Question

Akio sukura, a 64 year-old man comes into the emergency department after experiencing chest pain and diaphoresis. His ECG is abnormal. He scheduled for a cardic catherization

1. Is a consent required for this procedure? If so, would he be able to sign it?  

2. What questions would you need to ask him when preparing him for this diagnostic test

3. What would be the priorities of care related to this diagnostic test after the procedure is finished?

Jack Smith, a construction worker comes into the clinic. The provider suspects that he has peripheral vascular disease.

1. What are the risk factors for this type of cardiovascular disease?

2. What diagnostic tests might be ordered for him

3. why would it be important to assess for signs of diabetes mellitus as well?

Mrs. Dunn id being discharge from the hospital after being treated for arterial insufficiency in both lower extremities. Her provider requests that Mrs Dunn receive instruction in the care of her feet and legs before discharge.

1. What findings do you expect on physical examination of Mrs. Dunn's legs?

2. What medication and treatment do you expect the provider to prescribe? Why are these prescribed?

3. List five priority teaching points for Mrs. Dunn.

Answer 1

I . case study of Akio sukura

1. cardiac catheterization is an invasive procedure , in which a catheter is inserting in to the heart and surrounding vessels in order to obtain information regarding structure and function of the heart chambers, valves and coronary circulation. as like every invasive procedure an informed procedure consent should be taken before this procedure. if patient is physically or emotionally in competent to sign the consent the next kin can sign the consent. if there is no relatives and patient need urgent intervention , cardiologist can perform the procedure as per the institutional policy.

2. while preparing for the cardiac catheterization, ask the client for allergies to sea food, iodine, or radiopaque dyes.

3. post procedure care

. monitor vital singns and cardiac rhythm

.assess for chest pain

. monitor peripheral pulses and the colour , warmth and sensation of the extremity distal to the insertion site

and inform if any deviation  occure.

. apply compression device to the site.

.monitor for any hematoma or bleeding   , inform if occure.

.keep the ex tremity extended for 4-6 hrs. strict bed rest for 6 -12 hrs as prescribed.

. encourage fluid intake if not contraindicated.

II case study of jack smith

1. risk factors for peripheral vascular disease

smoking, diabetes, obesity, hypertension, high cholesterol, advanced age, hereditary

2. ankle or brachial index , treadmill exercise test,ultrasonography, angiography ,mri

3 . the risk of peripheral vascular disease is high in patient with diabetes which occure when blood vessels in the leg become blocked or narrowed due to fat deposits.

III case study of mrs , dunn id

1. painful cramping in hips, thighs, caif muscies after activities , numbness or weakness in lower limb, cold lower limb , sore on toes , feet or leg that wont heal.

2. antiplatelet medications that inhibit blood clot.

3. patient teaching

1 maintain healthy body weight.

2 eat well balanced diet.

3 avoid alcohol intake.

4.exercise regulary.

5. maintain blood pressure below 140/90 mm of hg .