(SOLVED) Based on the PE findings, what areas are of major concern and warrant continued assessment? Why?

Question

Case Study #4 Cardiac Compromise

As the on-coming nurse on a telemetry cardiovascular unit, you receive report about GC, who was admitted with a diagnosis of heart failure 48 hours ago. He is a 56 -year-old male who presented to his primary care provider with a 2-month history of worsening symptoms of dyspnea on exertion, a nonproductive cough, general fatigue, and decreased activity tolerance. Initially, the patient thought he had the flu; however, when the symptoms persisted, longer than expected, he sought medical attention. At the office, GC was found to have profound jugular venous distention, rhonchi in both lungs, and lower extremity swelling. After admission, he had an echocardiogram, and his serum BNP was found to be 1,560 pg/mL. Coronary angiography, which was performed to provide a definitive diagnosis, revealed no evidence of coronary artery disease. Echocardiogram reveals moderate concentric hypertrophy of the ventricles, moderate left ventricular dysfunction, ejection fraction $33\%$, and mild to moderate mitral regurgitation. Angiogram: normal coronary arteries, өjection fraction $33\%$, confirmed reduction in ventricular function with a ventriculogram.

Past Medical History

Hyperlipidemia diagnosed 3 years ago; hypertension diagnosed this past year. GC has had a history of obesity for over 20 years, and a history of hypothyroidism diagnosed 12 years ago.

Physicardq

Vital Signs: HR: 84 bpm; BP: 146/84 mm Hg; Temp: $36.8\mathrm{C}$; O2 sat: 94\% on $2\mathrm{L}$ NC; pt denies pain

General appearance: Well-nourished male with appropriate affect and no apparent distress.

Extremities: $2+$ pulses, skin warm, cap refill less than 3 seconds $3+$ pitting edema noted in lower ankles bilat extending to mid-calf.

Pulmonary: Bibasilar crackles without wheezing or retractions; nonproductive cough.

Cardiac: S1 and S2 present; S3 present at PMI. PMI displaced laterally into the anterior axillary line of his chest.

Abd: Bowel sounds active $X4$ quads; liver span percusses at $7\mathrm{cm}$ right midclavicular line; abd nontender, soft, nondistended. ABC Hospital Inpatient Orders Laboratory Results

CASE STUDY:

1. Based on the PE findings, what areas are of major concern and warrant continued
assessment? Why?

2. The abnormal cardiac findings are listed below. How would you explain these findings?
A. Displaced PMI
B. S3
C. Jugular vein distention
D. Pitting edema lower extremities
E. Fatigue

Expert Solution Preview

• Heart failure: GC was admitted with a diagnosis of heart failure, and his physical examination reveals signs of fluid overload such as jugular venous distention, pulmonary crackles, and lower extremity edema. Continued assessment of his volume status, including daily weights and monitoring of his urine output, will be crucial in managing his heart failure.
• Left ventricular dysfunction: GC has moderate left ventricular dysfunction with an ejection fraction of............................