Chest Pain, CHF & PVD

by marialpn_2009 (New) New

John McDonald is an 80-year-old Caucasian man with angina, congestive heart failure and peripheral vascular disease. He is easily fatigued, has a productive cough and dyspnea on exertion. He has bilateral leg edema and a venous stasis ulcer on his right inner

ankle. Upon initial assessment he states he is experiencing moderate chest pain. The

Nurse Practitioner is called to come and assess Gary Davis. He receives Oxygen at 3 L

/ min via nasal prongs prn (standing order). His fluid intake is: restricted water intake to

2 L/day.

His regular medications include:

• Digoxin 0.25 mg PO OD.

• Lasix 40 mg PO OD.

• Nitro Dur patch O.4mg on in the a.m. and off in the p.m.

Lab work results are as follows:

WBC 24 giga/L S o d i u m 128 mmol/L

RBC 4.1 tera/L C h lo ride 96 mmol/L

HGB 125 g/L P o t a s sium 2.9 mmol/L

Neutrophils 2.5 giga/L

So, I need to answer the following based on the above scenario.

  1. 1. Explain the relationship does the diagnosis have to each other and how it affects the overall health of the person?
  2. 2. What assessments do you need to consider and what would they reveal?
  3. 3. Give actual and potential pathophysiological complications and how or why they happened? How are they to be treated?
  4. 4. What physician's order you might receive on this and Why?

traumaRUs, MSN, APRN, CNS

Specializes in Nephrology, Cardiology, ER, ICU. Has 30 years experience. 163 Articles; 21,072 Posts

We have many posters who are very happy to HELP students out. However, we need to see what answers you have so far, please.

Thanks much

nurseprnRN, BSN, RN

2 Articles; 11,114 Posts

So, I need to answer the following based on the above scenario.

You have a bunch of interrelated medical diagnoses here with ample clues as to where to find the answers in the indexes / indices of your med-surg book, your pharmacology/drug reference, your laboratory tests book, your physiology book, and your pathophysiology book. Yes, it will take more time than asking us to do it for you.

Suggestion: Sketch this out on a big piece of paper with lines going between the things that influence others. This little tiny bit will get you started:

wet chest ------ :heartbeat: ------ venous stasis

Edited by cafeaulait

nurseprnRN, BSN, RN

2 Articles; 11,114 Posts

The obvious next question is: What happened to John and Gary? Or John or Gary? Or John/Gary? Or the OP?


4 Articles; 10,428 Posts

And here I was thinking it was a trick question, that we were supposed to recognize that the NP who was called to assess Gary Davis did not check wristband IDs to see she was really working on John McDonald! Or vice-versa. Or something...:unsure:

Esme12, ASN, BSN, RN

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma. Has 42 years experience. 4 Articles; 20,908 Posts

OP? Why the different names?