H.J. arrives to ED with c/o “racing heart”. 79 year old female experiencing sob during past 2-months and swelling in the ankles.

H.J. arrives to ED with c/o “racing heart”. 79 year old female experiencing sob during past 2-months and swelling in the ankles. She sleeps with several pillows to keep herself in a sitting up position. 5-years ago she had an anterior wall myocardial infarction and had two-vessel coronary artery bypass surgery. Family history for atherosclerosis, father died MI and mother a stroke. She smoked for 30-years but quit after having the CABG 4 1/2 years ago. She uses alcohol socially. She’s allergic to nuts, shellfish, strawberries and hydralazine. Her medical history includes osteoarthritis, hypercholesterolemia, and gout.

Current medications are; celecoxib, allopurinol, atorvastatin, daily aspirin and clopidogrel. She is admitted to cardiac observation unit in the hospital.

Will the prescribed home medications be therapeutic for H.J’s presenting problem? Explain

How do the medication actions relate to the medical history?

Physical Assessment

Vital Signs

B/P 135/80 (left arm sitting); AP 125 and irregular; peripheral pulses +1, RR 28, SaO2 91%, nonproductive cough, T 97.5F oral; reported weight 215lb, admission weight 102.7 Kilos; Height 5’8”; appropriately anxious

  • What do you conclude about the patient’s blood pressure?                           
  • Why is the patient tachycardic? Why is the patient tachypneic?
  • Using the reported height and weight what is her BMI?
  • Discuss your conclusions about patient’s admission weight, do you have concerns, why?
 
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Question 1 Identify all of the whole food sources of carbohydrates, fats and proteins from the following list (hint: there are 7):

Question 1 Identify all of the whole food sources of carbohydrates, fats and proteins from the following list (hint: there are 7): whole wheat fettuccini cooked white meat chicken corn syrup solids hydrogenated vegetable oil cilantro spices white rice noodles carrots peanut butter tomato paste Question 2 Two servings of the EG Pad Thai provides % of the Daily Value for iron: O 2 O 15 18 30 Question 4 How did you calculate the amount of kcalories derived from protein? (show your work) I UA I E xx, E E A G DT 12pt Paragraph Question 5 The LC Thai Chicken with noodles contains grams of total fat O No answer text provided. O 7 O 9 O 37 O 39 Question 6 EG Pad Thai has kcalories from total fat: 60 63 O 288 O 25 mg O 10% Question 7 Identify which of the following are minerals from the Nutrient Fact Panels: Select All That Apply fiber iron protein potassium table salt vitamin C sodium vitamin A monounsaturated fat calcium

 
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Joan Smith, 55 years of age, is a female patient who presents to the intensive care unit with the diagnosis of intracranial hemorrhage.

Joan Smith, 55 years of age, is a female patient who presents to the intensive care unit with the diagnosis of intracranial hemorrhage. The patient stopped taking her antihypertensive suddenly because of the cost of the medications and she recently lost her job to outsourcing. The patient is slightly drowsy and complains of headache and blurring vision. The patient’s blood pressure is 220/130 mm Hg upon presentation .

a. According to the definition set by the Seventh report of the joint National Committee of Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC 7), which type of hypertensive crisis is the patient currently experiencing?

b. Describe the treatment goals for handling the hypertensive crisis and apply the goals to the case study. Determine the current mean arterial pressure (MAP) and the goals for treatment.

The physician orders nicardipine hydrochloride 25mg/250ml, NS for peripheral IV starting at 2.5mg/hr, and titrate by 2.5mg/hr every 15 minutes to reach the goal for the first hour, which is to achieve 25% reduction of the initial MAP.

· Call the physician if the dosing range of 15mh/hr has been reached and the MAP is still not at target goal for the first hour treatment or up to four dose increases.

· Lower the BP within 6hours to 160/100mmhg

· Adjust the IV rate so that the IV fluids plus the nicardipine drip are equal to100ml/hr. in total. Cal the physician if the IV fluids must go above 100ml/hr to provide the nicardipine.

c. Explain what rate to set initially for both the nicardipine drip and the NS maintenance fluids

d. Explain the process of titrating the nicardipine drip for the first hour to achieve the final MAP goal of 25% reduction of the original MAP

 
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H.J. arrives to ED with c/o “racing heart”. 79 year old female experiencing sob during past 2-months and swelling in the ankles.

H.J. arrives to ED with c/o “racing heart”. 79 year old female experiencing sob during past 2-months and swelling in the ankles. She sleeps with several pillows to keep herself in a sitting up position. 5-years ago she had an anterior wall myocardial infarction and had two-vessel coronary artery bypass surgery. Family history for atherosclerosis, father died MI and mother a stroke. She smoked for 30-years but quit after having the CABG 4 1/2 years ago. She uses alcohol socially. She’s allergic to nuts, shellfish, strawberries and hydralazine. Her medical history includes osteoarthritis, hypercholesterolemia, and gout.

Current medications are; celecoxib, allopurinol, atorvastatin, daily aspirin and clopidogrel. She is admitted to cardiac observation unit in the hospital.

B/P 135/80 (left arm sitting); AP 125 and irregular; peripheral pulses +1, RR 28, SaO2 91%, nonproductive cough, T 97.5F oral; reported weight 215lb, admission weight 102.7 Kilos; Height 5’8”; appropriately anxious

  • Will the prescribed home medications be therapeutic for H.J’s presenting problem? Explain
  • How do the medication actions relate to the medical history?
  • What do you conclude about the patient’s blood pressure?                           
  • Why is the patient tachycardic? Why is the patient tachypneic?
  • Using the reported height and weight what is her BMI?
  • Discuss your conclusions about patient’s admission weight, do you have concerns, why?
 
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