: 6.0
Specific Gravity: 1.015
Puss cells: 4-6
RBC: 18-20
Bacteria: plenty
Epithelial cells: occasional
Albumin: 3+
Laboratory results revealed that there is
presence of albumin in the blood; this
indicates that glomerular cannot filter
large molecules such as that of albumin.
It also revealed that there is bacterial
infection as evidenced by presence of
bacteria, puss cells and red cells in the
urine
1. Creatinine
Ordered: Last June 30, 2010
This test was ordered in order to evaluate renal
function
14.84 (reference Value = 0.6-1.2)
mg/dL
Result was above normal level indicating
renal malfunction. The kidney cannot
excrete nitrogenous waste product of
protein leading to its accumulation in the
blood.
1. Sodium (Na+)
Ordered: Last June 30, 2010
To evaluate fluid and electrolyte imbalance and
identify renal dysfunction
133.6 ( reference value :135-148)
mmol/L
Result was below normal level. It results
from loss of sodium-containing fluids or
from water excess, such prolonged
diuretic therapy and renal disease.
1. Potassium(K+)
Ordered: Last June 30,2010
To evaluate fluid and electrolyte imbalance and
identify renal dysfunction.
5.36 (reference value:3.5-5.3) mmol/L There is high level of potassium in the
blood which usually or normally excreted
by the kidney, but due to decreased
GFR, kidney cannot filter potassium in
the urine causing retention of potassium
in the blood.
1. BUN (Blood urea nitrogen)
ordered; last June 30,2010
To evaluate kidney function in a wide range of
circumstances, to help diagnose kidney
disease, and to monitor patients with acute or
chronic kidney dysfunction or failure.
145.6 (reference value: 4.6-23.4)
mg/dL
A greatly elevated BUN generally
indicates a moderate-to-severe degree of
renal failure. Impaired renal excretion of
urea may be due to temporary conditions
such as dehydration or
shock, or may be due to either acute or
chronic disease of the kidneys
themselves.

51. Urinalysis Report
Color: Yellow
Clarity: hazy
pH: 6.0
Specific gravity: 1.020
Proteins:+3
Blood: +3

52. VII. HEALTH
TEACHINGS/DISCHARGE PLAN
Medications
> Take the entire course of any
prescribed medications.
> Emphasis on educating about
the action of the drug, right dosage,
timing and frequency on the intake
of the drug and its expected side
effects.

53. Exercise
Perform assistive range
of motion exercises
regularly.
Inform patient and
significant others about
the importance of exercise
on the patient's condition.

54. Treatment
> Emphasize the importance of
early ambulation.
> Encourage the use of proper
personal hygiene and handwashing.
> Provision of peaceful
environment to promote rest and
enhance well-being.

55. Home care:
> Take adequate rest
periods.
> Avoid activities that
can cause fatigue.

56. Out-patient
> Explain and
emphasize the importance
of compliance to follow
check- up and therapeutic
regimen.

57. Diet
> Diet restrictions should
be properly observed
> Intake of sodium-rich
foods should be minimized.
> Encourage the intake of
proper diet at proper timing
to display timely healing.

58. VIII. LEARNING EXPERIENCE
This is just actually our third time to be
exposed in the ward, where lots of patients
are admitted. We find the experience
exhausting though it's just our first rotation
and we need to accomplish three more to
proceed to the next round. we feel like we’re
drained and we can't proceed to pursuing this
course. Only until one thing came our mind,
there's no way for us to quit so we have to
develop the passion for us to succeed. If not,
then we’re just certainly wasting our parent's
fruit of labor.

59. We don't want it to happen so
merely as early as now we should
develop and learn to love the field
that we are into. On the very first
day of our duty, we've learned a lot
not just from our instructor neither
neither each of us but on our
patient herself.

60. We learned from them not
necessarily about sterile technique
nor diseases, nor what is being
typically taught in the classroom but
in life at large.

61. They taught us of things we
never knew about life. Well, so
much for that, in making this case
study, learnings that we have gained
are outpouring and overwhelming.
More so with the things that puts us
and our family at risk with this silent
killer disease.

62. We then would like to teach
them proper ways of taking care of
their health, what foods they ought
to eat and what are those they
should avoid. I also have learned
from making this case study the
importance of time and how to
properly manage it.

63. If projects are given at an earlier
time, make it as early as possible to
avoid cramming and refrain from
eleventh hour rush. Nevertheless,
though we started making this case
study a week before deadline, thank
God that we were able to
accomplish this with a heart.

64. The greatest learning I might
have gained is that I did this despite
my limited knowledge, with no
assistance and dependence from
others. To sum this all up, this paper
might not have been made possible
without God providing me the
ample time to devote in making this.
Thanks be to God for the success of
this project.

65. IX. REFERENCES:
Black, J.,et al. (2009). Medical
Surgical Nursing. Eighth ed.
Saunders Elsevier Printing office. Pp
1456-1492.
http://en.wikipedia.org/wiki/Cardio
vascular_disease

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67. Thank you!