Sample
Mount Carmel College of Nursing
Columbus, Ohio
Nursing 521: Advanced Pathophysiology
CASE STUDY#1: CONGESTIVE HEART FAILURE
Stephanie Barber
September 21, 2011
INITIAL HISTORY:
66 year-old white male increasing shortness of breath over the last month noticed feet and ankles swelling by end of the day has occasional episodes of chest tightness has been waking up in the middle of the night with acute shortness of breath feels tired most of the time
1. Based on this information, what are the differential diagnoses?
R/O Impaired gas exchange ↑o2 demand; alveolar compromise pt states sob; nocturnal dyspnea
R/O Activity Intolerance the patients feels tired most of the time
R/O Fluid Overload the patient states feet/ankle swelling @the end of the day
R/O Inadequate tissue perfusion d/t ↓cardiac output; pt states chest tightness
PAST MEDICAL/SURGICAL HISTORY:
History of transmural anterior wall MI 7 years ago
3-vessel coronary artery bypass graft surgery 7 years ago
15-year history of hypertension
SOCIAL HISTORY:
2-pack/day smoker for 40 years--quit after bypass surgery no alcohol or recreational drugs works as janitor at a local elementary school married with 2 children
FAMILY HISTORY: father had MI at age 50, and died at age 70 with an MI mother had hypertension, diabetes, and died after a stroke at age 82 one brother, age 58, with hypertension who had a coronary stent placed at age 57
CURRENT MEDICATIONS:
* NTG 1/150, SL., PRN
* Metoprolol 50mg, PO, BID
* ASA, PO, 81 mg QD
2. How has this additional information helped you focus your differential diagnosis?
The patient is an aging (66) male and has a significant cardiac history that includes MI, CABG, HTN, and smoking. In addition to his history there is a strong family history (MI, HTN, DM, CVA) which increases his risk as well. His current
Columbus, Ohio
Nursing 521: Advanced Pathophysiology
CASE STUDY#1: CONGESTIVE HEART FAILURE
Stephanie Barber
September 21, 2011
INITIAL HISTORY:
66 year-old white male increasing shortness of breath over the last month noticed feet and ankles swelling by end of the day has occasional episodes of chest tightness has been waking up in the middle of the night with acute shortness of breath feels tired most of the time
1. Based on this information, what are the differential diagnoses?
R/O Impaired gas exchange ↑o2 demand; alveolar compromise pt states sob; nocturnal dyspnea
R/O Activity Intolerance the patients feels tired most of the time
R/O Fluid Overload the patient states feet/ankle swelling @the end of the day
R/O Inadequate tissue perfusion d/t ↓cardiac output; pt states chest tightness
PAST MEDICAL/SURGICAL HISTORY:
History of transmural anterior wall MI 7 years ago
3-vessel coronary artery bypass graft surgery 7 years ago
15-year history of hypertension
SOCIAL HISTORY:
2-pack/day smoker for 40 years--quit after bypass surgery no alcohol or recreational drugs works as janitor at a local elementary school married with 2 children
FAMILY HISTORY: father had MI at age 50, and died at age 70 with an MI mother had hypertension, diabetes, and died after a stroke at age 82 one brother, age 58, with hypertension who had a coronary stent placed at age 57
CURRENT MEDICATIONS:
* NTG 1/150, SL., PRN
* Metoprolol 50mg, PO, BID
* ASA, PO, 81 mg QD
2. How has this additional information helped you focus your differential diagnosis?
The patient is an aging (66) male and has a significant cardiac history that includes MI, CABG, HTN, and smoking. In addition to his history there is a strong family history (MI, HTN, DM, CVA) which increases his risk as well. His current